By Ann H. Partridge, MD, MPH, as told to Alexandra Benisek
In the WebMD webinar Diagnosed before 40: the unique impacts of breast cancer on younger women“, Ann Partridge, MD, MPH, of the Dana-Farber Cancer Institute and Harvard Medical School, answered viewers’ questions about breast cancer risk in young people, treatment options, recurrence, and more.
It depends on your genetic makeup, the type of breast cancer you initially had, and the form of treatment you received. In general, for most young people, the risk of new breast cancer in the other breast is low.
We generally encourage young and old people who are not at high risk for a new type of cancer to have breast preservation on the side where they had the cancer, if possible. They can usually keep their other breast unless we find something wrong.
Clinical trials are a very important way for all of us to learn and improve care today and in the future. It is also helpful for some people to have access to different types of treatment that they might not otherwise have access to.
I’m a big fan of participating in clinical trials if it’s right for you and if the specific trial makes sense for your disease state. I suggest you talk to your oncologists and other doctors about clinical trials you could participate in. You can search for clinical trials on clinicaltrials.orgor through advocacy organizations and other websites.
I generally suggest testing all young women as well as some women over 45. Today, it might be worth considering the test for any woman who is worried about her future risks.
The tests can also help you determine if your family is at high risk for breast cancer, even without a known genetic mutation in your family.
As a general rule, we would advise against thinking about testing for a BRCA1 or BRCA2 mutation before your mid-20s. But if you’re interested sooner, talk to your doctor and a genetic counselor.
There is not much data on topical estrogen in the vagina for the treatment of vaginal dryness and sexual dysfunction. The data we have show mixed results.
For many people it may be safe, but we are just not sure. So we often suggest trying non-hormonal moisturizers and lubricants first, then only using vaginal estrogen when needed (and using it with caution).
But in some cases, there are exceptions, such as in low-risk patients. This is a conversation to have with your oncologist and gynecologist if you have symptoms.
There are a number of different endocrine therapy options for most people. These include both aromatase inhibitors as well as tamoxifen and for young people. Ovarian suppression is also used more for high-risk patients. Tamoxifen alone is also a good choice if your ovarian suppression is causing too many symptoms.
And, of course, you can decide to take less than the full 5-10 years of endocrine therapy. Longer periods are suggested for high-risk cases based on your preferences and tolerance. But there is concern that less than 5 years will give you all the benefits in terms of risk reduction.
Faced with the fear of recurrence, something completely normal for a young survivor of breast cancer, there are many strategies. These include deep breathing, exercise, and talking with friends, family, or a trusted therapist or doctor.
It is important that you take care of yourself, eat well, get enough sleep, and reduce your alcohol and caffeine intake, as this can make people more anxious.
Some young mothers can breastfeed their babies after breast cancer. This may be the case if they are no longer on treatment or on a break and have breast tissue remaining (including the nipple-areolar complex).
But it can be difficult to breastfeed after radiation therapy.
There are several resources that I recommend. First, talk to your doctor and healthcare team about your own needs and concerns about treatment and supportive care.
Second, most cancer centers have a social worker who can help you with psychosocial issues. There are also many resources online.
Generally reliable sources include Susan G. Komen’s website, Living Beyond Breast Cancer, Young Survival Coalition, American Cancer Society, Cancer Care, as well as our own. Dana-Farber young and strong website.
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