Not One-Size-Fits All: The Unique Needs of Young and Elderly Breast Cancer Survivors

In part two of our series on survivorship, we illuminate age-dependent challenges breast cancer survivors face and some BCRF projects focused on these groups

This is the second blog in BCRF’s three-part series, Thrivership After Breast Cancer. BCRF is exploring the nuances and realities of breast cancer survivorship: the emotional and physical challenges of the disease, the lingering effects of treatment, the latest in research to improve thrivers’ quality of life, and more. Read part one and part three.

More and more women and men are surviving breast cancer. Currently, there are an estimated 3.8 million breast cancer survivors in the United States. While breast cancer incidence rates continue to rise, the number of survivors is increasing as early detection and treatments improve, leading to longer survival. As the number of breast cancer thrivers grows, so does the necessity of research into challenges they face.

The likelihood of developing breast cancer increases with age. Only about five percent of women diagnosed with breast cancer in the U.S. are younger than 40. After 40, rates begin to climb and are highest in women over age 70. But that doesn’t mean these women and men experience breast cancer in exactly the same way. Surviving and thriving at different life stages come with their own challenges and needs.

In the first of BCRF’s three-part series on survivorship and thrivership, we discussed common issues many thrivers experience. Here in the second part of the series, we explore age-dependent issues thrivers may experience and highlight BCRF-funded work to understand and confront them.

The unique concerns of young survivors

A breast cancer diagnosis at a young age presents a host of challenges—both physical and emotional.

Breast cancers in women under the age of 40 are often more advanced at the time of diagnosis and tend to behave more aggressively.

Mammogram screening, the gold standard for early detection, does not typically begin until women are in their 40s. Tumors detected in those who are younger, therefore, are often larger and at a more advanced stage. These are more likely to be more aggressive subtypes, such as HER2-positive or triple-negative breast cancers, for reasons that are not well-understood.

For young breast cancer thrivers who want to have children, fertility preservation is a major concern. Premenopausal women who undergo a chemotherapy regimen may experience damage to their ovaries and/or a medical menopause, which can stop a period temporarily or permanently. The younger a woman is, the lower her risk that menopause will be permanent, and fertility will not be affected. In some cases, oophorectomy (removal of the ovaries) is recommended as part of treatment—the suddenness of which can lead to intense menopausal symptoms.

The good news is that women may have options to preserve fertility before starting breast cancer treatment, such as freezing embryos, eggs, or ovarian tissue.

Young women are also more likely to suffer emotionally and socially because of a breast cancer diagnosis. Fear, anxiety, and depression are common and can occur because of issues surrounding sexual health, self-image, and fertility to name a few. All these factors come together to make it difficult for young women to thrive beyond breast cancer—and especially highlight the need for further research and support for this group.

BCRF researcher spotlight:

• Dr. Meredith Regan has been involved in clinical trials that support the use of ovarian suppression drugs in addition to anti-estrogen therapy to preserve fertility in women who intend to have children after treatment. She is analyzing the data from these trials and conducting follow-up studies of trial participants to ensure that ovarian suppression reduces the risk of breast cancer recurrence and to identify any long-term side effects.
• Dr. Ann Partridge is improving our understanding of the unique and complex medical and psychosocial issues facing young women with breast cancer. She has launched an internet-based intervention program, Young Empowered and Strong, that follows and supports patients over time and points them to education and supportive care resources. 

The unique concerns of older survivors

Almost half of breast cancer survivors are over the age of 65—about 1.5 million women in the U.S.—and over 820,000 of these women are age 75 or older. This population continues to grow as people are thriving beyond breast cancer and living longer lives.

Older breast cancer survivors must cope with health issues related to their treatment and the aging process. Most, but not all, breast cancer cases that emerge in this older population are the estrogen receptor–positive subtype and tend to be slow-growing and not as aggressive as other types of breast cancer. However, it is the subtype that is most likely to have late recurrences.

While treatable, older patients can respond to therapy very differently. Chemotherapy dosing must be closely monitored for potential toxicities, such as congestive heart failure and osteoporosis, while still effectively fighting the breast cancer. Therapies can have age-accelerating effects that may lead to premature health decline and frailty. In addition, other existing conditions might be exacerbated by treatment.

Older thrivers are also more likely to struggle with side effects that impact quality of life than their younger counterparts, including sleep, cognitive functioning, physical activity, nutrition, and depression. Gaps in care have emerged as the number of older breast cancer thrivers increases—which must be addressed through research to improve the health and well-being of this population.

BCRF researcher spotlight:

• Dr. Hyman B. Muss is researching the effects of chemotherapy on aging of the immune system. He is identifying ways to lessen this process and other unwanted side effects and improve patients’ quality of life.
• Dr. Laura Biganzoli is working to identify biomarkers that predict how older patients respond to anti-cancer drugs in order to guide clinical management. Aging is associated with a progressive decline in the function of multiple organ systems, which may influence a patient’s response to cancer therapies and reduce normal tissues’ tolerance to these treatments.
• Dr. Electra Paskett is studying the effects of aging and of lifestyle factors on cancer survivors. She and her team are creating a standardized, longitudinal assessment of physical function among a large cohort of older female cancer survivors. This assessment will illuminate the relevance of aging, lifestyle, behavioral factors, and nutrition on breast cancer incidence as well as the long-term impact of a breast cancer diagnosis.

As part of our investment in survivorship research that improves quality of life for all, BCRF is committed to supporting research that addresses the distinctive needs of young and elderly breast cancer thrivers to help them live as fully as possible.

Read part one of BCRF’s Thrivership After Breast Cancer series—on common physical and mental symptoms thrivers experience and BCRF research to address them—here. And read part three—a BCRF researcher’s advice for navigating life after breast cancer—here.