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Young Women and Breast Cancer: The Future of Care Julie R. Gralow, M.D. Jill Bennett Endowed Professor of Breast Cancer Director, Breast Medical Oncology.

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Presentation on theme: "Young Women and Breast Cancer: The Future of Care Julie R. Gralow, M.D. Jill Bennett Endowed Professor of Breast Cancer Director, Breast Medical Oncology."— Presentation transcript:

1 Young Women and Breast Cancer: The Future of Care Julie R. Gralow, M.D. Jill Bennett Endowed Professor of Breast Cancer Director, Breast Medical Oncology University of Washington School of Medicine Fred Hutchinson Cancer Research Center Seattle Cancer Care Alliance

2 Breast Cancer in Young Women is a Relatively Rare Disease… (Hankey et al, JNCI 1994)

3 …However, Breast Cancer is the Most Common Cancer in US Women Starting at Age Testis Breast / Testis Breast Hodgkin Lymphoma Thyroid LeukemiaHodgkin Lymphoma MelanomaCervix Uteri Brain and Other CNS / Thyroid MelanomaCervix UteriMelanoma Non-Hodgkin Lymphoma LeukemiaBreastNon-Hodgkin Lymphoma Testis Source: National Cancer Institute, SEER Cancer Statistics Review Top 5 Cancers by Age Group

4 Incidence of Breast Cancer in Young Women Over 12,000 women under age 40 are diagnosed yearly with invasive breast cancer in the US alone (+2,000 DCIS)Over 12,000 women under age 40 are diagnosed yearly with invasive breast cancer in the US alone (+2,000 DCIS) Tens of thousands more worldwideTens of thousands more worldwide (ACS Research, SEER 2008; Porter, N Engl J Med 2008)

5 Breast Cancer in Young Women is Different Tumor differencesTumor differences –More ER negative, high grade disease –More HER-2 positive Patient differencesPatient differences –Biologic –Psychosocial

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7 How Can We Improve Breast Cancer Outcomes in Young Women?

8 Bridging the Gaps: Current Issues in Medical Research on Young Women and Breast Cancer A Basis for Advocacy and Action Young Survival Coalition White Paper 2001 Epidemiological Aspects: Incidence of Early Onset Breast CancerEpidemiological Aspects: Incidence of Early Onset Breast Cancer Pathological Aspects: Is Breast Cancer a More Aggressive Disease in Younger Women?Pathological Aspects: Is Breast Cancer a More Aggressive Disease in Younger Women? Medical Treatment of Younger Women at Risk and with Breast CancerMedical Treatment of Younger Women at Risk and with Breast Cancer Diagnostics and Screening Tools for Younger WomenDiagnostics and Screening Tools for Younger Women Ovarian Function: Premature Menopause and Subsequent Pregnancy after Breast CancerOvarian Function: Premature Menopause and Subsequent Pregnancy after Breast Cancer

9 Young Survival Coalition Research Think Tank February 7-8, 2013 Attendees: Educated advocates and multi-disciplinary group of medical and research experts Six groups focused on: Risk FactorsRisk Factors TreatmentTreatment FertilityFertility PregnancyPregnancy MetastasesMetastases Quality of LifeQuality of Life

10 YSC Criteria for Priority Questions Which research questions, if answered, would significantly impact the quality and quantity of life for young women diagnosed with breast cancer?

11 Young Survival Coalition Research Think Tank February 7-8, 2013 Workgroups formulated approximately 60 questions, based on the current state of the evidenceWorkgroups formulated approximately 60 questions, based on the current state of the evidence Each group presented their recommended top three goalsEach group presented their recommended top three goals Approx 26 hours of meeting audio files to transcribe and comb throughApprox 26 hours of meeting audio files to transcribe and comb through Still a lot of work to do before the new research agenda is finalized and sharedStill a lot of work to do before the new research agenda is finalized and shared Collaboration is key, along with the strategic goal of focusing on young womenCollaboration is key, along with the strategic goal of focusing on young women

12 Advisory Committee on Breast Cancer in Young Women CDC has convened an Advisory Committee on Breast Cancer in Young Women (ACBCYW), a federal advisory committee established by the Education and Awareness Requires Learning Young (EARLY) Act

13 European School of Oncology Breast Cancer in Young Women Conference (BCY1) Dublin, Ireland, November 2012 MAIN TOPICS Hereditary breast cancer Diagnostic tools in young women Local therapy Systemic therapy Pregnancy and breast cancer Fertility preservation Psychosocial aspects Management of side effects

14 How Can We Improve Breast Cancer Outcomes in Young Women? PreventionPrevention Earlier DetectionEarlier Detection Better TreatmentBetter Treatment Survivorship and Long-term Follow-upSurvivorship and Long-term Follow-up

15 How Can We Improve Breast Cancer Outcomes in Young Women? PreventionPrevention Earlier DetectionEarlier Detection Better TreatmentBetter Treatment Survivorship and Long-term Follow-upSurvivorship and Long-term Follow-up

16 Breast Cancer Risk Factors: Genetics 15-20% 5-10% 70-80%

17 Genes that Cause Hereditary Susceptibility to Breast Cancer BRCA1 and BRCA2BRCA1 and BRCA2 –Breast cancer risk % »Early onset, 1/2 diagnosed by age 41 »Second primary breast cancer % »Male breast cancer (BRCA2) 6% –Ovarian cancer risk % TP53 (Li Fraumeni syndrome)TP53 (Li Fraumeni syndrome) PTEN (Cowdens syndrome)PTEN (Cowdens syndrome) CHK2CHK2 –low penetrance – breast cancer risk doubled? Undiscovered genesUndiscovered genes

18 UW Laboratory Medicine: New BROCA Test for Hereditary Cancer Risk T Walsh, E Swisher, MC King Useful for evaluation of patients with suspected hereditary cancer predisposition, with focus on syndromes that include breast or ovarian cancerUseful for evaluation of patients with suspected hereditary cancer predisposition, with focus on syndromes that include breast or ovarian cancer Depending on the gene involved, these cancers may co-occur with other cancer types (colorectal, endometrial, pancreatic, endocrine, or melanoma)Depending on the gene involved, these cancers may co-occur with other cancer types (colorectal, endometrial, pancreatic, endocrine, or melanoma) If mutations in BRCA1 or BRCA2 are suspected, these should be evaluated with a separate testIf mutations in BRCA1 or BRCA2 are suspected, these should be evaluated with a separate test BROCA uses next-generation sequencing to detect mutations in 40 genesBROCA uses next-generation sequencing to detect mutations in 40 genes The assay completely sequences all exons and flanking introns of these genes AND detects large deletions, duplications, and mosaicismThe assay completely sequences all exons and flanking introns of these genes AND detects large deletions, duplications, and mosaicism

19 Breast Cancer Risk Factors: Lifestyle Risk FactorHigh Risk Category Referent GroupRelative Risk Obesity > 35 BMI < Physical Activity Inactive Regular activity Alcohol Use >2 drinks/day Non drinkers 1.5 McTiernan, Oncologist 2003; Hamijima, Br J Ca 2002

20 Physical Activity and Breast Cancer Womens Health Initiative (WHI) McTiernan A et al, JAMA 2003 Patients: 74,171 women ages 50-79Patients: 74,171 women ages –1,780 cases of breast cancer diagnosed over 5 yrs Study: evaluated incidence of breast cancer correlated to physical activity at age 18, 35, 50Study: evaluated incidence of breast cancer correlated to physical activity at age 18, 35, 50 Results:Results: –Regular strenuous physical activity at age 35 had 14% reduction in breast cancer risk (similar at age 18, 50) – hrs/wk brisk walking had 18% decreased risk –Greatest reduction seen with >10 hrs/wk brisk walking

21 New York Breast Cancer Study: Breast and Ovarian Cancer Risks in Jewish Women with BRCA1/2 Mutations King MC et al, Science 2003 In women with BRCA1/2 mutations who developed breast cancer, regular exercise delayed age of onset by 10 years

22 Exercise Can Impact Breast Cancer Survival Exercise and Survival After Breast Cancer Diagnosis (Nurses Health Study) Holmes MD et al, JAMA 2005 Patients: 2,987 nurses with early stage breast cancer Physical activity categories: –LOW: < 3 MET hours per week –LOW/MED: MET hours/week –MED/HIGH: MET hours/week –HIGH: > 24 MET hours/week (3 MET hours/week equal to walking average pace of 2-3 miles per hour for 1 hour) Results: Compared to women with LOW physical activity, risk of dying of breast cancer was:Results: Compared to women with LOW physical activity, risk of dying of breast cancer was: –20% less for LOW/MED exercise –40-50% less for MED/HIGH and HIGH exercise (at least 3 hours per week walking at average pace)

23 Ongoing Study SWOG S1008:Feasibility Study of a Weight Loss Intervention in Breast and Colorectal Cancer Eligibility Criteria: Female Female Age > 21 years Age > 21 years Postmenopausal Postmenopausal Stage I-III breast/colorectal CA Stage I-III breast/colorectal CA mos post-treatment mos post-treatment BMI > 25 kg/m 2 BMI > 25 kg/m 2 Sedentary Sedentary ENROLLENROLL 12 Month Weight Loss Program: Curves exercise (goal: 220 min/wk of mod-intense activity) + Curves diet (low-fat, high fruit/veg,1500 kcal/d) + Telephone-based behavioral counseling (14 sessions over 12 mos) Primary Endpoints (12 months): Feasibility in Breast ; ColorectalFeasibility in Breast ; Colorectal >5% change in weight in Breast; Colorectal>5% change in weight in Breast; Colorectal Secondary Endpoints: Anthropometric measures/ body compositionAnthropometric measures/ body composition Physical activityPhysical activity DietDiet BiomarkersBiomarkers Quality of lifeQuality of life Program acceptabilityProgram acceptability

24 Primary PreventionPrimary Prevention –Lifestyle –Chemoprevention –Prophylactic surgery Breast Cancer Risk Reduction

25 Ongoing SWOG S0812: Vitamin D in Premenopausal Women at High Risk for Breast Cancer (PI: K Crew) Eligibility: Premenopausal, Age yr Gail risk 1.67% or lifetime risk 20% BRCA1/2, PTEN, p53 mutation ADH, ALH, LCIS, DCIS (including microinvasive and T1a) Stage I-II breast CA, >5yrs in remission 25(OH)D 32ng/ml RANDOMIZERANDOMIZE Cholecalciferol (vit D3) 20,000 IU weekly x 1yr Matching placebo x 1yr Baseline data collection:Follow-up data collection:MammogramCore breast biopsyBlood Primary Endpoint: Change in mammographic density Secondary Endpoints: Serum and tissue-based biomarkers, toxicity Vitamin D3 600 IU qd Activation: November 2011 Accrual Goal: 200

26 Ongoing Phase II Low Dose Tamoxifen in Lymphoma Survivors for Breast Cancer Risk Reduction PI: M Palomares Eligibility: childhood and young adult cancer survivors treated with chest radiationchildhood and young adult cancer survivors treated with chest radiation RANDOMIZERANDOMIZE Tamoxifen 5 mg daily x 2 yrs Placebo x 2 yrs Baseline data collection:Follow-up data collection: MammogramMammogram Core breast biopsyCore breast biopsy BloodBlood Primary Endpoint: Change in mammographic density Secondary Endpoints: Serum and tissue-based biomarkers, toxicity

27 How Can We Improve Breast Cancer Outcomes in Young Women? PreventionPrevention Earlier DetectionEarlier Detection Better TreatmentBetter Treatment Survivorship and Long-term Follow-upSurvivorship and Long-term Follow-up

28 Young Women Present with More Advanced Disease Delays in diagnosisDelays in diagnosis –Lack of reliable screening –Lack of awareness of risk or difficult to diagnose: »Too young for breast cancer »breast cancer during pregnancy –Access to care issues

29 Diagnosis and imaging for staging and follow-up Diagnosis, imaging and staging in young women should follow standard algorithms Consideration should be given to breast MRI in young women, particularly in the setting of very dense breast tissue or a genetic predisposition to the disease For BRCA 1/2 mutation carriers and others at extremely high risk based on family history or predisposing mutations in other genes, and for those at increased risk because of therapeutic radiation in adolescence, annual surveillance is recommended

30 Early Detection of Breast Cancer: The Controversy Around Breast Imaging Mammogram Ultrasound Magnetic Resonance Imaging (MRI)Magnetic Resonance Imaging (MRI)

31 Mammography is Less Sensitive in Younger Women Screening mammograms miss up to 25% of breast cancers in women in their 40s, compared to 10% of cancers for older womenScreening mammograms miss up to 25% of breast cancers in women in their 40s, compared to 10% of cancers for older women Digital (vs film) mammography may be better for younger women and women with dense breastsDigital (vs film) mammography may be better for younger women and women with dense breasts

32 A Newly Recognized Breast Cancer Risk Factor: Mammographic Density Several states have now mandated reporting of high breast density as seen on mammograms to both patient and primary care provider

33 American Cancer Society Recommendations for Breast Cancer Screening 2013 Mammography: Annually beginning at age 40 and continuing as long as the woman is in good healthMammography: Annually beginning at age 40 and continuing as long as the woman is in good health Health Professionals Exam: About every 3 years between 20-39, then annuallyHealth Professionals Exam: About every 3 years between 20-39, then annually Self-Exam: An option for women beginning at about age 20Self-Exam: An option for women beginning at about age 20 MRI: Women at high risk (> 20% lifetime) should get a mammogram and MRI yearly. Women at moderately increased risk (15-20%) should talk with their health care providers about MRI screening.MRI: Women at high risk (> 20% lifetime) should get a mammogram and MRI yearly. Women at moderately increased risk (15-20%) should talk with their health care providers about MRI screening.

34 Breast Screening in Young Women with Hereditary Risk for Breast Cancer Kriege M et al, NEJM 2004 Results (3 years): 51 tumors detectedResults (3 years): 51 tumors detected % Patients: 1,909 Dutch women with elevated risk of breast cancerPatients: 1,909 Dutch women with elevated risk of breast cancer –average age 40 years; 358 BRCA1/2 + Screening: Clinical breast exam every 6 months, mammography and MRI yearlyScreening: Clinical breast exam every 6 months, mammography and MRI yearly Breast MRI is better at detecting cancer than mammogram in high risk women, but has a higher rate of false positives

35 How Can We Improve Breast Cancer Outcomes in Young Women? PreventionPrevention Earlier DetectionEarlier Detection Better TreatmentBetter Treatment Survivorship and Long-term Follow-upSurvivorship and Long-term Follow-up

36 Should Treatments be Different in Young Women with Breast Cancer?

37 Young age by itself should not be the reason to prescribe more aggressive therapy then general recommendations Both in early and advanced settings, choice of treatment should include the biological characteristics of the tumour (ER/PR, HER-2, proliferation, grade), tumor stage, hormonal milieu*, and patient's comorbidities * Young does not always mean pre-menopausal General Statements

38 Before any treatment decision, young women must be advised to have fertility and contraception specialized counselling Fertility preservation

39 Genomic Profiling of Cancer: Breast Cancer is NOT One Disease! Multiple breast cancer subtypes Luminal Subtype A Luminal Subtype B HER-2+ Basal Subtype Normal Breast–like Sorlie et al, Proc Natl Acad Sci 100:8418, 2003 Subtypes vary with respect to: Likelihood of recurrenceLikelihood of recurrence Sites of metastasesSites of metastases Response to treatmentResponse to treatment Frequency of subtypes varies across populations –additional subtypes likely existFrequency of subtypes varies across populations –additional subtypes likely exist

40 Whats the Latest? Triple Negative Breast Cancer is a Highly Diverse Group of Cancers Lehmann BD, et al. J Clin Invest 121: , subtypes of TNBC identified by gene expression array!

41 Endocrine Therapy Estrogen Receptor and Breast Cancer Estrogen Cell Growth and Division Estrogen Receptor SERMS (tamoxifen) SERDS (fulvestrant) Aromatase inhibitors, ovarian suppression

42 ATLAS: Adjuvant Tamoxifen Longer Against Shorter (5 vs 10 Years) Patients: 6846 women with breast cancer completing 5 years of tamoxifenPatients: 6846 women with breast cancer completing 5 years of tamoxifen –54% node-negative –Analysis only includes documented ER+ patients Randomized to continue tamoxifen to year 10, or stop at year 5Randomized to continue tamoxifen to year 10, or stop at year 5 Reporting on 8 yrs median follow-up: compliance, recurrence, deathReporting on 8 yrs median follow-up: compliance, recurrence, death Davies C et al. Presented at SABCS 2012, Abstract number S1-2

43 ATLAS: Adjuvant Tamoxifen Longer Against Shorter (5 vs 10 Years) Davies C et al. Presented at SABCS 2012, Abstract number S1-2 5 years10 yearsP value Recurrence 617 events 21.4% 711 events 25.1% P=0.002 Overall mortality 639 events 12.2% 722 events 15% P=0.01 Breast cancer mortality 331 events397 eventsP=0.01 Compliance after 2 years 80%

44 ATLAS: Adjuvant Tamoxifen Longer Against Shorter (5 vs 10 Years) Only had access to toxicity related to hospitalization or deathOnly had access to toxicity related to hospitalization or death Toxicities for 10 vs 5 years tamoxifen (from Lancet publication: Davies C et al, Lancet 2012, epub ahead of print)Toxicities for 10 vs 5 years tamoxifen (from Lancet publication: Davies C et al, Lancet 2012, epub ahead of print) –Pulmonary embolus HR 1.87 p=0.01 –Stroke HR 1.06 (ns) –Ischemic heart disease HR 0.76 p=0.02 –Endometrial cancer HR 1.74 p= (3.1% vs 1.6%) Davies C et al. Presented at SABCS2012, Abstract number S1-2

45 ATLAS: Adjuvant Tamoxifen Longer Against Shorter (5 vs 10 Years) Davies C et al. Presented at SABCS2012, Abstract number S1-2 How to incorporate into practice: Weighing risks vs benefitsWeighing risks vs benefits Need to estimate womans residual risk of recurrence after 5 years of tamoxifenNeed to estimate womans residual risk of recurrence after 5 years of tamoxifen Half of deaths NOT breast cancer related!Half of deaths NOT breast cancer related! Really only applicable in premenopausal womenReally only applicable in premenopausal women AIs standard in postmenopausalAIs standard in postmenopausal For women who have become postmenopausal while on tamoxifen, consider AI (ie NCIC MA17 study)For women who have become postmenopausal while on tamoxifen, consider AI (ie NCIC MA17 study) Patient acceptancePatient acceptance QOL issues on tamoxifen (hot flashes, night sweats, insomnia)QOL issues on tamoxifen (hot flashes, night sweats, insomnia) Generalizability to other endocrine agents (longer duration AIs)?Generalizability to other endocrine agents (longer duration AIs)?

46 Ongoing IBCSG 24-02: Suppression of Ovarian Function Trial (SOFT) PI: A. Goldhirsch Premenopausal, ER+, ovarian function intact after chemo or no chemo Tamoxifen vs. vs. Tamoxifen + OFS vs. Exemestane (Aromasin) + OFS Does ovarian function suppression add to the standard in premenopausal women (tamoxifen)?Does ovarian function suppression add to the standard in premenopausal women (tamoxifen)? Is an aromatase inhibitor of added benefit in premenopausal women when the ovaries are suppressed?Is an aromatase inhibitor of added benefit in premenopausal women when the ovaries are suppressed?

47 ABCSG-012: Adjuvant Hormonal Therapy in Premenopausal Breast Cancer Patients Gnant M et al, NEJM 360, premenopausal women with ER+ early breast cancer Anastrozole (Arimidex) Goserelin 3 years (ovarian suppression) Tamoxifen Zoledronic acid 4mg q6 mo ControlZoledronic acid 4mg q6 mo Control

48 ABCSG-12 Trial of Endocrine Therapy Gnant M et al, NEJM 360, 2009 Tamoxifen (n = 900) Anastrozole (n = 903) HR P Value Disease-Free Survival 65 events72 events Overall Survival15 events27 events months median follow-up Conclusion: No difference between tamoxifen and anastrozoleConclusion: No difference between tamoxifen and anastrozole A trend towards tamoxifen being better?A trend towards tamoxifen being better?

49 Can Bisphosphonates Prevent Cancer Recurrences? ABCSG-12: Premenopausal Breast Cancer Pts Receiving Adjuvant Hormonal Rx Gnant M et al, N Engl J Med 360: , 2009 Median follow-up = 48 months Time since Randomization, months Disease-Free Survival, % No ofHazard Ratio (95% CI) Eventsvs No ZOL P Value ZOL (0.46 to 0.91).01 No ZOL83 DFS First Event per Patient, n (n = 904)(n = 899) 35% reduction in recurrences from adding zoledronic acid – but very few recurrences!

50 Chemotherapy: THE PAST 2000 NCI Consensus Development Conference on Adjuvant Breast Cancer Chemotherapy should be offered to the majority of women with early stage breast cancer regardless of size, lymph node, menopausal or hormone receptor status Chemotherapy should be offered to the majority of women with early stage breast cancer regardless of size, lymph node, menopausal or hormone receptor status

51 Chemotherapy: THE PRESENT AND FUTURE Individualizing Estimates of Recurrence Risk and Chemotherapy Benefit from Therapy Using Genomic/Molecular Profiling Who Doesnt Need Chemotherapy?

52 Large Benefit of Chemotherapy in Young Women (EBCTCG, Lancet, 1998)

53 Interventions to Reduce Risk of Chemotherapy Toxicity SWOG S0230: Study of GnRH Analogue to Reduce Ovarian Dysfunction in Young Women Undergoing Chemotherapy PI: H Moore Eligibility: 458 premenopausal ER/PR-negative stage I-III breast cancer patients receiving standard chemotherapyEligibility: 458 premenopausal ER/PR-negative stage I-III breast cancer patients receiving standard chemotherapy Treatment:Treatment: –Randomized to receive ovarian suppression with goserelin with each chemo cycle versus no ovarian suppression Endpoints: Ovarian failure at 2 years (6 months amenorrhea with elevated FSH)Endpoints: Ovarian failure at 2 years (6 months amenorrhea with elevated FSH)

54 As of Yesterday, Four FDA-Approved Drugs with HER-2 as a Target cell division HER-2 nucleus cancer cell Trastuzumab (Herceptin) Anti-HER-2 Antibody Lapatinib (Tykerb) Dual HER-1/HER-2 Tyrosine Kinase Inhibitor Pertuzumab Anti-HER-2 Antibody T-DM1 Antibody-Drug Conjugate

55 Approved Yesterday: Trastuzumab-DM1 (T- DM1) Trastuzumab Mertansine: anti-tubulin

56 Identifying Additional Targets in the Treatment of Breast Cancer Death Receptors Courtesy of D. Budman Tubulin- interacting Agents HDAC Inhibitors Metastasis Inhibitors Anti- Angiogenesis HER-2 Inhibitors IGF-R Inhibitors MUC-1 Antibodies Proteosome Inhibitors mTOR Inhibitors Farnesyl Transferase Inhibitors Mdm2 Inhibitors Pro-apoptotic Drugs Kinesins Aurora Kinase Inhibitors MEK Inhibitors HIF Inhibitors Raf Inhibitors EGFR Inhibitors HSP90 Inhibitors Src Inhibitors Cell Cycle Inhibitors

57 How Can We Improve Breast Cancer Outcomes in Young Women? PreventionPrevention Earlier DetectionEarlier Detection Better TreatmentBetter Treatment Survivorship and Long-term Follow-upSurvivorship and Long-term Follow-up

58 In view of the long potential life-time, particular attention should be paid to possible long-term toxicities of adjuvant treatments Early Breast Cancer

59 Long-term/Late Effects of Diagnosis and Treatment are Different for Younger Women Longer-term effectsLonger-term effects »Very premature menopause Infertility, family planningInfertility, family planning OsteoporosisOsteoporosis Cognitive FunctionCognitive Function Cardiovascular healthCardiovascular health Weight gainWeight gain »Implications for second cancers Genetic issuesGenetic issues Screening issues (breast MRI?)Screening issues (breast MRI?)

60 Psychosocial Distress in Young Breast Cancer Survivors Young women are more likely to be concerned about:Young women are more likely to be concerned about: –Role functioning at home and/or work –Beauty and attractiveness –Sexual functioning –Fertility and family planning

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62 Breast cancer and pregnancy All retrospective available data report not only no detrimental effect of a subsequent pregnancy on breast cancer outcome Therefore, pregnancy after breast cancer should not in principle be discouraged Prospective definitive data from clinical trials should be collected

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65 Many specific issues in the treatment of young women with breast cancer, both in early and advanced settings, still lack definitive proven standardsMany specific issues in the treatment of young women with breast cancer, both in early and advanced settings, still lack definitive proven standards Therefore, well-designed, independent, prospective randomized trials should be a global research priorityTherefore, well-designed, independent, prospective randomized trials should be a global research priority Concluding Statement

66 Breast Cancer in Young Women: Summary Breast Cancer in Young Women: Summary The experience of breast cancer differs by age at diagnosisThe experience of breast cancer differs by age at diagnosis Young age may not be an independent predictor of outcome in all disease subtypesYoung age may not be an independent predictor of outcome in all disease subtypes Targeting the tumor in consideration of the host (including psychosocial concerns) is most prudentTargeting the tumor in consideration of the host (including psychosocial concerns) is most prudent Good news: increasing awareness is leading to focused research and comprehensive care approaches that may improve both breast cancer and psychosocial outcomesGood news: increasing awareness is leading to focused research and comprehensive care approaches that may improve both breast cancer and psychosocial outcomes


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