Young breast ca survivors have unique needs

OB/GYN News, April 1, 2003 by Nicholas Mulcahy

PHILADELPHIA -- Young breast cancer survivors have needs that are unique to their age and not found in older women, presenters .said at a meeting sponsored by Living Beyond Breast Cancer and the Young Survival Coalition.

The uniqueness of breast cancer in premenopausal women begins with diagnosis, said Dr. Kathy Miller, an oncologist in the department of medicine at Indiana University, Indianapolis.

Premenopausal women typically have longer delays in diagnosis than older women. As a consequence, breast cancers in young women tend to be more advanced at diagnosis. In general, there are no differences by disease stage in the way younger women are treated versus older women, but there are marked differences in the consequences of treatment.

Young women with breast cancer reach menopause faster and earlier than they otherwise would due to chemotherapy or tamoxifen treatment. "The onset of menopause can occur within several months to a couple of years in a young woman on these therapies," she said.

Because chemotherapy often causes premature ovarian failure and infertility, young breast cancer patients who want to become pregnant "should not waste time," said Dr. Kutluk Okray of the Center for Reproductive Medicine and Infertility at Cornell University, New York.

"Chemotherapy may not induce menopause immediately but menopause might very well occur within 2 or 3 years after chemotherapy" he noted. Young women have numerous options to either preserve fertility or help with fertility after treatment, including ovarian transplantation, tamoxifen-stimulated JVF, and egg-freezing.

Regarding the safety of pregnancy after breast cancer, Dr. Oktay said the findings were "neutral" and that results of most studies indicated no higher risk of disease recurrence after pregnancy Still, he noted that these data may be skewed by the fact that "only the healthiest women try to get pregnant after breast cancer."

Young women also differ from their older counterparts in a terribly obvious way--the amount of life lived, said Rosalind Kieban, supervisor of psychosocial programs, Memorial Sloan-Kettering Cancer Center, New York.

"Young women's lives are just taking off while the older group usually have established lives. For the group with local disease, they have many more years to worry about the cancer's return; for the metastatic group, they are devastated by the possibility that their life's dreams will not be realized," she said.

Ms. Kleban also sees differences emerging among young women who are now being diagnosed with breast cancer versus older women. "Younger women are less likely to see the illness as a curse, a plague, and are not as subject to the prejudices of the past. They find themselves more acceptable to their peers than do older patients. In my experience, today's younger patients very rarely feel they have to hide the illness," she said.