Introduction and impact of the young breast cancer in China consensus

Xin Yang; Chao Dong; Qiang Liu

doi:10.20892/j.issn.2095-3941.2025.0523

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Table 1

Consensus and guideline comparisons

Consensus/Guideline	YBCC³	BCY5²⁰	ESMO²¹	NCCN^22,23	ASCO^24,25
Age definition	< 40 years	< 40 years	Not specified	Not specified	Not specified
BRCA1/2 testing criteria	Recommended for patients with a family history, TNBC, or age < 40 years	Follow national/international guidelines	/	Patients ≤ 50 years	Recommended for all newly diagnosed patients ≤ 65 years
Surgical approaches (patients with BRCA mutation)	1. BCS based on individual risk	1. Encourage BCS	1. BCS with radiotherapy is a safe alternative to RRM for high-risk PV-associated patients	1. BCS possible; discuss risk reduction	1. BCS requires weighing risks and surveillance capabilities
	2. Contralateral mastectomy depends on age/family history	2. Consider bilateral mastectomy	/	/	/
	3. RRSO timing by mutation type/patient preference	3. RRSO:	3. RRSO:	3. RRSO:	/
		BRCA1 (35–40 years)	BRCA1 (35–40 years)	BRCA1 (35–40 years)
		BRCA2 (~40 years)	BRCA2 (~40 years)	BRCA2 (~40 years)
Chemotherapy	1. Intensification of chemotherapy solely based on age is not recommended	1. Intensification of chemotherapy solely based on age is not recommended	/	/	/
	2. Avoid platinum replacing anthracycline	2. Anthracycline remains standard	/	/	/
	3. No consensus on platinum for patients with BRCA mutation	3. Consider platinum for patients with TNBC or BRCA mutation in neoadjuvant	/	/	/
	4. Prefer liposomal doxorubicin because of less toxicity, such as cardiotoxicity and alopecia	/	/	/	/
Endocrine therapy	1. OFS + AI for high-risk patients	1. OFS + AI for high-risk patients	/	1. OFS + ET for premenopausal and high-risk patients	/
	2. 3M GnRHa or 1M GnRHa	2. Prefer 1M GnRHa	/	2. 3M GnRHa or 1M GnRHa	/
	3. Estrogen monitoring debated	3. Monitor estradiol if ovarian escape suspected	/	/	/
Fertility preservation	1. GnRHa during chemotherapy	1. GnRHa during chemotherapy	/	1. GnRHa during chemotherapy	1. GnRHa (When proven fertility preservation methods are not feasible)
	2. Avoid cyclophosphamide during chemotherapy	/		/	/
	3. Using ART before treatment	3. Using ART before treatment		3. Patients should be advised not to become pregnant while on any systemic therapy	3. Various ARTs are recommended
	4. Postpone pregnancy post-recurrence peak	4. HR+ patients: complete 18–24 months of ET before pregnancy	/	/	/
Gynecologic management	1. Monitor endometrial thickness (tamoxifen users)	/	/	/	/
	2. Use barrier contraception and avoid hormonal methods	2. Hormonal contraception contraindicated in young survivors	/	2. Use IUD, barrier, tubal ligation, or vasectomy (patients with no intent of future pregnancies) for contraception and avoid hormonal methods	/

AI, aromatase inhibitor; ART, assisted reproductive technology; BCS, breast-conserving surgery; GnRHa, gonadotropin-releasing hormone agonist; IUD, intrauterine device; OFS, ovarian function suppression; PV, pathogenic variant; RRM, risk-reducing mastectomy; RRSO, risk-reducing salpingo-oophorectomy; TNBC, triple-negative breast cancer.