Young Women With Breast Cancer Face Aggressive Disease, Complex Care Needs

Breast cancer in young women is driven by more aggressive molecular and epidemiologic features and requires age-specific, multidisciplinary management that balances oncologic goals with fertility preservation, psychosocial support, and long-term survivorship needs, experts said last week at the San Antonio Breast Cancer Symposium (SABCS).

Molecular, Epidemiologic Drivers of Breast Cancer in Young Women

SABCS concluded last Friday after 4 days of various breast cancer–focused programming and events, drawing more than 11,000 attendees from over 100 countries, both in person and virtually.¹ A recurring theme throughout the meeting was breast cancer in young women, highlighted in 2 dedicated sessions and numerous poster presentations.

One such session, titled “Breast Cancer in Young Women—When, Why, and How,” examined the drivers of breast cancer across the age continuum in younger populations.² During the session, Melissa Troester, PhD, of the University of North Carolina (UNC) at Chapel Hill, presented findings on the molecular epidemiology of breast cancer in young women using data from UNC Lineberger Comprehensive Cancer Center’s Carolina Breast Cancer Study (CBCS); her presentation primarily focused on Black women and patients younger than 50 across multiple phases of data collection.³ Troester noted that CBCS integrates detailed molecular, immunologic, and patient-reported survey data, enabling a comprehensive evaluation of cancer development, detection, treatment, and survivorship.²

Troester explained that young women experience a substantially higher burden of recurrence, with an approximately 1.7-fold higher hazard overall and an even greater risk among those with estrogen receptor–positive or HER2-positive disease. She emphasized that this elevated risk arises from a combination of biological, clinical, and external factors, as traditional risk factors such as body mass index, age, and waist-to-hip ratio do not fully account for the observed differences. Notably, Troester highlighted that a recent pregnancy increases breast cancer risk among young women.

She also noted that because standard screening recommendations typically do not apply to women younger than 45, breast cancer in the younger population is more often detected symptomatically, often through the discovery of a lump. Lumps are usually present at stages III or IV, meaning that younger women often have more advanced disease at diagnosis. They also tend to have larger, node-positive tumors, as well as significantly higher rates of multiple-site metastases.

At the molecular level, the CBCS found that breast cancers diagnosed in young women are significantly more likely to harbor TP53 mutations and other copy number alterations. In addition, RNA-based classification methods identified a higher prevalence of aggressive tumor profiles in this population, including high proliferation, elevated recurrence scores, and mutation-like gene expression profiles.

Regarding treatment, Troester described survey findings that identified 3 endocrine therapy adherence groups: highly adherent patients, variably adherent patients, and those facing substantial barriers to adherence. Barriers were more frequent and severe among both younger and Black women, contributing to worse outcomes. Even after adjusting for adherence, she emphasized that the outcome disparities persisted, likely due to underlying tumor biology.

Troester concluded by adding that patient-reported outcomes revealed a sustained, higher burden of unmet informational, emotional, and functional needs among young women with breast cancer, persisting up to 8 years post diagnosis across racial, educational, and clinical subgroups. Despite these ongoing challenges, she noted that emotional and well-being data show young women can improve significantly over time, demonstrating substantial resilience.

“I think it’s important that we address these challenges across the continuum so that these well-being changes can continue to be realized,” Troester said.

Special Management Considerations for Young Women With Breast Cancer

The other session, “Breast Cancer in Young Women—Biology, Treatment, and Ethics,” also explored the unique epidemiology and biology of young-onset breast cancer while addressing specialized management considerations and key ethical issues in caring for this population.⁴

On-site at SABCS, The American Journal of Managed Care^® (AJMC^®) spoke with one of the presenters, Yara Abdou, MD, of UNC Chapel Hill, about her presentation, “Special Management Considerations for Young Patients With Breast Cancer.”⁵ In her talk, she discussed the unique treatment strategies and conversations involved in caring for young women with breast cancer, which Troester had briefly touched on in her presentation.⁴

Abdou explained that breast cancer in young women often has more aggressive biological features than in older populations, frequently necessitating more intensive treatment regimens.⁵ Despite this, she emphasized that core treatment principles do not change based on age and remain driven by tumor biology, disease stage, and genomic risk. What becomes more complex, Abdou noted, is balancing oncologic goals with fertility planning, psychosocial needs, and long-term quality-of-life trade-offs.

As discussed, fertility preservation represents a critical consideration for younger patients. Abdou underscored that fertility concerns often shape treatment decisions in this population, whether through declining chemotherapy, altering regimens, or shortening the duration of endocrine therapy.

“Fertility counseling is not just nice to have; it’s really essential if we want our young patients to engage in their treatment without feeling like they’re sacrificing a big part of their lives,” she told AJMC.

Abdou added that timing is a key factor in fertility counseling and preservation, stressing the importance of early discussions and referrals before the initiation of any cancer-directed therapy, which may limit future fertility options.

Turning to survivorship, Abdou highlighted that concerns for young women extend well beyond the completion of treatment and into rebuilding identity and purpose after cancer disrupts pivotal years of personal and career development. Challenges include returning to work due to persistent fatigue and treatment-related adverse effects.

Mental health issues are also prevalent but often underrecognized, which she noted are compounded by societal pressure to quickly “bounce back.” Sexual health and body image issues are other major concerns, as many experience premature menopause and low libido, affecting personal relationships and intimacy. Lastly, Abdou emphasized the importance of connecting young survivors with peers facing similar experiences.

“There’s a lot we can do supporting mental health and sexual health, and connecting them with appropriate peers, in my opinion, is as important as medical follow-up in that survivorship stage,” she said.

Abdou concluded by identifying the greatest unmet need in managing this population as integrated, age-specific care that addresses not only the tumor but the whole person. She noted that this can be achieved through young adult breast cancer programs, routine fertility counseling and preservation services, and standardized mental and sexual health clinics. From a research perspective, Abdou emphasized the need for greater representation of young women in clinical trials and more data on the long-term implications of newer therapies.

“Medical oncologists, surgical oncologists, fertility specialists, psychosocial support—we all need to be working together to support these women and improve their outcomes,” Abdou concluded.

References

1. Welcome to SABCS 2025: greetings from the symposium co-directors. News release. SABCS. December 9, 2025. Accessed December 18, 2025. https://www.sabcsmeetingnews.org/welcome-to-sabcs-2025-greetings-from-the-symposium-co-directors/
2. Curtis C, Troester M, Polyak K, Loi S, Horn SE. Breast cancer in young women—when, why, and how? Presented at: San Antonio Breast Cancer Symposium 2025; December 9-12, 2025; San Antonio, Texas.
3. The Carolina breast cancer study. UNC Lineberger Comprehensive Cancer Center. Accessed December 18, 2025. https://unclineberger.org/cbcs/
4. Borges VF, Abdou Y, Engelstein LC, Partridge AH, Hodgdon C. Breast cancer in young women—biology, treatment, and ethics. Presented at: San Antonio Breast Cancer Symposium 2025; December 9-12, 2025; San Antonio, Texas.
5. McCormick B, Abdou Y. Early oncofertility counseling needed for young patients with breast cancer: Yara Abdou, MD. AJMC. December 11, 2025. Accessed December 18, 2025. https://www.ajmc.com/view/early-oncofertility-counseling-needed-for-young-patients-with-breast-cancer-yara-abdou-md