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Quality of Life, Fertility Concerns, and Behavioral Health Outcomes in Younger Breast Cancer Survivors: A Systematic Review
Abstract
BACKGROUND: Breast cancer is the most common cancer in women younger than age 50 years. Cancer treatments in younger women may cause premature menopause, infertility, and negative psychosocial effects. In this systematic review, we examined three key domains of functioning that are particularly relevant for younger breast cancer survivors: health-related quality of life (QOL), menopausal symptoms and fertility concerns, and behavioral health outcomes. METHODS: We conducted a literature review using PubMed and secondary sources and examined 840 articles published between January 1990 and July 2010. Inclusion criteria for articles were 1) published in English after 1989; 2) exclusively analyzed female breast cancer survivors aged 50 years or younger or premenopausal at diagnosis, with baseline characteristics and/or quantitative or descriptive analyses for this age group; 3) investigated QOL (health-related QOL including physical functioning and mental health, depression, and anxiety), menopause- or fertility-related concerns, and weight gain or physical activity-related behavioral health outcomes. Data were extracted using a standardized table collecting the purpose, design, population, and results of each study. Extracted data were reviewed for accuracy by two investigators and presented as descriptive tables. RESULTS: A total of 28 articles met the inclusion criteria (15 cross-sectional studies, eight longitudinal studies, and five randomized trials). Regarding data review, no discordance between investigators was noted. Standardized measures of QOL and depressive symptoms identified worse outcomes as being more frequent or severe in breast cancer survivors aged 50 years or younger when compared with the general age-matched population of women without cancer and to older women (aged >50 years) with breast cancer. Concerns about premature menopause, menopausal symptoms, and infertility were common in younger women (aged ≤ 50 years) and had a role in the level of distress after treatment. Weight gain and physical inactivity were common health outcomes in younger women. CONCLUSIONS: Younger women with breast cancer were found to experience distinct psychosocial and menopause-related concerns, weight gain, and physical inactivity. A need for more longitudinal research, including efforts at intervention to manage these symptoms and adverse health outcomes, remains.
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“Frailty tends to be a concern in older women37 while fertility issues uniquely impact younger premenopausal survivors.38”
From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [37]
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Adjustment Disorder in Female Breast Cancer Patients: Prevalence and Its Accessory Symptoms
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Zhang, W., Zhang, B., He, J., Fan, J., Li, J., Zhang, B., Yang, H., Xie, X., Tang, Z., Li, H., et al. (2021) · Gland Surgery · doi:10.21037/gs-20-574 · Cited by 14
“For example, it has been previously reported that in women of reproductive age, fertility issues due to treatment for breast cancer is a significant concern (28).”
BackgroundCarreira, H., Williams, R., Müller, M., Harewood, R., & Bhaskaran, K. (2017) · Systematic Reviews · doi:10.1186/s13643-017-0551-2 · Cited by 15
“[22] focused on younger breast cancer survivors (<50 years at diagnosis), an important group but who represent a small proportion of all breast cancer survivors.”
BackgroundVos, E. L., Koppert, L. B., van Lankeren, W., Verhoef, C. K., Koerkamp, B. G., & Hunink, M. G. M. (2017) · Quality of Life Research · doi:10.1007/s11136-017-1740-0 · Cited by 14
Sobota, A., & Özakinci, G. (2018) · BMC Cancer · doi:10.1186/s12885-018-4766-y · Cited by 14
Weiner, L. S., Nagel, S., Su, H.-C. I., Hurst, S., & Hartman, S. J. (2020) · JMIR Research Protocols · doi:10.2196/18420 · Cited by 15
“Younger breast cancer survivors often reduce their activity levels during and after treatment [25] and are less likely to be active than similar-aged women without cancer [26].”
BackgroundWheldon, C. W., Roberts, M. C., & Boehmer, U. (2018) · Journal of Women s Health · doi:10.1089/jwh.2018.6940 · Cited by 14
“Existing evidence suggests that women diagnosed with breast cancer at younger ages exhibit increased levels of distress.(9,10) Age at diagnosis may serve as a proxy for life course milestones relevant to long-term psychosocial outcomes for cancer survivors.”
BackgroundJang, C. E., Jung, M. S., Sohn, E. H., Kim, M., Yoo, H., Bae, K., Kim, J. R., & Lee, J. (2018) · Trials · doi:10.1186/s13063-018-2874-2 · Cited by 13
Determination of a Change Point in the Age at Diagnosis of Breast Cancer Using a Survival Model
Abdollahi, M., Hajizadeh, E., Baghestani, A. R., & Haghighat, S. (2016) · Asian Pacific Journal of Cancer Prevention · doi:10.7314/apjcp.2016.17.s3.5 · Cited by 13
Bobrie, A., Jarlier, M., Moussion, A., Jacot, W., & D’Hondt, V. (2022) · Supportive Care in Cancer · doi:10.1007/s00520-022-06810-3 · Cited by 13
Sampson, A., Block, R. G., Lake, P. W., Gagliardi, J., Augusto, B. M., Santiago-Datil, W., Sutter, M. E., Schabath, M. B., Vadaparampil, S. T., & Quinn, G. P. (2022) · Journal of Adolescent and Young Adult Oncology · doi:10.1089/jayao.2021.0208 · Cited by 13
Arrarás, J. I., Illarramendi, J. J., Salgado, E., de la Cruz, S., Asín, G., Manterola, A., Ibáñez, B., Zarandona, U., Dominguez, M. A., & Vera, R. (2016) · Współczesna Onkologia · doi:10.5114/wo.2016.60073 · Cited by 13
“Quality of life is considered especially important in long-term breast cancer survivors who were premenopausal at diagnosis [3].”
BackgroundInfluentialSanchez-Birkhead, A., Carbajal-Salisbury, S., Larreta, J. A., Lovlien, L., Hendricks, H. M., Dingley, C., & Beck, S. L. (2017) · Hispanic Health Care International · doi:10.1177/1540415317738016 · Cited by 13
Women’s perspectives of early menopause: development of a word cloud
Yeganeh, L., Boyle, J. A., Gibson‐Helm, M. E., Teede, H. J., & Vincent, A. J. (2020) · Climacteric · doi:10.1080/13697137.2020.1730318 · Cited by 14
de Kermadec, E., Zheng, Y. H., Rosenberg, S. M., Ruddy, K. J., Ligibel, J. A., Emmons, K. M., & Partridge, A. H. (2023) · Cancer Medicine · doi:10.1002/cam4.6838 · Cited by 11
“11,14,15,18,24,25 The fact that 32% of the patients had some fertility concerns at the time of treatment decision-making is somewhat lower than noted in prior studies.”
ResultChae, E. Y., Jung, M. R., Cha, J. H., Shin, H. J., Choi, W. J., & Kim, H. H. (2024) · European Radiology · doi:10.1007/s00330-024-10805-5 · Cited by 12
“Furthermore, young women with breast cancer may face unique challenges depending on their stage of life, including fertility concerns, sexual dysfunction, and dif fi culties in psychosocial adjustment [18].”
Preservation of fertility in premenopausal patients with breast cancer
Wang, S. S., Loong, H. H.-F., Chung, J. P. W., & Yeo, W. (2020) · Hong Kong Medical Journal · doi:10.12809/hkmj198268 · Cited by 12
Wang, Y., Tesch, M. E., Lim, C. A.-R., Xu, Y. H., Lee, S., Perdizet, K., Yokom, D., Warner, E., Roberts, J., & Lohrisch, C. A. (2022) · Breast Cancer Research and Treatment · doi:10.1007/s10549-022-06650-z · Cited by 12
“1 3 The burden young women face when diagnosed with breast cancer is often augmented by unique challenges in comparison to older women, including fertility concerns that contribute to higher levels of psychosocial distress in this vulnerable population [2].”
BackgroundCurrent Evidence Supporting Fertility and Pregnancy Among Young Survivors of Breast Cancer
Meneses, K., & Holland, A. C. (2014) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1111/1552-6909.12301 · Cited by 12
Decision-Making Process Regarding Fertility Among Reproductive-Age Women With Cancer in Taiwan
Huang, S., Hsieh, P.-L., Hsiung, Y., Tseng, L., Chen, P., & Hung, C. (2016) · Cancer Nursing · doi:10.1097/ncc.0000000000000439 · Cited by 12
Fertility‐related experiences after breast cancer diagnosis in the Sister and Two Sister Studies
Bressler, L. H., Mersereau, J. E., Anderson, C., Rodriguez, J. L., Hodgson, M. E., Weinberg, C. R., Sandler, D. P., & Nichols, H. B. (2019) · Cancer · doi:10.1002/cncr.32126 · Cited by 12
Wong, W. I., & VanderLaan, D. P. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108561716.009 · Cited by 12
Crown, A., Muhsen, S., Zabor, E. C., Sevilimedu, V., Kelvin, J. F., Goldfarb, S. B., & Gemignani, M. L. (2020) · Annals of Surgical Oncology · doi:10.1245/s10434-020-08883-y · Cited by 12
Patient‐centred communication for women with breast cancer: Relation to body image perception
Ghaffari, F., Ghahramanian, A., Zamanzadeh, V., Onyeka, T. C., Davoodi, A., Mazaheri, E., & Jafarabadi, M. A. (2020) · Journal of Clinical Nursing · doi:10.1111/jocn.15508 · Cited by 13
Understanding the Stress Process of Chinese- and Korean-American Breast Cancer Survivors
Paek, M.-S., & Lim, J. (2015) · Journal of Immigrant and Minority Health · doi:10.1007/s10903-015-0255-4 · Cited by 12
“Exposure to these stressors has been linked to deterioration in mental health and worse quality of life [5, 6].”
BackgroundMenopausal hormone therapy for breast cancer patients: what is the current evidence?
Glynne, S., Simon, J. A., Branson, A., Payne, S. J., Newson, L. R., Manyonda, I., Cleator, S. J., Douek, M., USISKIN, S. I., Tobias, J. S., et al. (2025) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000002627 · Cited by 12
“16 Vasomotor symptoms are commonly reported side effects of tamoxifen, whereas arthralgia, vaginal dryness and sexual dysfunction are more frequently associated with aromatase inhibitors (AIs).”
Sparidaens, E. M., Beerendonk, C. C. M., Fleischer, K., Nelen, W. L. D. M., Braat, D. D. M., & Hermens, R. (2022) · BMC Women s Health · doi:10.1186/s12905-022-01901-z · Cited by 11
Crown, A., Fazeli, S., Kurian, A. W., Ochoa, D. A., & Joseph, K.-A. P. (2023) · Journal of the American College of Surgeons · doi:10.1097/xcs.0000000000000647 · Cited by 11
Medical costs of treating breast cancer among younger Medicaid beneficiaries by stage at diagnosis
Trogdon, J. G., Ekwueme, D. U., Poehler, D. C., Thomas, C. C., Reeder-Hayes, K. E., & Allaire, B. T. (2017) · Breast Cancer Research and Treatment · doi:10.1007/s10549-017-4386-2 · Cited by 11
“As a result of these differences in tumor types between younger and older women, younger women may also have more intense or aggressive treatments and have distinct and more prevalent side effects from treatment than older women [2, 4–6].”
Menopausal-Related Symptoms in Women One Year After Breast Cancer Surgery
Mazor, M. B., Lee, K. A., Dhruva, A., Cataldo, J. K., Paul, S. M., Melisko, M., Smoot, B. J., Levine, J. D., Elboim, C., Conley, Y. P., et al. (2017) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2017.11.030 · Cited by 11
Park, B., Lee, M. H., Kong, S., & Lee, E. S. (2018) · Cancer Research and Treatment · doi:10.4143/crt.2017.585 · Cited by 11
Metadata
- Authors
- Howard-Anderson, J., Ganz, P. A., Bower, J. E., & Stanton, A. L.
- Affiliations
- University of California, Los Angeles (US)
- Venue
- JNCI Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-01-23
- Volume
- 104
- Issue
- 5
- Pages
- 386-405
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- OpenAlex
- W2109496096
- Cited by
- 830
- References
- 99
- Citations by year
- 2026: 35 · 2025: 44 · 2024: 38 · 2023: 49 · 2022: 55 · 2021: 69 · 2020: 125 · 2019: 62 · 2018: 75 · 2017: 67 · 2016: 60 · 2015: 51 · 2014: 46 · 2013: 43 · 2012: 10
- FWCI
- 5.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Breast Cancer Research Foundation
- Jonsson Comprehensive Cancer Center
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Keywords
- breast cancer survivors, young women, health-related quality of life, fertility concerns, premature menopause, menopausal symptoms, infertility, depression, anxiety, weight gain, physical inactivity, psychosocial distress, cancer treatment side effects
- MeSH terms
- Adult, Age Factors, Anxiety, Breast Neoplasms, Depression, Female, Fertility, Humans, Menopause, Premature, Motor Activity, Quality of Life, Risk Factors, Stress, Psychological, United States, Weight Gain, Health Behavior, Exercise, Age Distribution, Survivors
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