Breast cancer is traditionally expected to occur in older women, but a significant number of cases occur in women under the age of 40.
Breast cancer can strike at any age, and all women should be aware of their personal risk factors.
There are several factors that put a woman at higher risk for developing breast cancer, including:
• A personal history of breast cancer or high risk lesion found by biopsy
• A family history of breast cancer, particularly in a mother, daughter or sister
• History of radiation therapy
• Evidence of a specific genetic chance (BrCa1 / BrCa2 mutation) — Women who carry defects on either of these genes are at greater risk for developing breast cancer.
Women who started their menstrual cycle at an early age and women who experience their first pregnancy at an older age are both considered to be at greater risk of early onset breast cancer.
Diagnosing breast cancer in younger women (under the age of 40) is more difficult because their breast tissue is generally more dense than it is in older women. In addition, breast cancer in younger women may be aggressive and less likely to respond to treatment. Women who are diagnosed with breast cancer at a younger age are also more likely to have a mutated (altered) BrCa1 or BrCa2 gene.
Breast cancer poses particular challenges for younger women as it can involve issues concerning sexuality, fertility and pregnancy after the breast cancer treatment. Although a relatively small group, these younger women require particular care and support, over and above the norm, due to the additional challenges they face.
Delays in diagnosing breast cancer in younger women are a problem, with many being diagnosed only once the cancer is at a more advanced stage. Many younger women who have breast cancer ignore warning signs — such as a breast lump or unusual discharge — because they believe they are too young to get breast cancer, and tend to assume that a lump is a harmless cyst or other growth. Some health care providers also dismiss breast lumps in young women as cysts and adopt a wait-and-see approach.
Treating During Pregnancy
A particular challenge relating to breast cancer in the younger woman is pregnancy. Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy, in the first postpartum year or any time during lactation (breast feeding). Up to 20% of breast cancers in women under the age of 30 are pregnancy-associated – as opposed to 5% in women age 30 to 50.
Breast cancer occurring during pregnancy presents a challenging clinical situation since the welfare of both the mother and the foetus must be taken into account in any treatment planning. Diagnosis in the pregnant or lactating breast can be particularly tricky due to increased breast density, as well as the reluctance to expose pregnant women to xrays and radiation.
There is very little data from clinical trials regarding the optimum treatment for breast cancer during pregnancy. Where possible the doctors will try to avoid chemotherapy and radiation but in certain cases it will be deemed safer for both mother and baby to treat the cancer.
Despite the scarcity of data, it is generally accepted to be safe to give chemotherapy after the first trimester.
Another pertinent aspect is the younger woman’s desire to fall pregnant after treatment.
Young breast cancer survivors may experience early menopause and infertility due to chemotherapy-related gonadotoxicity and, in some cases, five years of hormonal therapy.
Data is limited with regard to the safety of falling pregnant after breast cancer treatment, but most studies have shown that it is safe to fall pregnant provided all treatment, including hormone blockade, has been successfully completed.
Self breast examination should begin at an early age and breast health and awareness should be taught to all young women.
Breast cancer can’t be prevented but, if detected early enough and successfully treated, more than 90% will survive.
Written by Dr Owen Nosworthy