Breast cancer is rare in young women. Fewer than five percent of all breast cancers diagnosed in the U.S. occur in women under 40 .
A breast cancer diagnosis can be very shocking 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.
With treatment, the chances of survival for young women diagnosed with early breast cancer are good and most women can expect to live for many years.
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 .
Age itself does not greatly affect breast cancer treatment. Treatment options are based mainly on cancer stage, tumor grade and tumor characteristics, such as hormone receptor status and HER2 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.
Whether or not a woman has gone through menopause 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 (unless ovarian suppression is also part of treatment).
Younger women who go into early menopause because of chemotherapy should take tamoxifen until there is no chance they are still premenopausal.
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A main concern for young women being treated for breast cancer is loss of fertility. Chemotherapy can damage the ovaries, and both chemotherapy and tamoxifen can cause irregular periods or stop periods altogether.
With tamoxifen, periods should return after treatment ends (sometimes, periods may be irregular). 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 . Tamoxifen is often taken for many years and over this treatment time, natural fertility may 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 increases with age.
Both tamoxifen and chemotherapy tend to bring on natural menopause earlier than normal, especially among women who are older than 40 during treatment . This further limits time for pregnancy and childbirth.
There are steps you can take before treatment begins to help preserve your ability to have children.
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 . However, breast cancer treatment may be delayed while eggs are collected, and a sperm donor is needed to fertilize the eggs before they are stored.
Unfertilized eggs (which do not require a sperm donor) can also be frozen and stored. In the past, this method was less likely to result in pregnancy compared to using fertilized eggs that had been frozen and stored. However, with modern techniques for freezing unfertilized eggs, pregnancy rates are similar .
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. Some study findings have shown these drugs may protect the ovaries from damage and lower the chances of early menopause .
If you wish to have a child after treatment, talk with 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.
Research is ongoing to improve fertility preservation and breast cancer treatment for young women. For example, new methods of fertility preservation are being studied in clinical trials.
After discussing the benefits and risks with your health care provider, you may want to consider joining a clinical trial. If you are considering a clinical trial of fertility preservation, talking with a fertility specialist is also helpful.
BreastCancerTrials.org in collaboration with Susan G. Komen offers a custom matching service. 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.
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Insurance coverage for fertility services varies widely. Check with your insurance provider to find out which procedures are covered in your policy.
Organizations such LIVESTRONG Fertility (formerly known as Fertile Hope) can provide financial assistance when insurance providers do not cover these services.
Some organizations offer fertility resources for breast cancer survivors. For example, the LIVESTRONG Foundation has an online tool to help you learn more about your fertility options and a guide to help you find resources such as sperm banks, donor egg services and adoption agencies in your area. They also offer telephone counseling on fertility issues.
Social support is important for young breast cancer survivors and their loved ones, especially spouses, partners and children.
Learn more about social support for breast cancer survivors.
Learn more about social support for spouses, partners and other family members.
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*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.
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