Tuesday 22nd November 2016
Breast cancer is the most common malignant tumour in teens and young adults and accounts for 15% of all invasive cancers. This age group tends to experience a more aggressive form of the type of cancer than older women do, and research is being done to uncover exactly why this is.
Breast Cancer in Adolecents and Young Adults
Physician, Division of Pediatric Hematology/Oncology at Mary Bridge Hospital, Tacoma, WA
I was diagnosed with breast cancer at age 27, during my residency in Internal Medicine and Pediatrics. I survived, became an oncologist and a researcher, and dedicated my career to working with teens and young adults with cancer.
During my cancer treatment, I asked my doctor specific questions about breast cancer incidence and survival in young adults. He had few answers, because at that time there was scant data in the medical literature on these topics. My doctor told me that “breast cancer is rare in young women.” He said that I had a "60% chance of survival, or maybe a little less than that. Young women with breast cancer do worse than older women, but no one knows exactly why.” In the years since then, research has begun to focus on the many differences between breast cancer arising in young, compared to older, women.
My presentation at Teenage Cancer Trust's International Conference and Global AYA Cancer Congress will highlight these new discoveries, and I will also share a few of them with you now. Breast cancer turns out to be the most common malignant tumor in adolescent and oung adults (AYAs) 15-39 years of age, accounting for 15% of all invasive cancers in the age group and more than 40% of cancers in AYA women. Of all women diagnosed with breast cancer, slightly more than one in twenty white women and one in ten black women will be under the age of 40. The chance of a woman being diagnosed with breast cancer under the age of 40 is 1 in 173. So, while the majority of young women will not have breast cancer themselves, almost every young women will have a relative, friend, or acquaintance around their own age who battles breast cancer.
Young women with breast cancer tend to experience more aggressive disease than older women. When breast cancer is diagnosed at an early stage (stage 1), young women are 44% more likely to die of their disease than older women. Compared to older women, young women present with higher stage disease, which has worse prognosis. Two out of every three 25-29-year-olds have cancer that has spread to regional or distant sites (stage II, III or IV) at diagnosis in comparison to slightly more than 1 in 3women 40 years of age and older.
I thought I was too young to have breast cancer and when I looked up the signs and symptoms of breast cancer they varied to mine and so I thought nothing of it. I left it for about 6 or 7 months, thinking it was just a swollen gland.
- Becki, 24
Over the past 30 years, the number of women young women who have metastatic (stage IV) breast cancer at diagnosis has almost tripled. No such increase has been observed in older women. The rapidity of this change suggests that the increase is not due to genetic causes, but instead to changes in one or more modifiable lifestyle risk factors or toxic environmental exposures. Obesity is a risk factor for the development of advanced cancer. Both vigorous exercise, and a diet emphasizing plants and limiting meat and alcohol consumption, have been reported to decrease breast cancer risk in young women.
While the basic principles of chemotherapy, radiation, and surgery remain similar for AYAs compared to older women with breast cancer, endocrine therapy recommendations have evolved substantially over the past 5 years.
Young women with breast cancer are more likely than older breast cancer patients to harbor a cancer predisposition syndrome. Young women treated for breast cancer are at risk for late toxicities of therapy, including infertility due to premature menopause, inferior bone health, and the development of second cancers.
Doctors caring for young women with breast cancer should initiate proactive conversations about fertility preservation, psychological health and sexual health, and offer subspecialist referrals when indicated.
Rebecca will be speaking more on how on how young people are affected by breast cancer during our International Conference and Global AYA Cancer Congress taking place 5-7 December at the Assembly Rooms in Edinburgh, UK.