Hot Topics in Breast Cancer

Leisha Elmore, MD, assistant professor of surgery at the Hospital of the University of Pennsylvania, spoke with Healio about early-onset breast cancer, including the role of genetic testing after identifying patients with early-onset breast cancer and whether current screening guidance should be updated in consideration of patients with early-onset disease.

In a written comment, Elmore told Healio, “While I do not think breast screening guidance should be changed, I think the messaging around the proper age to initiate screening is convoluted and frankly confusing.

“There are conflicting guidelines on when to initiate screening, ranging between 40 and 50 years of age, from prominent national organizations such as the American College of Surgeons, U.S. Preventive Services Task Force and American Society of Breast Surgeons,” she added. “It is important for all patients to start annual breast cancer screening at the age of 40, where breast cancer rates begin to increase significantly.”

In these videos, Elmore also discussed:

• the challenges of treating early-onset breast cancer and that these factors should be considered when creating treatment plans — “many of these women are in the midst of their careers, many of these women are still undergoing childbearing and family planning, and many of these women provide financially for their family”;
• racial disparities in early-onset breast cancer, including a higher prevalence of early-onset disease in Black women because while “we do know that Black women are more likely to have triple negative breast cancer … it’s not all biology; there are important social determinants of health as well,” including access to primary care, genetic counseling, and more;
• differences in survivorship between patients with early-onset breast cancer compared with women diagnosed later in life; and
• the importance of having conversations with patients about family planning and fertility before beginning treatment — “it’s a very difficult conversation to broach, but very critical.”