1471-2458: To increase attention to unique issues - Public health Assignment

Internal Code: MAS4413

Public health Assignment

An estimated 232,340 women living in the in the United States were diagnosed with breast cancer in 2013 [1], approximately 11% of whom were under the age of 45 [2]. Young women with breast cancer have the more aggressive disease and lower rates of survival than older women with breast cancer [3]. As a result, this population usually receives more therapy than women who are diagnosed when older (aged 46+) [4,5]. These treatments are physically and emotionally taxing, particularly given the lower survival rates for young women. Additionally, young women with breast cancer face problems unique to or accentuated by their young age, such as completing their education, developing a career, and parenting young children [6]. They are often concerned that their health care providers have not received adequate training on health issues specific to their young age, as the median age at breast cancer diagnosis is 61 [7]. Some young women may also place high importance on body image and attractiveness, which can be detrimentally impacted by cancer treatments. Additionally, younger women can feel isolated from other breast cancer patients due to their relative youth [8]. These life factors and stressors contribute to psychosocial distress, which is greater in this population than in older women with breast cancer at both diagnosis and follow-up [9-13]. Due to these multiple unique issues, the Centers for Disease Control and Prevention has stated that survivorship issues in young breast cancer patients are an important focus for further research and intervention [14]. In addition to the specific concerns outlined previously, young women diagnosed with breast cancer are of childbearing age and may desire biologic children. Cancer treatments can eliminate or delay fertility in premenopausal women [15,16]. Thus, fertility-related concerns must be addressed early to ensure that opportunities for fertility preservation are not missed [17,18]. Although the current recommendation is that fertility risks and concerns be considered in all treatment plans [17], in practice, risks to fertility and fertility options may not be discussed or, if addressed, may be addressed inadequately [13,19-21]. There are a number of factors that may impair attention to fertility: providers may be uncomfortable discussing loss of fertility or may simply forget that this could be an important topic for the patient, given her life stage; providers may also lack knowledge about this topic or feel like they do not have the time to adequately assist patients in making fertility-related decisions, including decisions related to fertility preservation methods [22,23].