The value of adjuvant treatment in young women with breast cancer

Abstract

The postoperative management of breast cancer is an ever-changing field. Young patients, in particular, have attracted recent interest as it has become apparent that age alone is a poor prognostic indicator for breast cancer. Adjuvant therapies indisputably delay breast cancer recurrence and save lives, and should be considered for all young patients. Chemotherapy is increasingly being considered appropriate for all women under the age of 35 years, regardless of other risk factors, but poses the particularly difficult problem of infertility for these young women. As the additional benefits of anthracyclines and taxanes in the adjuvant setting become clear, chemotherapy regimens are also becoming increasingly intensive and the risk of myocardial damage and leukaemia should not be ignored. The benefits of chemotherapy need to be weighed against the possible dangers, and therapy should be individualised according to cancer pathology and patient circumstance. Tamoxifen should be given for 5 years to all women whose cancer is estrogen receptor positive, regardless of whether the patient has received chemotherapy. If chemotherapy is not given, the addition of luteinising hormone-releasing hormone (LHRH) agonists to tamoxifen in patients with estrogen receptor positive breast cancers appears to be beneficial. The addition of LHRH agonists to chemotherapy and tamoxifen is currently being evaluated in randomised trials. Radiotherapy should be given after breast conservation surgery, and should include the axilla if nodes are involved and the axilla has not been surgically cleared. Chest wall radiotherapy should be considered following mastectomy in young women considered at high risk of local recurrence, but the long-term morbidity and mortality of local radiation therapy, which is increased in young women, needs to be considered.