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Article • San Antonio Breast Cancer Symposium (SABCS)
Young women and breast cancer: research in focus
At the San Antonio Breast Cancer Symposium (SABCS) in December, three experts presented new approaches and study results for the treatment of breast cancer in young women.
Article: Sonja Buske
Image source: CSHL
In her lecture, Camila dos Santos explained that the development of the mammary glands is strongly controlled by hormones that promote cell growth and cell division. ‘During pregnancy, there are significant structural and functional changes in the breast, such as the expansion of cells and the production of new proteins to prepare for milk production,’ said the Associate Professor at Cold Spring Harbor Laboratory, New York. ‘These hormonal influences not only change the growth pattern of epithelial cells but also affect the collagen structure of the breast and its alignment, as shown by microscopic techniques such as collagen staining.’
She emphasized that pregnancies leave epigenetic changes that permanently affect the gene expression of breast cells. ‘Early pregnancies can reduce the risk of breast cancer by 30-40%, depending on the subtype and genetic mutations. This protective effect often lasts into postmenopausal age,’ explained dos Santos. Using mouse models, it was shown that pregnancies promote cell aging, which inhibits tumour development. It was also discovered that pregnancy affects the immune system by infiltrating certain types of T cells that can alter the tissue environment of the breast and inhibit tumour growth.
Urinary tract infections promote tumour growth
The systemic effects of urinary tract infections (UTIs) on the breast are still relatively unknown. They lead to a systemic inflammatory reaction and increased collagen deposition in the breast. In mouse models, it was found that UTIs cause hyperplasia of the mammary gland ducts and changes in cell behaviour. These changes can accelerate tumour growth in genetically susceptible models. ‘Pregnancy and systemic factors such as infections can influence breast development and breast cancer risk in multiple ways. These findings could lead to the development of preventive therapies that modulate the immune system or influence epigenetic changes to reduce breast cancer risks,’ summarized the expert.
Image source: Peter MacCallum Cancer Centre
In her presentation, Professor Prudence Francis looked at various approaches to suppressing ovarian function in premenopausal women with early breast cancer. The medical oncologist breast cancer clinician-researcher at Peter MacCallum Cancer Centre, Melbourne, Australia, pointed out that ovarian function can be reversibly suppressed by GnRH agonists, which is particularly suitable for young women to avoid permanent menopause. ‘Alternatively, surgical menopause is an option for women close to the natural menopausal age,’ says the expert.
Monitoring estradiol levels is also important to ensuring effective suppression of ovarian function. ‘In clinical practice, this is often not done routinely unless specific symptoms indicate that suppression is inadequate. However, studies show that younger women, women without chemotherapy, and those with higher BMI are at increased risk of not achieving persistent suppression,’ Francis explained. Ovarian suppression is particularly indicated in premenopausal women with a high risk of recurrence, for example in very young women or those who are to be treated with an aromatase inhibitor. For premenopausal women with estrogen receptor-negative breast cancer, ovarian suppression is increasingly being discussed as a means of reducing the risk of premature menopause. ‘Although there is no oncological benefit in this group, the quality of life and health of women could be improved by avoiding premature menopause,’ the expert made clear.
Aftercare and treatment: a multidisciplinary approach
image source: Johns Hopkins Medicine
Dr Jenni Sheng addressed the various aspects of follow-up care and treatment for young women with breast cancer in her presentation. The Assistant Professor in the Department of Oncology at the Johns Hopkins University School of Medicine, Baltimore, emphasized that a multidisciplinary approach is necessary to optimize survival and quality of life, as this patient group is often underrepresented in studies. ‘There is a particular focus on fertility and family planning, including the importance of early fertility preservation discussions. Studies show that pregnancy after breast cancer does not worsen disease-free survival or overall survival,’ said Sheng. Another key point of her presentation was psychosocial health: ‘Younger patients often suffer from higher levels of psychological stress. The fear of relapse is widespread, but can be reduced through cognitive interventions,’ the expert made clear, emphasizing the importance of couples therapy to improve coping strategies. Problems such as insomnia could be successfully treated with a combination of cognitive behavioural therapy and light therapy.
Finally, Sheng discussed support programmes for young adults. These should cover a broad spectrum, from psychosocial support and fertility counselling to the treatment of menopausal symptoms. ‘However, the implementation of such programmes is hampered by limited financial and human resources,’ she criticized.
07.05.2025
