Editor’s Note: The 6th Precision Oncology Summit and the 9th Individualized Breast Cancer Treatment Conference (2023 COMB) were held from December 23 to 26, 2023, in a hybrid online and offline format. Professor Yuan Peng from the Cancer Hospital of the Chinese Academy of Medical Sciences delivered a lecture on “Precision Diagnosis and Treatment Strategies for Young Breast Cancer”. After the conference, Oncology Frontier conducted an exclusive interview with Professor Yuan, where she shared her experiences related to the diagnosis and treatment of young breast cancer.
Oncology Frontier: “How is ‘young breast cancer’ defined, and what are the clinical and pathological characteristics of these patients?”
Professor Peng Yuan: Currently, there is no international consensus on the age definition of young breast cancer. According to the “2022 Chinese Young Breast Cancer Diagnosis and Treatment Expert Consensus” [1], young breast cancer is defined as patients aged ≤40 years. The “Expert Consensus on Diagnosis and Fertility Management of Young Breast Cancer” [2] specifically refers to breast cancer patients who are diagnosed at ≤35 years of age. In contrast, the 5th edition of the “International Consensus Guidelines for Young Women with Breast Cancer,” released by the European Society of Medical Oncology in August 2022 [3], defines young women with advanced breast cancer as those diagnosed before the age of 40 with inoperable locally advanced or metastatic disease. As you can see, there are some differences in how young breast cancer is defined across various guidelines. Young breast cancer patients draw our attention because they have a higher risk of recurrence. Histologically, these patients often have a higher proportion of high-grade tumors and higher expression of Ki-67. We have conducted a cohort study on young breast cancer patients in China from 2000 to 2017 across eight centers nationwide, finding an increasing trend in the proportion of young breast cancer patients over nearly two decades. Additionally, as drug treatment options have expanded, the percentage of HR+ young breast cancer patients in China opting for stronger endocrine therapies has increased, as has the percentage of patients completing more than five years of endocrine therapy, showing that the diagnosis and treatment of young breast cancer in China are becoming more standardized. To further standardize and individualize the treatment of young breast cancer, collaborative efforts are essential.
Oncology Frontier: “Breast cancer treatment advocates ‘type-specific management.’ Do young breast cancer patients of different subtypes have the same clinical treatment needs? Please share based on your clinical experience.”
Professor Peng Yuan: Currently, the overall treatment strategy for breast cancer is based on the patient’s molecular subtype, categorized as “type-specific management.” However, young breast cancer patients have unique characteristics. For example, the SOFT&TEXT study shows that for HR+/HER2- young breast cancer patients with a higher risk of recurrence, the combination of ovarian function suppression (OFS) and aromatase inhibitors (AI) should be the preferred treatment option. For patients with low to moderate recurrence risk, OFS plus tamoxifen (TAM) can be considered. Previously, TAM was often the first choice for HR+/HER2- young breast cancer patients, but recent study results indicate that different treatment options should be considered for young patients with varying risks of recurrence. We have also found that young breast cancer patients have strong fertility desires. Before the relaxation of the two-child policy, our surveys showed that about one-fourth of young breast cancer patients (≤35 years) had fertility desires. Currently, chemotherapy is the main treatment for triple-negative breast cancer, and chemotherapy drugs significantly affect the fertility of breast cancer patients (especially premenopausal patients). Some domestic studies have shown that adjuvant chemotherapy without cyclophosphamide for triple-negative breast cancer patients aids in menstrual recovery and ovarian function restoration without affecting chemotherapy efficacy. Moreover, compared to other subtypes, triple-negative breast cancer patients have a poorer prognosis and a higher proportion of BRCA mutations among young triple-negative breast cancer patients. Therefore, guidelines recommend BRCA gene testing for breast cancer patients under 35. If a BRCA mutation is present, treatment with PARP inhibitors may be considered. Thus, in clinical practice, we also recommend routine BRCA testing for young breast cancer patients, especially those with a family history of breast cancer, as it helps in subsequent treatment and reducing recurrence risks.
Oncology Frontier: “How do multi-gene tests help advanced breast cancer patients move towards precision treatment?”
Professor Peng Yuan: Multi-gene testing is widely used in clinical practice, and international guidelines recommend that advanced breast cancer patients undergo multi-gene testing at various time points. I believe young breast cancer patients also need multi-gene testing. In the “Chinese Expert Consensus on Hot Issues in Genetic Testing for Advanced Breast Cancer,” we mentioned that different subtypes of patients should undergo different multi-gene tests. For instance, we recommend BRCA mutation testing and PI3K mutation testing for patients with triple-negative advanced breast cancer; for HR-positive patients, we suggest testing for pathways like ESR1. Past research has shown that patients who undergo genetic testing have advantages in treatment. With the increasing use of immunotherapy in clinical practice, tests like PD-(L)1 and TMB are likely to become part of the drug treatment selection for advanced breast cancer patients. Thus, we also recommend that young advanced breast cancer patients undergo repeated and multiple multi-gene tests at different time points to provide more treatment options.
Professor Yuan Peng:
- Chief Physician, Professor, Doctoral Supervisor, MD
- Deputy Director of the Special Medical Department at the Cancer Hospital of the Chinese Academy of Medical Sciences
- Executive Committee Member and Secretary-General of the Breast Cancer Committee of the Chinese Anti-Cancer Association
- Expert reviewer for the National Natural Science Foundation of China
- Expert reviewer for the Beijing Municipal Natural Science Foundation and other funds
- Member of the Expert Group on Consensus for Advanced Breast Cancer in China
- Member of the Expert Group on Breast Cancer Diagnosis and Treatment Standards
- Recipient of the 5th “People’s Top Doctor” award
- National March 8th Red-Banner Holder
- Has led numerous major scientific research projects under the National Key Research and Development Program, National Natural Science Foundation of China, and the Capital Medical Development Research Fund
- Author of over one hundred papers published nationally and internationally, recipient of several provincial and ministerial-level Science and Technology Progress Awards, voted as “Doctor in My Heart” and “Hurun China’s Good Doctor” by numerous patients
- Specializes in comprehensive diagnosis and treatment of breast cancer
