Managing Breast Cancer in Young Women

Abstract

IntroductionBreast cancer arising in young women is relatively uncommon constituting around 5-7 % of women diagnosed in the Western World [ 1 , 2 ]. The prevalence is higher in the developing world, with up to 20 % of patients diagnosed below the age of 40 in Africa and the Middle East [ 3 , 4 ].Breast cancer in young women differs in several aspects from tumors diagnosed in older patients. Women ≤40 tend to have advanced disease at diagnosis, typically presenting with large palpable, often multifocal tumors and exhibiting higher prevalence of lymphatic involvement and nodal spread [ 1 , 5 , 6 ]. Moreover, young age at breast cancer diagnosis has consistently been shown to be an independent predictor of worse outcome in both early and late stage disease [ 1 , 6 -10 ]. This likely provides an explanation for the trends observed in clinical practice favoring mastectomy and adjuvant chemotherapy use in this patient population despite lack of proven recurrence or survival benefi t justifying a more aggressive treatment approach [ 11 -18 ].It is unclear whether the adverse clinical and histologic features of breast cancer in young patients can entirely account for their increased risk of relapse and diseaserelated mortality. Despite lack of differences in stage-adjusted short-term survival in younger compared to older women [ 19 ], studies with long-term follow-up have revealed that survival disparities are more prominent in early rather than late stage disease [ 1 , 20 ], emphasizing the precedence of tumor biology over clinical stage as predictor of outcome in this disease [ 21 ].Higher rates of hormone-receptor negative and HER2-overexpressing tumors occur in younger patients [ 1 , 3 ]. Other adverse histologic features seen in this patient population include high tumor grade, poor differentiation, and