Breast Cancer in Young Women: Victorian Comprehensive Cancer Centre (VCCC) Breast Cancer Symposium

19th February 2021

Hosted by VCCC Research & Education leads, Professor Bruce Mann and Dr Belinda Yeo. 
International guest speaker Dr Ann Partridge, Professor of Medicine Harvard Medical school, vice-chair of Medical Oncology, Dana - Farber Cancer Institute.   

Panellists for discussion: 

• Ms Kathryn Wallace - Breast Care Nurse Consultant; Northpark Private Hospital, Epworth Eastern Box Hill and Austin Health. 
• Dr Keelan Byrne - Radiation Oncologist; Peter MacCallum Cancer Centre 
• Ms Jodie Lydeker - Consumer representative, Breast Cancer Network of Australia (BCNA) 
   

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Breast Cancer in young women is a complex disease, occurring when women are at the peak of their reproductive years, family life and careers. Dr Partridge presented her research highlighting the impact and outcomes of breast cancer in young pre-menopausal women. 

Findings show that women of a younger age have poorer prognosis and survival outcomes than older women. Whilst the 5-year survival rates continue to improve, there remains an increased risk of recurrence and associated mortality. 

Research around Quality of Life also indicates that women under the age of forty identify concerns around physical, social and emotional functioning. The "top 4” being sexual health, anxiety, fatigue and stress.   

Dr Partridge stated that" life is harder for young women" with multiple issues pertinent to premenopausal women as opposed to those over the age of 50. 

Managing treatments such as surgery, chemotherapy, endocrine therapy and radiation can cause a multitude of side effects which impact on physical wellbeing, psychological functioning, sexual health and body image. Additionally, complex issues associated with fertility and genetics add to the minefield of decisions these women may have to contend with.  

Whilst advancements in treatment and support are encouraging, the issue of quality of life, as well as quantity of life, remains foremost important to younger women. Poor adherence to longer-term treatments such as ovarian suppression and endocrine therapy need to be acknowledged and addressed by the multidisciplinary team. 

At the Boston based, Dana-Faber Cancer Institute, a web-based portal "Young, Empowered & Strong"(YES), is being piloted as a multicomponent intervention to engage and activate young women with breast cancer to self-monitor and self-manage concerns and symptoms by providing tailored information, resources and support. The aim of this tool is to move from observation to intervention. Recruitment into this program is already reaching target numbers. The next 18 months promise to collect data and evaluate the findings. 

Following the keynote presentation, the panel discussion addressed questions from the audience including surgical choices such a breast-conserving surgery versus unilateral or bilateral mastectomy with or without reconstruction.   A question was raised as to how and why some younger women choose bilateral mastectomy over breast-conserving surgery. Professor Bruce Mann asked, " Does this potentially lead to "decisional regret"? As part of the multidisciplinary team, our response should be to discuss all of the options. Motivational conversations around reconstruction, lifestyle behaviours such as diet and exercise and appropriate referral pathways including psychology to assist women in their decision-making process. Studies have revealed that younger women who have a bilateral mastectomy without reconstruction have poorer outcomes which include increased anxiety, poor self-image and sexual health issues. 

Jodie Lydeker provided insights from a consumer perspective. Jodie was diagnosed three years ago at the age of 40. Having dealt with her mother's bilateral mastectomy two years earlier, Jodie raised issues she had encountered. These included managing a new relationship, altered body image, poor self-esteem, early menopause and long-term side effects associated with ovarian suppression and endocrine treatment. Kathryn Wallace, Breast Care Nurse agreed that with adherence to long term endocrine treatment being an issue, listening to women, identifying the barriers they are experiencing and encouraging strategies to deal with changed relationships, hot flushes, arthralgias, low libido, vaginal dryness and fatigue are paramount. Dr Belinda Yeo agreed with the general view from oncologists in the audience that offering a "tablet holiday" or other options during a consultation may encourage younger women to be more "open" in their outlook and willing to have the discussions.  

As we focus on the "survivorship" phase of treatment, many of these younger women are seeking quality of life equal to longevity. As specialists in the field, we owe these women the tools and resources to feel empowered for this to occur