Breast Cancer in Young Women - John Link, MD
John Link is one of the top breast cancer doctors in the world. He is the author of The Breast Cancer Survival Manual and Take Charge of Your Breast Cancer. He is a passionate campaigner for the importance of a second opinion and Optimal Care for women with breast cancer.
Young women with breast cancer have special issues that are often not addressed by the medical community. These issues deal with medical treatment, fertility, sexuality, genetic risk and future risk. There are also complex social issues to do with balancing motherhood, career and marriage.
First we must define what is young in relation to breast cancer. For the purpose of this article, we will define young as 40 or less, but this is an arbitrary line. If you look at the age distribution of newly diagnosed cases, less than 10% will be in women under 40. Breast cancer in this group almost always presents as a breast mass, mainly because screening mammography usually begins after 40.
The medical community tends to generalize about breast cancer in young women. There is the perception that these cancers are more aggressive and have a worse prognosis. This is not necessarily true. It is very important to remember breast cancer is very heterogeneous and not to generalize about prognosis based solely on a single factor such as age of the woman. We see the whole spectrum of different types of breast cancer in young women. We believe that each woman with newly diagnosed breast cancer should have a thorough analysis of her cancer. A comprehensive second opinion is often warranted and helpful. Each woman should have a thorough discussion with her team of doctors regarding optimal treatment and the potential repercussions of the treatment. In our opinion, there are tendencies to both "overtreat" and "undertreat" young women based on fear or faulty information.
We believe it is important to consider the possibility of hereditary breast cancer when a young woman is diagnosed. Hereditary breast cancer often presents in women before 40, and it can come from the father's side of the family. If a young woman has hereditary breast cancer, it may affect decisions regarding the types of breast surgery and radiation.
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When a young woman presents with a malignant mass in her breast, she often feels a tremendous urgency to have it immediately removed, even if it requires a mastectomy. In some cases Optimal Care requires chemotherapy be given prior to surgery. It can make the surgery easier and probably safer. It allows for treatment of the whole body, and gives very important information about response and prognosis. It is important to have your case reviewed by a team before an operation is done. All the necessary testing of a cancer can now be done on the material from a needle biopsy, so the removal of the mass is not usually necessary for diagnosis.
Approximately one half of breast cancers in young women are hormone receptor positive. This means that there are estrogen receptors on the surface of the cancer cells, and that female hormones influence the growth and survival of the cancer. Interrupting the supply of estrogen to the cancer may be an important part of treatment. There are ways to do this with medications. This type of treatment can be very effective.
Chemotherapy can affect ovarian function and cause infertility and premature menopause in young women. As mentioned above, sometimes it is desirable to decrease estrogen production, but chemotherapy is probably not the best way to do this. Research is being done on mechanisms to protect the ovaries. These are issues that need to be addressed with your oncologist. We have seen many young women treated with chemotherapy for breast cancer later becoming pregnant and having children.
Breast cancer treatment in young women can affect self-esteem, sexuality and relationships. Most of the side effects are temporary and after the treatment period life becomes much more normal. However, during the treatment period, we believe many young women benefit from a supportive environment. Many treatment centers have programs for younger women that include support groups, peer mentoring and counseling. Please inquire about these types of services because it can make a big difference to your treatment experience.
The purpose of this article is not to be comprehensive. The point here is that young women with breast cancer have special concerns because of a variety of factors, which often are not addressed. Optimal Care requires that these issues are considered and that you are offered the best treatment possible, regardless of your age.
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