Breast cancer in young women – defined in this report as women less than 40 years of age – is not a phenomenon that has received much attention to date in Australia. Yet almost
800 young women per year are diagnosed. While the incidence of breast cancer is not as high as in older generations, young women face an utterly disproportionate burden of impact on every aspect of their lives. This is poorly publicised, and even more poorly understood, thereby adding to that burden.
From the moment of concern when typically they may discover a worrying change in their breasts, young women face an uphill battle. Even being taken seriously with their request for diagnostic testing can be a challenge.
Young women tend to think they are ‘bullet proof’. They are often fit, active and lean with no discernible risk factors. Because the incidence of breast cancer in the 20s and 30s is low, when it does occur it takes everyone by surprise. Mammographic screening is not offered to women under 40 in Australia, because it is not particularly effective in younger age groups. So, young women must rely on breast self-examination or clinical breast examination to find any changes.
For young women, having an accurate understanding of family history can be an important tool to aid early diagnosis. However, it’s important that young women don’t overestimate the role of family history in breast cancer. We know for women of all ages, only a maximum of 15% of breast cancers are related to family history.
Although breast cancer is not common in young women, those affected are typically diagnosed with more aggressive sub-types of the disease and larger tumours – which means a poorer prognosis. Because young women often manifest with ‘triple negative’ disease, there are few targeted therapies available for them – unlike older women who most often manifest with hormonally-driven breast cancers responsive to antihormone therapies. So, young women are often aggressively treated with chemotherapy, which can be effective but also a ‘blunt instrument’ in killing healthy cells as well as cancer cells, with effects for years to come. Treatments can have severe impacts on young women’s abilities to remain employed and certainly to remain employed in the same job and with the same working conditions. This in turn can have very significant impacts on their financial situation and future career prospects.
More young women die of their disease, compared with older women, and they have a higher rate of recurrence and spread from the breast to other parts of the body, such as the bone, liver, lungs and brain. Once that metastasis has happened, the science today can keep them alive for some years, but ultimately cannot save them – yet. Young women in this situation are particularly challenged. The content in this report focuses on early detection and management of primary breast cancer. However, we are very conscious of the unmet needs of young women whose breast cancer has spread, and recognise the requirement for further support, greater awareness, better therapies and more research for these women.