Cited by 830Cancer survivorship and careChildhood Cancer Survivors' Quality of LifeWomen's cancer prevention and management

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Quality of Life, Fertility Concerns, and Behavioral Health Outcomes in Younger Breast Cancer Survivors: A Systematic Review

Howard-Anderson, J., Ganz, P. A., Bower, J. E., Stanton, A. L.·2012·JNCI Journal of the National Cancer Institute

DOI 10.1093/jnci/djr541

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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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Background
Barriers and facilitators for weight management interventions in breast cancer patients: a systematic review of qualitative studies
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Background
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Boutib, A., Azizi, A., Youlyouz‐Marfak, I., Kouiti, M., Taiebine, M., Benfatah, M., Nejjari, C., Bounou, S., & Marfak, A. (2024) · Digital Health · doi:10.1177/20552076241297041 · Cited by 13
Motivations associated with physical activity in young breast cancer survivors
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Self-citation
Can models of self-management support be adapted across cancer types? A comparison of unmet self-management needs for patients with breast or colorectal cancer
Mansfield, E. L., Mackenzie, L., Carey, M. L., Peek, K., Shepherd, J., & Evans, T. (2017) · Supportive Care in Cancer · doi:10.1007/s00520-017-3896-0 · Cited by 7
Fertility decision-making in cancer patients – current status and future directions
Ehrbar, V., Urech, C., & Tschudin, S. (2018) · Expert Review of Quality of Life in Cancer Care · doi:10.1080/23809000.2018.1503539 · Cited by 7
Impact of imatinib or dasatinib coadministration on in vitro preantral follicle development and oocyte acquisition in cyclophosphamide-treated mice
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“tients may severely impair ovarian function or lead to premature ovarian failure [1-4].”
Background
Effects of Breast-Conserving Surgery Combined with Immediate Autologous Fat Grafting on Oncologic Safety, Satisfaction and Psychology in Patients with Breast Cancer: A Retrospective Cohort Study
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“It is well known that poor breast appearance can lead to various psychological problems such as inferiority, anxiety, depression, etc.(28,29) But in our study, AFG did not seem to reduce depression and anxiety correspondingly while improving the satisfaction of patients.”
Background
The mediating effect of pleasure and menopausal symptoms on sexual activity among young breast cancer survivors
Klein, S., Paluch–Shimon, S., & Braun, M. (2022) · Supportive Care in Cancer · doi:10.1007/s00520-022-06923-9 · Cited by 7
“Early menopause due to cancer treatment may manifest in symptoms including hot flashes, night sweats, vaginal dryness, weight gain, and tiredness [11, 15, 16].”
Background
Adherence to adjuvant tamoxifen and associated factors in breast cancer survivors
Uslu, Y., Kocatepe, V., Sezgin, D. S., & Uras, C. (2023) · Supportive Care in Cancer · doi:10.1007/s00520-023-07742-2 · Cited by 11
“Although postmenopausal women are reported to have lower rates of non-adherence, impaired quality of life and subsequent treatment discontinuation has been observed [14, 15].”
Background
Comparison of Clinical and Pathological Differences of Breast Cancer Patients under 35 and above 55 Years of Age
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Childbearing across borders: Fertility and parenthood attitudes and decisions among breast cancer survivors in USA and Portugal
Gonçalves, V., Hudson, J. N., Canavarro, M. C., Morris, J., Lee, M. C., Donovan, K. A., Sutton, S. K., Vadaparampil, S. T., & Quinn, G. P. (2018) · The Breast · doi:10.1016/j.breast.2018.04.001 · Cited by 7
“Our results support the evidence that younger women and those without children before the diagnosis are more likely to place a greater importance on childbearing after cancer, reporting more fertility concerns [20,29,30].”
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Presentation, tumour and treatment features in immigrant women from Arabic‐speaking countries treated for breast cancer in Australia
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“Previous studies have shown that premenopausal breast cancer survivors tend to have poorer quality of life than older women, predominantly due to the side effects of chemotherapy and/or endocrine therapy that may cause menopausal or other hormonal symptoms.(10,11) Fertility concerns may also be relevant in this younge…”
BackgroundResult
Return-to-Work and Breast Cancer Survivorship Care
Sun, Y., Shigaki, C. L., & Armer, J. M. (2020) · Current Breast Cancer Reports · doi:10.1007/s12609-020-00371-2 · Cited by 7
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“There is also evidence showing that young women diagnosed with breast cancer are doing worse in terms of quality of life, depression, and fear of cancer recurrence.([5,6]) Moreover, compared with middle-aged and elderly patients, young breast cancer patients received relatively less external support, making it more ch…”
Psychosocial Adaptation During and After Breast Cancer
Özkan, M. (2016) · Springer eBooks · doi:10.1007/978-3-319-26012-9_47 · Cited by 7
“[ 78 ] found that concern with either weight gain or weight loss was associated with poorer body image, most studies in breast cancer survivors have focused exclusively on perceptions of weight gain, which occurs much more commonly than weight loss in this population [ 82 ].”
Background
Intimate Relationships
Mozafari, A. R., & Xu, X. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108561716.029 · Cited by 7
Relationships among attention function, exercise, and body mass index: a comparison between young breast cancer survivors and acquaintance controls
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Background
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Molecular Factors Predicting Ovarian Chemotoxicity in Fertile Women: A Systematic Review
Raimondo, D., Raffone, A., Neola, D., Genovese, F., Travaglino, A., Aguzzi, A., Gobbi, V. D., Virgilio, A., Santo, S. D., Vicenti, R., et al. (2024) · Cancers · doi:10.3390/cancers16162793 · Cited by 6
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Background
Return rates for the use of ovarian tissue cryopreserved prior to gonadotoxic treatment as fertility preservation: a systematic review
Yde, A. M., Colmorn, L. B., Johansen, A. S., Larsen, E. C., Pinborg, A. B., & Macklon, K. T. (2025) · Human Reproduction Open · doi:10.1093/hropen/hoaf068 · Cited by 6
“The risk of treatment-induced infertility is a major concern among these women (Partridge et al. , 2004; Peate et al. , 2009; Howard-Anderson et al. , 2012; Bentsen et al. , 2023).”
Reduced Psychosocial Well-Being among the Children of Women with Early-Onset Breast Cancer
Schliemann, A., Teroerde, A., Beurer, B., Hammersen, F., Fischer, D., Katalinic, A., Labohm, L., Strobel, A. M., & Waldmann, A. (2023) · Current Oncology · doi:10.3390/curroncol30120731 · Cited by 16
A Dedicated Menopausal After Cancer Clinic May Improve Adherence to Endocrine Therapy For Breast Cancer: A Population Based Study
Martin, H. L., Saunders, C. M., Redfern, A. D., & Hickey, M. (2024) · Clinical Breast Cancer · doi:10.1016/j.clbc.2024.08.017 · Cited by 6
A Partnership in Health-Related Social Media for Young Breast Cancer Survivors
Williams, D. L., Nolan, T. S., Chiu, Y., Ricks, L., Gisiger-Camata, S., Craft, B. S., & Meneses, K. (2018) · Health Promotion Practice · doi:10.1177/1524839918797620 · Cited by 6
We are different: Young adult survivors’ experience of breast cancer
Henneghan, A. M., Phillips, C. S., & Courtney, A. (2018) · The Breast Journal · doi:10.1111/tbj.13128 · Cited by 6
“"Very young breast cancer (BC) survivors” are typically defined as women <50, or in some studies, <40.(1) Little is known about the experiences and unique needs of young adult women in their 20s who have undergone BC treatment.”
Background
Systematic screening as a tool for individualized rehabilitation following primary breast cancer treatment: study protocol for the ReScreen randomized controlled trial
Möller, U., Rydén, L., & Malmström, M. (2020) · BMC Cancer · doi:10.1186/s12885-020-06815-3 · Cited by 7
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Psychosocial Adaptation During and After Breast Cancer
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The Unmet Needs of Breast Cancer Navigation Services: Reconciling Clinical Care With the Emotional and Logistical Challenges Experienced by Younger Women with Breast Cancer in a Healthcare Delivery System
Lunders, C., Dillon, E. C., Mitchell, D., Cantril, C. A., & Jb, J. (2023) · Journal of Patient Experience · doi:10.1177/23743735231171126 · Cited by 6
Differences in clinician understanding and management of early menopause after breast cancer
Sayakhot, P., Teede, H. J., Gibson‐Helm, M. E., & Vincent, A. J. (2013) · Climacteric · doi:10.3109/13697137.2013.765842 · Cited by 6
Fertility Preservation in BRCA -Mutated Breast Cancer Patients
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Efecto de un programa de ejercicio de corta duración sobre la condición física y la calidad de vida en mujeres supervivientes de cáncer de mama del ámbito rural: Estudio Piloto. [Effect of a short duration exercise program on physical fitness and quality of life in rural breast cancer survivors: A pilot study].
Santos-Olmo, P. A., Díaz, J. F. J., & Collado, N. R. (2019) · RICYDE Revista Internacional de Ciencias del Deporte · doi:10.5232/ricyde2019.05604 · Cited by 6
Patients’ satisfaction with a supportive care program for young breast cancer patients in Mexico: Joven & Fuerte supports patients’ needs and eases their illness process
Villarreal-Garza, C. M., Platas, A., Ávila, M. M., Mesa-Chávez, F., García-García, M., Fonseca, A., Pineda, C., de la Rosa-Pacheco, S., Gálvez‐Hernández, C. L., Bargalló‐Rocha, E., et al. (2020) · Supportive Care in Cancer · doi:10.1007/s00520-020-05334-y · Cited by 6
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Fertility Preservation
Duncan, F. E., Brannigan, R. E., & Woodruff, T. K. (2013) · Elsevier eBooks · doi:10.1016/b978-1-4557-2758-2.00033-0 · Cited by 6
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Characterizing Early Changes in Quality of Life in Young Women With Breast Cancer
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“I’m Not Fighting Anymore So What Do I Do Now?” Young Women’s Challenges While Transitioning Out of Active Breast Cancer Treatment and into Survivorship
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Vadaparampil, S. T., Christie, J., Bowman, M., Sehovic, I., Meade, C. D., Gwede, C. K., & Quinn, G. P. (2016) · The Journal of Continuing Education in Nursing · doi:10.3928/00220124-20160715-10 · Cited by 6
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“While women across all ages may experience concerns regarding health and body changes; Paterson et al. 37 and Howard-Anderson et al. 38 noted that younger patients may more often focus on issues surrounding body image, fertility, and the lasting effects on their lifestyle, while older women may face unique obstacles,…”
Impact of a Breast Cancer Diagnosis on Finances and Marital Status in Young Women
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Background

Authors: Howard-Anderson, J., Ganz, P. A., Bower, J. E., & Stanton, A. L.
Affiliations: University of California, Los Angeles (US)
ORCID: Howard-Anderson, J.
Ganz, P. A.
Bower, J. E.
Stanton, A. L.
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
DOI: 10.1093/jnci/djr541
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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Quality of Life, Fertility Concerns, and Behavioral Health Outcomes in Younger Breast Cancer Survivors: A Systematic Review

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