Unique Issues for Young Women with Breast Cancer

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About 4% of all breast cancers diagnosed in the U.S. occur in women under 40 [224].

A breast cancer diagnosis is shocking for young women. At a time in life most often focused on family and career, issues of treatment, recovery and survivorship suddenly take top priority.

Prognosis

With treatment, prognosis (chance of survival) for young women diagnosed with early breast cancer is good.

However, prognosis tends to be worse for women under 40 than for older women. This is because breast cancers in younger women can be more aggressive than breast cancers in older women [225].

Breast cancers in younger women are more likely to be [225]:

Each of these factors makes breast cancer more aggressive and more likely to need chemotherapy [225].

Screening mammography isn’t recommended for women under 40 unless they have an increased risk of breast cancer. So, breast cancers found in younger women may be larger and more likely to be lymph node-positive than those found in older women who get regular mammograms.

However, tumor size isn’t as strongly related to breast cancer prognosis as other tumor factors. A large tumor may have a better prognosis than a small tumor, based on biomarkers such as hormone receptor status and HER2 status.

Genetic testing

If you’re diagnosed with breast cancer at age 40 or younger, you have an increased risk of having an inherited gene mutation related to breast cancer [226]. The National Comprehensive Cancer Network (NCCN) recommends you get genetic testing for BRCA1, BRCA2 and possibly other inherited gene mutations that increase breast cancer risk [226].

Learn more about genetic testing.

Treatment

Age

Age itself doesn’t greatly affect breast cancer treatment.

Treatment is based mainly on cancer stage and tumor characteristics, such as hormone receptor status and HER2 status.

However, age may play a role in the choice of certain treatment options. For example, younger women may be more likely than older women to get breast reconstruction after a mastectomy.

Learn more about factors that affect treatment options.

Menopausal status

Whether or not a woman has gone through menopause is important for some breast cancer treatments.

Women with hormone receptor-positive breast cancers are treated with hormone therapy. Hormone therapy drug options depend on a woman’s menopausal status.

For example, premenopausal women may get ovarian suppression in addition to tamoxifen or an aromatase inhibitor. Postmenopausal women don’t need ovarian suppression.

Learn more about factors that affect treatment options.

Treatment options for ductal carcinoma in situ and invasive breast cancers

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Breast cancer treatment and fertility

Young women with breast cancer may be concerned about loss of fertility.

Chemotherapy can damage the ovaries.

Both chemotherapy and tamoxifen can cause irregular periods or stop periods altogether. They both also tend to bring on natural menopause earlier than normal, especially in women who are over 40 during treatment [33].

Chemotherapy and fertility

With chemotherapy, the loss of periods may be permanent. Some chemotherapy combinations are less likely to cause permanent menopause than others.

Women under 40 at the time of treatment are more likely than older women to have their periods return after chemotherapy [33]. The risk of permanent menopause increases with age [33].

Hormone therapy and fertility

With tamoxifen, periods continue, or they may stop and then return after treatment ends (although they may be irregular).

If ovarian suppression is added to tamoxifen or given with an aromatase inhibitor, periods will usually stop temporarily and return after treatment ends.

However, even in women whose periods return, the time it takes to complete treatment can shorten the window of time to have children. Menopause may come sooner if a woman gets chemotherapy in addition to hormone therapy.

Because of the danger of birth defects, women should not become pregnant while taking hormone therapy [8]. Hormone therapy is taken for 5-10 years and during this time, natural fertility may decline.

Taking a break from hormone therapy to have a child

A recent study looked at women ages 42 and younger who had stage I-III hormone receptor-positive breast cancer who wished to try and have a child [311]. The women had been taking hormone therapy (tamoxifen (with or without ovarian suppression) or an aromatase inhibitor with ovarian suppression) for 18-30 months [311].

The women in the study paused hormone therapy for up to 2 years to try to have a child [311]. After that time, women went back on hormone therapy so they could complete their planned 5-10 years of treatment [311].

After 3 years of follow-up, findings showed no evidence of an increased rate breast cancer recurrence or metastases in the women [311].

If you’re on hormone therapy and wish to have a child, talk with your oncologist about your personal risk of breast cancer recurrence and whether it makes sense for you to take a break from treatment to try to have a child (and then return to hormone therapy).

Other drug therapies and fertility

There are a number of new drug therapies for early breast cancer, including antibody-drug conjugate therapy, CDK 4/6 inhibitor therapy, immunotherapy and PARP inhibitor therapy. We don’t yet understand the impact these new therapies might have on future fertility.

Preserving fertility

Storing eggs

Before treatment begins, you can help preserve your ability to have children in a few ways.

The most common way to preserve fertility is to store eggs (fertilized or unfertilized) before chemotherapy begins. Some of your eggs are collected, frozen and stored. The eggs may be fertilized by sperm from a spouse, partner or donor. Or you may store unfertilized eggs, which don’t require a sperm donor.

After treatment, the eggs can be thawed, and if they were frozen unfertilized, they are fertilized. Then the eggs are implanted into the uterus.

Breast cancer treatment may be delayed while eggs are collected (and if a sperm donor is needed to fertilize the eggs before they are stored). Studies suggest these treatment delays are not long and should not affect prognosis (chances for survival) [227-230].

Learn about insurance coverage and financial assistance for fertility services.

Protecting the ovaries

Chemotherapy attacks fast-growing cells. These include cancer cells as well as healthy 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.

Studies have shown these drugs may protect the ovaries from damage during chemotherapy, lower the chances of early menopause and help preserve fertility [231-233].

Ovarian suppression with goserelin or leuprolide is also part of breast cancer treatment for some premenopausal women with hormone receptor-positive early breast cancer. Some women may start ovarian suppression before chemotherapy begins and it not only starts their hormone therapy, but also potentially protects their ovaries.

Talking with a fertility specialist

If you wish to have a child after breast cancer treatment, discuss your options with your health care provider (and if possible, a fertility specialist) before making treatment decisions.

Meeting with a fertility specialist as early as possible (before surgery) offers the widest range of options.

Clinical trials for young women with breast cancer

Research is ongoing to improve fertility preservation and breast cancer treatment for young women.

After discussing the benefits and risks with your health care provider, you may want to consider joining a clinical trial.

If you’re considering a clinical trial of fertility preservation, talking with a fertility specialist is also helpful.

Susan G. Komen^® Breast Care Helpline

If you or a loved one needs information or resources about clinical trials, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877- 465- 6636) or email clinicaltrialinfo@komen.org.

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BreastCancerTrials.org in collaboration with Komen offers a custom matching service. This matching service can help find clinical trials for fertility preservation.

Learn what else Komen is doing to help people find and participate in breast cancer clinical trials, including trials supported by Komen.

You can also visit the National Institutes of Health’s website to find a clinical trial.

Learn more about clinical trials.

Komen Perspectives

Read our perspective on clinical trials.*

Learn More

Insurance and financial assistance

Many cancer centers have patient financial offices where you can discuss insurance and cost coverage.

Fertility services

Insurance coverage for fertility services varies widely. Check with your insurance company to find out which procedures are covered in your policy.

Organizations such LIVESTRONG Fertility offer financial help if your insurance company doesn’t cover these services.

LIVESTRONG Fertility also offers information on fertility options.

Learn more about other financial assistance programs.

Prescription drug assistance

Chemotherapy drug costs can quickly become a financial burden for you and your family.

Many insurance companies offer prescription drug plans. One may already be included in your policy, or you may be able to buy an extra plan for prescriptions.

Some drugs are off-patent and may have a generic form. Generic drugs cost less than the name brands but are just as effective.

You may also qualify for programs that help with drug costs or offer low-cost or free prescriptions.

Learn more about insurance plans and prescription drug assistance programs.

Learn more about other financial assistance programs.

Other medical and personal expenses

Insurance issues (such as a claim is denied) can be a major concern while you’re being treated for breast cancer.

Paying out-of-pocket expenses related to your treatment can be a burden. This can lead to struggles paying other expenses such as rent, groceries and car payments. There are financial assistance programs that may help.

Learn about insurance and financial assistance programs.

Learn about maintaining health insurance if you lose your job, change jobs, or need to take time off during your breast cancer treatment.

Komen Financial Assistance Program

Susan G. Komen^®created the Komen Financial Assistance Program to help those struggling with the costs of breast cancer treatment by providing financial assistance to eligible individuals.

Funding is available for eligible individuals undergoing breast cancer treatment at any stage or living with metastatic breast cancer (stage 4).

To learn more about this program and other helpful resources, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636) or email helpline@komen.org.