Optimal adjuvant therapy for very young breast cancer patients

Approximately one in forty women diagnosed with early breast cancer is very young (<35 years) and this age group has a worse prognosis. The inferior prognosis in very young women appears to have two aspects. Very young women present more frequently with tumors with adverse histo-pathologic features. However, even when the histo-pathologic features appear favorable (ie. endocrine responsive tumors), analyses suggest that very young women with hormone receptor positive tumors are a sub-group at particular risk for adverse outcomes, compared to older premenopausal women with similar tumors. Chemotherapy induced amenorrhea has been shown to be associated with better outcomes and very young women are less likely to develop amenorrhea. Trials to determine the optimal adjuvant hormonal therapy for very young women are important. After breast conserving surgery, very young women are at increased risk for local recurrence and require particular attention to adequacy of surgical excision, including DCIS. Younger women undergoing breast conservation benefit from a boost dose of radiation. The option of genetic counseling should be provided to women diagnosed at a very young age. When considering adjuvant systemic treatments, fertility and contraception may be important considerations for this age group. Pregnancy after a diagnosis of adequately treated early breast cancer does not appear to be associated with an increased risk for relapse. Very young women are at higher risk for psycho-social distress and non-compliance with adjuvant systemic therapy. Young women should be informed that lifestyle factors after diagnosis may reduce the risk of recurrence.