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Younger Women Experience Distinct Treatment-Related Effects

Quality of life, fertility and menopausal side effects, and behavioral health top list of concerns

April 2, 2012

Written By Robin Warshaw, Contributing Writer
Reviewed By Gregory D. Garber, MSW, LCSW

A systematic review of studies on younger women diagnosed with breast cancer found they may have frequent or significant difficulties in three key areas: quality of life, fertility or menopausal concerns, and behavioral health.

Published online in the Journal of the National Cancer Institute by researchers from the University of California Los Angeles, the review looked at numerous studies of various emotional and health-related outcomes for women younger than 51, the average age of menopause.

Background and Reason for the Review

As treatments for breast cancer improve, younger women are living many years beyond diagnosis. They account for about 25 percent of all women affected by the disease and have certain concerns that differ from those of older women.

Younger women face distinct effects on physical function and mental health. Treatment may stop menstrual periods and produce premature menopause, cause menopausal symptoms (hot flashes, vaginal dryness, etc.) and result in infertility. Women who are younger when diagnosed may also gain weight and become less physically active.

Emotional well-being may be affected, with common concerns including depression, anxiety, distress over physical symptoms and worry about the risk of recurrence, or cancer returning.

The reviewers wanted to identify what is known—and what needs further study—about younger women’s health-related quality of life. Their work will help guide research that could improve care, relieve symptoms, reduce risk and prevent more cancers in young women.

Structure of the Review

Findings were drawn from 28 studies, performed over 15 years, that looked at women who were younger than 51 or premenopausal when diagnosed. Standardized measures assessed various aspects of functioning including quality of life and depressive symptoms. Results were compared with women of similar age without cancer and older women affected by breast cancer.

The reviewers considered demographics (age, number of children, living situation, etc.), medical and emotional factors (including social support and coping skills) and differences in disease and treatment types. Each outcome was looked at separately.

Review Findings

Compared to the other two groups, younger women had some reduction in quality of life, with emotional well-being more severely affected than physical functioning. Chief anxieties were about what would happen in the future and fear of recurrence. Depressive symptoms, including loss of sleep, depressed mood, guilt and appetite changes, were relatively common, especially among women younger than 35.

Menopausal symptoms such as hot flashes, vaginal dryness and lack of sexual desire bothered many. Not surprisingly, women who wanted to have children worried about fertility.

Study differences limited conclusions about weight gain, but it was a concern. Physical activity lessened during treatment and increased afterward, with many women still exercising years later.

The reviewers noted that relationships among the three key areas may be important, such as how weight gain and physical changes caused by premature menopause might produce distress. An approach that integrates the range of outcomes may be needed, they stated.

They concluded more research is needed on methods for younger women that promote healthy weight, preserve fertility, ease menopausal symptoms and manage depression and anxiety. They urged addressing other long-term and late effects, such as heart problems, that were not looked at in the review. All these areas are important to explore, given that many young women live a long time after breast cancer treatment.

What This Means for You

It’s important to address the physical and emotional life changes you may feel after breast cancer. Doing so will help support and strengthen your quality of life for years. For example, talking with your healthcare provider and finding relief for menopausal symptoms or emotional concerns can make it easier to remain on hormonal therapies, which can significantly reduce the risk of cancer returning.

If you are having difficulties with mental or physical function, don’t assume that things can’t improve! Speak with your doctor, nurse or other provider, or call our   Breast Cancer Helpline at (888) 753-LBBC (5222) to talk one-on-one with a woman who has been on the same road as you.

Studies mentioned in this article:

J Howard-Anderson, P Ganz, J Bower, A Stanton. Quality of Life, Fertility Concerns, and Behavioral Health Outcomes in Younger Breast Cancer Survivors: A Systematic ReviewJ Natl Cancer Inst 2012;104:1–20.

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.