Breast cancer is the most common cancer among women in India. Breast cancer, though a disease of the older age group, it rarely occurs in younger woman. In the western countries, about 10% of the breast cancers occur in women less than 45 years. However in India, data from the National Cancer registry programs show that approximately 20% of breast cancer occurs in women below the age of 45yrs. The diagnosis of breast cancer is often delayed in young women, resulting in advanced stages. These delays are mainly because younger women are less concerned about and are not aware of breast cancer, and also because of physicians, who have less suspicion of this disease in younger women. Diagnosis is also complicated by the various physiological changes that occur during periods of pregnancy and lactation. The special issues among the young are the higher likelihood of a genetic predisposition, premature menopause, fertility and sexuality issues, education and career concerns, and role functions that may be threatened including partnering and caring for young children.
Generally prognosis is worse in younger women than in older women. This is because breast cancers in younger women are usually aggressive in nature and early detection through population screening is not effective in this age group.
Basics of breast cancer treatment are the same for patients of all ages. Being young, most patients prefer breast conservation surgery as opposed to mastectomy. Even if they need mastectomy breast reconstruction is possible. As the disease is usually of aggressive nature, majority will need chemotherapy and radiotherapy in addition. For women with breast cancer during pregnancy, chemotherapy is safe after the first trimester. A main concern for young women being treated for breast cancer is loss of fertility. Chemotherapy can damage the ovaries and in some cases can lead to permanent menopause. So, young breast cancer patients should consider fertility preservation options (storing the embryo, collecting and freezing of unfertilized eggs for later fertilization or using hormones to temporarily shut down and protect the ovaries during chemotherapy) before starting the treatment.
Breast cancer can be familial in about 5% of cases. If a woman inherits a defective gene, her chance of developing breast and/or ovarian cancer is very high, so they need to be counseled regarding prophylactic risk reduction surgeries.
In doubtful cases of breast lumps in young women, they should be investigated further to exclude the possibility of breast cancer. As screening measures are not effective in this age group, breast self-examination and an annual checkup by a health care provider is very important. High risk women should have screening with MRI mammogram.
Dr K Pavithran, MD, DM, FRCP,
Professor of Medical Oncology and Hematology,
Amrita Institute of Medical Sciences, Kochi, Kerala.