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Laura Urbina
Breast cancer (BC) is often thought of as a disease that affects mainly older women. Statistics show that about 10% of new BC diagnoses in the U.S. represent women under 45 years old [1]. For these young patients, the experience of BC is challenging, with more aggressive tumor characteristics, poorer prognosis, and late diagnosis affecting survival [2,3]. Moreover, unique quality of life concerns are observed in young women [4]. This article will explore the hidden burdens that young BC patients face, and why their needs and experiences are so distinct from their older counterparts.
In young women, aggressive tumor behavior is observed in BC compared to older women. Young patients frequently present more aggressive clinical subtypes (Triple-negative (TNBC), and human epidermal growth factor receptor 2 HER2-positive), lymph node invasion, high histological grades, high proliferation rates, and advanced stages at diagnosis [5]. A higher incidence of TNBC and basal-like types are observed in young women, which may explain a worse prognosis for young patients [6]. With the tumor’s aggressive characteristics and lower survival rates for young women, age is considered an independent negative prognostic factor for survival in women with BC and a leading contributor to cancer-related deaths [7].
Timely detection of BC is fundamental for patient-increased survival rates [8]. In developed countries, such as the United States and New Zealand, most young women with BC are diagnosed in the early stages. However, in other countries, including Latin American countries such as Mexico and Brazil, a high percentage of young women are diagnosed in advanced stages. This is considered an important mortality factor for these women. In Latin America, the mean age at BC diagnosis is 10 years younger than in developed countries and women are often diagnosed at late stages due to inequity in healthcare access. As a result, these women require more aggressive treatments, which can have significant socioeconomic impacts and lead to poorer outcomes. Young women with BC in this region face an extra challenge around prevention, early detection, treatment, and long-term survival compared with their counterparts in developed countries [9].
Perhaps the most profound impact of BC on young women is the toll it takes on their quality of life. Younger women have greater psychological morbidity, including elevated levels of depression, after BC than older women and age-matched women with no cancer history [10]. The implications of this disease, such as physical and mental health issues, and impacts on finances, fertility, and relationships, differ from other age groups. These women may feel more burdened by the disease and therapy options in comparison with older women. These women are vulnerable and question fertility, family planning, and pregnancy, their future ability to breastfeed, return to work, and care for children when deciding on surgical treatment options [11,12]. Fertility concerns can also affect treatment decisions [1], as less than 10% of young BC survivors achieve post-treatment pregnancy [3,4]. Improved understanding of the effects of treatments on fertility, and fertility preservation services are crucial for optimizing fertility prospects after cancer treatment [13]. Moreover, young women are underrepresented in research models and clinical trials, increasing their risk of receiving unnecessary chemotherapy, and potentially leading to overtreatment [3].
In conclusion, young women with BC face unique physical and psychological challenges, with more aggressive tumor characteristics, poorer prognosis, and quality of life implications in their prime years impacting their professional growth and personal plans. Moreover, the more aggressive nature of early onset BC increases the negative and poor prognosis of the disease. As the incidence of BC in young women is rising, more studies are still needed to better understand the biological mechanisms and the life quality impact for young women with BC and to understand the differences of this disease in different parts of the world. All of this will help to ensure that young BC patients receive the comprehensive support and care they deserve during this difficult journey.
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Edited by Karli Norville
References
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