Q&A with Ann Partridge, MD, MPH

By Ann H. Partridge, MD, MPH, as told to Alexandra Benisek

On the WebMD webinar “Diagnosed before 40: unique impacts of breast cancer in younger women,” Ann Partridge, MD, MPH, of the Dana-Farber Cancer Institute and Harvard Medical School, answered viewers’ questions about young breast cancer risk, treatment options, recurrence, and more.

This depends on your genetic makeup, the type of breast cancer you had at first, and the type of treatment you received. In general, for most young people, the risk of new breast cancer in the other breast is low.

We generally support young and old people who are not at high risk for a new type of cancer to have breast preservation on the side where they had cancer, if possible. They can usually keep their other breast unless we find something wrong.

Clinical trials are a very important way for all of us to learn and improve care today and in the future. It is also helpful for some people to have access to different types of treatment that they might not otherwise have.

I’m a big fan of participating in clinical trials if that’s right for you and if the specific trial makes sense for your disease state. I suggest that you talk to your oncologists and other doctors about clinical trials in which you might participate. You can search for clinical trials at clinical trials.orgor through advocacy organizations and other websites.

I generally suggest testing all young women, as well as some women over the age of 45. Today, it might be useful to consider testing for any woman who is concerned about her future risks.

The tests can also help you determine if your family is at high risk for breast cancer, even without a known gene mutation in your family.

We generally don’t recommend that you think about testing for a BRCA1 or BRCA2 mutation until your mid-20s. But if you’re interested sooner, talk to your doctor and a genetic counselor.

There is not much data on topical estrogens in the vagina for the treatment of vaginal dryness and sexual dysfunction. The data we have have mixed results.

For many people, it may be safe, but we are not sure. Therefore, we often suggest trying non-hormonal moisturizers and lubricants first, and then only using vaginal estrogens when needed (and using them carefully).

But in some cases, there are exceptions, such as in lower-risk patients. It’s a talk to have with your oncologist and gynecologist if you have symptoms.

There are several different endocrine therapy options for most people. These include both aromatase inhibitors and tamoxifen and for younger people. Ovarian suppression is also being used more for higher-risk patients. Tamoxifen alone is also a good option if ovarian suppression causes too many symptoms.

And of course, you can decide to take less than the full 5 to 10 years of endocrine therapy. Longer periods are suggested for higher risk cases depending on your preferences and tolerance. But there is concern that less than 5 years may not give you the full benefit in terms of risk reduction.

For the fear of recurrence, which is a very normal thing for a young breast cancer survivor to feel, there are many strategies. These include deep breathing, exercise, and talking with friends, family, or a trusted therapist or doctor.

It is important to take care of yourself, eat well, get enough sleep, and cut back on alcohol and caffeine, as this can make people feel more anxious.

Some young mothers are able to breastfeed their babies after breast cancer. This may be the case if they are no longer undergoing treatment or are taking a break from treatment and have breast tissue remaining (including the nipple-areola complex).

But it can be hard to breastfeed after radiation.

There are a number of resources that I recommend. First, talk with your doctor and care team about your own needs and concerns about treatment and supportive care.

Second, most cancer centers have a social worker who can help you with your psychosocial concerns. There are also many resources online.

Generally reliable sources include the Susan G. Komen website, Living Beyond Breast Cancer, Young Survival Coalition, the American Cancer Society, Cancer Care, as well as our own Dana-Farber young and strong website.

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