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Breast Cancer in Young Patients (< 40 Years)
Haydee Ojeda-Fournier, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Breast cancer diagnosed in women < age 40
                  • Excluding pregnancy-associated breast cancer

              IMAGING

              • General Features

                • Mammographic Findings

                  • Ultrasonographic Findings

                    • CT Findings

                      • MR Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Chen Y et al: Value of mammography for women 30-39 years old presenting with breast symptoms. AJR Am J Roentgenol. 211(6):1416-1424, 2018
                                            2. Lee CS et al: Risk-based screening mammography for women age < 40: Outcomes from the National Mammography Database. Radiologic Society of North America, 2018 (abstr)
                                            3. Monticciolo DL et al: Breast cancer screening in women at higher-than-average risk: recommendations from the ACR. J Am Coll Radiol. 15(3 Pt A):408-414, 2018
                                            4. Shoemaker ML et al: Differences in breast cancer incidence among young women aged 20-49 years by stage and tumor characteristics, age, race, and ethnicity, 2004-2013. Breast Cancer Res Treat. 169(3):595-606, 2018
                                            5. Stapleton SM et al: Race/ethnicity and age distribution of breast cancer diagnosis in the United States. JAMA Surg. 153(6):594-595, 2018
                                            6. Yfantis A et al: Health-related quality of life of young women with breast cancer. Review of the literature. J BUON. 23(1):1-6, 2018
                                            7. Zimmer AS et al: Analysis of breast cancer in young women in the Department of Defense (DOD) database. Breast Cancer Res Treat. 168(2):501-511, 2018
                                            8. Dackus GM et al: Long-term prognosis of young breast cancer patients (≤40 years) who did not receive adjuvant systemic treatment: protocol for the PARADIGM initiative cohort study. BMJ Open. 7(11):e017842, 2017
                                            9. Donovan CA et al: Bilateral mastectomy as overtreatment for breast Cancer in women age forty years and younger with unilateral operable invasive breast cancer. Ann Surg Oncol. 24(8):2168-2173, 2017
                                            10. Owrang M et al: Breast cancer prognosis for young patients. In Vivo. 31(4):661-668, 2017
                                            11. Spring L et al: Pathologic complete response after neoadjuvant chemotherapy and long-term outcomes among young women with breast cancer. J Natl Compr Canc Netw. 15(10):1216-1223, 2017
                                            12. Brenner DR et al: Breast cancer survival among young women: a review of the role of modifiable lifestyle factors. Cancer Causes Control. 27(4):459-72, 2016
                                            13. Menen RS et al: Considerations for the treatment of young patients with breast cancer. Breast J. 22(6):667-672, 2016
                                            14. Phi XA et al: Contribution of mammography to MRI screening in BRCA mutation carriers by BRCA status and age: individual patient data meta-analysis. Br J Cancer. 114(6):631-7, 2016
                                            15. Trogdon JG et al: Breast Cancer in young women: health state utility impacts by race/ethnicity. Am J Prev Med. 50(2):262-9, 2016
                                            16. An YY et al: Breast cancer in very young women (< 30 years): Correlation of imaging features with clinicopathological features and immunohistochemical subtypes. Eur J Radiol. 84(10):1894-902, 2015
                                            17. Arleo EK et al: Breast cancer in women in their thirties (2007-2013): a retrospective review. Breast Dis. 35(2):87-93, 2015
                                            18. Appleton DC et al: Ultrasonography alone for diagnosis of breast cancer in women under 40. Ann R Coll Surg Engl. 96(3):202-6, 2014
                                            19. Azim HA Jr et al: Biology of breast cancer in young women. Breast Cancer Res. 16(4):427, 2014
                                            20. Gewefel H et al: Breast cancer in adolescent and young adult women. Clin Breast Cancer. 14(6):390-5, 2014
                                            21. Liu Y et al: Prognosis in very young women with triple-negative breast cancer: retrospective study of 216 cases. Med Oncol. 31(12):222, 2014
                                            22. Webb ML et al: A failure analysis of invasive breast cancer: Most deaths from disease occur in women not regularly screened. Cancer. 120(8):2839-49, 2014, 2013
                                            23. Lehman CD et al. Accuracy and value of breast ultrasound for primary imaging evaluation of symptomatic women 30-39 years of age. AJR Am J Roentgenol. 2012;199:1169-77
                                            24. Narod SA: Breast cancer in young women. Nat Rev Clin Oncol. 9(8):460-70, 2012
                                            25. Biglia N et al: Role of MRI (magnetic resonance imaging) versus conventional imaging for breast cancer presurgical staging in young women or with dense breast. Eur J Surg Oncol. 37(3):199-204, 2011
                                            26. Liukkonen S et al: Breast cancer in very young women. Eur J Surg Oncol. 37(12):1030-7, 2011
                                            27. Peng R et al: Patients 35 years old or younger with operable breast cancer are more at risk for relapse and survival: a retrospective matched case-control study. Breast. 20(6):568-73, 2011
                                            28. Loving VA et al: Targeted ultrasound in women younger than 30 years with focal breast signs or symptoms: outcomes analyses and management implications. AJR Am J Roentgenol. 195:1472-7, 2010
                                            29. Sentís M: Imaging diagnosis of young women with breast cancer. Breast Cancer Res Treat. 123 Suppl 1:11-3, 2010
                                            30. Saunders CM et al: A pilot study of trimodality breast imaging surveillance in young women at high risk of breast cancer in Western Australia. Med J Aust. 191(6):330-3, 2009
                                            31. Brinton LA et al: Recent trends in breast cancer among younger women in the United States. J Natl Cancer Inst. 100(22):1643-8, 2008
                                            32. Litton JK et al: Multifocal breast cancer in women < or =35 years old. Cancer. 110(7):1445-50, 2007
                                            33. Lord SJ et al: A systematic review of the effectiveness of magnetic resonance imaging (MRI) as an addition to mammography and ultrasound in screening young women at high risk of breast cancer. Eur J Cancer. 43(13):1905-17, 2007
                                            34. Colleoni M et al: Role of endocrine responsiveness and adjuvant therapy in very young women (below 35 years) with operable breast cancer and node negative disease. Ann Oncol. 17(10):1497-503, 2006
                                            35. Wright H et al: Magnetic resonance imaging as a diagnostic tool for breast cancer in premenopausal women. Am J Surg. 190(4):572-5, 2005
                                            36. Han W et al: Young age: an independent risk factor for disease-free survival in women with operable breast cancer. BMC Cancer. 4:82, 2004
                                            37. Rivera-Hueto F et al: Long-term prognosis of teenagers with breast cancer. Int J Surg Pathol. 10(4):273-9, 2002
                                            38. Peto J et al: Prevalence of BRCA1 and BRCA2 gene mutations in patients with early-onset breast cancer. J Natl Cancer Inst. 91(11):943-9, 1999
                                            39. Morrow M et al: The evaluation of breast masses in women younger than forty years of age. Surgery. 124(4):634-40; discussion 640-1, 1998
                                            40. Guenther JM et al: Feasibility of breast-conserving therapy for younger women with breast cancer. Arch Surg. 131(6):632-6, 1996
                                            41. Walker RA et al: Breast carcinomas occurring in young women (< 35 years) are different. Br J Cancer. 74(11):1796-800, 1996
                                            42. Hankey BF et al: Trends in breast cancer in younger women in contrast to older women. J Natl Cancer Inst Monogr. 7-14, 1994
                                            43. Bassett LW et al: Usefulness of mammography and sonography in women less than 35 years of age. Radiology. 180(3):831-5, 1991
                                            44. Shaw de Paredes E et al: Breast cancers in women 35 years of age and younger: mammographic findings. Radiology. 177(1):117-9, 1990
                                            45. Harris VJ et al: Indications for breast imaging in women under age 35 years. Radiology. 172(2):445-8, 1989
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Definitions

                                                          • Breast cancer diagnosed in women < age 40
                                                            • Excluding pregnancy-associated breast cancer

                                                        IMAGING

                                                        • General Features

                                                          • Mammographic Findings

                                                            • Ultrasonographic Findings

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  DIAGNOSTIC CHECKLIST

                                                                                  • Consider

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Chen Y et al: Value of mammography for women 30-39 years old presenting with breast symptoms. AJR Am J Roentgenol. 211(6):1416-1424, 2018
                                                                                      2. Lee CS et al: Risk-based screening mammography for women age < 40: Outcomes from the National Mammography Database. Radiologic Society of North America, 2018 (abstr)
                                                                                      3. Monticciolo DL et al: Breast cancer screening in women at higher-than-average risk: recommendations from the ACR. J Am Coll Radiol. 15(3 Pt A):408-414, 2018
                                                                                      4. Shoemaker ML et al: Differences in breast cancer incidence among young women aged 20-49 years by stage and tumor characteristics, age, race, and ethnicity, 2004-2013. Breast Cancer Res Treat. 169(3):595-606, 2018
                                                                                      5. Stapleton SM et al: Race/ethnicity and age distribution of breast cancer diagnosis in the United States. JAMA Surg. 153(6):594-595, 2018
                                                                                      6. Yfantis A et al: Health-related quality of life of young women with breast cancer. Review of the literature. J BUON. 23(1):1-6, 2018
                                                                                      7. Zimmer AS et al: Analysis of breast cancer in young women in the Department of Defense (DOD) database. Breast Cancer Res Treat. 168(2):501-511, 2018
                                                                                      8. Dackus GM et al: Long-term prognosis of young breast cancer patients (≤40 years) who did not receive adjuvant systemic treatment: protocol for the PARADIGM initiative cohort study. BMJ Open. 7(11):e017842, 2017
                                                                                      9. Donovan CA et al: Bilateral mastectomy as overtreatment for breast Cancer in women age forty years and younger with unilateral operable invasive breast cancer. Ann Surg Oncol. 24(8):2168-2173, 2017
                                                                                      10. Owrang M et al: Breast cancer prognosis for young patients. In Vivo. 31(4):661-668, 2017
                                                                                      11. Spring L et al: Pathologic complete response after neoadjuvant chemotherapy and long-term outcomes among young women with breast cancer. J Natl Compr Canc Netw. 15(10):1216-1223, 2017
                                                                                      12. Brenner DR et al: Breast cancer survival among young women: a review of the role of modifiable lifestyle factors. Cancer Causes Control. 27(4):459-72, 2016
                                                                                      13. Menen RS et al: Considerations for the treatment of young patients with breast cancer. Breast J. 22(6):667-672, 2016
                                                                                      14. Phi XA et al: Contribution of mammography to MRI screening in BRCA mutation carriers by BRCA status and age: individual patient data meta-analysis. Br J Cancer. 114(6):631-7, 2016
                                                                                      15. Trogdon JG et al: Breast Cancer in young women: health state utility impacts by race/ethnicity. Am J Prev Med. 50(2):262-9, 2016
                                                                                      16. An YY et al: Breast cancer in very young women (< 30 years): Correlation of imaging features with clinicopathological features and immunohistochemical subtypes. Eur J Radiol. 84(10):1894-902, 2015
                                                                                      17. Arleo EK et al: Breast cancer in women in their thirties (2007-2013): a retrospective review. Breast Dis. 35(2):87-93, 2015
                                                                                      18. Appleton DC et al: Ultrasonography alone for diagnosis of breast cancer in women under 40. Ann R Coll Surg Engl. 96(3):202-6, 2014
                                                                                      19. Azim HA Jr et al: Biology of breast cancer in young women. Breast Cancer Res. 16(4):427, 2014
                                                                                      20. Gewefel H et al: Breast cancer in adolescent and young adult women. Clin Breast Cancer. 14(6):390-5, 2014
                                                                                      21. Liu Y et al: Prognosis in very young women with triple-negative breast cancer: retrospective study of 216 cases. Med Oncol. 31(12):222, 2014
                                                                                      22. Webb ML et al: A failure analysis of invasive breast cancer: Most deaths from disease occur in women not regularly screened. Cancer. 120(8):2839-49, 2014, 2013
                                                                                      23. Lehman CD et al. Accuracy and value of breast ultrasound for primary imaging evaluation of symptomatic women 30-39 years of age. AJR Am J Roentgenol. 2012;199:1169-77
                                                                                      24. Narod SA: Breast cancer in young women. Nat Rev Clin Oncol. 9(8):460-70, 2012
                                                                                      25. Biglia N et al: Role of MRI (magnetic resonance imaging) versus conventional imaging for breast cancer presurgical staging in young women or with dense breast. Eur J Surg Oncol. 37(3):199-204, 2011
                                                                                      26. Liukkonen S et al: Breast cancer in very young women. Eur J Surg Oncol. 37(12):1030-7, 2011
                                                                                      27. Peng R et al: Patients 35 years old or younger with operable breast cancer are more at risk for relapse and survival: a retrospective matched case-control study. Breast. 20(6):568-73, 2011
                                                                                      28. Loving VA et al: Targeted ultrasound in women younger than 30 years with focal breast signs or symptoms: outcomes analyses and management implications. AJR Am J Roentgenol. 195:1472-7, 2010
                                                                                      29. Sentís M: Imaging diagnosis of young women with breast cancer. Breast Cancer Res Treat. 123 Suppl 1:11-3, 2010
                                                                                      30. Saunders CM et al: A pilot study of trimodality breast imaging surveillance in young women at high risk of breast cancer in Western Australia. Med J Aust. 191(6):330-3, 2009
                                                                                      31. Brinton LA et al: Recent trends in breast cancer among younger women in the United States. J Natl Cancer Inst. 100(22):1643-8, 2008
                                                                                      32. Litton JK et al: Multifocal breast cancer in women < or =35 years old. Cancer. 110(7):1445-50, 2007
                                                                                      33. Lord SJ et al: A systematic review of the effectiveness of magnetic resonance imaging (MRI) as an addition to mammography and ultrasound in screening young women at high risk of breast cancer. Eur J Cancer. 43(13):1905-17, 2007
                                                                                      34. Colleoni M et al: Role of endocrine responsiveness and adjuvant therapy in very young women (below 35 years) with operable breast cancer and node negative disease. Ann Oncol. 17(10):1497-503, 2006
                                                                                      35. Wright H et al: Magnetic resonance imaging as a diagnostic tool for breast cancer in premenopausal women. Am J Surg. 190(4):572-5, 2005
                                                                                      36. Han W et al: Young age: an independent risk factor for disease-free survival in women with operable breast cancer. BMC Cancer. 4:82, 2004
                                                                                      37. Rivera-Hueto F et al: Long-term prognosis of teenagers with breast cancer. Int J Surg Pathol. 10(4):273-9, 2002
                                                                                      38. Peto J et al: Prevalence of BRCA1 and BRCA2 gene mutations in patients with early-onset breast cancer. J Natl Cancer Inst. 91(11):943-9, 1999
                                                                                      39. Morrow M et al: The evaluation of breast masses in women younger than forty years of age. Surgery. 124(4):634-40; discussion 640-1, 1998
                                                                                      40. Guenther JM et al: Feasibility of breast-conserving therapy for younger women with breast cancer. Arch Surg. 131(6):632-6, 1996
                                                                                      41. Walker RA et al: Breast carcinomas occurring in young women (< 35 years) are different. Br J Cancer. 74(11):1796-800, 1996
                                                                                      42. Hankey BF et al: Trends in breast cancer in younger women in contrast to older women. J Natl Cancer Inst Monogr. 7-14, 1994
                                                                                      43. Bassett LW et al: Usefulness of mammography and sonography in women less than 35 years of age. Radiology. 180(3):831-5, 1991
                                                                                      44. Shaw de Paredes E et al: Breast cancers in women 35 years of age and younger: mammographic findings. Radiology. 177(1):117-9, 1990
                                                                                      45. Harris VJ et al: Indications for breast imaging in women under age 35 years. Radiology. 172(2):445-8, 1989