Breast Cancer in Young Women: Implications for Pregnancy, Lactation, and Fertility Preservation

The care of young women with breast cancer can be influenced by pregnancy and desire for future fertility. Here, we provide an overview of breast cancer management in young women with special emphasis on gestational breast cancer and postpartum breast cancer, which are now understood to be distinct clinical entities with disparate outcomes. Typically, breast cancer is detected in young women after self-identification of a breast mass. The initial workup consists of diagnostic breast ultrasonogram and mammogram. Breast cancer treatments vary by histologic subtype of cancer and stage. Chemotherapy and surgery are safe during pregnancy, and it is now known that pregnant women with breast cancer have oncologic outcomes equivalent to those of nonpregnant women when treated according to standard of care. Postpartum breast cancer, however, has higher rates of metastatic disease and mortality. In general, breastfeeding can be safely continued during treatment with appropriate counseling and guidance from a breastfeeding medicine expert. Similarly, fertility preservation and future fertility can be safely pursued with appropriate interventions in young women with breast cancer.