Breast cancer in young women is a rare case. 5% of all the cases of breast cancer are diagnosed every year in women younger than 40.
Living with such a diagnosis is a shock and a hard trial for young women. Their life priorities being family and career, they have a difficult time changing them to treatment, rehabilitation, and survival.
The treatment of breast cancer in young women is mostly effective and, as a rule, the chances to survive are high. Nevertheless, the prognosis for women under 40 is in general worse than for older women. Breast cancer in young women will most likely be fast-growing and hormone-receptor-negative. Each of these factors makes breast cancer more aggressive so that it requires chemotherapy more often.
The age itself doesn’t have a great influence on breast cancer treatment. The options for treatment are based mainly on the stage of the disease and the characteristics of the tumor, such as, for instance, hormone receptor status and HER2/neu status.
The patient’s age can play a significant part in the choice of various ways of treatment. For example, young women prefer lumpectomy rather than mastectomy.
Menopause is of great importance for some methods of breast cancer treatment. For example, aromatase inhibitors are used only in the treatment of postmenopausal breast cancer and are not an option for women before menopause. Young women who have just been entering early menopause because of breast cancer treatment side-effects have to take tamoxifen.
The main problem of young women undergoing breast cancer treatment is the loss of fertility. Chemotherapy and hormonal therapy (tamoxifen) can damage the ovaries, and, as a result, the periods can become irregular or stop altogether.
When the patient stops taking tamoxifen, the regular monthly periods should start again. But after chemo, they will most likely stop for good. Though with some chemotherapy combinations there is less possibility to enter menopause.
As a rule, women under 40 want to exit menopause after the end of their treatment more than older women. The risk of entering permanent menopause increases with age.
Nevertheless, even if the monthly periods have started again, the breast cancer treatment can cut back the period of time left before age menopause. Tamoxifen and chemotherapy usually shorten this time by 3-5 years. This has to be considered if you’re planning to get pregnant after the treatment.
Because of the danger of inborn defects in the fetus, women should use birth control during the intake of tamoxifen (it’s usually taken for 5 years) and the course of chemotherapy.
Staying fertile during breast cancer treatment
Storage of embryos
There are certain steps you can take before the treatment starts to preserve genital function. One of the options is the storage of embryos. The procedure includes collecting oocytes during a few menstrual cycles, their insemination, and freezing. After the end of the treatment, they can be defrosted and implanted into the uterus.
This procedure has a high success rate, but it also has its disadvantages. The treatment has to be delayed until the oocytes are collected, and the woman will need a sperm donor in order to fertilize the eggs before freezing them.
There is another method which allows preserving unfertilized egg cells which can also be defrosted after the end of the treatment, fertilized and implanted into the uterine wall. But this method is far less successful concerning the subsequent successful pregnancy and is at the moment used mostly for scientific research.
Protection of the ovaries during treatment
Chemotherapy attacks the fast-growing cells. They include not only cancerous cells but also the cells in other body parts, such as the ovaries. Such medications as goserelin (Zoladex), leuprolide (Lupron), and triptorelin can protect the ovaries from damage during chemotherapy and reduce the odds of early menopause.
Nowadays, scientists conduct a research to confirm if these medications, in fact, defend the ovaries and hasten the return of regular menstruations. It’s also still unclear if the drugs affect the treatment prognosis.
If the woman wants to have a baby after breast cancer treatment, she needs to discuss it with her healthcare provider before making a decision to take any form of treatment as well as discuss all the treatment and fertility preservation options. An appointment with a reproductologist before the beginning of the treatment offers a large number of possible options.