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  • br A Szollar et al European Journal of


    2 A. Szollar et al. / European Journal of Surgical Oncology xxx (xxxx) xxx
    of research priorities were identified. Young (from 36 to 45 years) and very young ( 35 years) women with breast cancer (YWBC and VYWBC, respectively) have become a more recent focus, with im-provements in diagnosis, treatment, and survivorship [4,5]. Ac-cording to the literature controversy exists about the definition of very young and young breast cancer and different cut-off have been proposed, it has been shown that younger age is associated with a less favourable prognosis. These findings suggest that young women with breast cancer should be subgrouped into very young and young women populations. The cut-off for young age differed between studies according to the literature and it is unclear whether the survival-age relationship is a linear function across age in premenopausal women. According to the study Han et al. the risk of death rose by 5% for every 1-year reduction in age for patients aged <35 years, whereas there was no significant correlation be-tween risk of death and age for patients aged 35e50 years [6]. VYWBC are more likely to be diagnosed with more aggressive forms of cancer and have a higher mortality rate than older breast cancer patients [7]. Approximately 6.5% of all breast cancers are diagnosed in women <40 years of age, 2.4% are diagnosed in women under the age of 35 and 1% is diagnosed in women under30 years [8].
    According to case-control studies, the likelihood that VYWBC had a detectable BRCA1/2 Lovastatin was 9.4% (compared to a pop-ulation prevalence of 0.2%) [9,10]. In BRCA1/2 mutation carriers, the breast cancer incidences increased rapidly in early adulthood, 10 years earlier for BRCA1 carriers, then plateaued to remain relatively constant throughout the remaining lifetime [11], therefore BRCA1/ 2-related inherited syndrome (Hereditary Breast- Ovarian Cancer Syndrome, HBOC) should be considered when developing treat-ment algorithms for these subgroups. Multimodality treatments such as chemotherapy, endocrine therapy, and local therapies have the potential to significantly impact both the physiologic and psy-chological health of YWBC and VYWBC as they face a diagnosis of breast cancer. The differences in epidemiology and management options, the unique issues surrounding fertility, sexuality, and pregnancy, and the multidisciplinary approach for the treatment of these two subgroups may also frequently incorporate individuals with other areas of expertise, such as surgeons, medical oncolo-gists, radiation oncologists, radiologists, pathologists, clinical ge-neticists, gynaecologists, social workers, and plastic surgeons [12,13].
    Breast cancer in young women tends to develop as more aggressive subtypes (more triple-negative (TN) and more human epidermal growth factor receptor 2 (HER2)-positive disease), pre-sents with a more advanced disease stage at diagnosis and requires individualized treatment plans [14e16]. Mammographic diagnosis in this population is challenging due to increased breast density. Poor sensitivity may lead to missed or misinterpreted lesions in women with dense breast tissue. Therefore, breast cancer in young women usually presents with breast complaints, and clinicians frequently fail to address the possible malignant behaviour of a palpable mass. Women younger than 45 years are less likely to have lower grade breast cancer and are more likely to have oestrogen receptor-negative tumours, nodal metastasis, and larger primary breast tumours [14]. Young age, as a well-known prognostic and predictive factor also impacts local recurrence and overall survival. An analysis of two trial groups, the European Organization for Research and Treatment of Cancer (EORTC) and the National Sur-gical Adjuvant Breast and Bowel Project (NSABP), revealed a higher risk of local recurrence in patients younger than 35 years [17,18]. Overall survival is also affected in women diagnosed when they are younger than 40 years. Studies have shown higher mortality rates in these subgroups [19].