Dr Partridge on Unique Treatment Challenges for Young Patients with ER+/Node-Positive Breast Cancer

Ann H. Partridge, MD, MPH, vice chair, Medical Oncology; founder, director, Program for Young Adults with Breast Cancer; director, Adult Survivorship Program; Eric P. Winer, MD, Chair, Breast Cancer Research, Dana-Farber Cancer Institute, senior physician, professor of medicine, Harvard Medical School, discusses unique challenges experienced by very young patients undergoing treatment for their estrogen receptor–positive, node-positive breast cancer, and how to integrate fertility preservation into treatment plans for patients in this population if needed.

When a young person is diagnosed with breast cancer, they face not only the typical decisions about treatment but also issues that are uniquely challenging due to their age, Partridge begins. In addition to choices about surgery, hormonal therapy, and whether or not to undergo chemotherapy, young patients often confront concerns about fertility, sexual health, and genetics, she states. Furthermore, younger patients typically present with more aggressive breast cancer tumors, leading to more intense treatments that can result in long-term survivorship challenges and more severe adverse effects (AEs), she adds.

One of the most important aspects of managing breast cancer in young patients is discussing fertility preservation, Partridge emphasizes. For those who express an interest in having biological children in the future, it is essential to inform them about the potential impact of cancer therapies, especially chemotherapy, on their fertility. Treatments may either reduce fertility or lead to permanent infertility, she adds. Options for fertility preservation, such as egg or embryo banking before beginning treatment, should be explored with these patients, Partridge says. In some cases, ovarian suppression during chemotherapy may help reduce the risk of premature menopause and improve future fertility prospects, she notes.

Because young patients are more likely to face aggressive tumors that require stronger treatments, they must also contend with more significant AEs and survivorship issues, Partridge continues. This often includes managing sexual health, psychological stress, and the long-term effects of therapies. Therefore, the care of young breast cancer patients should be holistic and proactive, addressing both immediate treatment concerns and future quality of life, Partridge concludes.