Breast Cancer and Young Women
We are regularly reminded that breast cancer, like most cancers, is generally a disease of aging. Aging, in this case, certainly does not mean elderly women, but it does mean that young women are diagnosed less often than those over 50 or so. It is especially distressing when the disease strikes someone in her 20s or 30s. These are women are are "supposed" to be dealing with education and early professional choices and choosing partners, maybe marriage, maybe children. It is definitely not the time in life ordinarily associated with life-threatening illness. Within the last week, I have met two women who are in their 20s and just diagnosed. They are, of course, scared and overwhelmed. They share many of the same worries as those of us who are older, but they have additional ones, too. The most painful concerns are often associated with fertility and children, both living children and hoped for babies. Twenty years ago, after breast cancer, women were told that it likely would be dangerous to consider a pregnancy. That has changed, and a few studies have even suggested that there may be a protective effect of pregnancy and reducing recurrence risk. The practicalities, however, may preclude this choice: the months of treatment and then five years of Tamoxifen, if relevant, may push someone past the usual childbearing years. As we all know, fertility declines with age, anyway, and it surely is possible that breast cancer treatment hastens this decline.
I do want to add a happy story here. Yesterday, I had the absolute joy of meeting with a very dear woman, in her early 30s, who was treated for breast cancer two years ago. She and her husband had initiated adoption proceedings even before her diagnosis, but those were put aside for the duration of treatment. She came yesterday to introduce me to James, a beautiful 7 month old boy whom she and her husband are adopting. As she said, "Miracles do happen."
From General Surgery News, here is a good summary of the challenges and issues for young women with breast cancer:
Breast Cancer in Younger Women Poses Unique Challenges
By Monica J. Smith Phoenix—Within the population of breast cancer patients, there is a group that is particularly discomfiting to surgeons: women under the age of 40 years, which includes, on rare occasion, women diagnosed with breast cancer while pregnant.
These challenging and poignant cases are few and far between, but “when it happens, it’s really important that people know what to do or know how to get information on what to do,” said Ann H. Partridge, MD, MPH, Dana-Farber Cancer Institute, Boston, who addressed the topic at the American Society of Breast Surgeons’ annual meeting.
Breast cancer in young women is difficult, partly because it is so uncommon, representing only a small proportion of the breast cancers that surgeons see. “It’s more unknown to us, and the stakes are high. Therefore, it becomes problematic in trying to care for them,” Dr. Partridge said.
Surgeons may not meet these patients often, but breast cancer strikes about 12,000 women under the age of 40 every year in the United States, and tens of thousands worldwide, and it is the leading cancer-related cause of death in young women. Things may have changed with the availability of trastuzumab (Herceptin, Genentech) but Surveillance, Epidemiology and End Results [SEER] data published seven years ago (plus recent information provided by the American Cancer Society) showed a significant difference in five-year survival rates between younger breast cancer patients and those aged 40 years or older, at 84% and 90%, respectively. “We all see this clinically, unfortunately,” Dr. Partridge said.
This is due largely to the fact that younger women present at a more advanced stage of the disease. Reliable screening is lacking for this group, as is awareness; diagnosis is difficult in young women who are pregnant; and younger patients are more likely than older patients to have access issues.
Younger women are more likely to have endoplasmic reticulum (ER) disease, lymphovascular invasion and possibly more HER2-positive disease, and 60% to 67% of young women with breast cancer present with high-grade disease, making it more difficult to achieve negative margins and increasing the risk for recurrence. Young black women in particular appear to be more likely to develop aggressive basal-like subtypes of breast cancer than older black women and non-black women in general (JAMA 2006;295:2492-2502).
“All of these data beg the question: Is this a different disease in young women, or is it a At a Glance
different mix of tumor subtypes?” Dr. Partridge asked.
See the source.