Breast cancer and the young patient

breast_cancer

How do we define a young breast cancer patient? In terms of breast cancer, a patient is defined as ‘young’ if they are younger than 35 or 40 years of age.

This is because the statistics for developed nations show that 6% of all breast cancer occurs in women under 40 years of age. In the practice where I work in Cape Town, however, one in 6 women who are diagnosed with breast cancer is younger than 40 years of age. This may be due to the younger age structure of the population in a developing country but there is also evidence that breast cancer in indigenous populations occurs at an earlier age.

Current research shows that many of the young patients are found to have a mutation in the breast cancer genes.This is not the only reason for the high incidence of breast cancer, however. Obesity, a sedentary lifestyle, drinking and environmental factors as well as starting menstruation before the age of nine, and falling pregnant for the first time after 30 years of age are also associated with breast cancer.

On diagnosis of breast cancer in a younger woman, the impact of treatment on body image, sexuality, fertility, premature menopause, as well as pregnancy and long-term side-effects of treatment such as the impact on mental functioning and osteoporosis, all have to be taken into consideration.

In these women, the breasts are generally denser and combined with cyclical hormonal changes in the breast tissue, the clinical examination is more difficult.  The accuracy of mammography is lower in younger than in older women due to the increased density in the young group. Screening mammography is not recommended for young women except for those with a significant family history of breast cancer.  This means that they present more often with palpable disease, rather than with a mammographically detected abnormality.

It is vital that a woman of young age should have any lump fully investigated. Clinical examination along with imaging of the lesion should be compulsory. As mentioned, mammography can be more difficult to interpret in younger women as their breasts are more dense, which can obscure small lesions. Full field digital mammography can aid in this regard. The addition of good ultrasound of the breast in conjunction with fine needle aspiration or core needle biopsy of the lump assures a complete examination. A cytological and/or histological diagnosis has to be established before accepting a lump as benign.

Tomorrow we will look at some of the other issues that come into play for the younger patients.

Were you diagnosed with breast cancer at a young age? Please share your experience with us.

 

 

Post written by Dr Karin Baatjes, Specialist Surgeon and Professor Apffelstaedt, Associate Professor University of Stellenbosch and Head: Breast Clinic, Tygerberg Hospital

 

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