What are guidelines on the treatment of breast cancer in young women?

Updated: Dec 27, 2019
  • Author: Pavani Chalasani, MD, MPH; Chief Editor: John V Kiluk, MD, FACS  more...
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Answer

Guidelines on the management of breast cancer in young women from the European School of Oncology (ESO) and the European Society of Medical Oncologists (ESMO), and endorsed by the European Society of Breast Specialists (EUSOMA), include 75 statements. [195] Among them are the following recommendations:

  • There is no clear role for routine screening by any imaging technique for early breast cancer detection in healthy, average-risk young women. However, in young women with a cancer predisposition syndrome (germline mutation in a known cancer predisposition gene), significant family history, or prior personal history of ionizing radiation to the chest, consideration may be given to screening breast MRI.
  • In young women with the diagnosis of either invasive disease or preinvasive lesions who are not high-risk mutation carriers, there is no evidence that performing risk-reducing bilateral mastectomy leads to improved overall survival (OS)
  • In patients with triple-negative breast cancer (TNBC) or BRCA-associated tumors, the incorporation of platinum agents increases pathologic complete response (pCR) rates and may be considered when neoadjuvant chemotherapy is indicated. Data on the impact of incremental increases in pCR on long-term outcome are inconclusive.
  • The use of platinum derivatives has potential additional impact on fertility and increased toxicity that may compromise standard duration and dosing of systemic treatment, and this needs to be clearly communicated to patients.
  • For patients with TNBC not achieving a pCR after standard neoadjuvant regimens, the routine addition of adjuvant chemotherapy (such as capecitabine or metronomiccyclophosphamide and methotrexate [CM]) is not recommended; however, it may be considered in highly selected patients, as in other age groups
  • It is recommended that young women with ER-positive advanced breast cancer have adequate ovarian suppression or ablation and then be treated in the same way as postmenopausal women with endocrine agents and targeted therapies, such as an aromatase inhibitor or fulvestrant plus a cyclin-dependent kinase (CDK) 4/6 inhibitor or exemestane with everolimus.
  • Olaparib monotherapy may be considered in women with advanced breast cancer harboring a germline BRCA mutation in early lines of therapy.
  • All patients with hormone receptor–positive disease should receive adjuvant endocrine therapy (ET). Tamoxifen alone for 5 years is indicated for low-risk patients. Tamoxifen for 10 years should be considered in high-risk patients, if tolerated. The addition of a gonadotropin-releasing hormone (GnRH) agonist (or ovarian ablation) to tamoxifen is indicated in patients at higher risk who remain premenopausal after chemotherapy.
  • Young women with stage I or II breast cancer who cannot take tamoxifen (due to contraindications or severe side effects) may receive a GnRH agonist alone, oophorectomy, or an aromatase inhibitor + GnRH agonist.

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