Dr Nick Zdenkowski is a clinician-researcher with an interest in breast cancer. He would like to see research more embedded in routine clinical practice, to enable rapid and efficient translation of research into patient care. He works as a Medical Adviser with Breast Cancer Trials, a collaborative breast cancer clinical trials group based in Newcastle, NSW.
What age do you consider as young when it comes to a breast cancer diagnosis?
This usually refers to women who are pre-menopausal and roughly under 40 years of age.
What % of women under the age of 45 will get diagnosed with breast cancer?
It is estimated that in 2021, 1,000 young women were diagnosed with breast cancer in Australia or roughly 7% of all breast cancers, and 79 are estimated to die from the disease. That’s about 3 women under 40 years old each year and more than 1 dying every week.
What % of breast cancers are in young women?
7% of breast cancers in Australia are in young women or 1,000 young women each year, and 79 are estimated to die from the disease. It is the most commonly diagnosed cancer in women aged 20-39 years and the most common cause of cancer deaths in this age group, causing around 1 in 5 cancer deaths.
Overall, the 5-year survival rate in young women is lower compared to women aged 40 and over. In 2013-2017 the relative 5-year survival rate in women aged 20-39 was 89.6%, compared to women aged 40-59 years was 93.4%.
Here are some tables from the Australian Institute of Health and Welfare:
Are there particular reasons why young women get breast cancer?
All women are at risk of developing breast cancer and the risk greatly increases with age with most cases of breast cancer occurring in women over the age of 50. There are a range of factors that can increase breast cancer risk in young women. The causes of breast cancer in young women can include modifiable factors (such as lack of exercise and alcohol consumption) and non-modifiable factors (such as genetics). Young women may have an increased risk of breast cancer due to factors such as: family history, genetic susceptibility, reproductive and hormonal factors, and alcohol intake.
What % of those breast cancers in young women are because of genetic abnormalities?
Roughly 5% of all breast cancers (all ages of women) are caused by genetic mutations. Genetic/inherited breast cancers are more common in younger women.
What are the main types of breast cancer that young women get?
Young women are more likely to be diagnosed with more aggressive breast cancers like triple-negative and/or high grade breast cancer. Invasive ductal carcinoma is the most common breast cancer type for women of all ages. However, a higher proportion of young women are diagnosed with this type of breast cancer than older women (87% compared with 78%).
Young women face unique medical and psychosocial challenges, including premature menopause, fertility and sexuality issues and role functions that may be threatened, including partnering, caring for young children, education and career issues. Concern about these issues may contribute to younger women experiencing higher levels of psychosocial distress following diagnosis, compared with older women.
Young women are more likely to have a delayed diagnosis of breast cancer. Breast changes to look out for include:
- a change to the nipple, such as crusting, ulcer, redness or inversion
- a nipple discharge that occurs without squeezing
- a change in the skin over your breast such as redness or dimpling
- or an unusual pain that doesn’t go away.
All women, regardless of age, should be aware of how their breasts look and feel. Most changes aren’t due to breast cancer, but it’s important for women to see their doctor if they notice anything new or unusual for them. If the change is due to breast cancer, the earlier cancer is found and treated, the better the chances of survival.
Does drinking alcohol or taking drugs make young women more likely to be diagnosed with breast cancer?
Alcohol increases the risk of breast cancer for all women and also increases the risk of other diseases. Smoking is also a recognised risk factor for breast cancer.
Does taking the birth control pill increase young women’s chances of being diagnosed with breast cancer?
According to the Cancer Council of Australia, oral contraceptives are associated with a slightly increased risk of breast cancer and, in a certain group of women, an increased risk of cervical cancer. The risk begins to decline shortly after stopping use and returns to normal after 10 or more years of stopping use. Apart from preventing pregnancy, oral contraceptives provide some level of protection against endometrial and ovarian cancer.
Breast cancer treatment can affects a woman’s fertility. Why does this happen?
The impact of chemotherapy on fertility depends on a number of factors, including the woman’s age and the type of drugs she receives. The effects experienced can also vary among different women of the same age.
Treatment with hormonal therapies (endocrine therapies) do not cause a woman to become permanently infertile. However, a woman’s fertility may decrease while taking hormonal therapies. Most hormonal therapies for breast cancer are given for 5 or more years to prevent cancer recurrence. After 5 years, it is possible that a woman’s fertility may have decreased naturally.
Treatments for breast cancer may reduce fertility temporarily or permanently. However, this does not mean it is impossible to become pregnant during or after treatment. For example, although hormonal therapies for breast cancer can cause menstrual periods to stop, this does not necessarily mean that a woman cannot become pregnant while taking hormonal therapies. Women who are sexually active while taking tamoxifen should use effective contraception if they do not wish to become pregnant during this time.
Women who are pregnant when their breast cancer is diagnosed may not be able to receive some of treatments given to non-pregnant patients. Radiotherapy is not generally recommended during pregnancy because it may harm the unborn baby, however radiotherapy can be given after birth. Chemotherapy is not recommended during the first trimester because it may harm the unborn baby, with treatment often given during the second and third trimesters. Hormonal therapy and trastuzumab (Herceptin) are not recommended while pregnant.
Breast Cancer Trials conducted the POEMS clinical trial, which proved the benefits of goserelin to preserve a women’s fertility during chemotherapy for breast cancer. This drug has since been listed on the PBS for all woman undergoing cancer treatment not just those with breast cancer.
What genetic testing is now available for young women with a strong family history of breast cancer? Can genes other than just BRCA be tested?
Genetic testing is usually offered when someone is at a high risk of having inherited a faulty gene, based on a strong family history of cancer, their cancer subtype and/or the age at which they are diagnosed. There is an increasing number of genes that have a link with breast cancer including BRCA1/2, PALB2, CHEK2, PTEN and ATM. The first person to be tested if there is no known genetic predisposition should be the person who has been diagnosed with cancer. If a gene is found, then family members may be offered genetic counselling and testing.
While mammographic screening is effective in the early detection of breast cancer among older women, there is no evidence to support the use of mammographic screening in women aged under 40 years.
What would you recommend to a young woman who had just been diagnosed with breast cancer?
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- There are effective treatments
- Seek out information and advice
- You are not alone
- Support is available
Breast Cancer Trials is hosting the next in their popular series of Q&As about breast cancer and young women – for more information please click here. The Q&A will be held at Federation Square and will be broadcast live so that all interested parties can tune in. The event takes place on Wednesday 27th July from 5.30-7pm.
