Unique Issues for Young Women with Breast Cancer
About 4 percent of all breast cancers diagnosed in the U.S. occur in women under 40 [191].
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, the chances of survival for young women diagnosed with early breast cancer are good.
However, prognosis tends to be worse in women under 40 than in older women. This is because breast cancers in these younger women can be different from breast cancers in older women.
Breast cancers in younger women are more likely to be [192]:
- Fast-growing
- Higher grade
- Hormone receptor-negative
Each of these factors makes breast cancer more aggressive and more likely to need chemotherapy [192].
Screening mammography isn’t recommended for women younger than 40 unless they have an increased risk of breast cancer. So, breast cancers found in younger women may be larger 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 biological measures (such as hormone receptor status and HER2 status).
Treatment
Age
Age itself doesn’t greatly affect breast cancer treatment.
Treatment is based mainly on cancer stage, tumor grade 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.
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 are not given ovarian suppression.
Learn more about factors that affect treatment options.
Treatment options for ductal carcinoma in situ and invasive breast cancers
To learn more about treatment options, visit the pages below:
- Ductal carcinoma in situ (DCIS) (non-invasive)
- Early and locally advanced breast cancer
- Inflammatory breast cancer
- Metastatic breast cancer
Breast cancer treatment and fertility
Young women being treated for 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 older than 40 during treatment [193]. This limits time for pregnancy and childbirth.
Tamoxifen and fertility
With tamoxifen, periods can return after treatment ends. Sometimes, periods may be irregular.
However, even in women whose periods return, treatment can shorten the window of time to have children.
Because of the danger of birth defects, women should not become pregnant while taking tamoxifen [6]. Tamoxifen is taken for 5-10 years and during this time, natural fertility may decline.
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 younger than 40 at the time of treatment are more likely than older women to have their periods return after chemotherapy. The risk of permanent menopause increases with age.
Preserving fertility
Storing embryos
Before treatment begins, you can help preserve your ability to have children in a few ways.
Storing embryos before treatment is an option. In this procedure, eggs are collected over a number of menstrual cycles, fertilized and frozen. After treatment, the embryos can be thawed and implanted into the uterus.
This procedure has a good rate of success [194]. However, breast cancer treatment may be delayed while eggs are collected, and a sperm donor is needed to fertilize the eggs before they are stored.
Unfertilized eggs (which don’t require a sperm donor) can also be frozen and stored. With modern techniques for freezing unfertilized eggs, pregnancy rates are similar to pregnancy rates using fertilized eggs that have been frozen and stored [27].
Protecting the ovaries
Chemotherapy attacks fast-growing cells. These include not only cancer cells but also 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 [195-197].
Talking with a fertility specialist
If you wish to have a child after 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 are considering a clinical trial of fertility preservation, talking with a fertility specialist is also helpful.
Susan G. Komen® Breast Cancer Clinical Trial Information Helpline |
If you or a loved one needs information or resources about clinical trials, call our Clinical Trial Information Helpline at 1-877 GO KOMEN (1-877- 465- 6636) or email clinicaltrialinfo@komen.org. |
BreastCancerTrials.org in collaboration with Susan G. Komen® offers a custom matching service. This matching service can help find clinical trials for women with breast cancer and clinical trials for fertility preservation.
You can also visit the National Institutes of Health’s website to find a clinical trial.
Learn more about clinical trials.
Insurance and financial assistance
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 and telephone counseling on fertility issues at 1-855-844-7777.
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 what to do if 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 daily life expenses such as rent, groceries and car payments. There are some financial assistance programs that may help.
Learn about insurance and financial assistance programs.
Susan G. Komen® offers the Komen Treatment Assistance Program to help eligible, underserved individuals who are actively undergoing breast cancer treatment. With this program, we aim to help those who are facing financial challenges by providing: limited financial assistance, breast cancer education, psychosocial support and information about local resources. Funding helps women and men of any age who have been diagnosed with breast cancer, at any stage of the disease. Financial assistance is granted to those who meet pre-determined eligibility criteria. 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). |
Support
Social support is important for young women diagnosed with breast cancer and their loved ones, especially spouses, partners and children.
Learn more about social support for young women diagnosed with breast cancer.
Learn more about social support for spouses, partners and other family members.
Learn more about social support for children.
SUSAN G. KOMEN® SUPPORT RESOURCES |
|
Komen Perspectives
Read our perspective on fertility issues and pregnancy after breast cancer treatment.*
*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date.
