Breast cancer doesn’t occur often in younger women. Of the more than 230,000 new cases of breast cancer expected to be diagnosed in the United States in 2015, only about 11 percent will involve women younger than 45.
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Young breast cancer patients have special concerns. Their cancers tend to be more advanced, more aggressive, more likely to be caused by an inherited defective gene, and may respond differently to treatment than do breast tumors in older women. Issues of infertility, body image, and the disease’s impact on family life, relationships, career and finances also are different for younger women.
“When breast cancer happens to women in their 20s, 30s and 40s, it poses some novel challenges,” says Jame Abraham, MD, Director of Medical Breast Oncology and Co-Director of Cleveland Clinic’s Comprehensive Breast Cancer Program. “From diagnosis to treatment and lifestyle support, it requires a coordinated, comprehensive approach. Young women with breast cancer should look for a specialized program with care tailored to their unique needs.”
Early detection and diagnosis
Unless they have a family history or other risk factors for breast cancer, women younger than 40 typically aren’t advised to get regular mammograms. The X ray test isn’t as effective at revealing suspicious areas in younger women’s breasts because of the increased density of their breast tissue. Many younger women also ignore warning signs, such as a breast lump or an unusual nipple discharge, because they think they are too young to get breast cancer.
For these reasons, breast cancers in young women have often progressed to a later stage, meaning they’ve spread to the lymph nodes or other parts of the body by the time they’re diagnosed, making them harder to treat and increasing the risk of recurrence. Monthly breast self-exams, scheduling an immediate medical appointment if unusual symptoms appear, and annual breast exams by a doctor that include a discussion of family breast cancer history, are all important to improve the odds of early detection.
Breast cancer can occur spontaneously, or it can be caused by one or more inherited defective genes. Women younger than 35 with breast cancer are much likelier to have the kind that arises from inherited faulty genes – usually one of two genes called BRCA1 and BRCA2.
When working properly, BRCA1 and BRCA2 help repair damaged DNA and prevent tumors from forming. If a woman inherits a flawed version of BRCA1 or BRCA2, her lifetime risk of developing breast and/or ovarian cancer is much greater than that of women in the general population. Inherited defects in several other genes have also been linked to a higher risk of breast and/or ovarian cancer.
That’s why it’s important that young women diagnosed with breast cancer, and those with a family history of breast cancer, have access to genetic testing, and to genetic counselors that can provide guidance about the appropriateness of various tests, including benefits and risks. “Our belief is that younger breast cancer patients should be seen by a certified genetics counselor and the decision to test or not should be made in consultation with a genetics program,” says Stephen Grobmyer, MD, Director of Breast Surgical Oncology and Co-Director of Cleveland Clinic’s Comprehensive Breast Cancer Program.
Although the basics of breast cancer treatment – surgery, radiation and chemotherapy – are the same for patients of all ages, younger women have some special considerations.
The aggressiveness, complexity and frequent genetic origin of breast cancers in young women require a team approach to care involving a wide range of medical and surgical specialists. Seeking treatment from a hospital that regularly participates in clinical trials ensures access to the latest treatments, especially those that target the unique biology of breast tumors in younger patients.
Though appearance is important to everyone, young women may be particularly concerned about the cosmetic impact of surgery to excise breast tumors or to preventively remove the breast. For appropriate patients, surgical options to consider include nipple-sparing mastectomy, and a one-stage reconstruction procedure in which cancer surgeons and plastic surgeons combine mastectomy with insertion of a breast implant. Some programs use skin and fatty tissue from the patient’s abdomen to rebuild the breast.
Chemotherapy to treat breast cancer can disrupt a woman’s menstrual cycle and in some cases trigger permanent menopause. Young breast cancer patients who have yet to start a family or want to have more children should look for a treatment program that provides fertility-preservation counseling and services. The counseling should take place as soon as possible after the breast cancer diagnosis, since fertility-sparing procedures must be done before chemotherapy can begin. Fertility-preserving options include using hormones to temporarily shut down and protect the ovaries during chemotherapy; collecting, fertilizing and freezing embryos; and collecting and freezing eggs for later fertilization.
Chemotherapy also can cause forgetfulness, impaired concentration, slowed thinking and the general mental fogginess commonly called “chemo brain.” While it affects cancer patients of all ages, chemo brain can cause special hardships for young women trying to manage job and family responsibilities, especially caring for young children, while undergoing treatment. “A 27-year-old will notice even a slight drop in cognitive function because she’s multitasking and juggling so many things,” says Dr. Abraham. Exercise, adequate rest, proper diet and memory aids such as list-making and daily planners may help.
Counseling and support groups of similarly aged cancer survivors can help young women with breast cancer cope with the special issues they face, like hair loss at a time when they’re dating or hoping to meet a partner, or explaining why they’re sick to their young children. “Along with advanced medical and surgical care, having a support system of mental health professionals, social workers and peers who understand and can help with what you’re going through is extremely important,” says Dr. Grobmyer.