BREAST CANCER IN YOUNG WOMEN

Breast cancer is rare in young women, 6%-7% of new cases are diagnosed in women under 40 years old. The risk of breast cancer increases with age. Breast cancer is a cause of death in women under the age of 40 years, and diagnosis usually is not made in time. Typically, the clinical course of young women with breast cancer is worse than in older women, even after staging, determining the subtype, or intensive therapies.

Mammography is the most common screening method even though it has a lower effectiveness due to the high density of the breast in these women. Breast cancer in young women has fewer biological elements, including high histological grade, ki67, lymphovascular invasion. Young women are more likely to have the triple-negative subtype.

Determining the BRCA1/2 mutation plays a special role in the treatment of early and advanced disease. At the time of diagnosis, breast MRI should be considered for women under the age of 30, with high breast density, or carriers of the BRCA1/2 mutation. Risk factors include family history or a history of therapeutic radiation of the breast. Genetic testing should be considered for early patient management.

TREATMENT

Decisions regarding treatment are a choice between local and systemic treatment, directed based on the biological profile, staging, subtype, related to the young age of the patient, at all stages of the disease. Young age is a risk for local recurrence and for contralateral breast cancer. Mastectomy is not associated with survival in young women and should be performed only if indicated or at the patient's wish.

Breast cancer diagnosed during pregnancy is complex and it is best to be treated under the care of a multidisciplinary team. Pregnancy after breast cancer is not contraindicated but should be planned very carefully. Symptoms of menopause, sexual dysfunction, and psychological problems have a significant impact on lifestyle.

Adjuvant endocrine therapy includes tamoxifen, or suppression of ovarian function OFS with tamoxifen or an aromatase inhibitor. Adjuvant systemic therapy can cause infertility and early menopause. This is the biggest cause of anxiety and psychological problems.

Gonadotrophin releasing hormone analogues GnRH, during adjuvant chemotherapy should be considered for ovarian protection.