Breast Cancer

    Breast cancer is known to strike at any age, but is rare among young women. Only 7% of women below the age of 40 have breast cancer and the risk increases with age. In fact, 50% of women who have had cancer were 61 years or more.

    However, compared to older women, breast cancers among the young are associated with larger (median size=2 cm vs. 1.5 cm), more aggressive (mostly involves lymph nodes) and advanced (less well differentiated) tumors, higher mortality, shorter disease-free survival, higher rate of recurrence and have greater chances of having a mutated BRCA1 or BRCA2 gene.

    Young women usually have a first degree relative also affected with breast or ovarian cancer or have other risk factors that would lead to the genetic mutations. BRCA positive patients are at an increased risk of getting breast cancer in the other breast and of developing ovarian cancer.

    Diagnosis

    Breast cancer diagnosis in young women suffers the most because they feel that they are too young to develop cancer, and undergo screening only if they think they are at a risk or face symptoms. Imaging tests are also discouraged by many doctors as they do not feel the need to expose a young patient to unnecessary radiation. In contrast, diagnosis is more frequent among older women with the establishment of population-based mammographic screening programs for the over 50 age group.

    Diagnosis is more difficult in younger women because they have denser breast tissue. Clinical examination and mammography are not very sensitive, so early signs of breast lumps are often ignored and dismissed as cysts and the patient is usually advised to wait and watch. By the time a lump can be felt, the cancer is often already advanced. Young women don’t show typical mammographic features.

    Ultrasound is more sensitive and has the ability to differentiate solid masses from cysts. However, there are cases of benign sonographic features being identified for malignant lesions. Therefore, a combination of mammography, ultrasound and biopsy is recommended for maximum imaging accuracy.

    Treatment

    Treatment of breast cancer remains the same regardless of age. Depending on the extent of the disease, lumpectomy or mastectomy is done. Radiation therapy, chemotherapy and/or hormone therapy usually follow surgery to ensure complete destruction of residual cancer cells and prevent recurrence. This can be followed by immediate or delayed reconstruction of the resected breast.

    Complications

    Breast cancer treatment in young women may be associated with the following complications:

    • Premature menopause: You may achieve menopause at an early age. The chances increase with age and intensity of chemotherapy.
    • Bone health: Risk of osteoporosis due to early menopause.
    • Psychological factors: Breast cancer diagnosis and treatment may have more psychological impact on younger women.

    Special Considerations for Young Women with Breast Cancer

    There are certain factors, like sexuality, body image, fertility, contraception, pregnancy, familial and genetic issues, career and finances that need to be considered in women below 40 developing breast cancer.

    Breast Cancer during Pregnancy

    Late pregnancies may lead to breast cancer. With the current trend of women waiting to get pregnant until a much later age, the risks of breast cancer are increasing. The cancer can even occur during pregnancy owing to the hormonal changes that take place in a woman’s body.

    Diagnosis during pregnancy is even more difficult due to changes such as enlarged breasts and development of milk ducts. Late diagnosis results in larger and more advanced cancer by the time it is detected. Mammography, ultrasound and biopsies can be carried out with extreme care to minimize any risk to the fetus.

    The National Comprehensive Cancer Network (NCCN), consisting of 19 leading cancer organizations across the US, has established guidelines for treating breast cancer during pregnancy. Treatment depends on the stage of gestation when the cancer is detected.

    • First trimester: Pregnancy can be terminated, or mastectomy with chemotherapy (during second trimester) can be performed over lumpectomy and radiation therapy.
    • Second trimester or third trimester: Mastectomy or lumpectomy, with sentinal lymph node dissection. In the case of a lumpectomy, radiation or hormonal therapy can be performed after child birth.

    Pregnancy after Breast Cancer

    Breast cancer can lower the fertility of a woman so she may find it difficult to get pregnant. However, the affect that the hormonal changes of pregnancy have on breast cancer is not the same for a recurrence after treatment. Some oncologists suggest a 2-year window period for recurrence and recommend delaying pregnancy for that period. If the breast cancer is hormone receptor-positive, women are advised not to get pregnant until they stop the medication that may affect the fetus. Breastfeeding will be restricted to only the healthy breast as the cancer treated breast will not be able to produce milk.

    Conclusion

    Breast cancer in young women, although rare, harbors aggressive clinical features and needs to be managed with care. Apart from giving information on the details of the procedure, your doctor should also brief you on the following:

    • Impact of treatment on fertility and options for preserving it before chemotherapy
    • Use of contraceptives
    • Risk of early menopause or menopausal irregularity and how to cope with it
    • Reduction in bone density due to premature menopause and how to minimize its effects
    • Pregnancy after treatment

    As a young women suffering from breast cancer, you may be extremely concerned about sexuality, body image and most importantly how treatment would affect your future and family life. You may feel overwhelmed when diagnosed with breast cancer during pregnancy. Your doctor must be sensitive to the specific issues and concerns of the treatment affecting your unborn child. You should consider visiting a surgeon who works with fertility specialists, plastic surgeons and geneticists so that all stages of your recuperation are managed seamlessly.