Avis Antel

Although most of us are aware that the risk of breast cancer increases with age, about 5% of all diagnosed cases occur in women under the age of 40, according to Dr. Karen Gelmon, Chair of the Breast Tumour Group of the B.C. Cancer Agency. It is estimated that, in Canada, about 100 women between the ages of 20 and 29 and about 1,000 women between the ages of 30 and 39 will be diagnosed this year. Most of these women are likely to have a mutated BRCA1 or BRCA2 gene.

Breast cancer in younger women raises particular issues. Delays in diagnosing breast cancer in younger women may occur because younger women tend to ignore warning signs of breast cancer, assuming they are too young and that a lump or discharge is harmless. Some doctors also dismiss symptoms in young women and adopt a "wait and see" approach. Moreover, despite evidence that the disease in younger women can be more aggressive and less likely to respond to treatment, by the time a lump in a younger woman's breast can be felt, the cancer is often advanced, and those diagnosed under the age of 35 usually have a poorer prognosis.

In addition, because younger women have been under-represented in research studies, there is too little educational material focusing on issues unique to younger women, such as fertility, pregnancy, genetic predisposition, and the impact of hormonal status on the effectiveness of treatment. When undergoing treatment, younger women must deal with the possibility of chemotherapy-induced menopause, as well as issues of sexuality, fertility and pregnancy after treatment, psychosocial and long-term survivorship, and the higher mortality rates for young women.

Although younger women with breast cancer may have different issues, breast cancer 'prevention' in younger women is no different than prevention in the general population: being aware of what is going into and onto our bodies and avoiding environmental toxins wherever possible. In terms of screening, the American and Canadian Cancer Societies no longer promote monthly BSE (breast self-examination), but becoming familiar with the look and feel of one's breasts offers the best chance for a young woman to notice changes. Any change should be checked by a doctor.

While the course of treatment for breast cancer at any age is based on the extent of the person's disease and other factors, younger women have youth and general health in their favour.