The Challenge of ‘Young Women with Breast Cancer’

By Dr. Aditi Chaturvedi in Breast Cancer , Cancer Care / Oncology , Surgical Oncology

Nov 17 , 2023 | 2 min read

Breast cancer is known to be the most common cancer among women globally, accounting for roughly 2.3 million cases each year. Among all breast cancer cases, 10-20% of new cancers occur in women under the age of 40, which poses a major health challenge. Conventionally, cancer is known to be a disease of the ‘elderly’, and thus, the rising number of cases in young women comes as a surprise to many.

Breast cancer in young women presents with the same symptoms as that in older women: namely, lump with or without pain, watery or bloody nipple discharge or ulceration or any change in the breast skin such as a dimple or redness or swelling. However, often, these changes are overlooked because benign/‘hormonal’ breast problems are far more common in this age group. Neither patients nor the health community expect a sinister diagnosis at this age, leading to delayed investigations and advanced-stage diagnosis. Many studies have reported that breast cancer in the young is picked up at advanced stages, leading to poor outcomes. This delay in diagnosis is due to a lack of screening or routine tests in young women, stigma and hesitation to seek medical help and limited accuracy of tests such as mammograms in this population. Pregnancy-associated breast cancer is also a rare type of breast cancer that is often diagnosed quite late because early signs are missed as normal changes during pregnancy and breastfeeding.

Read More: 5 Early Signs of Breast Cancer

The biological type of breast cancer in the young is also different: it is more commonly Hormone receptor negative or HER2 positive, subtypes which are aggressive in nature with challenging treatment pathways. This adds to the challenge for the treating team as the need for chemotherapy and targeted therapy is often greater.

Conversations with the surgeon about the safety of breast conservation, i.e. removal of the tumour alone with oncoplasty or whole breast reconstruction using implants or tissue transfer from the abdomen, etc., are of immense importance to ensure the preservation of a young woman’s image and quality of life. The impact of breast cancer diagnosis and treatment on future fertility also needs to be carefully discussed in this age group.

There are various options, such as embryo or egg preservation, which can be explored with a fertility specialist. Genetic testing after detailed family history evaluation and counselling is also recommended to find out if the cancer is hereditary in nature, which can have implications for the patient and her family.

The emotional toll of the diagnosis of breast cancer in this population is often huge. Coping with the fear of danger to life, body changes, and potential infertility can be overwhelming. The need for psychological and emotional support needs to be sensitively catered to through counselling and support groups.

The evaluation of disease, treatment planning, execution and post-treatment care: every part of a patient’s journey needs a highly trained team with professionals from all spheres and this access to high-quality care is something we must strive to provide to every young woman being diagnosed with breast cancer. This area also needs focused research, especially in the Indian population, to formulate the best possible guidelines for the future.

While we talk about the complex aspects, it is equally important to remember the basics: Awareness about early signs of breast cancer, focus on maintaining a healthy weight and increased screening from an early age if there is a family history of breast cancer can be small steps which can be adapted by the community to combat this problem.