Breast cancer is rare in young women. Fewer than 5 percent of all breast cancers diagnosed in the U.S. occur in women under 40 [161].

A breast cancer diagnosis can be very shocking for young women. At a time in life most often focused on family and career, issues of treatment, recovery and survivorship suddenly take top priority.

Prognosis

With treatment, the chances of survival for young women diagnosed with early breast cancer are good and most women can expect to live for many years.

However, prognosis tends to be worse in women under 40 than in older women.

Breast cancers in younger women are more likely to be [162]:

• Fast-growing
• Higher grade
• Hormone receptor-negative

Each of these factors makes breast cancer more aggressive and more likely to need chemotherapy [158].

Treatment

Age

Age itself does not greatly affect breast cancer treatment.

Treatment is based mainly on cancer stage, tumor grade and tumor characteristics, such as hormone receptor status and HER2 status.

However, age may play a role in the choice of certain treatment options.

For example, younger women may be more likely to prefer lumpectomy (also called breast conserving surgery) over mastectomy.

Menopausal status

Whether or not a woman has gone through menopause is important for some breast cancer treatments.

For example, women with hormone receptor-positive breast cancers are treated with hormone therapy (such as tamoxifen and aromatase inhibitors).

• Tamoxifen can be used to treat premenopausal women and postmenopausal women.
• Aromatase inhibitors are only used to treat postmenopausal women and are not an option for premenopausal women (unless ovarian suppression is also part of treatment).

Learn more about factors that affect treatment options.

Treatment options for ductal carcinoma in situ and invasive breast cancers

To learn more about treatment options, visit the pages below:

• Ductal carcinoma in situ (DCIS) (non-invasive)
• Early breast cancer
• Locally advanced or inflammatory breast cancer
• Metastatic breast cancer

Breast cancer treatment and fertility

Young women being treated for breast cancer may be concerned about loss of fertility.

Chemotherapy can damage the ovaries, and both chemotherapy and tamoxifen can cause irregular periods or stop periods altogether.

Both tamoxifen and chemotherapy also tend to bring on natural menopause earlier than normal, especially among women who are older than 40 during treatment [163]. This limits time for pregnancy and childbirth.

Tamoxifen and fertility

With tamoxifen, periods can return after treatment ends (sometimes, periods may be irregular).

However, even in women whose periods return, treatment can shorten the window of time to have children.

Because of the danger of birth defects, women should not become pregnant while taking tamoxifen [9]. Tamoxifen is often taken for many years and during this time, natural fertility may decline.

Chemotherapy and fertility

With chemotherapy, the loss of periods may be permanent. (Some chemotherapy combinations are less likely to cause permanent menopause than others.)

Women younger than 40 at the time of treatment are more likely than older women to have their periods return after chemotherapy. The risk of permanent menopause increases with age.

Preserving fertility

Storing embryos

Before treatment begins, you can take steps to help preserve your ability to have children.

Storing embryos before treatment is an option. In this procedure, eggs are collected over a number of menstrual cycles, fertilized and frozen. After treatment, the embryos can be thawed and implanted into the uterus.

This procedure has a good rate of success [164]. However, breast cancer treatment may be delayed while eggs are collected, and a sperm donor is needed to fertilize the eggs before they are stored.

Unfertilized eggs (which don’t require a sperm donor) can also be frozen and stored.

With modern techniques for freezing unfertilized eggs, pregnancy rates are similar to pregnancy rates using fertilized eggs that have been frozen and stored [34].

Protecting the ovaries

Chemotherapy attacks fast-growing cells. These include not only cancer cells but also healthy cells in other parts of the body, like the ovaries.

Drugs like goserelin (Zoladex), leuprolide (Lupron) and triptorelin can shut down the ovaries during chemotherapy.

Some study findings have shown these drugs may protect the ovaries from damage and lower the chances of early menopause [165-167].

Talking with a fertility specialist

If you wish to have a child after treatment, discuss your options with your health care provider (and if possible, a fertility specialist) before making treatment decisions.

Meeting with a fertility specialist as early as possible (before surgery) offers the widest range of options.

Clinical trials for young women with breast cancer

Research is ongoing to improve fertility preservation and breast cancer treatment for young women.

After discussing the benefits and risks with your health care provider, you may want to consider joining a clinical trial.

If you are considering a clinical trial of fertility preservation, talking with a fertility specialist is also helpful.

BreastCancerTrials.org in collaboration with Susan G. Komen^® offers a custom matching service. This matching service can help you find a clinical trial for young women with breast cancer or a clinical trial for fertility preservation.

You can also visit the National Institutes of Health’s website to find a clinical trial.

If you or a loved one needs information or resources about clinical trials, call our Clinical Trial Information Helpline at 1-877 GO KOMEN (1-877- 465- 6636) or email at clinicaltrialinfo@komen.org.

Learn more about clinical trials.

KOMEN PERSPECTIVES

Read our perspective on clinical trials (July 2012).*

LEARN MORE

Insurance and financial assistance for fertility services

Insurance coverage for fertility services varies widely.

Check with your insurance provider to find out which procedures are covered in your policy.

Organizations such LIVESTRONG Fertility can provide financial help if your insurance provider does not cover these services.

LIVESTRONG Fertility also offers information on fertility options and telephone counseling on fertility issues at 1-855-844-7777.

Support

Social support is important for young women diagnosed with breast cancer and their loved ones, especially spouses, partners and children.

Learn more about social support for young women diagnosed with breast cancer .

Learn more about social support for spouses, partners and other family members.

Learn more about social support for children.

KOMEN PERSPECTIVES

Read our perspective on fertility issues and pregnancy after breast cancer treatment
(January 2012).*

LEARN MORE

*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date at this time.