ARRS 2022 Abstracts

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E1054. Young Breast Cancer in Women Under 40: A Comprehensive Review
Authors
  1. Hannah Singhal; University of Missouri-Kansas City School of Medicine
  2. Derik Kenworthy; University of Missouri-Kansas City School of Medicine
  3. Amy Patel; The Breast Care Center at Liberty Hospital
Background
Breast cancer is the most common cancer in women throughout the world, including the subgroup of women aged 15–39 years old. Approximately 5.6% of all invasive breast cancers from 2000–2014 were in women less than 40 years old. In 2013, 1,000 of 11,000 women in this age group diagnosed with invasive breast cancer died. These adolescent and young adult women are more likely to have predisposition genes to familial cancers, larger breast tumors, unfavorable biological characteristics, distant metastatic disease at diagnosis, and adverse outcomes when compared to older women. Incidence varies according to race and ethnicity, with a higher incidence of invasive breast cancer in black women. Treatment in this group of patients requires multidisciplinary care including genetics testing, tailored treatment to limit the effects on fertility/pregnancy, and counseling for psychosocial issues and long-term survivorship care.

Educational Goals / Teaching Points
The purpose of this educational exhibit is to review the epidemiology of breast cancer in women less than 40; describe risk factors in this age group; identify important clinical and imaging findings; and discuss the multidisciplinary approach to treatment.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
More aggressive breast cancer phenotypes are seen in women less than 40, who have a higher risk of developing estrogen receptor negative, progesterone receptor negative, and pathologic grade 3 tumors, in addition to vascular or lymphatic invasion. Basal-like and human epidermal growth factor receptor 2 (HER-2) enriched tumors are also more common in younger women. Breast cancer in women less than 40 typically presents as a self-detected palpable mass. Ultrasound is often the first modality for diagnosis in females under 30. A combination of mammography and ultrasound is used for females aged 30–39. MRI can also aid in diagnosis and evaluation of the extent of the disease. On ultrasound, imaging findings include irregular shape, microlobulated-angulated margins, and posterior acoustic enhancement. The presence of a mass with suspicious microcalcifications is most commonly seen on mammography, as well irregular shape and obscured margins. Finally, MRI can be variable and may show mass enhancement or non-mass enhancement with T2W hyperintensity [1].

Conclusion
Breast cancer is the most common malignancy among women less than 40 years old. It presents with more aggressive cancer subtypes and worse outcomes compared to breast cancer in older women. Treatment is therefore different in this group of patients and requires multidisciplinary care including investigation of familial cancer susceptibility and tailored treatment to limit the effects on fertility, premature ovarian failure, or pregnancy, as well as counseling for psychosocial issues and long-term survivorship care.