Breast Cancer in Young Women
Introduction
Breast cancer in young women (below the age of 40) isn’t common. The risk of a young woman at age 30 diagnosed with breast cancer is 1 in 300.
When cancer is diagnosed at a young age, it is more likely to be aggressive and spread more quickly.
Young women are generally not recommended to go for regular mammogram screening until the age of 45 to 50 years old.
Young women has denser breast tissue compared to older women and as such may not easily be diagnosed or picked up
Certain Risk Factors to Diagnose Breast Cancer at an early age are:
- Familiar breast cancer in family where women are diagnosed before the age of 45
- Family members with BRCA1 or BRCA2 gene mutation
- Radiotherapy given to the chest or breast at a young age
Common Subtypes of Breast Cancer in Young Women
- High grade tumors ie Grade 3
- Hormone receptor negative breast cancer (ER/PR Negative)
- Triple negative breast (TNBC)
Diagnosis and Investigation are generally the same
- Mammogram
- Breast Ultrasound
- Breast MRI
- US guided core biopsy
Treatment and Management
- Breast conserving surgery /Lumpectomy
- Mastectomy – Total mastectomy, Nipple sparing mastectomy or Skin sparing mastectomy
- Reconstruction – Immediate or delayed
Fertility and Pregnancy
When breast cancer is diagnosed in young women, cancer treatment can affect her fertility. As the cancer tend to be aggressive, chemotherapy and radiation therapy is often necessary and these can damage the cells in the ovaries. This will make pregnancy difficult and sometimes impossible.
Hormone therapies such as tamoxifen is an anti-oestrogen treatment and this will stop the ovulation thus affecting your fertility. The treatment can also emotionally affect your sex drive and dampen your desire to be intimate with your partner physically.
It is recommended to discuss with the fertility specialist about options available to preserve your eggs or fertilized embryos before starting treatment.
There are some drugs that can also shut down your ovaries during treatment to protect them from damage. (eg Leuprolide / Lupron or goserelin / Zoladex)
Psychosocial & Emotional Support
Young women undergoing breast cancer treatment develop emotional distress at the time of diagnosis and during treatment.
A young women or young mother in her 20s or 30s would be thinking of a secure job, starting a family, looking forward to life ahead would be deeply traumatised if she has been diagnosed with breast cancer.
Issues to Consider for a Young Women:
- Children and family
- Husband and parents
- Job and Finances
- Support during treatment
- Survivorship and recurrence
- Quality of life and body image
- Decision making
- Financial and insurance concerns