The young female breast: case review

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Published: 2 Feb 2023
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Prof Shilpa Lad - NM Medical Centre, Mumbai, India

Prof Shilpa Lad speaks to ecancer about spreading awareness to both patients and healthcare professionals about young breast cancer patients. 

She highlights that 90% of women under 40 who are diagnosed with BC have no family history and continues to discuss the ways in which these patients should be treated and tested.

It’s been an interesting journey, BGICC, over the last few years. Over the last few years we have seen breast cancer evolve too. This year my talk was on cancers in young women. It is an interesting area because up until now we just assumed that breast cancers typically happen in older women, at least older than 40 years of age. All the screening that started in women under the age of 40 was in the high risk category. This is the category where women have first degree family who have been diagnosed with breast or ovarian cancer or they have some genetic mutations. So screening starts pretty early for women who are carriers of the mutant genes like BRCA1 or BRCA2. However, in the last few years we have found that 90% of women under the age of 40 who are diagnosed with breast cancer have no family history, no risk factors, for that matter, they have no genetic mutations. So they are average risk women who are suddenly diagnosed one fine day with breast cancer. 

Now, the scary part is that these are women who are in their 20s, who are in their 30s, who are in their early 40s, so it hugely impacts a lot of things. First, nobody assumes they’re going to get a breast cancer, therefore, even if they notice a lump or nipple discharge or some skin changes, they don’t go to the doctor. A girl in her 20s, even if she shows up to the doctor, the doctor doesn’t assume that she may be having a cancer because up until now 20-year olds were not getting diagnosed with breast cancer as often. 

So there are two areas of work – awareness amongst the general public and awareness amongst the medical community too, that the incidence of breast cancer is rising in women under 40 years of age – between the age of 20 to 40 – and these are typically average risk women, not high risk women.

The second point was, and a very important point, that cancers in this age group, they’re typically more aggressive. Now we know more about the biologic nature of cancers, in younger women they get triple negative cancers or HER2 positive cancers. They grow very fast and they metastasise also very fast. This leads to a decreased cancer-free survival despite aggressive treatment.

The other problem with these cancers is the imaging appearance of these cancers can be very similar to benign lesions like fibroadenomas or cysts. Therefore, having a high level of suspicion and the ability to look at subtle signs on imaging in the form of ultrasound or mammogram or knowing when to ask for an MRI because it can be a useful problem-solving tool. Those are the factors where we wanted to work on and that is an area of work, consistent work, for us. So those are the areas of work that are there and that is the main area of discussion that we had during this session.