Managing breast cancer in younger women: challenges and solutions

the ONA take:

Compared with older women, breast cancer in younger women is relatively rare, but it tends to have a more aggressive biology and an associated poorer prognosis. These women also face unique challenges such as reduced fertility due to premature ovarian failure, extended survivorship and its associated complications, and the psychological effect caused by a cancer diagnosis.

One unique concern for young women with breast cancer is treatment-induced ovarian failure and infertility. Young women who would like to bear children in the future should be properly counseled by an oncofertility specialist on their fertility preservation options prior to the start of chemotherapy. Options include embryo and oocyte cryopreservation, cryopreservation of ovarian tissue, and ovarian suppression with luteinizing hormone release hormone (LHRH) agonists.

Another distinct challenge is pregnancy at the time of breast cancer. Patients who have a pregnancy-associated malignancy should not receive endocrine or cytotoxic therapies during the first trimester of pregnancy; therefore, surgery is often the safest treatment approach during early pregnancy. Radiotherapy is contraindicated in the third trimester and trastuzumab is contraindicated at any point during the pregnancy.

Younger women with breast cancer are also at an increased risk for developing long-term treatment-associated adverse events, particularly bone loss. Chemotherapy, radiation, and hormonal treatments can all induce bone loss or impair bone integrity. Certain patients may benefit from bisphosphonates or RANK ligand inhibitors if they have a history of osteoporosis, fragility fractures, and osteopenia with additional risk factors.

Breast Cancer: Targets and Therapy
Breast Cancer: Targets and Therapy

Abstract: Breast cancer in young women is relatively rare compared to breast cancer occurring in older women. Younger women diagnosed with breast cancer also tend to have a more aggressive biology and consequently a poorer prognosis than older women. In addition, they face unique challenges such as diminished fertility from premature ovarian failure, extended survivorship periods and its attendant problems, and the psychosocial impact of diagnosis, while still raising families. It is therefore imperative to recognize the unique issues that younger women face, and plan management in a multidisciplinary fashion to optimize clinical outcomes. This paper discusses the challenges of breast cancer management for young women, as well as specific issues to consider in diagnosis, treatment, and follow-up of such patients.


Keywords:
 breast cancer, young women, diagnosis, treatment

INTRODUCTION

Early-onset breast cancer is relatively rare; however, it represents the commonest cause of cancer in women under age the of 40.1 In the US, approximately 33,000 women under the age of 45 years are diagnosed with breast cancer every year, and it is the leading cause of cancer-related deaths in this age group.2 Compared to older women with breast cancer, younger women tend to have a more aggressive biology and a poorer prognosis (Table 1). Younger women with breast cancer also face unique challenges such as premature ovarian failure, psychosocial issues with ongoing careers, and raising young families, as well as extended survivorship periods and its attendant complications as summarized in Figure 1. It is therefore imperative to recognize the unique issues that younger women face and plan management in a multidisciplinary fashion to optimize clinical outcomes.


 
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