Rising Incidence, Trial Enrollment, and Other Key Breast Cancer Challenges

In a conversation with CancerNetwork^®, Shari Goldfarb, MD spoke about key developments and challenges regarding the treatment of younger populations with breast cancer. Key areas across the field included the rising incidence of disease, including HER2-positive and triple-negative subtypes; expanding opportunities for clinical trial enrollment; and preserving fertility among patients undergoing treatment, among other focuses.

Although it’s not entirely clear why breast cancer diagnoses are becoming more common in younger groups, Goldfarb noted that a combination of genetic and environmental factors may be driving this increase. Beyond facilitating yearly mammograms among average-risk individuals starting at age 40, she said that knowing one’s family history and genetic risk may also inform personalized screening approaches.

Goldfarb also described how patients in their 20s to 40s may be underrepresented in breast cancer clinical trials due to enrollment criteria typically requiring postmenopausal status, which may be amended by expanding eligibility to patients who receive medically suppressive therapy. The conversation also touched upon providing supportive care for younger patients with breast cancer, as Goldfarb emphasized prompt fertility consultations following diagnosis for patients who desire to have children as well as other services related to integrative medicine and social work.

Additionally, Goldfarb reviewed strategies for mitigating chemotherapy-induced alopecia, highlighting how modalities like scalp cooling may reduce hair loss and improve hair regrowth. In the end, she noted the importance of employing a multi-disciplinary approach to ensure whole-person care and meet the emotional and psychological needs of patients who undergo treatment.

“Patients should always advocate for themselves…If something is different in your body, you should make sure to bring it to a doctor's attention,” Goldfarb stated. “[Patients should] make sure they get imaging or a biopsy if they need it. [They should not] wait because early diagnosis helps with finding things at an earlier stage and [yielding] better prognosis.”

Goldfarb is an assistant attending physician specializing in breast cancer at Memorial Sloan Kettering Cancer Center.