Q&A: Young Women and Breast Cancer

When young women receive a breast cancer diagnosis, they face unique medical and psychosocial challenges. Here Ann Partridge, MD, MPH, founder and director of the Program for Young Women with Breast Cancer; director of the Adult Survivorship Program at Dana-Farber Cancer Institute; and associate professor of Medicine at Harvard Medical School, describes some of the considerations for providers treating young women.

Q. What are some of the key concerns you consider when caring for young women diagnosed with breast cancer?

A. There are some pretty well-documented issues of concern for young women with breast cancer (and a large percentage of young adults with all kinds of cancers). First, it has been shown repeatedly that young adults are more likely to die from cancer than older patients. In breast cancer we don’t know if there is something unique to the biology, but we do know that young women are more likely to get aggressive subtypes, like triple-negative breast cancer and HER2-positive breast cancer; and we also know that young women are less likely to stay on tamoxifen for various reasons.

Another major concern among young women is the psychosocial and emotional impact of the disease. It’s not that women at any age are happy to receive a cancer diagnosis, but due to where young adults are in their life stage, they are much more likely to have psychosocial distress both at diagnosis and at follow-up. There are many potential sources for this distress: treatment is often more aggressive; disease can be more aggressive; cancer is likely one of their first significant challenges; they have fewer peers who have been through it before; they have less support; they are more likely to live alone; they may not have a partner, or they have a young marriage; they are not as established in their career; and they are much more likely to be caring for young children. Ultimately, young women are just more vulnerable in many ways because of their life stage and unique challenges.

Young women also tend to get more-aggressive treatment—often because they are diagnosed with a more aggressive cancer, which can result in premature menopause. The symptoms related to premature menopause can be difficult to bear.

In addition to treatment-related and psychosocial and emotional concerns, fertility is a significant issue for this population: young patients are diagnosed when they still potentially want to have biological children, and cancer or treatment can threaten or impair future fertility. That is an issue not only from a biological standpoint but also from an emotional one. There are a lot of data to suggest that, historically, fertility has not been adequately addressed. We are working to fill the gap and to make sure these needs are met—that women are offered information about fertility upfront so that they can consider available options. (See “Young and Newly Diagnosed with Cancer? Think about Fertility” on page 44.)

Patients presenting at a young age are also more likely to harbor a genetic predisposition to developing cancer, and that has implications for treatment decisions and for their families, which can lead to medical and emotional issues.

Finally, while they may do just fine getting through it, younger people treated for cancer have a lot longer to live with long-term late effects into their survivorship—they have more years ahead to deal emotionally and medically with the aftermath of cancer and its treatment.

Ultimately, there are lots of data showing that the adolescent and young adult population falls through the cracks from both an access and an adherence standpoint, but there may also be something going on with the biology of the disease, which we are continuing to investigate.

Ann Partridge, MD, received her medical degree from Cornell University Medical College in 1995. She completed her residency in internal medicine at the Hospital of the University of Pennsylvania and went on to complete fellowships in medical oncology and hematology at Dana-Farber Cancer Institute. Later she received a master of public health degree from the Harvard School of Public Health. She is a medical oncologist focusing on the care of women with breast cancer, and she has a particular interest in the psychosocial, behavioral, and communication issues in breast cancer care and treatment.