Editor’s Note The 2025 Yat-sen Breast Cancer Conference, held in conjunction with the 2025 CSCO BC Southern Forum, the Second National Conference on the Release of the Chinese Expert Consensus on the Diagnosis and Treatment of Young Breast Cancer, and the Fourth Yat-sen Breast Nursing Conference, took place in Guangzhou from December 26 to 27, 2025. The meeting focused on standardized breast cancer care, the evolution of cutting-edge treatment strategies, and precision management of young breast cancer patients, systematically presenting the latest advances and future directions in the field. During the conference, Oncology Frontier invited Professor Jing Yao from Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, to interpret the newly released Chinese Expert Consensus on the Diagnosis and Treatment of Young Breast Cancer (2025 Edition), and to analyze the characteristics, treatment strategies, and evolving screening approaches for young breast cancer patients in China.01
Oncology Frontier: In recent years, the incidence of breast cancer among young women has continued to rise. Based on the latest epidemiological data, what are the key characteristics of young breast cancer patients in China in terms of age distribution, molecular subtypes, and clinicopathological features?
Professor Jing Yao: Globally, the incidence of young breast cancer has increased significantly in recent years. In Asia—particularly in China—the proportion of young breast cancer patients reaches approximately 10–12.5%, compared with about 4.9% in Western countries. This more pronounced upward trend among young Chinese patients was a key reason why Professor Qiang Liu from Sun Yat-sen Memorial Hospital of Sun Yat-sen University led the development of the Chinese Expert Consensus on the Diagnosis and Treatment of Young Breast Cancer (2025 Edition). Clinically, we are indeed seeing an increasing number of young patients in outpatient practice.
From a molecular and pathological perspective, young breast cancer patients tend to have higher histologic grades. The proportion of grade 2–3 tumors—especially grade 3—is higher than in older patients, and the proportion of locally advanced disease is also greater, making treatment more challenging. In addition, Luminal A breast cancer, traditionally considered a favorable prognostic subtype, paradoxically becomes a poorer prognostic subtype in patients under 40 years of age. This may be related to a higher likelihood of endocrine resistance and recurrence or metastasis. Combined with data from the NATALEE study, I believe clinicians should pay particular attention to this subgroup of young patients.
Furthermore, young breast cancer patients have a higher probability of carrying hereditary pathogenic gene mutations. Familial genetic mutations represent a clearly defined carcinogenic factor, leading to earlier disease onset. Therefore, it is crucial to carefully assess family history in young patients—specifically whether first-degree relatives have had breast cancer, ovarian cancer, or even prostate or pancreatic cancer, all of which are associated with BRCA gene mutations.
Finally, treatment considerations also differ for young breast cancer patients. These patients often have stronger desires for survival, breast conservation, and axillary preservation. As a result, we place greater emphasis on communication in clinical practice—not only treating the disease, but also helping patients preserve physical function and enabling them to return to their normal roles in society and within their families.
02
Oncology Frontier: Compared with older patients, young breast cancer patients often present with more aggressive disease and face unique challenges such as fertility preservation and long-term quality of life. How does the Chinese Expert Consensus on the Diagnosis and Treatment of Young Breast Cancer (2025 Edition) address these challenges with more precise recommendations in systemic therapies (such as chemotherapy, targeted therapy, and endocrine therapy) and local treatment strategies?
Professor Jing Yao: Young breast cancer patients represent a very special population. Many are highly active members of society and key pillars of their families. Therefore, while striving to prolong survival, we also place great emphasis on quality of life. Quality of life encompasses multiple dimensions, including minimizing treatment-related adverse effects, preserving fertility, maintaining the ability to return to work, and even addressing cosmetic concerns such as hair loss. Treatment decisions should be individualized based on patient needs and disease characteristics, while incorporating newer therapeutic options such as targeted therapy and immunotherapy when appropriate.
Among these considerations, fertility preservation is a critical component of treating young breast cancer patients. We initiate discussions as early as possible after diagnosis, asking patients about their reproductive plans. Many patients initially state that they will no longer consider pregnancy after diagnosis. However, in reality, the vast majority of patients with lymph-node involvement but no distant metastasis can still achieve cure, and many have a high likelihood of successful pregnancy after curative treatment. If fertility desires are revisited only after treatment, the chances of success may be significantly reduced due to the lack of protective measures during earlier therapy.
Therefore, we encourage young patients to prepare early. Preparatory steps include ovarian protection at the initiation of treatment, as well as oocyte or embryo cryopreservation. These procedures can typically be completed within two weeks after diagnosis. In large comprehensive hospitals or those with reproductive medicine centers, fertility preservation does not delay cancer treatment. Even for patients with highly aggressive disease such as triple-negative breast cancer, the first two weeks after diagnosis are usually required for immunohistochemistry, FISH testing, and full staging work-up. Thus, assisting patients in preserving fertility does not compromise treatment delivery or prognosis. Additionally, by selecting appropriate treatment regimens, we can help meet patient preferences such as minimizing hair loss and preserving gastrointestinal function.
03
Oncology Frontier: Young breast cancer patients have a higher detection rate of hereditary susceptibility genes such as BRCA1/2. Does the new consensus provide clearer guidance on indications and timing for genetic testing, as well as subsequent risk management strategies (such as prophylactic surgery and family surveillance)?
Professor Jing Yao: Young breast cancer patients carry a higher genetic risk. BRCA1 mutations are more commonly seen in young patients with triple-negative breast cancer, whereas BRCA2 mutations are more frequent in young patients with hormone receptor–positive disease. Therefore, our treatment team routinely performs genetic testing early in the diagnostic process, particularly in patients with tumors ≥2 cm, lymph-node involvement, or a positive family history.
Genetic testing has multiple clinical implications. For patients seeking breast-conserving surgery, disclosure of BRCA or other hereditary susceptibility mutations allows multidisciplinary teams to recommend breast-conserving surgery or mastectomy based on comprehensive evaluation. Depending on mutation type and tumor stage, prophylactic contralateral mastectomy or oophorectomy may also be considered. These decisions require individualized risk stratification and close collaboration with relevant specialties. In addition, for patients with hereditary mutations, intensified adjuvant therapy—such as the use of PARP inhibitors—may be considered after standard treatment, based on molecular subtype, disease stage, and response to neoadjuvant or adjuvant therapy.
Detection of BRCA and other hereditary susceptibility genes also provides important information regarding cancer risks for both patients and their families, including ovarian and pancreatic cancer. This is particularly meaningful for young patients with identified mutations. For those with clear fertility desires, consultation with reproductive medicine specialists can help guide strategies such as avoiding embryos carrying pathogenic mutations, thereby supporting healthy reproduction.
Professor Jing Yao Union Hospital, Tongji Medical College Huazhong University of Science and Technology
