Feature Article

Breast cancer: challenges in treating young women

Feature Article

Breast cancer: challenges in treating young women

LYNNE MANN, LUCIA SALIBA

Figures

© andreaobserova/ stock.adobe.com model used for illustrative purposes only
© andreaobserova/ stock.adobe.com model used for illustrative purposes only

Abstract

Although breast cancer in women aged 40 years or younger is rare, these women face unique challenges. A strong family history of breast cancer can help identify young women at potentially high risk of breast cancer who would benefit from referral for risk assessment. A multidisciplinary approach to management includes guiding the patient through diagnosis and treatment. Addressing psychosocial impacts and counselling young patients about  the impacts on fertility are essential.

Key Points

  • Breast cancer in women aged 40 years and younger is rare, comprising 5 to 7% of all breast cancers.
  • Breast cancer in young women is associated with a higher rate of a positive family history and mutations in breast cancer genes 1 and 2 and tumour protein p53 (BRCA1, BRCA2 and TP53).
  • Women identified as high-risk for breast cancer should be referred to a familial cancer service for assessment and screening.
  • Most young women with breast cancer are symptomatic and present at a more advanced disease stage; therefore, any breast changes should be thoroughly investigated.
  • Careful consideration should be given to imaging modality for young women, as dense breast tissue impedes accurate interpretation of standard breast imaging such as mammograms. Ultrasound is the initial imaging investigation of choice in young women with breast symptoms.
  • Surgical options should be discussed; breast conservation should be offered when possible and adequate time and counselling given before proceeding with more extensive or bilateral surgery.
  • A multidisciplinary team, of which the GP is a part, is the cornerstone of management.