A diagnosis of breast cancer is hard to receive at any age. But for women in their early 40s and younger, the concerns may be more challenging, say breast cancer experts at Dana-Farber Cancer Institute in Boston.
“When young women are diagnosed with breast cancer, they face not only concerns about the breast cancer itself, but they may have issues with fertility and family planning, genetics, sexual function, as well as emotional hurdles that may be more difficult to handle compared to older women,” said Ann Partridge, MD, MPH, Clinical Director of the Breast Oncology Center and Director of the Program for Young Women with Breast Cancer at Dana-Farber, and recently appointed to the CDC’s Advisory Committee on Breast Cancer in Young Women. “Many of these women are just starting careers, families or relationships, and having breast cancer at such an early age is the furthest thing from their minds.”
According to the American Cancer Society, about 5 percent of all breast cancer cases occur in women under the age of 40 in the United States. Breast cancer is the second leading cause of cancer-related death in women; however, relatively little is known about breast cancer in women in their 40s and younger. Partridge, who founded the Program for Young Women with Breast Cancer at Dana-Farber, said that evidence shows that young age is a risk factor for disease recurrence and death. It is controversial whether the poorer prognosis is a reflection of delays in diagnosis, differences in tumor biology or the effectiveness of treatment, but growing evidence indicates that biologic differences may play an important role.
Young women are likely to be diagnosed at a later stage with more aggressive types of breast cancer. They therefore tend to receive more aggressive treatment than older women usually including chemotherapy, and often radiation, hormonal and new biologic treatments. “Treatment with chemotherapy, in particular, can be difficult because many of these younger women may be interested in having a baby after breast cancer and treatments may result in premature menopause and infertility,” Partridge said.
Risk factors for breast cancer in young women appear to be slightly different than they are for older women. “Family history is the strongest risk factor for younger women,” said Partridge. “Women who have a first-degree blood relative such as a mother or sister who have had breast cancer especially at a younger age may be a higher risk of developing the disease.”
The genetic risk can also come from the father’s lineage. So if the father’s sister had breast cancer particularly at a younger age that could increase a young woman’s risk for breast cancer. In general, having a mother, father, daughter or sister who has had breast cancer can increase a woman’s risk of developing breast cancer at any age.
Women who have a mutation or defect in the BRCA1 or BRCA2 genes are at greater risk of developing breast and ovarian cancer. A genetic counselor can help discuss any risk factors and can suggest genetic testing options.
Delayed diagnosis in young women is an issue. Because it is rare for a young woman to develop breast cancer, any change in the breast may be minimized or ignored. Partridge stressed the importance for all women to be aware of the following warning signs. “Do not be afraid to go to the doctor if you’re concerned about any breast symptoms.”
Lump or thickening in the breast: Especially one that is growing or changing as well as lumps under the arm or axilla.
Skin changes: Skin changes on the breast, like swelling or a rash, warmth, redness or darkening; or an itchy, scaly or sore nipple.
Nipple discharge: “We are also worried when we hear about nipple discharge particularly if it is bloody,” said Partridge.
Breast changes: Change in size or shape, dimpling or puckering of skin.
Pain: Pain in the breast or under arm that does not go away or gets worse over time. “There is a common misperception that if it’s painful, it’s not breast cancer,” said Partridge.
More information is available at www.dana-farber.org/YoungWomenBreastCancer.
Dana-Farber Cancer Institute (www.dana-farber.org) is a principal teaching affiliate of the Harvard Medical School and is among the leading cancer research and care centers in the United States.