The evidence suggests that all should be treated with adjuvant therapy

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Breast cancer is uncommon in young women, but when it strikes it has a devastating effect on patients and their families. Several studies have shown that women who develop breast cancer in their 20s and 30s have worse survival and more biologically aggressive cancers with higher rates of proliferation and lymphovascular invasion and lower levels of oestrogen receptors than older patients with cancers of the same stage.1 Yet despite their apparently worse survival, younger women get more benefit from chemotherapy than older women. An overview of randomised trials showed that patients with operable breast cancer aged under 40 have a 37% (SD 7) proportional reduction in the odds of recurrence and a 27% (SD 8) reduced risk of death with adjuvant chemotherapy compared with reductions of 20.3% (SD 2.6) and 11.3% (SD 2.9) respectively for women aged 50-69.2 These proportionally greater benefits from adjuvant chemotherapy seem to be independent of node status.

There has been an increasing trend to give chemotherapy to almost all young patients with operable breast cancer regardless of lymph …