Breast cancer in young women is biologically different than those who get it at an older age. Breast cancer in young women also typically comes with a worse prognosis and is diagnosed with a later stage of the disease. These women face a myriad of challenges, which often aren’t talked about prior to the initiation of treatment such as the impact of treatment on fertility or the impact a cancer diagnosis has on the patient’s young children.
The HER program at Brown Cancer Center, which stands for Hope, Empower and Restore, addresses these challenges with regional experts in the management of breast cancer in young women and offers treatment regimens that provide:
Hope for cure
Empowerment of choice in therapy and risk
Restoration after cancer treatment
About the HER program
Patients 45 and younger who are diagnosed with breast cancer are automatically enrolled in the HER program upon referral to Brown Cancer Center. Upon an initial appointment with a medical oncologist to introduce the program and offerings, it is determined the types of services which may need an early referral: medical, research and/or support services. Read more about the specific services offered under the tabs for each of these categories.
While the same issues impact patients of all ages, they are most pronounced in this group. Younger women are more likely to be high risk and get more aggressive therapy. In addition, they are more likely to be concerned about their role at work, at home, in sexuality, attractiveness and family planning. The HER program was developed to address these issues from the beginning so the patient can continue to live life as normally as possible while undergoing treatment and be prepared to move forward as a cancer survivor.
Breast imaging is the first step in the early detection and diagnosis of breast cancer. All breast ultrasounds performed at the Brown Cancer Center are performed by radiologists, the doctors who specialize in breast imaging, and not performed by technologists.
Multiple studies confirm that regular screening mammography cuts cancer deaths by roughly one-third.
Recommendations for when to begin screening vary across several medical organizations. Brown Cancer Center follows the American College of Radiology, Society of Breast Imaging and American Society of Obstetricians and Gynecologists which continue to recommend annual screening mammography beginning at age 40. Annual screening mammography starting at age 40 results in the greatest mortality reduction, the most lives saved and the most life-years gained. This is why the American College of Radiology and the Society of Breast Imaging recommend regular mammography in women 40 and older.
You are at average risk of breast cancer if you have:
- No symptoms
- No personal history of breast cancer
- No family history of breast cancer in a first-degree relative
- No history of mantle radiation (radiation treatment to the chest area used to treat some cancers)
It is important for all women to be screened and even more so for those at high risk. Some women, based on individual risk factors, are recommended to begin screening before age 40. Your health care provider may use different tools to determine your risk and help you make a personalized cancer screening plan.
You are at increased risk for breast cancer if you have:
- BRCA1 or BRCA2 gene mutation
- An ATM, CHEK2 or PALB2 gene mutation
- Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome (TP53 or PTEN gene mutation)
- Strong family history of breast cancer, such as a mother or sister diagnosed at a younger age
- Personal history of breast cancer
- Personal history of high-risk lesion, such as lobular carcinoma in situ (LCIS) or ductal carcinoma in situ (DCIS)
- Radiation treatment to the chest area between ages 10-30
Early screening guideline per American Cancer Society guidelines:
- Women at greater than 20 percent average lifetime risk: Yearly mammogram and breast MRI beginning at age 30
- Women with a history of radiation treatment to the chest between ages 10-30: Yearly mammogram and breast MRI beginning at age 30
- Women with certain genetic mutations such as BRCA1 and BRCA2: Yearly mammogram and breast MRI beginning at age 30
- Women with a history of a mother or sister diagnosed with breast cancer at an early age: Annual mammography starting no later than 10 years before the age of the earliest diagnosis in the family (but no earlier than age 25 and not later than age 40)
Your healthcare provider can discuss your individual risk factors with you and discuss screening options. We are committed to the highest quality of care, including offering patients access to the newest technological advances in the fight against breast cancer.
What if I have dense breast tissue?
Dense breast tissue is common and normal. Approximately 40 percent of women over 40 have dense breasts. Dense breasts are more common in younger women. Dense breast tissue can sometimes hide findings on screening mammography and is now being included in risk modeling. This along with other known risk factors for breast cancer is used to evaluate an individual’s lifetime risk. It is important to note that extremely dense breasts as a sole risk factor does not put women into a high lifetime or 10-year risk of breast cancer. If you have dense breast tissue along with other risk factors you may qualify for adjunctive screening such as breast MRI.
Digital breast tomosynthesis (DBT or 3D) mammography creates image slices through the breast, reducing overlap of normal dense tissue and thereby allowing improved cancer detection across all breast densities. Numerous studies show an improvement in invasive cancer detection. DBT has also been shown to reduce false positive recalls across all breast densities. This means less anxiety and fewer doctor visits. The greatest reduction in recall rate was found in women with extremely dense breasts. Digital mammography is now covered by many insurance companies and can be requested when scheduling.
Based on individual risk stratification, a young woman with dense breasts and additional risks may also qualify for additional screening with Breast MRI in addition to annual mammography. Contrast enhanced magnetic resonance imaging (MRI) is recommended for supplemental annual screening in women who are at a high risk of breast cancer based on risk modeling and, although not perfect, it is currently the most sensitive test available for detecting breast cancer. It is a vascular-based test and IV contrast is given during the examination. Breast MRI is performed in addition to and does not replace an annual mammogram.
The HER Breast Cancer Program offers a variety of medical services including those focused on curing cancer itself, and others dealing with the side effects of cancer treatment.
Cancer Treatment and Surgery Options
Medical oncologists specialize in the treatment of cancers of all stages. These physicians oversee chemotherapy, targeted therapy (such as tamoxifen or aromatase inhibitors), as well as immunotherapy.
Dedicated breast surgeon
Premenopausal patients with breast cancer benefit from surgical treatment in conjunction with radiation therapy and chemotherapy.
Mastectomy (removal of the entire breast) and lumpectomy (removal of the cancerous lump) have been proven to have equivalent survival results.
For patients with small tumors, breast-conserving therapy (lumpectomy followed by whole breast radiation) is an excellent option. This operation can be done as an outpatient procedure and requires a short recovery time, with good cosmetic results and preservation of breast sensation.
Some patients with large breasts may have a breast reduction at the time of lumpectomy to improve the appearance of the breast and facilitate radiation therapy, a concept known as oncoplastic breast surgery. Read more about plastic surgery options below.
For patients with larger or multiple tumors, a mastectomy is indicated. For those with a strong family history or hereditary breast cancer, a risk-reducing mastectomy of the opposite breast should be considered.
Young patients are very motivated to have their breasts reconstructed by a plastic surgeon after a mastectomy. In these situations, the skin over the breast (skin-sparing mastectomy) and sometimes the nipple can be preserved (nipple-sparing mastectomy) to improve the cosmetic outcome of the reconstruction. Read more about breast reconstruction options below.
Lymph Node Biopsy and Removal
At the time of surgery, the lymph nodes in the axilla should also be evaluated. For patients without clear evidence of cancerous involvement of the lymph nodes, a limited lymph node sampling (sentinel lymph node biopsy) allows us to rule out lymph node involvement with minimal discomfort or risk for arm swelling. When cancerous lymph node involvement is confirmed prior to surgery, a thorough removal of all the axillary lymph nodes is necessary at the time of surgery.
Oncoplastic reconstructive surgery
Plastic surgery at UofL Health is available and involved in most breast cancer patients cared for at Brown Cancer Center. Our Plastic surgeons are board-certified in plastic surgery by the American Board of Plastic Surgery. As authors of many textbook chapters and research publications, we are experts in the field of breast reconstruction and able to provide cutting-edge options for reconstruction after mastectomy or partial mastectomy operations.
Our team of plastic surgeons is highly skilled and trained and thus they can provide implant-based reconstruction, flap reconstruction (taking tissue from another part of the body), fat grafting, nipple reconstruction and nipple tattoos. Breast reconstructions can be performed at the time of the cancer removal surgery or delayed after other cancer treatments. Read more about these options below.
We strive to individualize the care of each patient to provide the safest and most appropriate procedures to our patients with an emphasis on cancer treatment first and foremost.
Implant-based reconstruction is most common and involves placing a tissue expander at the time of the mastectomy. The tissue expander is filled with fluid over time to stretch the skin and create a pocket for the implant. You will work with your surgeon to determine the desired size. Once the tissue has expanded to the desired size, a second surgery takes place to remove the expander and place a permanent gel implant. Later, the areola and nipple can be "reconstructed" with a tattoo.
Autologous flap reconstruction
Autologous flap reconstruction involves using your own tissue to reconstruct the breast. The tissue itself is called a flap and it's taken from a "donor site" on your body. Flaps may be taken from latissimus myocutaneous (back), transverse rectus abdominis myocutaneous (abdominals), superior gluteal artery (buttocks), and DIEP (free tissue transfers).
An oncoplastic breast flap reconstruction is another option, which is a skin-sparing mastectomy and may also preserve the nipple. Unlike a traditional mastectomy, skin and nipple-sparing mastectomies preserve a thin layer of fat and blood vessels to maintain blood flow and keep the tissue viable. In this case, breast reconstruction would occur at the same time as the mastectomy. If the nipple cannot be spared, the areola and nipple can be "reconstructed" later with a tattoo.
Fat grafting is a minimally-invasive procedure which involves liposuctioning fat cells from another part of the body to be injected into the breast. This is often used to improve the breast shape or size after a flap reconstruction, but it may also be used after a lumpectomy.
If you have been diagnosed with breast cancer, radiation therapy will likely be required as part of your treatment. Radiation Oncology at Brown Cancer Center offers patients the world’s most sophisticated cancer-fighting technology and most proven radiation treatment techniques available. Our radiation oncologists are experts in radiation therapy and offer specialized care for cancer treatment. Each cancer diagnosis requires an individually-designed treatment plan based on the type and stage of the tumor.
We were the first in the Kentuckiana region to receive a three-year accreditation for the American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR).
Other consultation and treatment options
Breast cancer affects approximately 10 percent of women in their childbearing years. Breast cancer treatments may adversely impact a young woman’s fertility. Discussing strategies to preserve fertility prior to the initiation of breast cancer therapy is an integral part of maintaining the quality of life after cancer in young women.
Our OB/GYN & Women's Health providers can also assist with other gynecological issues you may face before, during or after treatment. Learn more about UofL Physicians – OB/GYN & Women's Health.
Sexual health and wellness expertise
We understand the impact that breast cancer treatment may have on a woman physically and psychologically. A change in body shape can affect how you feel about your sexuality and womanhood. Our sexual health and wellness experts can discuss body image with you, help you deal with these changes, including any pain or change in libido.
Our medical social worker has 30 years of experience, including 20 in oncology.
Cancer Rehabilitation is focused on your function before, during and after cancer treatments. Learn more about Cancer Rehabilitation.
Cardio-oncology is a subspecialty that assists in the overall care of cancer patients with and without cardiovascular disease. Learn more about cardio-oncology.
High-Risk genetics clinic
Not all breast cancers are hereditary, but anytime someone under age 50 has cancer, there is a higher risk of it being hereditary.
M. Krista Loyd Cancer Resource Center
From coffee to counseling, the M. Krista Loyd Resource Center was created to help connect patients and family members with complementary services needed to aid in their healing.
For patients and their loved ones, a cancer diagnosis means having to understand information about treatment plans, side effects and complicated medical terms that can often be confusing and frightening. For those just beginning their families and/or careers, a cancer diagnosis challenges the very essence of their being creating questions to an unknown future.
Inside the M. Krista Loyd, you will find services that provide an environment to learn, relax and heal emotionally. All services are offered free of charge to both the patients and caregivers.
- Massage therapy is the therapeutic practice of manipulating the muscles too ease tension, reduce pain and reduce stress.
- Personalized art therapy sessions promote the healing process with the power of expression through artistic creations.
- Reiki therapy is a simple therapeutic touch technique that improves the flow of energy in a person reducing tension and stress.
- Educational classes concerning chemotherapy, radiation and surgery are offered along with one-on-one nutritional counseling.
- Behavior oncology offers counseling sessions for patients dealing with stress, depression and anxiety.
The M.Krista Loyd Resource Center has partnered with Gilda’s Club of Louisville offering support groups so that family and friends can join with others to build social and emotional support as a supplement to medical care.
Kids Inquire, We Inform (KIWI)
Many of our young patients still have children at home. A special program, KIWI (Kids Inquire, We Inform) was established to provide information and give children and adolescents the tools to work their way through the parent’s diagnosis. This has been highly successful in building good communication channels for parents and their children during a very stressful time. When “normalcy” is not normal and things aren’t exactly what they seem, this program which includes art therapy serves as a way to express feelings about illness, treatment and life itself. The primary focus is to open the conversation between family members dealing with cancer.
When radiation and chemo are over, and a cancer patient no longer needs treatment, a patient and their family still have unique needs to thrive in life and focus on living normally again. The Survivorship Clinic at Brown Cancer Center helps patients transition from active treatment into surveillance mode.
UofL Physicians providers see patients from the Brown Cancer Center after treatment is completed, ideally within a couple of months, to provide education and help patients grasp hold of what’s happened and how they can move forward.
We understand that this is a unique period of time and we focus on educating patients about their diagnosis and potential short and long-term side effects from their treatment. We spend time discussing strategies to restore function and improve quality of life. We help manage physical dysfunctions as well as emotional well-being, sexual dysfunction and sleep disturbance. We also educate our patients on their unique cancer surveillance needs. Survivorship care also focuses on healthy lifestyle choices with exercise, nutrition and tobacco cessation.
The success of the clinic is centered on a Survivorship Care Plan, which serves as a roadmap to transition from active treatment to anticipate needs in post-cancer life. This also helps close any disconnect between oncologists and primary care physicians, by helping guide patient care so the PCP can anticipate unique needs and better treat that patient in the future.
Our physicians work both in the treatment of breast cancer patients but are also dedicated to understanding new and innovative treatments which help save lives. One of the missions of the HER program is to better understand why cancer is different in young women and how treatment can be improved to save more lives and provide less side effects for patients.
We are leading the research of Brown Cancer Center’s breast cancer program to find new and innovative treatments for breast cancer with the goal to reduce the number of breast cancer deaths in the region and worldwide.
The HER program aims to increase specific research to this patient population and gives patients an opportunity to contribute to such research through the donation of blood and tissue.
We can also provide direction on any clinical trials tailored to young women with breast cancer that you may qualify for.