Breast Cancer in Young Women

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (1 November 2019) | Viewed by 14084

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Guest Editor
1. Women’s College Research Institute, Women’s College Hospital, Toronto, ON M5S 1B2, Canada
2. Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
3. Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A8, Canada
Interests: breast cancer; ovarian cancer; BRCA1; BRCA2; cancer prevention; screening
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Dear Colleagues,

In the United States, approximately 4.4% of breast cancers are diagnosed in women younger than 40, and these cases account for 2.5% of breast cancer deaths. These statistics actually underestimate the impact of early-onset breast cancer, because of all women who die from breast cancer, 8.6% are diagnosed before age 40. Little is known about the etiology of this disease, as the incidence of breast cancer in individuals aged under 40 is stable for women worldwide, but the mortality rate varies widely. The proportion of young women who have a genetic predisposition to breast cancer may be 20% or greater.

The poor prognosis of women with early-onset breast cancer is reflected, to some extent, by the relatively high proportion of young women who present with distant metastases and relatively poor pathologic features; however, stage and grade do not tell the whole story. Breast cancer-related deaths in young women are largely restricted to ER-positive cases. It is of interest that ER status is not a favorable marker for prognosis for young women, and it is important to determine whether other prognostic markers are associated with poor outcomes in this subgroup of women, and, in particular, if they can be used to determine the need for chemotherapy. However, caution should be exercised if chemotherapy is to be with-held from young women on the basis of prognosis. Further, treatment of this condition in young women is complicated by the fact that they may wish to have children after treatment; this raises concerns about optimizing treatment and maintaining fertility at the same time considering the possible teratogenic and toxic effects of current treatments. In the current issue, we explore topics related to breast cancer occurring in women before age 40.

Dr. Steven Narod
Guest Editor

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Published Papers (2 papers)

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Research

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11 pages, 1021 KiB  
Article
Risk of Contralateral Breast Cancer in Women with and without Pathogenic Variants in BRCA1, BRCA2, and TP53 Genes in Women with Very Early-Onset (<36 Years) Breast Cancer
by Zerin Hyder, Elaine F. Harkness, Emma R. Woodward, Naomi L. Bowers, Marta Pereira, Andrew J. Wallace, Sacha J. Howell, Anthony Howell, Fiona Lalloo, William G. Newman, Miriam J. Smith and D Gareth Evans
Cancers 2020, 12(2), 378; https://doi.org/10.3390/cancers12020378 - 07 Feb 2020
Cited by 20 | Viewed by 3888
Abstract
Early age at diagnosis of breast cancer is a known risk factor for hereditary predisposition and some studies show a high risk of contralateral breast cancer in BRCA1 carriers diagnosed at very young ages. However, little is published on the risk of TP53 [...] Read more.
Early age at diagnosis of breast cancer is a known risk factor for hereditary predisposition and some studies show a high risk of contralateral breast cancer in BRCA1 carriers diagnosed at very young ages. However, little is published on the risk of TP53 carriers. 397 women with breast cancer diagnosed <36 years of age were obtained from three sources: (i) a population-based study of 283 women diagnosed sequentially from 1980–1997 in North-West England, (ii) referrals to the Genomic Medicine Department at St Mary’s Hospital from 1990–2018, and (iii) individuals from (i) and the Family History Clinic at Wythenshawe Hospital South Manchester who tested negative for pathogenic variants (PV) in all three genes. Sequencing of BRCA1, BRCA2, and TP53 genes was carried out alongside tests for copy number for PV on all referred women. Rates of contralateral breast cancer were censored at death, last assessment, or risk-reducing mastectomy. In total, 47 TP53, 218 BRCA1, and 132 BRCA2 PV carriers were identified with breast cancer diagnosed aged 35 years and under, as well as a representative sample of 261 not known to carry a PV in BRCA1, BRCA2, and TP53. Annual rates of contralateral breast cancer (and percentage of synchronous breast cancers) were TP53: 7.03% (4.3%), BRCA1: 3.57% (1.8%), and BRCA2: 2.63% (1.5%). In non-PV carriers, contralateral rates in isolated presumed/tested non-carrier cases with no family history were 0.56%, and for those with a family history, 0.69%. Contralateral breast cancer rates are substantial in TP53, BRCA1, and BRCA2 PV carriers diagnosed with breast cancer aged 35 and under. Women need to be advised to help make informed decisions on contralateral mastectomy, guided by life expectancy from their index tumor. Full article
(This article belongs to the Special Issue Breast Cancer in Young Women)
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Review

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16 pages, 830 KiB  
Review
Breast Cancer during Pregnancy—Current Paradigms, Paths to Explore
by Ayelet Alfasi and Irit Ben-Aharon
Cancers 2019, 11(11), 1669; https://doi.org/10.3390/cancers11111669 - 28 Oct 2019
Cited by 22 | Viewed by 9605
Abstract
Breast cancer is the most common form of malignancy in pregnant women. The prevalence of pregnancy-associated breast cancer (PABC) is up to 0.04% of pregnancies and is expected to rise in developed countries. PABC represents a unique clinical scenario which requires a delicate [...] Read more.
Breast cancer is the most common form of malignancy in pregnant women. The prevalence of pregnancy-associated breast cancer (PABC) is up to 0.04% of pregnancies and is expected to rise in developed countries. PABC represents a unique clinical scenario which requires a delicate balance of risks and benefits for both maternal and fetal well-being. Currently, there is paucity of data regarding the short- and long-term outcomes of in-utero exposure to anti-neoplastic agents. In general, when possible, treatment for PABC should follow the same guidelines as in non-pregnant patients. Surgery, including sentinel lymph node biopsy, is possible during all trimesters of pregnancy. Radiotherapy is contraindicated during pregnancy, although it might be considered in highly selected patients based on risk–benefit assessment. Evidence supports that administration of chemotherapy may be safe during the second and third trimesters, with cessation of treatment three weeks prior to expected delivery. Currently, hormonal therapy and anti-HER2 agents are contraindicated during pregnancy and should be postponed until after delivery. Prematurity is associated with worse neonatal and long-term outcomes, and thus should be avoided. While current data on the long-term effects of anti-neoplastic treatments are reassuring, grade of evidence is lacking, hence additional large prospective studies with long-term follow-up are essential to rule out any treatment-induced adverse effects. Full article
(This article belongs to the Special Issue Breast Cancer in Young Women)
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