To reduce mortality, screening must detect life-threatening disease at an earlier, more curable stage. Effective cancer-screening programs therefore both increase the incidence of cancer detected at an early stage and decrease the incidence of cancer presenting at a late stage.

In the United States, one in 196 women is diagnosed with breast cancer under the age of 40 years. Adolescents and young adults (AYAs), of age 15-39 years at diagnosis, experience a number of unique challenges when confronting breast cancer. The incidence of invasive breast cancer has increased among AYA women in the United States since 2004, and most of this change is due to an increase in young women diagnosed with distant disease. AYAs are more likely than older women to present with aggressive subtypes and advanced disease, and they often require systemic staging at diagnosis. Clinical trials should be considered whenever possible, particularly in AYAs with locally advanced or metastatic disease at diagnosis and those with disease progression or recurrence. A significant proportion of AYAs carry germline cancer predisposition mutations, which necessitates prompt genetic testing for all AYAs at diagnosis and may influence choice of local therapy. Suppression of ovarian function, as an adjunct to chemotherapy, may improve breast cancer survival in AYAs. To provide optimal care for AYAs with breast cancer, clinicians should engage multidisciplinary teams that offer fertility preservation, genetic counseling, physical and occupational therapy, nutrition, and psychosocial support, along with medical expertise in tailoring cancer-directed therapy and symptom management toward young women.

Purpose: A need to examine survival trends of individual cancers in older adolescents and young adults (AYAs) is prompted by overall survival trends that have indicated a lack of progress in survival improvement for AYAs compared with both younger and older cancer patients. Patients and Methods: The most recent Surveillance, Epidemiology and End Results (SEER) data were used to ascertain survival trends of the 24 most frequent cancers in AYAs. Results: Of the 20 types of cancers in 15- to 39-year-olds evaluable for survival rate trends, only eight had evidence for a statistically significant improvement in their age-adjusted 5-year survival rate since 1985. As of 2000–2007, of the 24 most common types of cancer in American AYAs, nine had an age-adjusted 5-year survival rate in excess of 80% and eight had a survival rate below 60%. In 19 of 21 cancers for which a comparison of survival by gender is feasible, AYA males had a worse survival rate than females. Of the 23 types of cancer that are classifiable as distant disease, 13 had 5-year survival rates of less than 30%. Conclusion: While some progress has been made, the lack of improvement for some cancers with distant disease is disappointing. Increased survival of AYA cancer patients offers significant societal gains in terms of years of productivity compared to older adults. If the potential long-term economic impact of health in AYAs is considered, the need to improve the survival of AYAs with cancer is obvious.