Breast Cancer in Adolescent and Young Adult Women Under the Age of 40 Years

Abstract

In the United States, one in 196 women is diagnosed with breast cancer under the age of 40 years. Adolescents and young adults (AYAs), of age 15-39 years at diagnosis, experience a number of unique challenges when confronting breast cancer. The incidence of invasive breast cancer has increased among AYA women in the United States since 2004, and most of this change is due to an increase in young women diagnosed with distant disease. AYAs are more likely than older women to present with aggressive subtypes and advanced disease, and they often require systemic staging at diagnosis. Clinical trials should be considered whenever possible, particularly in AYAs with locally advanced or metastatic disease at diagnosis and those with disease progression or recurrence. A significant proportion of AYAs carry germline cancer predisposition mutations, which necessitates prompt genetic testing for all AYAs at diagnosis and may influence choice of local therapy. Suppression of ovarian function, as an adjunct to chemotherapy, may improve breast cancer survival in AYAs. To provide optimal care for AYAs with breast cancer, clinicians should engage multidisciplinary teams that offer fertility preservation, genetic counseling, physical and occupational therapy, nutrition, and psychosocial support, along with medical expertise in tailoring cancer-directed therapy and symptom management toward young women.

Cancer-Specific Survival Outcome in Early-Stage Young Breast Cancer: Evidence From the SEER Database Analysis

“…Over the past years, with an increasing prevalence of breast cancer worldwide ( 1 – 4 , 6 ), the comprehensive and individualized management for patients with this particular disease has gradually attracted much attention, especially in terms of young breast cancer ( 7 , 9 , 10 , 14 , 15 ). It was believed that age was an independent prognostic indicator among female breast cancer and younger age, especially under the age of 40 years, frequently presented a higher risk of locoregional metastasis, recurrence, and ultimately worse OS outcomes ( 7 , 10 , 12 ).…”

“…Currently, only a small number of listed studies were focused on investigating the risk factors for predicting the clinical outcomes in young women with breast cancer ( 10 , 12 ). For instance, based on the clinicopathological features of the large-scale population, Billena et al ( 9 ) determined that tumor size, hormone receptor status, surgery, adjuvant therapies, lymph node status, and race were independent predictive factors for overall survival (OS) in young female breast cancer.…”

A Review of Breast Cancer Risk Factors in Adolescents and Young Adults

“…Disease-free and overall survival outcomes in the AYA setting are worse, and differences in the biology and epidemiology of these tumours have been observed [ 1 , 5 , 6 , 7 ]. There is evidence that AYA patients present with a more aggressive disease and use mastectomy and chemotherapy at higher rates than adult breast cancer patients [ 8 , 9 , 10 , 11 , 12 ]. Furthermore, AYAs have additional complicating factors related to fertility preservation and family planning, as well as psychosocial implications.…”

Oncologic Outcomes of Immediate Breast Reconstruction in Young Women with Breast Cancer Receiving Neoadjuvant Chemotherapy

“…Historically, young age at diagnosis itself is a prognostic factor associated with adverse breast cancer outcomes [7]. Compared to the older counterparts, younger women with breast cancer are more likely to present with more aggressive tumor characteristics such as higher tumor grade, larger tumor size, higher incidence of nodal involvement, and more lympho-vascular invasion (LVI) [8][9][10]. In addition, because of the higher likelihood of having hormone receptor-negative tumors [8][9][10], young patients are more likely to bene t from neoadjuvant chemotherapy (NACT).…”