View additional Susan G. Komen® educational materials for young women about breast cancer.
Breast cancer is rare in young women. Only five percent of all breast cancers diagnosed in the United States each year occur in women under 40 . This can make a diagnosis especially shocking and challenging for young women. At a time in life most often reserved for family and career, issues of treatment, recovery and survivorship suddenly take top priority.
Prognosis for young women
Breast cancer treatment in young women is often effective and survival is usually good. However, prognosis tends to be worse in women under 40 than in older women. Breast cancers in younger women are more likely to be fast-growing, higher grade and hormone receptor-negative . Each of these factors makes breast cancer more aggressive and more likely to require chemotherapy .
Breast cancer treatment for young women
Age and breast cancer treatment
Age itself does not greatly affect breast cancer treatment. Treatment options are based mainly on cancer stage and tumor characteristics, such as hormone receptor status and HER2/neu status.
Age may play a role in the choice of certain treatment options over others. For example, younger women may be more likely to prefer lumpectomy (also called breast conserving surgery) over mastectomy.
Menopausal status and breast cancer treatment
Menopausal status is important for some breast cancer treatments. For example, aromatase inhibitors are only used to treat postmenopausal breast cancer and are not an option for premenopausal women. Younger women who go into early menopause because of breast cancer treatment should take tamoxifen until there is no chance they are still premenopausal.
Learn more about factors that affect treatment options.
Treatment options for non-invasive and invasive breast cancers
To learn more about treatment options, visit the pages below:
Finding clinical trials for young women with breast cancer
BreastCancerTrials.org in collaboration with Susan G. Komen® offers a custom matching service. (Learn more about this program.) This matching service can help you find a clinical trial recruiting young women with breast cancer or a clinical trial for fertility preservation. You can also visit the National Institutes of Health's website to find a clinical trial.
Learn more about clinical trials.
Breast cancer treatment and fertility
A main concern for young women being treated for breast cancer is loss of fertility. Both chemotherapy and tamoxifen can damage the ovaries, causing irregular periods or stopping periods altogether.
With tamoxifen, regular periods should return after treatment ends. However, even in women whose periods return, treatment can shorten the window of time to have children. Because of the danger of birth defects, women should not become pregnant while taking tamoxifen (generally given for five years) [29,100]. Over this treatment time, natural fertility may have begun to decline.
With chemotherapy, it is more likely the loss of periods will be permanent. (Certain chemotherapy combinations are less likely to cause permanent menopause than others.) Women younger than 40 at the time of treatment are more likely than older women to have their periods return after chemotherapy. The risk of permanent menopause slowly increases with age.
Both tamoxifen and chemotherapy tend to bring on natural menopause three to five years earlier than normal . This further limits time for pregnancy and childbirth.
Preserving fertility during breast cancer treatment
There are steps you can take before treatment begins to help preserve your childbearing options. Storing embryos before treatment is one option. In this procedure, eggs are collected over a number of menstrual cycles, fertilized and frozen. After treatment, the embryos can be thawed and implanted into the uterus.
This procedure has a good rate of success, but it also has some down sides. Treatment may be delayed while eggs are collected, and a sperm donor is needed to fertilize the eggs before they are stored [29,148].
Unfertilized eggs (which do not require a sperm donor) can also be frozen and stored. However, this method is much less likely to result in pregnancy compared to storing fertilized eggs and is still considered experimental .
Protecting the ovaries during treatment
Chemotherapy attacks fast-growing cells. These include not only cancer cells but also cells in other parts of the body, like the ovaries. Drugs like goserelin (Zoladex), leuprolide (Lupron) and triptorelin can shut down the ovaries during chemotherapy, which may protect them from damage and lower the chances of early menopause .
More studies are needed to know if these drugs truly protect the ovaries and speed a return to regular periods. It is also unclear if these drugs affect prognosis.
Talking with a fertility specialist
If you wish to have a child after treatment, talk to your health care provider (and if possible, a fertility specialist) before making treatment decisions and discuss your options. Meeting with a fertility specialist as early as possible (before surgery) offers the widest range of options.
Clinical trials for fertility preservation
Research is ongoing to improve fertility preservation. New methods are being studied in clinical trials. After discussing the benefits and risks with your health care provider (and if possible, a fertility specialist), you may want to consider joining a clinical trial on fertility preservation.
BreastCancerTrials.org in collaboration with Susan G. Komen® offers a custom matching service that can help you find a clinical trial for fertility preservation. You can also visit the National Institutes of Health's website to find a clinical trial.
Insurance and financial assistance for fertility services
Insurance coverage for fertility services varies widely from state to state. Check with your insurance provider to find out which procedures are covered in your policy.
Organizations such as Fertile Hope can provide financial assistance when insurance providers do not cover these services.
Young breast cancer survivors
The prospects are very good for young women with breast cancer. With treatment, most women can expect to live for many years.
*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date at this time.