Ann H. Partridge, MD, MPH, discusses unique challenges associated with very young patients who have ER+/node-positive breast cancer.  

Dr Partridge on Unique Treatment Challenges for Young Patients with ER+/Node-Positive Breast Cancer  


Ann H. Partridge, MD, MPH, vice chair, Medical Oncology; founder, director, Program for Young Adults with Breast Cancer; director, Adult Survivorship Program; Eric P. Winer, MD, Chair, Breast Cancer Research, Dana-Farber Cancer Institute, senior physician, professor of medicine, Harvard Medical School, discusses unique challenges experienced by very young patients undergoing treatment for their estrogen receptor–positive, node-positive breast cancer, and how to integrate fertility preservation into treatment plans for patients in this population if needed.

When a young person is diagnosed with breast cancer, they face not only the typical decisions about treatment but also issues that are uniquely challenging due to their age, Partridge begins. In addition to choices about surgery, hormonal therapy, and whether or not to undergo chemotherapy, young patients often confront concerns about fertility, sexual health, and genetics, she states. Furthermore, younger patients typically present with more aggressive breast cancer tumors, leading to more intense treatments that can result in long-term survivorship challenges and more severe adverse effects (AEs), she adds.

One of the most important aspects of managing breast cancer in young patients is discussing fertility preservation, Partridge emphasizes. For those who express an interest in having biological children in the future, it is essential to inform them about the potential impact of cancer therapies, especially chemotherapy, on their fertility. Treatments may either reduce fertility or lead to permanent infertility, she adds. Options for fertility preservation, such as egg or embryo banking before beginning treatment, should be explored with these patients, Partridge says. In some cases, ovarian suppression during chemotherapy may help reduce the risk of premature menopause and improve future fertility prospects, she notes.

Because young patients are more likely to face aggressive tumors that require stronger treatments, they must also contend with more significant AEs and survivorship issues, Partridge continues. This often includes managing sexual health, psychological stress, and the long-term effects of therapies. Therefore, the care of young breast cancer patients should be holistic and proactive, addressing both immediate treatment concerns and future quality of life, Partridge concludes.

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Ann H. Partridge, MD, MPH, discusses unique challenges associated with very young patients who have ER+/node-positive breast cancer.
 

Dr Partridge on Unique Treatment Challenges for Young Patients with ER+/Node-Positive Breast Cancer

Ann H. Partridge, MD, MPH, vice chair, Medical Oncology, founder and director, Program for Young Adults with Breast Cancer, director, Adult Survivorship Program, Eric P. Winer, MD, Chair in Breast Cancer Research, senior physician, Dana-Farber Cancer Institute; professor, medicine, Harvard Medical School, discusses the incidence of second primary breast cancer in young patients with a history of breast cancer.

The risk of contralateral breast cancer is higher among patients who are under the age of 40 at their primary breast cancer diagnosis, although this risk differs based on primary tumor traits, genetic risk, and treatments.

The Young Women’s Breast Cancer Study aimed to determine the incidence of second primary breast cancer in patients aged 40 years and under at diagnosis who received lumpectomy or unilateral mastectomy after their primary breast cancer diagnosis between 2006 and 2016. At a median follow-up of 10 years, of the 685 patients included in the study, 526 were alive without recurrence, 45 had local recurrence, 94 had metastases, 3 had died from causes unrelated to breast cancer, and 17 had second primary breast cancer.

This retrospective study showed that among all patients, the risk of developing a new primary breast cancer was higher in patients with a genetic predisposition for breast cancer, such as a 

 pathogenic variant compared with those who were not pathogenic variant carriers, Partridge says. The 5- and 10-year risks of developing a second primary breast cancer were 6.1% and 9.1% in patients with pathogenic variants vs 1.1% and 1.7% in those without pathogenic variants.

The risk of developing a second primary breast cancer was relatively low in younger patients when pathogenic variant carriers were removed from the study population, Partridge emphasizes. These findings can be helpful for patients as they make local therapy decisions after a diagnosis of unilateral breast cancer, Partridge concludes.

Ann H. Partridge, MD, MPH, discusses the incidence of second primary breast cancer in young patients with a history of breast cancer.

Dr Partridge on Breast Cancer Recurrence in Young Breast Cancer Survivors

Ann H. Partridge, MD, MPH, physician, vice chair, Medical Oncology, founder and director, Program for Young Adults with Breast Cancer, director, Adult Survivorship Program, Eric P. Winer, MD, chair in Breast Cancer Research, Dana-Farber Cancer Institute, senior physician, professor of Medicine, Harvard Medical School, Brigham and Women’s Hospital, discusses the utilization of GnRH agonists to preserve ovarian function in premenopausal patients with breast cancer.

GnRH agonists represent the only current available modality to protect ovarian function in premenopausal patients with breast cancer who are treated with cytotoxic chemotherapy, including anything containing cyclophosphamide, Partridge says. Multiple studies have demonstrated that the use of GnRH agonists prior to the administration of chemotherapy helps maintain the ability for patients to have a baby if they still want to become pregnant, Partridge explains.

However, data for fertility with the use of GnRH agonists are still limited and appear to apply to women under the age of 40, Partridge continues. Alternatives to managing ovarian toxicity related to chemotherapy in this patient population include egg harvesting, Partridge concludes.

Ann H. Partridge, MD, MPH, discusses the utilization of GnRH agonists to preserve ovarian function in premenopausal patients with breast cancer.


Dr. Partridge on the Utilization of GnRH Agonists in Breast Cancer

H. Partridge, MD, MPH, vice chair of medical oncology, ​founder and director, Program for Young Women With Breast Cancer, director, Adult Survivorship Program, senior physician, Dana-Farber Cancer Institute, professor of medicine, Harvard Medical School, discusses the role of genomic testing in breast cancer.

Genomic expression prediction assays have been instrumental in understanding the value of chemotherapy ​for patient​s with breast cancer, says Partridge. ​For example, the Oncotype DX test looks at a set of 21 genes in cancer cells from tumor biopsy or surgery sample in order to obtain a recurrence score.

​Moreover, the test provides critical insight into whether a patient may or may not benefit from chemotherapy, Partridge explains.

Now, encouraging prospective data show that chemotherapy may be beneficial in the adjuvant setting for patients with node-negative or hormone receptor–positive breast cancer, concludes Partridge.

Ann H. Partridge, MD, MPH, discusses the role of genomic testing in breast cancer.

Dr. Partridge on the Role of Genomic Testing in Breast Cancer

Ann H. Partridge, MD, MPH, founder and director, Program for Young Women with Breast Cancer, director, Adult Survivorship Program, senior physician, Dana-Farber Cancer Institute, associate professor of Medicine, Harvard Medical School, discusses preimplantation genetic diagnosis (PGD) in young patients with breast cancer.

Fertility and fertility preservation are significant issues in young patients with breast cancer. One controversial area of this is PGD, a technology that determines whether a patient's embryo will harbor the same breast cancer predisposing mutant gene, such as 

, as the patient, Partridge explains. This is available and is a relatively safe proceudure; however, it is associated with financial and emotional stress. Patients must also undergo in vitro fertilization, Partridge says.

Societal and ethical issues also surround the procedure and, ultimately, what decision patients make with their embryo. Though PGD is a significant technological advancement in the field, it does remain controversial, she adds.

Dr. Partridge on PGD in Young Patients With Breast Cancer

Ann H. Partridge, MD, MPH, Founder and Director, Program for Young Women with Breast Cancer, Director, Adult Survivorship Program, Dana-Farber Cancer Institute, Associate Professor of Medicine, Harvard Medical School, gives an overview of the Adult Survivorship Program.

In the program at Dana-Farber, Partridge is looking to provide all cancer survivors with more comprehensive care from the beginning through their long-term survivorship.

The program focuses on issues that are related to the aftermath of cancer and cancer treatment such as long-term or late toxicities, optimization of health behaviors, and emotional well-being. Further, care coordination is important for patients to receive streamlined, comprehensive care and are not seeing too many providers.

Ann H. Partridge, MD, MPH, from Dana-Farber Cancer Institute and Harvard Medical School, gives an overview of the Adult Survivorship Program.

Ann H. Partridge, MD, MPH

Articles

Dr Partridge on Unique Treatment Challenges for Young Patients with ER+/Node-Positive Breast Cancer

Dr Partridge on Breast Cancer Recurrence in Young Breast Cancer Survivors

Dr. Partridge on the Utilization of GnRH Agonists in Breast Cancer

Dr. Partridge on the Role of Genomic Testing in Breast Cancer

Dr. Partridge on PGD in Young Patients With Breast Cancer

Dr. Partridge on Dana-Farber's Adult Survivorship Program