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Young Breast Cancer Patients Face Unique Risks and Issues E-mail
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breast cancerBreast cancer is the most common type of cancer in the U.S., but little is known about breast cancer in women in their early 40s and younger. Ann Partridge, MD, MPH, at Dana-Farber says young breast cancer patients have a higher risk of dying from breast cancer than older women and an increased risk of psychosocial distress at diagnosis and in follow-up.

Ann Partridge, MD, MPH, who founded and directs the Program for Young Women with Breast Cancer at Dana-Farber Cancer Institute in Boston, says that evidence shows that young age is a risk factor for breast cancer recurrence and death. It is controversial whether the poorer breast cancer prognosis is a reflection of delays in diagnosis, differences in tumor biology, or the effectiveness of treatment, but accumulating evidence indicates that biologic differences may play an important role.

"In addition to being at higher risk of dying from breast cancer than older women, young women with breast cancer are at increased risk of psychosocial distress at the breast cancer diagnosis and in follow-up when compared with older women," explains Partridge, "Young women with breast cancer face a variety of unique medical and psychosocial concerns as a result of their breast cancer diagnosis and subsequent treatment. In particular, fertility and family planning, menopausal symptoms, and sexual functioning are of great concern to this breast cancer patient population."

Partridge and her colleagues are studying the biology of breast cancer and better ways to treat the disease, as well as investigating psychosocial, behavioral, and communication issues associated with breast cancer care, especially the unique issues facing young women with breast cancer. "Our ultimate goal is to understand and treat each woman and her breast cancer in the context of her life." Several ongoing projects include evaluation of adherence with hormonal therapies in women with early-stage breast cancer, assessment of fertility and fertility concerns in young women undergoing breast cancer treatment, and communication of study results to patients following clinical trial participation. 

About Breast Cancer

Breast cancer is a malignant (cancerous) tumor that starts from cells of the breast. The disease occurs mostly in women, but men can get breast cancer too. In the U.S., it affects one in eight women. There are many types of breast cancer, though some of them are very rare. Sometimes a breast tumor can be a combination of these types and to have a mixture of invasive and in situ cancer.  The most common types of breast cancer are: 

  • Ductal carcinoma in situ (DCIS): This is the most common type of non-invasive breast cancer (85 - 90% of all cases). DCIS means that the cancer is only in the ducts. It has not spread through the walls of the ducts into the tissue of the breast. Nearly all women with cancer at this stage can be cured. Often the best way to find DCIS early is with a mammogram.
  • Lobular carcinoma in situ (LCIS): This condition which occurs in approximately 8% of all cases, begins in the milk-making glands but does not go through the wall of the lobules. Although not a true cancer, having LCIS increases a woman's risk of getting cancer later. For this reason, it's important that women with LCIS to follow the screening guidelines for breast cancer.
Less common are: 
  • Inflammatory breast cancer (IBC): This uncommon type of invasive breast cancer accounts for about 1% to 3% of all breast cancers. Usually there is no single lump or tumor. Instead, inflammatory breast cancer (IBC) makes the skin of the breast look red and feel warm. It also gives the skin a thick, pitted appearance that looks a lot like an orange peel. Doctors now know that these changes are not caused by inflammation or infection, but by cancer cells blocking lymph vessels in the skin. The breast may become larger, firmer, tender, or itchy. IBC is often mistaken for an infection in its early stages. Because there is no defined lump, it may not appear on a mammogram, which may make it even harder to catch it early. It usually has a higher chance of spreading and a worse outlook than invasive ductal or lobular cancer.
  • Paget's disease of the nipple. Paget's disease of the nipple or breast is a rare type of breast cancer, which can occur in women and men. It shows up in and around the nipple, and usually signals the presence of breast cancer beneath the skin. Most cases are found in menopausal women, but can also appear in women that are as young as 20.  Early stages symptoms include redness, scaly and flaky, and  mild irritation of  nipple skin. Advanced stages may include: tingling in nipple skin, very sensitive skin on the nipple, burning or painful nipple skin, ooze or bloody discharge from the nipple (not milk), itchiness that doesn't respond to creams, nipple retraction (pulls into the breast), scaly rash on areola skin, and/or breast lump beneath the affected skin.
Symptoms of breast cancer may include: 
  • a lump or a thickening in the breast or in the armpit. Note Most breast lumps are benign (be-nine); that is, they are not cancer. Benign breast tumors are abnormal growths, but they do not spread outside of the breast and they are not life threatening. But some benign breast lumps can increase a woman's risk of getting breast cancer. Most lumps turn out to be caused by fibrocystic (fi-bro-sis-tik) changes. Cysts are fluid-filled sacs. Fibrosis is the formation of scar-like tissue. Such changes can cause breast swelling and pain. The breasts may feel lumpy, and sometimes there is a clear or slightly cloudy nipple discharge.
  • a change of size or shape of the mature breast
  • fluid (not milk) leaking from the nipple
  • a change of size or shape of the nipple
  • a change of color or texture of the nipple or the areola, or of the skin of the breast itself (dimples, puckers, rash)
  • a discharge from the breast
 
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