Breast cancer rates are rising among women under 40: why tailored treatment is needed for every age group

The figures never lie. And they show that in Italia, the number of women developing breast cancer at a young age – and in any case well before the menopause – is on the rise. Every year, more than 3,000 women under the age of 40 are diagnosed with the disease, and between 2008 and 2016, the incidence rate amongst these patients rose by 1.6 per cent per year. For them, as indeed for all patients, there is an ever-increasing need for targeted treatments with objectives that respect the different needs of women of childbearing age. One example stands out: we need to identify treatment strategies capable of protecting the ovaries from the toxic effects of chemotherapy and enabling motherhood after cancer. In fact, because of their illness, these women are 35 per cent less likely to become mothers than the rest of the population. Fertility preservation strategies are precisely one of the key themes at the heart of the conference marking the 25th anniversary of the GIM (Italian Breast Cancer Group), a consortium which has been coordinating independent breast cancer research in Italia since 2001. The event is currently taking place in Genoa.

“The rise in ‘young’ breast cancers is a well-established fact that has led to profound changes in clinical practice,” notes Lucia Del Mastro, Scientific Director of the event, Professor and Head of the Medical Oncology Clinic at the IRCCS San Martino, University of Genoa. “ “These women have different needs compared to older women. For this reason, research must be increasingly ‘tailored’ to young adults.” In this regard, the GIM has produced studies that have yielded scientifically significant findings based on clinical practice, often anticipating needs that would become central many years later. In recent years, experts have also devised treatment pathways that have helped us understand how to provide better care, which components of therapy can be omitted without compromising effectiveness, for how long it is beneficial to continue treatment, and how to minimise its impact on future quality of life. An example? “The Promise-GIM6 study demonstrated that temporarily ‘resting’ the ovaries during chemotherapy reduces the risk of early menopause and increases the likelihood of ovarian function being restored,” explains the expert. ‘It is a concrete example of research that looks not only at recovery, but also at life after cancer.’

Thanks to studies carried out in Italia, GIM’s commitment has led to significant advances in treatment. The GIM2 study demonstrated that dose-dense chemotherapy, administered at shorter intervals, is more effective than the standard regimen in patients with high-risk early-stage breast cancer. The same study showed that 5-fluorouracil can be omitted without compromising efficacy, thereby avoiding an unnecessary component of treatment. The GIM4 study, on the other hand, helped to establish the benefit of extending adjuvant endocrine therapy beyond five years in selected post-menopausal women, improving disease-free survival and overall survival. ‘Over the last quarter of a century, the treatment of breast cancer has changed radically,’ says Fabio Puglisi, full professor of Medical Oncology at the University of Udine and director of the Department of Medical Oncology at the CRO in Aviano. Increasingly precise diagnoses in terms of biological characterisation now allow us to personalise treatments and, in many cases, reduce the need for chemotherapy; immunotherapy, molecularly targeted drugs and new endocrine therapies have expanded treatment options. In this progress, collaborative groups such as the GIM play an essential role: they enable independent studies to be carried out on clinical issues that directly influence day-to-day decisions.”

In recent years, the GIM’s work has also extended to metastatic breast cancer. The largest Italian registry dedicated to advanced-stage disease has been established, with over 5,000 cases recorded: a wealth of data that enables the study of the efficacy and safety of treatments in the real-world population, outside the selective criteria of registration trials. ‘Innovative therapies have significantly improved the prognosis and, for many patients, enable the long-term control of metastatic disease,’ adds Michelino De Laurentiis, director of the Department of Breast and Thoracic-Pulmonary Oncology at the Irccs Fondazione Pascale National Cancer Institute in Naples. “The GIM registry enables us to understand how these treatments work in clinical practice, across larger and more diverse populations. This knowledge is essential for translating innovation into real-world practice and improving treatment decisions.”

“The GIM is one of the leading centres of excellence in independent clinical research in Italy,” concludes Francesco Perrone, president of the Aiom Foundation/Italian Association of Medical Oncology. “ “Its studies have helped to change clinical practice and guidelines on breast cancer, demonstrating the value of a national network capable of sharing expertise, data and responsibilities.”