Although breast cancer in young women is rare – it is often undiagnosed until it’s too late.
Don’t ignore that lump, even if you’re under 35, say oncologists.
‘In young women, breast cancer tends to be diagnosed in its later stages and is more aggressive,’ says Dr Rika Pienaar, an oncologist at Mediclinic Panorama and the Cancercare Panorama Oncology Centre located in the same medical precinct.
‘Women under the age of 40 also have a higher mortality rate and a higher risk of metastatic recurrence (return of breast cancer in areas beyond the breast).’
This situation is compounded by the fact that there is currently no effective breast-screening tool for women under 40.
‘While it is easy to detect cancer via a mammogram in older women, younger women have dense breast tissue that prevents a mammogram from being a useful screening tool,’ Dr Pienaar explains.
According to a study entitled ‘Presentation of breast cancer in young women’ published in the Journal of Clinical Oncology, nearly 80% of young women diagnosed with breast cancer find their breast abnormality themselves.
‘In young women, a breast lump is often treated as a milk duct and not always taken seriously,’ Dr Pienaar says. ‘Young women fall outside of international guidelines and therefore there isn’t good management of young patients who present with a lump.’
However, if you have any symptoms such as nipple retraction, nipple discharge or a change in breast size, Dr Pienaar advises you go to be examined properly. There are three ways to diagnose breast cancer – clinical histology (the study of cells under a microscope), imaging (an ultrasound or MRI is more able to detect breast cancer in young women than a mammogram) and biopsy.
‘Remember, early diagnosis translates into a better outcome for the patient – less surgery, less treatment chemotherapy and better survival rates,’ Dr Pienaar says.
She adds that the reason that younger women are presenting with breast cancer can be attributed to changes in lifestyle due to industrialisation.
‘In previous decades, females married young, had their first of many children shortly afterwards, breastfed and generally lived a more active lifestyle. Today, young women take oral contraception, delay having their first child, have fewer children and often stop breastfeeding as they have to go back to work. All this translates into a different hormonal environment that translates into a higher incidence of breast cancer.’
Although breast cancer in young women is rare – only 7% of women under the age of 35 are diagnosed with it – it carries complexities around pregnancy and fertility that need to be addressed, Dr Pienaar adds.
‘Women of 35 years and younger have a 15% risk of going into permanent menopause after chemotherapy so it is essential that, if you are in this age group, you discuss your fertility status with a specialist as soon as possible,’ she says. ‘You can opt to harvest your eggs, you can freeze your ovarian tissue or you can suppress ovary function throughout your treatment – none of these fertility preservation methods will affect your cancer treatment.’
Speak to specialists and your oncologist, explore your choices and ask questions. Ensure that you get the information you need in bite-sized chunks and in language you understand.
‘Young women with breast cancer don’t have to face an uncertain fertility future alone,’ Dr Pienaar concludes. ‘Spend time talking to experts, see a counsellor and weigh all your options. Your future can still be close to the one you envisioned before your diagnosis.’
