Key takeaways:

• Fertility remains a significant concern among young women with breast cancer.
• A mobile health tool can help alleviate concerns and provide information and resources without burdening clinicians.

Ann H. Partridge, MD, MPH, still remembers her patient’s anger 25 years later.

Partridge, founder and director of the Young and Strong Program for Young Adults with Breast Cancer at Dana-Farber Cancer Institute, was treating a young woman with breast cancer who was “distraught” she would potentially not be able to have a baby.

In 2001, clinicians had concerns pregnancy would lead to worse disease outcomes, including recurrence.

The patient, “mad at the world,” became more enraged seeing Partridge, who had her own baby bump at the time.

“I was the messenger, and I was pregnant,” Partridge recalled. “I felt bad for her. She was angry. It’s normal human emotions. People go through those phases of grief. She was in the anger phase. I happened to be pregnant, and it hurt her.”

Partridge said that patient and others “compelled” her to dedicate her career to helping young women with breast cancer.

And knowing what she knows now, Partridge wishes she could go back and visit with that patient again. She wishes she could tell her and countless other young women with breast cancer the recent data now show they could safely have a child and treat their disease.

That research has been done, but the work is far from over.

Breast cancer incidence among adolescents and young adults continues to rise, and these patients have unique challenges compared with older women who develop breast cancer.

Multiple studies presented this year at ASCO Annual Meeting detail various aspects of early-onset breast cancer that could inform care, including outcomes, patient characteristics and concerns, and fertility, as well as an intervention that could help.

“When a young person is diagnosed with breast cancer, they suffer from all the slings and arrows that an older person might suffer from in terms of the physical and psychosocial affects — potentially life-threatening diagnosis, loss of safety of feeling you’re invulnerable. Now, magnify that because your average 60-something already knows they’re not invulnerable,” Partridge said. “The average 20, 30 and even early 40-something, they often haven’t had a medical problem yet. They have to deal with that. The existential threat of a cancer is magnified for a young person.”

‘Not a new problem’

Between 2013 and 2022, breast cancer diagnoses in women younger than 50 years increased 1.4%, double the rate seen in those older than 50, according to American Cancer Society’s Cancer Statistics 2026 report.

Healio previously reported breast cancer accounted for the largest absolute increase of all early-onset malignancies, more than double that of colorectal cancer.

“It’s not a new problem,” Shoshana M. Rosenberg, ScD, MPH, associate professor of population health sciences at Weill Cornell Medicine, told Healio. “Breast cancer has been the most common malignancy diagnosed in younger adults for a long time, and it is increasing.”

Breast cancer also kills more women than any other early-onset malignancy.

American Cancer Society reported 3,782 women aged 20 to 49 years died of breast cancer in 2023. Colon and rectal cancer accounted for the second most deaths in that age range (n= 1,670).

“On average, they tend to be more aggressive breast cancer,” Partridge said. “They’re more likely to get triple-negative breast cancer. They’re more likely to have bigger tumors.”

‘Extremely important’

Investigations into early-onset breast cancer can have very different populations.

Some studies focus on all women aged younger than 50 years. Some evaluate adolescent and young adult cohorts, those aged less than 40 years.

Samanta Catueno, MD, third-year fellow in pediatric hematology and oncology at The University of Texas MD Anderson Cancer Center, and colleagues decided to study an even younger population — individuals no older than 25 years.

“We realized that there was not much information out there on the younger part of the adolescent and young adult population,” Catueno told Healio.

They evaluated every patient aged 25 years and younger diagnosed with breast cancer at MD Anderson Cancer Center between 2000 and 2024.

The cohort included 110 patients (median age at diagnosis, 23.9 years, range, 15.7-25.5; 98.1% women; 44.9% white).

“Very few instances, but we wanted to see what’s happening with these patients,” Catueno said.

Most patients had invasive ductal carcinoma (75.5%) or sarcoma and malignant phyllodes tumors (12.7%), and 10% had metastatic disease, which included bone, lung, liver and distant lymph nodes.

Among 96 individuals with carcinoma, 57.3% of patients had estrogen-positive disease, 50% had progesterone-positive, 25% had HER2-positive and 33% had triple-negative tumors.

Overall, 53.6% of patients had a family history of breast cancer and 9% had a family history of ovarian cancer. Additionally, 30.9% had cancer predisposition syndrome, the most common being Li-Fraumeni, BRCA1 and BRCA2.

“These patients have a lot of family history of breast cancer,” Catueno said. “Genetic counseling in this age group is extremely important.”

The cohort had a 5-year EFS of 30%, 5-year DFS of 55.3%, and 5-year OS of 71.8%.

The 5-year OS for all patients with breast cancer is around 90%, according to American Cancer Society.

“It has been described that adolescent and young adult populations have lower overall survival,” Catueno said. “You usually have more metastatic disease, or you can have more aggressive forms of breast cancer, but the proportion was something that surprised us.”

Catueno and colleagues plan to do future research on breast cancer trends in these younger populations and take a closer look at carcinoma, as well as survival differences over the decades.

“We hope to collaborate with other institutions and be able to contribute to improving outcomes of these patients,” Catueno said.

‘Very validating’

In 2023, Partridge and colleagues published data on the POSITIVE trial, which showed that women aged 42 years and younger with hormone receptor-positive breast cancer who paused endocrine therapy had similar short-term recurrence rates as those who continued their treatment.

These data changed the narrative on having a child after diagnosis.

“Historically, people were told they couldn’t get pregnant after breast cancer because it would be like pouring gasoline on the fire,” Partridge said.

Partridge and colleagues conducted another prospective investigation to evaluate the long-term safety outcomes for women with breast cancer who get pregnant, which they presented at ASCO.

They included 1,016 survivors (median age, 32 years; range, 17-40) who had stage 0 to III breast cancer (73% ER-positive tumors) who did not have a prior hysterectomy.

Overall, participants had 198 pregnancies after breast cancer, including 165 live births.

After median follow-up of 12 years, breast cancer-free interval, distant recurrence-free interval and OS did not significantly differ between patients who got pregnant and those who did not, including among women who had ER-positive disease and those who had live births.

“Most datasets are either registries or retrospective,” Partridge said. “These people didn’t go into this around pregnancy. They went into it just being young, and we followed them over time. It’s really quite robust, and not surprisingly, we showed that having a pregnancy in follow-up did not worsen survival. It’s very validating. These women are young and want to thrive after their diagnosis. Many want their babies yesterday.

“We still need long-term follow-up of the safety of breast cancer interruption,” she added. “POSITIVE showed it at 41 months and 71 months, and we’re now going out to 10 years. We need to continue to follow them and make sure it’s safe, even in the very long term.”

‘Huge burden’

The data indicate women can safely have a baby after breast cancer, but barriers persist.

Adolescent and young adult women with early-stage ER-negative and/or HER2-positive breast cancer often are treated with chemotherapy, Bolun Liu, MD, assistant professor of medicine at Mayo Clinic Health System, told Healio.

Chemotherapy kills oocytes and impairs estrogen production. It also can cause premature or early menopause and lower the number of eggs in a woman’s ovaries. All of these can impact fertility, according to American Cancer Society.

Healio previously reported on a survey showing 32% of women with breast cancer had concerns about fertility at the time of their treatment decision, and 47% reported fertility impacted their therapeutic choice.

Liu and colleagues investigated fertility concerns, counseling and preservation among 363 adolescent and young adults with ER-negative and/or HER2-positive breast cancer treated at Kaiser Permanente Northern and Southern California between 2013 and 2022.

“[These patients] face urgent and deeply personal decisions at the diagnosis,” Liu said. “Any decision they make may have a huge impact on their life quality later.”

Researchers defined fertility concerns as “not having completed desired family size or being unsure about having completed desired family size at diagnosis.”

Overall, 54% of participants reported fertility concerns at diagnosis.

“We have a huge burden in this group,” Liu said.

However, chemotherapy receipt did not significantly differ between patients who had fertility concerns (93%) and those who did not (92%).

“Chemotherapy uptake was high — over 90% — whether or not patients had fertility concerns, which is exactly what you want to see,” Liu said.

Among patients who had fertility concerns and received chemotherapy, 30% underwent fertility preservation and 25% saw a fertility specialist but did not get fertility preservation.

“One possibility is that many of the 45% who didn't see a fertility specialist still had a satisfactory conversation about fertility with their medical oncologist or primary care provider, and didn’t feel they needed to take it further,” Liu said.

Among women who had fertility concerns and received neoadjuvant chemotherapy (n = 112), those who chose fertility preservation had significantly longer mean time to chemotherapy (41 days vs. 30 days, adjusted ratio = 1.39; 95% CI, 1.15-1.69), but Liu described the difference as “modest.”

Additionally, women who saw a fertility specialist but did not pursue preservation had no difference in time to therapy.

“It is quite reassuring seeing this result,” he said. “The delay was less than 2 weeks on average. These fertility discussions and fertility preservation didn’t meaningfully delay neoadjuvant chemotherapy based on the raw numbers comparison.”

Among women who had fertility concerns and got adjuvant chemotherapy, researchers did not observe significant differences in time to chemotherapy among those who did not see a specialist, those who froze their oocytes or embryos, and those who visited a specialist but did not undergo preservation.

“We should continue to do better to give patients a chance to make informed decisions when it comes to fertility concerns, and also try to minimize the delay to the breast cancer treatment,” Liu said. “The next steps should include more studies to understand which workflow helped patients access fertility counseling quickly, and identify the barriers for patients who want fertility preservation but did not receive it, or they had concerns but did not get counseling, and whether they were satisfied with the counseling service provided.”

In 2025, ASCO updated its guidelines recommending clinicians discuss fertility preservation both at diagnosis and throughout survivorship.

“This infertility risk discussion is a continuum, not just at the time of cancer treatment or cancer diagnosis, but also yearly post-treatment, as well as any time that a young patient with cancer is thinking about starting their family,” H. Irene Su, MD, MSCE, reproductive endocrinologist and professor of obstetrics, gynecology and reproductive sciences at UC San Diego Health, previously told Healio. “People’s goals change. Sometimes their cancer treatments change, and that prompts the necessity to readdress what is risk so that patients can consider their family building options and fertility preservation options.”

‘Feel inspired’

Fertility is one of many concerns patients with early-onset breast cancer have that may be more common in that age group compared with older women.

“Things like body image, financial concerns since they haven’t accumulated a lifetime of savings, or they may be in school or just starting a career,” Rosenberg said. “They may be parenting young children. They have concerns around recurrence and long-term effects of cancer and health. Those issues concern any patient, but when we think about younger adults with cancer, hopefully they have a much more extended survivorship due to being diagnosed younger.”

Partridge, Rosenberg and colleagues developed the Young, Empowered & Strong (YES) mobile health tool to help address these concerns.

YES gives tailored information, resources and support to users based on surveillance from monthly electronic patient-reported outcomes. It also has an expressive writing platform and chat room.

Researchers evaluated YES in a randomized trial.

They randomly assigned 360 women aged 15 to 39 years (median age at diagnosis, 34 years; range, 21-39; 80.6% white) with stage 0 to III breast cancer to YES (n = 179) or usual care (n = 181).

Participants had to speak English, have no evidence of breast cancer recurrence, and be less than 3 years from the conclusion of active therapy.

Patients received a monthly text or email, where they were prompted to self-report symptoms and concerns they were experiencing.

Potential symptoms included anxiety, depression, fatigue, hot flashes, musculoskeletal complaints, sexual problems, sleep problems, stress and other issues.

Potential concerns included body image, diet and nutrition, fertility, financial issues, genetics, physical activity, recurrence concerns, survivorship care and weight management.

Healio previously reported YES achieved its primary endpoint, significantly improving quality of life compared with standard of care.

At ASCO, Rosenberg presented data addressing survivorship concerns.

At baseline, most patients reported concerns on recurrence (79%), long-term health effects of cancer (70%), long-term side effects of treatment (67%), possibility of a new malignancy (67%), exercise (60%), nutrition (58%), checking for signs of recurrence (57%), body image (56%) and familial cancer risk (51%).

A sizeable minority also expressed concerns about fertility (43%), financial concerns (38%) and financial support for medical care (37%).

After 6 months, the number of patients who reported being somewhat or very concerned decreased across almost all topics.

The YES arm had significantly lower likelihood of being concerned with alcohol and cancer risk (OR = 0.15; 95% CI, 0.03-0.75), financial support for medical care (OR = 0.35; 95% CI, 0.13-0.96), financial concerns (OR = 0.36; 95% CI, 0.13-0.98) and familial cancer risk (OR = 0.36; 95% CI, 0.17-0.77).

“This intervention is not solving all the problems, but it does seem to be helpful in terms of effectively delivering resources and information,” Rosenberg said.

That could be seen in data Rosenberg presented at ESMO Breast Cancer Annual Congress in May, which showed YES significantly reduced information needs across nearly all topics, including long-term effects of treatment (OR = 0.35; 95% CI, 0.2-0.6), recurrence (OR = 0.32; 95% CI, 0.18-0.56), financial support for medical care (OR = 0.59; 95% CI, 0.36-0.98), exercise (OR = 0.45; 95% CI, 0.26-0.77), familial risk (OR = 0.32; 95% CI, 0.18-0.57), talking about cancer with family and friends (OR = 0.31; 95% CI, 0.17-0.57), fertility (OR = 0.6; 95% CI, 0.36-1) and body image (OR = 0.52; 95% CI, 0.32-0.85).

“The YES intervention is really about information,” Rosenberg said. “It was reassuring to see that it effectively did reduce informational needs.”

Partridge expressed optimism that YES could be a model not just for adolescents and young adults with breast cancer, but for those with other early-onset malignancies.

“The great news is our technology allows for that now with electronic patient-reported outcomes,” Partridge said. “Instead of waiting for patients to complain and say what they are worried about, if you ask them a list of questions about their concerns and informational needs, and they check items like on a menu, it’s more likely to resonate and they’re more likely to be informed by it.”

AI could help too.

“The idea is that patients can self-manage many of these symptoms,” Rosenberg said. “If it’s not getting better, if it’s getting worse, they’re advised to call their physician, but I think this is a model of care that potentially is scalable and sustainable because it doesn’t rely on the physician addressing every little thing.”

“I want people to feel inspired that there is a way to do this,” Partridge added.

Partridge also expressed optimism in the treatment and survivorship of early-onset breast cancer moving forward.

“[These studies] give you hope that patients will benefit tomorrow from all the things researchers are doing today,” she said. “That’s what we’re here for.”

For more information:

Samanta Catueno, MD, third-year fellow in pediatric hematology and oncology at The University of Texas MD Anderson Cancer Center, can be reached at sscatueno@mdanderson.org.

Bolun Liu, MD, assistant professor of medicine at Mayo Clinic Health System, can be reached at liu.bolun@mayo.edu.

Ann H. Partridge, MD, MPH, vice chair of medical oncology, chief clinical strategy officer, and founder and director of the Young and Strong Program for Young Adults with Breast Cancer at Dana-Farber Cancer Institute, can be reached at ann_partridge@dfci.harvard.edu.

Shoshana M. Rosenberg, ScD, MPH, associate professor of population health sciences at Weill Cornell Medicine, can be reached at shr4009@med.cornell.edu.