Breast cancer is rare in young women. Just five percent of all breast cancers diagnosed each year in the U.S. occur in women under 40 [78]. This can make such 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 unexpectedly take top priority.
As for all women, breast cancer treatment in young women is often effective and survival is usually good. However, breast cancers in women under 40 tend to have a poorer prognosis than those in older women. The cancers are more likely to be fast growing, higher grade and hormone receptor-negative, each of which makes such cancers more aggressive and also more likely to require chemotherapy [116]. Age itself does not greatly affect breast cancer treatment. Treatment options are based mainly on cancer stage and tumor characteristics. Age, though, may play a role in women favoring certain options over others--whether it's choosing lumpectomy (also called breast conserving surgery) or mastectomy; or choosing chemotherapy or oophorectomy (removal/suppression of the ovaries). Menopausal status is also important for some therapies. For example, aromatase inhibitors may be an option for young women who have already entered menopause. However, since these drugs are used to treat postmenopausal breast cancer only, they are not an option for young women who are premenopausal. Weighing treatment options in relation to your personal values and lifestyle is key at any stage in life.
One of the main concerns 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. With chemotherapy, however, the chances are greater that the loss of periods will be permanent. Regular periods will most often return in women under 40, but the risk of permanent menopause slowly increases with age. Certain chemotherapy regimens may lower the chances of permanent menopause.
Even in women whose periods return, treatment can shorten the window of opportunity for having children. Because of the danger of birth defects, it is recommended that women taking tamoxifen put off pregnancy until after they finish the standard five years of therapy. And, 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.
There are several steps that women can take to help preserve their fertility after treatment. Storing embryos before treatment is one option. In this procedure, a woman's eggs are collected over a number of menstrual cycles. They are then fertilized and stored at very low temperatures. 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. Another approach involves storing unfertilized eggs that can then be thawed, fertilized and implanted sometime after treatment. This approach is much less successful, however, and is generally only recommended for women taking part in a research study on the procedure.
There is some evidence that drugs like goserelin (Zoladex) and leuprolide (Lupron) may help protect the ovaries during chemotherapy, making it more likely that regular periods return after treatment. Chemotherapy attacks rapidly dividing cells--which include not only cancer cells but also cells in some other parts of the body, like the ovaries. Goserelin and leuprolide can shut down the ovaries during chemotherapy, in theory protecting them from damage. More studies are needed to know if this approach truly protects the ovaries and speeds a return to regular periods. It is also unclear if this approach affects prognosis.
If you wish to have a child after treatment, you should speak to a fertility specialist prior to making treatment decisions to discuss the options. Because insurance coverage for fertility services varies widely from state to state, it is also important to check with your insurance provider to find out what procedures are covered. Organizations such as Fertile Hope can provide financial assistance when insurance providers do not cover these services.
Overall, the prospects are very good for young women with breast cancer. With effective treatment, most women can expect to live many fulfilling years. For more on life as a young survivor, see the After Treatment section. Also, learn about Susan G. Komen for the Cure’s efforts to increase awareness about breast cancer in young women.
To learn more about factors that affect treatment options, see the Diagnosis section.
To learn more about treatment options, visit the pages below:
Updated 08/26/09
