Komen Scholar Ann Partridge, M.D., M.P.H., has dedicated her career to understanding and treating breast cancer in young women. She recently talked with Susan G. Komen about the person who inspired her to work with young women and how breast cancer treatment has evolved for these patients over time.
Dr. Partridge is a professor of medicine at Harvard Medical School and Vice Chair of Medical Oncology at Dana-Farber Cancer Institute. She also leads the Program for Young Women with Breast Cancer at Dana-Farber.
Komen: Why is it important for younger women to be educated about breast cancer, and what is unique about their experience if they’re diagnosed with the disease?
Partridge: When you see a young woman under 40 or so, she doesn’t have friends who have breast cancer, until she’s actually been diagnosed. Because breast cancer in young women is relatively rare, it’s something that hasn’t been as well studied over the last several decades, until recently. We’ve learned, in general, it’s harder to treat breast cancer in young women. These women also have unique issues because of their young age, like fertility concerns or genetic risk. Because of these issues and where they are in their life stage, they tend to have a harder time emotionally, both at diagnosis and in follow-up.
Komen: What are the emotional and psychological challenges like for young women?
Partridge: When a young woman is diagnosed, it’s also often at a life stage when dealing with a breast cancer is the last thing she thought she would deal with, and the last thing her partner thought they would deal with. Frankly, it’s often the first thing she’s ever faced that’s been significant and negative in her life. It’s also at a time when they may be building a career and trying to have a family. All of that can make it much harder, emotionally, on younger women.
Komen: What can we do to support young women who are diagnosed with breast cancer?
Partridge: First and foremost, we need to make sure they’re getting outstanding care. And as providers and supporters of young women, we need to know how we should treat them best. One size doesn’t fit all, even when you’re a young woman.
The second thing is making sure we have psychosocial support and other supportive care to manage their emotional concerns, their symptoms from treatment, their need to have peer support or to have symptom management support over time, both during early treatment but also critically in their survivorship. This also includes making sure they’re optimizing healthy behaviors: if they’re smokers this means quitting smoking, if they haven’t been exercising, we’re getting them to exercise or maintain a healthy body mass index or weight. We’re helping these women turn breast cancer into a learning experience so they might even live better beyond the breast cancer and find some silver linings out of an unfortunate event.
Komen: Why is it harder to treat breast cancer in young women?
Partridge: Young women are less likely to be diagnosed early because we don’t routinely start screening people in the United States until they’re in their early 40s, and their tumors tend to be bigger and more advanced when they’re diagnosed. They’re more likely to develop HER2-positive and triple negative breast cancer. When they get hormone sensitive breast cancer, they’re more likely to get the more aggressive type. This combination of factors means that young women develop disease that tends to be higher risk and warrants a more aggressive treatment approach.
The good news is that our treatments are improving, particularly for women with HER2-positive breast cancer, and that young women seem to do just as well as older women with HER2-positive breast cancer. We’re working on that in the ER-positive space with better hormone therapy and ovarian suppression for young women.
In the triple negative breast cancer space, there’s a lot of work going on to identify a treatment target. And the good news is there’s a growing number of targets we’re finding and treatment strategies, such as immunotherapy, that are actually starting to show promise and efficacy. I’m really excited about the promise of what’s going on in all of those tumor types.
Komen: How has our approach to treating young women with breast cancer changed over the years?
Partridge: In the field of breast cancer oncology, we are starting to move toward really refining who needs what treatment at what time and who doesn’t. For example, recently we’ve learned we don’t need to give chemotherapy to all young women with hormone receptor positive breast cancer. In fact, we can use the tumor profiling tests for our young patients to help predict who might benefit from chemotherapy and who might do just as well with hormone therapy alone. And I’m proud to say that some Komen-funded research recently was published on this topic.
We’ve also been able to scale back chemotherapy treatments and are starting to de-escalate things like surgery. We’re getting more and more data, and we’re applying this data to both younger and older women, which is really exciting because younger women often have higher risk but they’re also most likely to do well overall.
Komen: Young women tend to be underrepresented in clinical trials. What have you done to try and encourage their participation in clinical trials?
Partridge: We know when women or men in any group are offered clinical trials, they often say yes. So, the real problem is not about people saying no and not participating. The barrier is often they’re not in places where the research is as available or they’re not being offered the studies. So it’s our job, for me as a cancer researcher and my colleagues around the country and the world, to break down those barriers and to reach out and meet women where they are or help them to engage, to be part of breast cancer research so that we can learn for them, about them.
Komen: What drew you to working with young breast cancer patients?
Partridge: As I was figuring out what I wanted to do in oncology and started seeing patients in the breast cancer clinic, I was really drawn to what I was seeing with our young patients and how difficult the diagnosis and the treatment was on them. I was a young woman at that time, and I got a call from my best friend from high school who had found a lump. I’m sure you can tell where the story is going. She ended up having early stage breast cancer, and I went through it with her, as her friend. I didn’t treat her, but I got her plugged in as best I could with the best available care in her city.
I saw the experience through her eyes. And it wasn’t just about what treatment to get, it was about a lot of things I had never considered because I’d never been in her shoes. It was about how do I go out and date my new boyfriend with one breast? How do I dress? Can I have children? Do I have to worry about my genetics? And it really hammered home to me how different it is for young women and, to some degree, how a lot of these things that were sometimes afterthoughts for medical professionals were really important to the individual woman. So that’s where I personally started to say, “Hey, you know what? We do need to pay a little more attention to young breast cancer patients now that we’re getting a better handle on the disease.” There are just so many things we’re getting better at addressing with our young patients now, that historically we just didn’t pay as much attention to.
