It’s a misconception that breast cancer occurs exclusively in elderly women – in fact as many as 7% of the cases are diagnosed in women under 40. And while unfortunate for women (or indeed, men) of any age, breast cancer can be particularly distressing for younger women, given the physical, emotional, and social challenges associated with the diseases, that tend to be exacerbated for younger women. Not only are survival rates for younger patients lower than those in other age groups, so much so that multivariate analysis has shown a somewhat direct proportionality between chances of survival and age, but the treatment algorithms such as Chemotherapy, endocrine, and local therapies can have side-effects that are much more far-reaching in younger women than elderly women, such as reduced future fertility, premature menopause, and bone health issues.
Risk factors are a little different for different age groups. Whereas, in the older age group, the most important risk factor is a positive family history, in the younger age group the recent oral contraceptive use is also a risk factor for early-onset breast cancer, especially for estrogen receptor tumors. Younger women who have had an early pregnancy or multiparity are also at an elevated risk for several months immediately following the delivery. In addition, younger women who have had a prior mantle irradiation for Hodgkin lymphoma, who had an early onset of menstruation, and who are heavy on consumption of alcohol and red meat are also at an elevated risk of breast cancer.
Another important risk factor for premenopausal breast cancer is a high mammographic density. Studies have revealed that regular ingestion of multivitamin-multimineral supplements can cause higher mean breast density, and hence breast cancer. Paradoxically, several studies have suggested that high vitamin D intake (at least 400 IU daily) can be helpful in lowering the risk of Premenopausal Breast Cancer.
While the basic management of breast cancer remains same across age-groups, younger patients face a lot of issues, including emotional and psychosocial problems, that require special consideration. Younger women are more desirous of breast-conserving surgery however, this treatment option poses nine times higher risk of local recurrence in women under 35 than in women over 60. Another treatment option is adjuvant therapies, which reduce the relative risk of recurrence by 35% and of death by 27%. However, use of adjuvant therapies in young women can trigger an early menopause and impairment to fertility. It can also have an adverse effect on bone mineral density.
Further complicating the treatment options is the fact that amenorrhea, or the absence of menses, has been found to be an important factor in obtaining favorable results from the chemotherapeutic agents. Because of this, the doctors often therapeutically induce amenorrhea in premenopausal women, as this significantly improves both relapse-free and overall survival. However, the chances of becoming amenorrheic are inversely dependent on age, making younger women less likely to gain maximum benefit from the adjuvant chemotherapy.
Researchers have found that intense physical activity can help reduce the risk of breast cancer in premenopausal women by as much as 23%. While there have been studies that have failed to establish a link between the two, into a systematic review of 76 studies found that 53% of studies confirmed a significant protective effect, 37% reported a non-significant risk reduction, and only 10% failed to show a correlation. With regards to diet, some studies have shown that women who consume a diet high in animal fat have nearly 50% greater risk of premenopausal breast cancer, than women with a diet rich in vegetable fat. Also, Mediterranean diet rich in extra virgin oil has also been found helpful in reducing risks of breast cancer
Across all groups, 5-year relative survival rates have been found to be lower for women under 40 than for older women, with lowest being for those aged 25-29 years (72%), followed by those aged 20-24 and 30-34 (75% and 76%, respectively), and those aged 35-39 (80%). In contrast, survival rates for women aged 45-80 were between 84% to 86%.
If you are a young woman with a family history of breast cancer, or you know that you have a BRCA1 or BRCA2 mutation (or to a lesser extent, a TP53 mutation), you may be at a risk of premenopausal breast cancer.
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