Why do Young Women get Breast Cancer?

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is
00:02 --> 00:04provided by Smilow Cancer Hospital.
00:06 --> 00:07Welcome to Yale Cancer Answers
00:07 --> 00:09with your host
00:09 --> 00:11Doctor Anees Chagpar.
00:11 --> 00:12Yale Cancer Answers features the latest
00:12 --> 00:14information on cancer care by
00:14 --> 00:16welcoming oncologists and specialists
00:16 --> 00:18who are on the forefront of the
00:18 --> 00:20battle to fight cancer. This week,
00:20 --> 00:22it's a conversation about why
00:22 --> 00:24young women develop breast cancer
00:24 --> 00:25with Doctor Mariya Rozenblit.
00:25 --> 00:28Dr Rozenblit is an instructor of
00:28 --> 00:29medicine and medical oncology
00:29 --> 00:31at the Yale School of Medicine,
00:31 --> 00:33where Doctor Chagpar is a professor
00:33 --> 00:34of surgical oncology.
00:36 --> 00:38Maryia, before we dive into
00:38 --> 00:40what I'm sure is going to be
00:40 --> 00:42a really interesting topic,
00:42 --> 00:44tell us a little bit more about
00:44 --> 00:45yourself and what it is you do.
00:46 --> 00:48I see all types of breast cancer,
00:48 --> 00:51but my personal interest is in young
00:51 --> 00:53women who develop breast cancer.
00:53 --> 00:57So you know, breast cancer is one of
00:57 --> 01:01these malignancies that is so very common.
01:01 --> 01:02Can you kind of give us
01:02 --> 01:05a bit of a landscape of
01:05 --> 01:07who gets breast cancer?
01:07 --> 01:08Do we, generally speaking,
01:08 --> 01:11see this in younger women, older women?
01:11 --> 01:13Kind of set the scene for us.
01:13 --> 01:17Breast cancer typically
01:17 --> 01:22occurs in women in their 50s and 60s,
01:22 --> 01:23and in that age group breast
01:23 --> 01:25cancer is pretty common.
01:25 --> 01:27It happens in about one
01:27 --> 01:29out of every eight women.
01:29 --> 01:31Breast cancer in younger women is
01:31 --> 01:33what we consider when the woman is
01:33 --> 01:35diagnosed before the age of 40,
01:35 --> 01:37and that's actually pretty
01:37 --> 01:39rare and happens in about 5%
01:39 --> 01:40of breast cancers that we see.
01:41 --> 01:44So you know the obvious question
01:44 --> 01:47that I am certain every listener
01:47 --> 01:49is thinking about right now is.
01:49 --> 01:53How do young women get diagnosed
01:53 --> 01:56with breast cancer younger than 40?
01:56 --> 01:58Because I thought we were all
01:58 --> 01:59supposed to start getting
01:59 --> 02:01mammograms at the age of 40.
02:01 --> 02:03So how does that happen?
02:04 --> 02:06So that's a great question.
02:06 --> 02:09So a lot of women that we see
02:09 --> 02:11self palpates something so they
02:11 --> 02:13feel something or they notice a
02:13 --> 02:14change in their breast and they
02:14 --> 02:16go to their primary care doctor
02:16 --> 02:19and it gets diagnosed from there.
02:19 --> 02:21And then other women have a family
02:21 --> 02:24history of cancer or perhaps breast
02:24 --> 02:26cancer in their family and got
02:26 --> 02:29tested and actually were found
02:29 --> 02:31to have a genetic mutation and
02:31 --> 02:32followed with a high risk clinic.
02:32 --> 02:34And perhaps it was picked up.
02:34 --> 02:36Through imaging through that clinic,
02:37 --> 02:41so I want to dive into both of those
02:41 --> 02:44scenarios independently, so the first
02:44 --> 02:48is women who self palpate a mass.
02:48 --> 02:52Now there has been a lot of
02:52 --> 02:55controversy about self breast exam,
02:55 --> 02:59and recently the American Cancer Society.
02:59 --> 03:02Kind of moved away from self breast exam,
03:02 --> 03:04whereas other organizations
03:04 --> 03:08continue to advocate for this.
03:08 --> 03:10So what's the answer?
03:10 --> 03:12Should women be doing a
03:12 --> 03:15breast exam every month,
03:15 --> 03:18and if So what should they
03:18 --> 03:22be looking for and if not?
03:22 --> 03:25How do these things get picked up?
03:26 --> 03:28So that's a great question.
03:28 --> 03:31I think part of the reason why
03:31 --> 03:33it's controversial is because it's
03:33 --> 03:35difficult for people who are not
03:35 --> 03:38medically trained to pick up something
03:38 --> 03:39when they feel their own breast,
03:39 --> 03:40and that's understandable.
03:40 --> 03:43They haven't been trained to do so,
03:43 --> 03:45and so I think part of the controversy
03:45 --> 03:48is that we don't want women to become
03:48 --> 03:51super anxious and to worry about this
03:51 --> 03:53and to constantly be checking for it.
03:53 --> 03:55On the other hand.
03:55 --> 03:56At least in my clinic,
03:56 --> 03:58I've definitely seen some women
03:58 --> 04:00who found it on their own,
04:00 --> 04:02and then that's what prompted
04:02 --> 04:03them to go to the doctor.
04:03 --> 04:05So I think in an ideal world,
04:05 --> 04:08if somebody is going to see their,
04:08 --> 04:10whether it's their primary or
04:10 --> 04:12their OB GYN on a regular basis
04:12 --> 04:14and getting a physical exam
04:14 --> 04:17through them at least once a year,
04:17 --> 04:19that's usually sufficient and they
04:19 --> 04:21don't have to do their own exam.
04:21 --> 04:22But if they know that they
04:22 --> 04:23have a family history,
04:23 --> 04:26or if they know that they have a genetic.
04:26 --> 04:26Mutation.
04:26 --> 04:28I think it's OK for them to
04:28 --> 04:31do it on their own just to
04:31 --> 04:33keep an extra eye on things.
04:33 --> 04:35And if they ever find anything worrisome,
04:35 --> 04:37they can always point it out to
04:37 --> 04:38their primary or their OB GYN.
04:39 --> 04:43OK, so at what age should women start
04:43 --> 04:46either doing self breast exams if
04:46 --> 04:49they've got a high risk family history
04:49 --> 04:52or seeing their family physician or
04:52 --> 04:56OB GYN for a clinical breast exam?
04:56 --> 05:00Should that start at 18 or later
05:00 --> 05:03earlier, how does that work?
05:04 --> 05:07So early breast cancer is still very rare,
05:07 --> 05:08so the recommendation for the
05:08 --> 05:10majority of women remains the same,
05:10 --> 05:13which is probably around the age of 40.
05:13 --> 05:16You can start to do these self exams and
05:16 --> 05:19that's around the time when most women
05:19 --> 05:21would start doing mammograms as well.
05:21 --> 05:23Unless of course you you know have
05:23 --> 05:25a known genetic mutation and then
05:25 --> 05:27you would follow what the high risk
05:27 --> 05:29clinic is telling you and and based
05:29 --> 05:32on what genetic mutation you have,
05:32 --> 05:35you might want to start screening earlier.
05:36 --> 05:38So let's talk a little bit
05:38 --> 05:39about genetic mutations.
05:39 --> 05:42Then you mentioned having a family history.
05:42 --> 05:45Now family histories can vary right?
05:45 --> 05:49So some people might have a mother
05:49 --> 05:52who was diagnosed at the age of 75.
05:52 --> 05:56Others might have aunts or cousins
05:56 --> 05:58who were diagnosed earlier.
05:58 --> 06:01What counts is a significant family history.
06:01 --> 06:03When should women start worrying about that
06:03 --> 06:06and start asking about genetic testing?
06:07 --> 06:09Sure, that's a great question,
06:09 --> 06:11so we have a whole set of guidelines
06:11 --> 06:13that actually defines what is a higher
06:13 --> 06:16risk family history and and they're a
06:16 --> 06:18little bit complicated, but in general,
06:18 --> 06:21what we consider high risk is if you have
06:21 --> 06:25first degree relative with breast cancer,
06:25 --> 06:28and we know that that puts somebody at
06:28 --> 06:30twice as high of a risk as the general
06:30 --> 06:32population of getting breast cancer.
06:32 --> 06:34And and then there are other things.
06:34 --> 06:36So even if it's not a first degree relative,
06:36 --> 06:40but if you have multiple family members
06:40 --> 06:43with cancer and sometimes it depends on
06:43 --> 06:46what type of cancer some cancers are more
06:46 --> 06:49closely associated together than others,
06:49 --> 06:51so I would say if there's a first
06:51 --> 06:53degree relative or if there
06:53 --> 06:54are multiple family members,
06:54 --> 06:56or if there's a family member who
06:56 --> 06:58was diagnosed at an early age.
06:58 --> 07:00So like we were talking about
07:00 --> 07:00earlier than 40,
07:00 --> 07:02that's a reason to just maybe check
07:02 --> 07:04in with a primary care doctor and
07:04 --> 07:06seeing if you would be eligible to
07:06 --> 07:07see a genetic counselor to talk
07:07 --> 07:09about that a little bit more.
07:10 --> 07:14And So what age should you be
07:14 --> 07:16thinking about genetic testing?
07:16 --> 07:20I know that some people you know,
07:20 --> 07:22they they know their,
07:22 --> 07:23their family history.
07:23 --> 07:26Maybe they've gotten tested or
07:26 --> 07:30or not and maybe they have young
07:30 --> 07:32children Pediatrics populations.
07:32 --> 07:36Should those people be getting tested?
07:36 --> 07:39Should they be getting their kids tested?
07:39 --> 07:41At what age should people
07:41 --> 07:43pursue genetic testing?
07:44 --> 07:48That's a great question, so in general,
07:48 --> 07:52most of our screenings start around
07:52 --> 07:55the 20s for this very high penetrance.
07:55 --> 07:57Genetic mutations that
07:57 --> 07:59we worry about the most.
07:59 --> 08:01Nothing really starts earlier than that,
08:01 --> 08:04so we usually if somebody tests positive,
08:04 --> 08:07the genetic counselors are really great
08:07 --> 08:09about counseling them about who needs to
08:09 --> 08:11get tested in the family and at what age.
08:11 --> 08:14But in general, when it comes to kids.
08:14 --> 08:16They don't have to get tested
08:16 --> 08:18until they're in their 20s and
08:18 --> 08:19and that's really beneficial.
08:19 --> 08:21And you know several different factors.
08:21 --> 08:25First, they're old enough to to
08:25 --> 08:27take the benefits and the risks
08:27 --> 08:29into account on their own and
08:29 --> 08:31make that decision on their own,
08:31 --> 08:32and then they don't have to worry about it.
08:32 --> 08:34While they can't do anything about it,
08:34 --> 08:37so it's better to get tested a little bit
08:37 --> 08:40closer to when actual you can actually
08:40 --> 08:42put a treatment plan into effect.
08:42 --> 08:44If it comes back positive.
08:44 --> 08:47So I would say in your mid 20s or late
08:47 --> 08:4920s you can kind of start thinking
08:49 --> 08:51about it and if you're eligible,
08:51 --> 08:54talk to a genetic counselor and they
08:54 --> 08:57really do a good job of going through
08:57 --> 08:59extensive family history of many
08:59 --> 09:02generations and kind of giving you a
09:02 --> 09:04good risk assessment of what genetic
09:04 --> 09:06tests you might be eligible for.
09:07 --> 09:10Surly obvious question then is.
09:10 --> 09:13Can people under the age of
09:13 --> 09:15mid 20s get breast cancer?
09:17 --> 09:20So we really have not seen that there
09:20 --> 09:24are other types of mutations that.
09:24 --> 09:26Have other types of cancers
09:26 --> 09:28associated with them, and some of
09:28 --> 09:30them are more of childhood cancers,
09:30 --> 09:33so some things like P53.
09:33 --> 09:35You know that's a gene that can cause
09:35 --> 09:37many types of different cancers,
09:37 --> 09:38and that's something that
09:38 --> 09:39can affect children.
09:39 --> 09:41But in general,
09:41 --> 09:44unless you have that kind of you
09:44 --> 09:47know what we refer to as a syndrome.
09:47 --> 09:48Usually we don't see breast cancer
09:48 --> 09:50in such a young population.
09:50 --> 09:53OK, but I think that the
09:53 --> 09:56caveat to that you had.
09:56 --> 09:59Alluded to earlier.
09:59 --> 10:00Still applies, right?
10:00 --> 10:04So if you are 21 and you see
10:04 --> 10:06something that is unusual for
10:06 --> 10:09you different, causing concern,
10:09 --> 10:11you should still say something.
10:11 --> 10:13Is that right? Yeah,
10:13 --> 10:15absolutely. I think it never hurts
10:15 --> 10:18to to just get it checked out
10:18 --> 10:20by medical professional and and
10:20 --> 10:22sometimes it can be reassuring and
10:22 --> 10:24sometimes you might just need some
10:24 --> 10:26extra imaging to take a closer look.
10:27 --> 10:32OK, great so you know when we talk about
10:32 --> 10:35you had mentioned earlier that seeing
10:35 --> 10:39breast cancer in younger populations.
10:39 --> 10:43So under the age of 40 is rare.
10:43 --> 10:47So 5% are these cancers different from
10:47 --> 10:50what we see in the older population?
10:51 --> 10:53Yeah, so in general these breast cancers
10:53 --> 10:57tend to be a little bit more aggressive.
10:57 --> 11:00And So what we mean by that is they tend to.
11:00 --> 11:03Grow a little bit faster.
11:03 --> 11:05By the time these women come to us,
11:05 --> 11:08they're usually a bigger size than
11:08 --> 11:10something that would be you know.
11:10 --> 11:12Picked up on a screening mammogram,
11:13 --> 11:18yeah, and and so you had mentioned
11:18 --> 11:20earlier when we were talking about
11:20 --> 11:22genetic testing that one of the
11:22 --> 11:24things that would prompt genetic
11:24 --> 11:26testing is having a family member
11:26 --> 11:28who was diagnosed at a young age.
11:28 --> 11:31So is that something that you recommend?
11:31 --> 11:33For all patients who get breast cancer at
11:33 --> 11:36a young age is to get genetic testing.
11:36 --> 11:38Or does that really rely
11:38 --> 11:40on their family history so
11:40 --> 11:43all women who are diagnosed with
11:43 --> 11:45breast cancer before the age
11:45 --> 11:47of 40 are eligible for genetic
11:47 --> 11:48testing and we do refer them?
11:48 --> 11:51It can be very helpful, like if they
11:51 --> 11:53come back with a positive mutation.
11:53 --> 11:55Sometimes that can change.
11:55 --> 11:58What kind of surgery they might
11:58 --> 12:00opt for and then as you mentioned,
12:00 --> 12:02it's very helpful for their family members.
12:02 --> 12:03To know as well.
12:04 --> 12:07So many of us have heard that breast cancer
12:07 --> 12:10when diagnosed at an early age tends to
12:10 --> 12:12be more aggressive as you mentioned.
12:12 --> 12:15Do we know why that is in younger patients?
12:17 --> 12:18So we don't quite know why
12:18 --> 12:20that is and there's a lot of
12:20 --> 12:21research being done about it.
12:21 --> 12:24We think that on some level it probably
12:24 --> 12:28has to do with the hormone levels.
12:28 --> 12:29The estrogen levels are
12:29 --> 12:31much higher in young women,
12:31 --> 12:35and so that might prompt more growth,
12:35 --> 12:37but we also see a lot of what
12:37 --> 12:39we call triple negative breast
12:39 --> 12:41cancers in these young women that
12:41 --> 12:43are not driven by hormone levels,
12:43 --> 12:46so it's a little bit unclear.
12:46 --> 12:50We do know that about 20 to 30% of
12:50 --> 12:52these young women do end up testing
12:52 --> 12:54positive for genetic mutations,
12:54 --> 12:56and so perhaps those mutations
12:56 --> 12:57are contributing to their cancer
12:57 --> 12:59being more aggressive as well.
13:00 --> 13:02Terrific, well, we're going to take
13:02 --> 13:05a short break for a medical minute,
13:05 --> 13:06but on the other side of the break,
13:06 --> 13:09I hoped to find out more about
13:09 --> 13:10how treatment algorithms might
13:10 --> 13:13be different in younger women
13:13 --> 13:14diagnosed with breast cancer.
13:14 --> 13:16So please stay tuned to learn more
13:16 --> 13:19with my guest Doctor Mariya Rozenblit.
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13:25 --> 13:28strategies for the diagnosis and treatment
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13:30 --> 13:35To learn more, visit yalecancercenter.org.
13:35 --> 13:39The American Cancer Society,
13:39 --> 13:41estimates that more than 65,000
13:41 --> 13:43Americans will be diagnosed with
13:43 --> 13:46head and neck cancer this year,
13:46 --> 13:48making up about 4% of all
13:48 --> 13:50cancers diagnosed when detected.
13:50 --> 13:52Early, however, had a neck,
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13:59 --> 14:01Comprehensive cancer centers such
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14:29 --> 14:32More information is available at
14:32 --> 14:34yalecancercenter.org. You're listening
14:34 --> 14:35to Connecticut Public Radio.
14:37 --> 14:39Welcome back to Yale Cancer Answers.
14:39 --> 14:41This is doctor Anees Chagpar
14:41 --> 14:43and I'm joined tonight by my
14:43 --> 14:44guest Doctor Mariya Rozenblit.
14:44 --> 14:47We're learning today about why younger
14:47 --> 14:51women develop breast cancer and how
14:51 --> 14:54that might vary from older women.
14:54 --> 14:56So right before the break,
14:56 --> 14:58Mariya, you were telling us that most
14:58 --> 15:00breast cancers are actually diagnosed
15:00 --> 15:03in what we'll call older women.
15:03 --> 15:06Not really old, but older, so 50s.
15:06 --> 15:1060s in that range and what you're
15:10 --> 15:13really interested in is women who
15:13 --> 15:16are diagnosed under the age of 40.
15:16 --> 15:20So you had mentioned that these cancers
15:20 --> 15:24sometimes present at a larger size.
15:24 --> 15:27They tend to be a little bit more aggressive,
15:27 --> 15:31and we're not really sure why that happens,
15:31 --> 15:34but tell us a little bit more about how
15:34 --> 15:38the treatment of younger women might vary
15:38 --> 15:41from how treatment is for older women.
15:42 --> 15:44Sure, so sometimes because
15:44 --> 15:47these women are presenting with
15:47 --> 15:50a larger tumor to begin with,
15:50 --> 15:54they may require chemotherapy along with some
15:54 --> 15:58targeted treatments that we have available.
15:58 --> 16:02And then if the tumors hormone positive,
16:02 --> 16:05that really affects their fertility,
16:05 --> 16:07we often have to give medications
16:07 --> 16:09that induce menopause early for
16:09 --> 16:11hormone positive breast cancers.
16:11 --> 16:13And so we always talk to them about.
16:13 --> 16:15What are their childbearing plans
16:15 --> 16:18and and if they would like to see a
16:18 --> 16:20fertility specialist to talk about
16:20 --> 16:22possible fertility preservation
16:22 --> 16:24options before they start treatments.
16:24 --> 16:27So let's let's pick up on that before
16:27 --> 16:30we go much further because I think
16:30 --> 16:32that this is a really interesting
16:32 --> 16:35topic and many young women might
16:35 --> 16:37actually be very scared about this.
16:37 --> 16:39So you know you're in your mid
16:39 --> 16:4320s or 30s and you've just been
16:43 --> 16:45diagnosed with breast cancer.
16:45 --> 16:48You were thinking about starting a family.
16:48 --> 16:50And now you need to get chemotherapy,
16:50 --> 16:53which will you know,
16:53 --> 16:56put you at amenorrheic so you'll
16:56 --> 16:58stop having your cycles if you're
16:58 --> 17:00a hormone receptor positive,
17:00 --> 17:02you might be given something
17:02 --> 17:04that'll put you into menopause.
17:04 --> 17:06Many women might have the question
17:06 --> 17:11as to a whether they can have
17:11 --> 17:14children and be whether that's safe,
17:14 --> 17:16sure, so.
17:16 --> 17:18For young women,
17:18 --> 17:20this becomes a complicated discussion,
17:20 --> 17:24because if they were planning to
17:24 --> 17:27start a family, this does delay that,
17:27 --> 17:31and so we do want them to be on
17:31 --> 17:33treatments that decrease their estrogen
17:33 --> 17:35levels and make them amenorrheic
17:35 --> 17:38for at least a certain amount of
17:38 --> 17:41time to treat their breast cancer.
17:41 --> 17:44But after they're done with treatment,
17:44 --> 17:45most women, especially if
17:45 --> 17:48they're young and in their 20s.
17:48 --> 17:50Regain their fertility and will
17:50 --> 17:53actually probably be able to
17:53 --> 17:55have children on their own, UM,
17:55 --> 17:57but it's always nice to talk
17:57 --> 17:59about the fertility preservation
17:59 --> 18:01options and to have you know eggs
18:01 --> 18:03or embryos stored as an option.
18:03 --> 18:05And as women get closer to
18:05 --> 18:07their late 30s or 40s,
18:07 --> 18:10there is a possibility that they may
18:10 --> 18:12not regain those estrogen levels,
18:12 --> 18:14and so it's good to have those
18:14 --> 18:15eggs and embryos stored.
18:15 --> 18:18But in terms of safety.
18:18 --> 18:19We do have data showing that
18:19 --> 18:21it is safe to have children,
18:21 --> 18:23and so after a certain amount of time
18:23 --> 18:25of being treated for breast cancer,
18:25 --> 18:28we have had women have a healthy
18:28 --> 18:31pregnancy and have healthy children
18:31 --> 18:33and it is safe from from our standpoint
18:33 --> 18:35and from the OB GYN standpoint.
18:36 --> 18:39So having children after a breast
18:39 --> 18:41cancer diagnosis doesn't increase your
18:41 --> 18:43risk of recurrence. Is that right?
18:43 --> 18:45As far as we know it does not
18:45 --> 18:47increase the risk of recurrence.
18:47 --> 18:51What we do worry about? As if.
18:51 --> 18:53So there's a certain amount of
18:53 --> 18:55time after the breast cancer.
18:55 --> 18:57For example, in the first one to two
18:57 --> 18:59years where we want to make sure that
18:59 --> 19:01those estrogen levels are still low.
19:01 --> 19:02So if somebody wants to have
19:02 --> 19:03children earlier than that,
19:03 --> 19:05we worry about that.
19:05 --> 19:06But if they completed,
19:06 --> 19:08you know that treatment time,
19:08 --> 19:09then as far as we know it,
19:09 --> 19:10it's safe to do so.
19:11 --> 19:14So tell us a little bit more
19:14 --> 19:16about fertility options.
19:16 --> 19:18People who have gone through IVF,
19:18 --> 19:21which is a similar kind of.
19:21 --> 19:24Process one would think are often
19:24 --> 19:27injected with hormones like estrogen,
19:27 --> 19:29and yet we know that estrogen
19:29 --> 19:32for many cancers is a stimulant
19:32 --> 19:34for that breast cancer.
19:34 --> 19:36So how does that work?
19:36 --> 19:39I mean, what are our fertility
19:39 --> 19:41preservation options and?
19:41 --> 19:44Are they associated with being
19:44 --> 19:46stimulated with hormones,
19:46 --> 19:48and what effect does that
19:48 --> 19:49have on breast cancer?
19:49 --> 19:52So because somebody has already
19:52 --> 19:54developed the breast cancer,
19:54 --> 19:58we don't think that being stimulated to
19:58 --> 20:01increase those estrogen levels for egg
20:01 --> 20:04or embryo retrieval is that dangerous.
20:04 --> 20:06It's a very short amount of time,
20:06 --> 20:07and we're going to treat them
20:07 --> 20:09for the breast cancer anyway,
20:09 --> 20:11so we do think it's safe.
20:11 --> 20:13To go through these options and
20:13 --> 20:15it's especially important for women
20:15 --> 20:16and will affect their childbearing
20:16 --> 20:18options for many years to come.
20:18 --> 20:20So we think it's really important
20:20 --> 20:23and is that covered by insurance,
20:23 --> 20:25or is that something that women
20:25 --> 20:26have to pay for out of pocket?
20:26 --> 20:30So when it's related to a cancer diagnosis,
20:30 --> 20:32it is usually covered by insurance
20:32 --> 20:36and so the idea here is that you need to,
20:36 --> 20:37you know, kind of.
20:37 --> 20:39Think about that and harvest those
20:39 --> 20:41ovaries and those embryos before
20:41 --> 20:43you start treatment. Because.
20:43 --> 20:46If you've gone through chemotherapy,
20:46 --> 20:50you may not be able to generate
20:50 --> 20:53those eggs or embryos on your own,
20:53 --> 20:58so so let's talk a little bit more about
20:58 --> 21:01other treatment issues that are pertinent,
21:01 --> 21:03particularly for young women.
21:03 --> 21:05One is the chemotherapy that
21:05 --> 21:08you mentioned that many women
21:08 --> 21:10who present to at a younger age,
21:10 --> 21:13especially with more advanced cancers,
21:13 --> 21:15need to go through chemotherapy.
21:15 --> 21:18Is the type of chemotherapy
21:18 --> 21:20different than for older women?
21:20 --> 21:21I mean,
21:21 --> 21:23are you treating them with different drugs,
21:23 --> 21:24and if so,
21:24 --> 21:25tell us a little bit more about that.
21:27 --> 21:30So the drugs themselves are pretty
21:30 --> 21:32standard and usually the same.
21:32 --> 21:36It really depends on the size of the tumor.
21:36 --> 21:38If we think that there are
21:38 --> 21:40lymph nodes that are involved,
21:40 --> 21:43really the stage of the tumor drives
21:43 --> 21:45the decision regarding what type of
21:45 --> 21:47chemotherapy to use regarding whether
21:47 --> 21:50we're going to use a more aggressive
21:50 --> 21:52regimen or a less aggressive regimen.
21:53 --> 21:56And because many of these women,
21:56 --> 22:00as you mentioned, undergo genetic testing,
22:00 --> 22:02are there some chemotherapeutic
22:02 --> 22:04regimens that are are geared towards
22:05 --> 22:07particular mutation carriers than others?
22:09 --> 22:12So now it's very exciting.
22:12 --> 22:14Not prior to surgery,
22:14 --> 22:16but after surgery.
22:16 --> 22:18There are now a specific
22:18 --> 22:19treatments available.
22:19 --> 22:21So for example,
22:21 --> 22:23if somebody has abraka mutation
22:23 --> 22:25or a palb 2 mutation,
22:25 --> 22:27we now have something
22:27 --> 22:29called a PARP inhibitor,
22:29 --> 22:31which is a pill and we're able
22:31 --> 22:33to use that if prior treatments
22:33 --> 22:36have not been effective for
22:36 --> 22:37this patient population
22:38 --> 22:40and so that. Is only available
22:40 --> 22:44after surgery, is that right?
22:44 --> 22:45So let's talk a little bit,
22:45 --> 22:48then about surgeries you had
22:48 --> 22:50mentioned earlier before the break
22:50 --> 22:53that you know many of these women
22:53 --> 22:55may make different decisions about
22:55 --> 22:57their surgery than older women.
22:57 --> 22:59Talk to us a little bit more about that.
23:00 --> 23:04So it really depends on if they have a
23:04 --> 23:06positive mutation and some mutations.
23:06 --> 23:10For example Baraka, we know that those
23:10 --> 23:13increase the risk of getting a recurrence
23:13 --> 23:16and so by that we mean a breast cancer
23:16 --> 23:19that comes back in the same breast or
23:19 --> 23:23in the other breast, and so for that,
23:23 --> 23:25if the woman has abraka mutation,
23:25 --> 23:28it is recommended to get a
23:28 --> 23:30mastectomy and bilateral mastectomy.
23:30 --> 23:32To decrease the risk of the breast cancer
23:32 --> 23:34coming back in the other breast as well.
23:35 --> 23:37OK, and so one of the questions
23:37 --> 23:40that I know many patients ask is
23:40 --> 23:43if I have a bilateral mastectomy.
23:43 --> 23:44Do I still need chemo?
23:46 --> 23:47Yeah, and that's a great question,
23:47 --> 23:50so you know the different
23:50 --> 23:52treatments kind of affect different
23:52 --> 23:54parts of breast cancer risk.
23:54 --> 23:56So the surgery like we talked about
23:56 --> 23:59decreases the risk of the cancer
23:59 --> 24:01coming back in the breast specifically.
24:01 --> 24:03But what we worry about is oncologist
24:03 --> 24:05is is the cancer going to come
24:05 --> 24:07back in other parts of the body.
24:07 --> 24:10So sometimes breast cancer can come back
24:10 --> 24:12in the bones or the liver or other organs.
24:12 --> 24:14And if that happens it's considered
24:14 --> 24:17metastatic and at that point we can't.
24:17 --> 24:19Cure it so we really want to make
24:19 --> 24:21sure that we're preventing our
24:21 --> 24:23occurrence of metastatic breast cancer,
24:23 --> 24:26and chemotherapy helps to do that because
24:26 --> 24:28if there is any kind of microscopic
24:28 --> 24:31cell that might have escaped from the
24:31 --> 24:33tumor and gone to the bloodstream,
24:33 --> 24:35chemotherapy is a treatment that can
24:35 --> 24:37treat that because it goes everywhere.
24:38 --> 24:41Great, and so you know.
24:41 --> 24:44I think it's important for young women
24:44 --> 24:47to understand that even if you're
24:47 --> 24:50going to decide to have mastectomy,
24:50 --> 24:52reconstruction is is always
24:52 --> 24:54an option for you as well.
24:54 --> 24:59If young women wanted to keep their breasts,
24:59 --> 25:02could they do that, and if so,
25:02 --> 25:04how do you continue to
25:04 --> 25:05screen for their breasts,
25:05 --> 25:08knowing that they may be at increased
25:08 --> 25:10risk of developing breast cancer?
25:10 --> 25:12In the same breast or in the other breast?
25:13 --> 25:16Yeah, absolutely. So it's always
25:16 --> 25:18you know the choice of the women on
25:18 --> 25:20what kind of surgery to do and if
25:20 --> 25:22they choose to keep their breast up.
25:22 --> 25:24We do have breast MRI's that are
25:24 --> 25:27available and they're a little bit more
25:27 --> 25:29sensitive than mammograms and ultrasounds.
25:29 --> 25:31And we usually alternate
25:31 --> 25:33doing those with mammograms.
25:33 --> 25:35So every six months they can get a type
25:35 --> 25:38of imaging to keep a closer eye on them.
25:39 --> 25:40You know the other.
25:40 --> 25:41The other question that comes up,
25:41 --> 25:44I think in young women and especially in
25:44 --> 25:48those who may have a genetic mutation,
25:48 --> 25:51is that genetic mutations like BRCA
25:51 --> 25:55one and two palb 2 and a number of
25:55 --> 25:58the other ones not just increase your
25:58 --> 26:00risk of breast cancer but may increase
26:00 --> 26:03your risk of other cancers as well.
26:03 --> 26:07In the main, when we talk about BRCA,
26:07 --> 26:10we talk about ovarian cancer and so
26:10 --> 26:13do you recommend that these women also
26:13 --> 26:16have their ovaries removed and if so,
26:16 --> 26:19should that be done after they've
26:19 --> 26:20finished having children?
26:20 --> 26:23Or is that something that would
26:23 --> 26:25prevent them from having children?
26:26 --> 26:28Yeah, so it's a complicated
26:28 --> 26:31question and we know that for BRCA,
26:31 --> 26:34whether it's one or two,
26:34 --> 26:35you know there's a different
26:35 --> 26:36risk in terms of how,
26:36 --> 26:39how high the risk is for ovarian cancer.
26:39 --> 26:41So it depends a little bit on what type,
26:41 --> 26:44and we know that for pal B2 there is a
26:44 --> 26:47slightly higher risk of ovarian cancer,
26:47 --> 26:50but we don't quite know it if they
26:50 --> 26:52necessarily have to get their ovaries
26:52 --> 26:55out so it really is our our risk and
26:55 --> 26:56benefit discussion that they have
26:56 --> 26:58with us as well as with the OB GYN.
26:58 --> 27:00Doctor and and it also depends on
27:00 --> 27:03where they are in childbearing age,
27:03 --> 27:06so it is OK to hold off on that surgery
27:06 --> 27:09until they're done having children.
27:09 --> 27:11And we know that even though
27:11 --> 27:12the risk is higher,
27:12 --> 27:15the risk for ovarian cancer really
27:15 --> 27:18becomes highest in their late 30s,
27:18 --> 27:19early 40s.
27:19 --> 27:20So if they really do want to have children,
27:20 --> 27:23it's OK to hold off on that surgery,
27:24 --> 27:25and I think the other thing always
27:25 --> 27:27to keep in mind with young women,
27:27 --> 27:29as with older women as well, but.
27:29 --> 27:31You know these are women who
27:31 --> 27:32are getting breast cancer in
27:32 --> 27:34the primes of their lives.
27:34 --> 27:35So they may be
27:37 --> 27:39on a professional track,
27:39 --> 27:42they may be at the height of their career.
27:42 --> 27:45They may already have young children.
27:45 --> 27:48What kinds of things do you
27:48 --> 27:50recommend in terms of making
27:50 --> 27:52sure that the rest of their life,
27:52 --> 27:54not just their breast cancer,
27:54 --> 27:56is taken care of?
27:56 --> 27:58Absolutely, we know that it's
27:58 --> 28:00incredibly hard to get breast
28:00 --> 28:02cancer at such a young age,
28:02 --> 28:04and you know our treatment
28:04 --> 28:06affects their body image,
28:06 --> 28:07their sexual function,
28:07 --> 28:09their quality of life,
28:09 --> 28:10their psychosocial health,
28:10 --> 28:13and we know that for young people,
28:13 --> 28:15getting all kinds of cancer,
28:15 --> 28:18there is a higher financial burden,
28:18 --> 28:20so we always try to get social
28:20 --> 28:23work involved and it really is a
28:23 --> 28:25multidisciplinary team where we have
28:25 --> 28:26lots of different professionals and.
28:26 --> 28:28Involved to try to help them of
28:28 --> 28:29all different aspects of life
28:29 --> 28:31that are affected by the cancer.
28:32 --> 28:34Doctor Mariya Rozenblit is an instructor
28:34 --> 28:36of medicine and medical oncology
28:36 --> 28:38at the Yale School of Medicine.
28:38 --> 28:40If you have questions,
28:40 --> 28:42the address is canceranswers@yale.edu
28:42 --> 28:45and past editions of the program
28:45 --> 28:47are available in audio and written
28:47 --> 28:48form at yalecancercenter.org.
28:48 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:55cancer here on Connecticut Public
28:55 --> 28:56radio funding for Yale Cancer Answers
28:56 --> 29:00is provided by Smilow Cancer Hospital.

Information

Why do Young Women get Breast Cancer? with guest Dr. Mariya Rozenblit January 23, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095