Young breast cancer patients in the developing world: Incidence, choice of surgical treatment and genetic factors
Carcinoma of the breast is the most common cause of cancer in women in Western society. Although breast cancer occurs predominantly in older premenopausal and postmenopausal women, it also occurs in young women. Literature defines breast cancer in a young woman (or early onset breast cancer) as occurring in a woman less than 35 years of age. A diagnosis of breast cancer in a young woman impacts severely on all aspects of her life, as well as on those around her. In Africa and other developing countries, the breast cancer burden is increasing and poor reporting and data availability may underestimate the exact numbers. The average age of diagnosis may be younger for women in developing countries than for women in developed countries. African patients are more likely to be premenopausal at diagnosis and the breast cancers tend to be more advanced at presentation than in other population groups in a country such as South Africa. The choice of surgical treatment in early onset cancer depends on various factors. Young age is an independent risk factor for worse outcome regardless of whether a patient had a mastectomy or breast conserving therapy. Breast conserving treatment is an option for treatment of breast cancer in a young patient given the correct indications and that the patient is fully informed about the high risk of local recurrence. The extent of genetic factors such as mutations on BRCA 1 and 2 (BReast CAncer 1 and 2) genes is still largely unknown on the continent of Africa, and much research still needs to be done. In the USA, only 5-10% of early onset breast cancers are attributable to mutations on BRCA 1 and 2 genes, and another 15-20% of early onset breast cancers are due to gene polimorphisms and environmental factors. General breast awareness among women of all age groups in Africa should be promoted. This includes how to perform self breast examinations and to seek urgent medical attention when a breast lump is discovered. In time, given the resources, good screening programmes on this continent to detect breast cancer at its earliest presentation would be the ideal.