Home Journals Articles Updates About
CN
image
收藏切换
Introduction and impact of the young breast cancer in China consensus
收藏切换
PDF
Xin Yang1, 2, Chao Dong3, Qiang Liu1, 2
Cancer Biology & Medicine | 2026, 23(1) : 8 - 14
Less
收藏切换
Cancer Biology & Medicine | 2026, 23(1): 8-14
• Editorial •
Introduction and impact of the young breast cancer in China consensus
Full
Xin Yang1, 2, Chao Dong3, Qiang Liu1, 2
Affiliations
  • 1Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
  • 2Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
  • 3The Clinical Medical Research Center of Breast and Thyroid Tumor in Xinjiang, Tumor Hospital Affiliated to Xinjiang Medical University Urumqi, 830000, China
About Author:

Author contributions

Data curation and original draft preparation: Xin Yang, Chao Dong.

Validation and editing: Qiang Liu.

Published: 2026-01-15 doi: 10.20892/j.issn.2095-3941.2025.0523
Outline
收藏切换
Xin Yang, Chao Dong, Qiang Liu. Introduction and impact of the young breast cancer in China consensus[J]. Cancer Biology & Medicine, 2026 , 23 (1) : 8 -14 . DOI: 10.20892/j.issn.2095-3941.2025.0523
Full Text
Less
Introduction
Less
Breast cancer is the most common cancer type in adolescents and young adults < 40 years of age, accounting for 30% of cancers in this age group1. Breast cancer in the young presents significant challenges for patients and society, including more aggressive tumor biology, poor prognosis, genetic susceptibility, fertility preservation, and complex psychosocial issues. Moreover, because of the markedly younger median age of breast cancer, the proportion of young breast cancer patients in China is significantly higher than Western countries2. The first Young Breast Cancer in China (YBCC) consensus meeting was held in Guangzhou, China in December 2021 to address exclusive challenges and requirements facing young patients with breast cancer. Chinese medical experts from multiple specialties had an extensive discussion and formulated a consensus over several hot topics in young patients with breast cancer. The “Expert Consensus on the Diagnosis and Treatment of Young Breast Cancer in China (2022 edition)” published in the Chinese Medical Journal has garnered significant attention3, highlighting enormous interest in the YBCC consensus in the medical community and public.
YBCC epidemiology
Studies indicate that breast cancer among young patients in China imposes an enormous disease burden for society. First, China has the largest global share of breast cancer in all age groups (15.6%) as well as young patients (13.2%)2. Second, the proportion of young breast cancer patients in China is markedly higher than Western countries. Several large population studies showed that 15%–19.9% of breast cancer patients are < 40 years of age4,5 and approximately 10% of patients are ≤ 35 years of age6. Moreover, the incidence of breast cancer in young patients increases by approximately 2% annually7. In fact, the median age of breast cancer onset in the United States is 62–64 years but the median age of breast cancer onset is much younger (45–49 years) in East Asia countries, including China4,8.
Unmet needs of young patients with breast cancer in China
Lack of breast cancer awareness and a standard screening program
Breast cancer screening has a crucial role in establishing an early diagnosis. Nevertheless, the participation rate in breast cancer screening is low in China with < 5% of cases identified through screening initiatives9,10. In addition, the optimal strategy for breast cancer screening in young women is controversial for the following reasons: dense breast tissue; lack of a standard protocol; and low cost-effectiveness.
Clinical questions without a standard answer or high-level evidence
The optimal surgical approach for patients with BRCA1/2 genes mutations is controversial11–13. Because breast reconstruction is less affordable and accessible in China, young breast cancer patients often express preferences for breast-conserving surgery (BCS), even in the presence of a BRCA mutation. The risk of ovarian cancer is also increased in patients with BRCA1/2 germline mutations14,15 but the optimal timing of prophylactic oophorectomy has not been determined.
The higher risk of recurrence and metastasis in young breast cancer patients raises the question of whether more or stronger adjuvant chemotherapy should be administered. Moreover, incomplete ovarian function suppression (OFS) during treatment has a higher incidence in younger patients16,17. The definition, incidence, monitoring, prognostic impact, and treatment strategy of ovarian escape is not completely understood.
Tamoxifen use is associated with endometrial proliferation and a potential increase in endometrial cancer risk18,19, prompting several unresolved clinical questions, including the necessity and optimal frequency of endometrial surveillance in tamoxifen-treated patients, the endometrial thickness threshold for intervention, and standardized indications for diagnostic dilation and curettage in asymptomatic patients with a thickened endometrium. Fertility preservation is a common request in young breast cancer patients. Unresolved issues include optimal conception timing and the development of individualized fertility preservation protocols that balance oncologic safety with reproductive outcomes.
The current international guidelines or consensus is insufficient
Several international guidelines and consensus statements have been developed to help manage young breast cancer patients [Breast Cancer in Young Women (BCY), European Society of Breast Cancer Specialists (EUSOMA), and American Society of Clinical Oncology (ASCO)]. These statements provide recommendations on fertility preservation, psychosocial support, and long-term survivorship issues. However, because of different culture and healthcare resources, there are many questions from young breast cancer patients in China that are not addressed in the international guidelines. Therefore, it is necessary to develop a consensus that suits the needs of young breast cancer patients in China.
The first YBCC expert consensus3
Less
Definition of YBCC
Although the median age of breast cancer onset in China is 45–49 years, 62% of the YBCC panelists were of the opinion that the definition of young breast cancer is < 40 years, which is the same as the BCY international consensus, and 32% of the panelists chose < 35 years of age as the definition of young breast cancer. Consequently, a consensus was reached by YBCC expert panel to define young patients with breast cancer as < 40 years of age.
BRCA1/2 gene mutation
The YBCC experts were more conservative with respect to the indications for BRCA1/2 mutation testing. Of the panelists, 63% supported testing in young patients (< 40 years of age), 97% endorsed testing for patients with a family history of breast cancer, and 91% recommended testing for triple-negative breast cancer (TNBC). These outcomes reflect the different epidemiologic characteristics and socioeconomic status of the Chinese breast cancer population.
For young breast cancer patients with a BRCA1/2 mutation who are candidates for BCS, 72% of YBCC experts recommend that the surgical decision should be based on an individualized recurrence risk assessment, including age, family history, and personal preference. For patients with a BRCA1/2 mutation who will undergo a nipple-sparing mastectomy (NSM) with implant reconstruction, 66% of experts suggest the choice of contralateral prophylactic mastectomy should be made considering patient age, family history, and contralateral breast cancer risk. In addition, for patients with a BRCA1/2 mutation choosing BCS or not opting for contralateral prophylactic mastectomy, 82%, 71%, and 87% of experts recommend close surveillance with ultrasonography, mammography, and MRI, respectively.
The clinical utility of platinum-based chemotherapy in the adjuvant setting for BRCA1/2 mutation carriers is controversial but no consensus has been reached by the YBCC expert panel.
The decision regarding prophylactic bilateral salpingo-oophorectomy and the timing should consider the mutation type, family history, and personal preferences according to 72% of experts.
Chemotherapy
YBCC experts suggest that young patients, like the older patients, should have the chemotherapy regimen chosen based on factors, such as disease stage and molecular subtype, but not age. Choosing more aggressive chemotherapy solely due to younger age may pose a risk of overtreatment.
Of the YBCC panelists, 84% were in favor of the anthracycline-taxane sequential regimen for medium-high risk (defined as stage II or III with positive lymph nodes) human epidermal growth factor receptor 2 (HER2)-positive young breast cancer patients, while 70% of the panelists chose a taxane combined with platinum regimen in addition to dual HER2 blockade. Most panelists chose an anthracycline-taxane sequential regimen and only 17% of the panelists chose an anthracycline-free regimen consisting of six cycles of docetaxel and cyclophosphamide (6TC) for medium-high risk HER2-negative young breast cancer patients. Of the YBCC panelists, 71% were opposed to routinely considering platinum as a substitute for anthracyclines in adjuvant chemotherapy regimens for medium-high risk HER2-positive or TNBC young breast cancer patients.
Endocrine therapy
Hormone receptor (HR)-positive young breast cancer patients often need OFS to lower relapse risk. A gonadotropin-releasing hormone agonist (GnRHa) is the most frequently used drug to achieve OFS. Of the YBCC panelists, 81% supports both formulations as options for OFS when used together with selective estrogen receptor modulators (SERMs). However, 50% of the panelists were cautious when aromatase inhibitors (AIs) were used with a three month (3M) GnRHa in young patients because younger patients are more likely to experience OFS escape (defined as failure to achieve complete OFS with a GnRHa) due to potent ovarian function.
The optimal timing for initiating AI has not been established for patients using a GnRHa in combination with an AI. The YBCC expert panel has not reached a consensus on this issue with 43% recommending that AI should only be used after confirming ovarian suppression to avoid the increase in plasma estradiol levels caused by AI monotherapy when OFS is not successful. Nevertheless, 53% of YBCC panelists proposed simultaneous initiation of a GnRHa and AI when GnRHa begins to control hormone levels from the hypothalamic-pituitary axis because the stimulatory effect of an AI on the hypothalamic-pituitary pathway is limited.
Regular estradiol (E2) monitoring facilitates early detection and management of ovarian function escape, ensuring effective treatment. However, a unified frequency and standard for E2 monitoring have not been established in clinical practice. The YBCC expert panel did not reach a consensus because 45% did not support the routine monitoring of E2 levels in patients receiving GnRHa treatment.
Fertility preservation
The YBCC expert panel suggested that suitable fertility preservation strategies should be considered prior to initiating systemic therapy for young patients with desired fertility. In addition, a chemotherapy regimen without cyclophosphamide should be considered to minimize ovarian damage. A GnRHa, although not sufficient alone, should be used for ovarian protection during chemotherapy in addition to the aforementioned measures.
Gynecologic conditions
Of the YBCC panelists, 90% agreed that tamoxifen increases the risk of endometrial cancer in peri- and post-menopausal patients. However, 48% of the YBCC panelists never encountered a patient with endometrial cancer after tamoxifen use, indicating the low incidence of tamoxifen-related endometrial cancer in China. Moreover, 67% and 91% of the YBCC panelists supported regular monitoring of endometrial thickness in premenopausal and peri-/post-menopausal patients, respectively. However, the YBCC expert panel did not reach a consensus within the gynecologic community on the appropriate threshold for diagnostic curettage in asymptomatic patients receiving tamoxifen.
The YBCC expert panel did not reach a consensus on whether breast cancer patients can use progestin-containing intrauterine devices or long-term oral contraceptives due to the low level of existing evidence.
Guideline differences for young breast cancer patients
The YBCC consensus is more focused on the questions and needs in young Chinese patients compared to the comprehensive coverage of the BCY5 consensus20. More importantly, the YBCC consensus references research data from the Chinese population and aligned recommendations with the Chinese context. The guidelines related to young breast cancer patients are summarized in Table 1, offering a comparative view of similarities and differences.
Impact of the YBCC consensus in China
Less
As the first Chinese consensus of young breast cancer patients, the YBCC consensus selected 50 issues for voting, taking into account specific characteristics of China. The final consensus included six sections: epidemiology; BRCA mutation; chemotherapy; endocrine treatment; fertility issues; and gynecologic concerns in young breast cancer patients. These sections address the most common concerns of young patients and highlight areas where treatment approaches may differ and require additional study.
The first edition of the “The Expert Consensus on the Diagnosis and Treatment of Young Breast Cancer in China (YBCC consensus)” was published in the Chinese Medical Journal in February 2023. To date, the YBCC consensus has garnered > 21,000 reads and nearly 4000 downloads, highlighting the enormous interest from the medical community and public. Furthermore, the Second YBCC Consensus Conference was held in December 2024, with the hope to address more specific questions for such a large and growing population.
Greater than 20 symposia were held in different cities in China to facilitate a better understanding and application of the YBCC consensus. These meetings often attracted a huge interest from local physicians and fostered collaboration among different medical disciplines. Moreover, researchers in China have begun to focus on young breast cancer patients and published several prominent papers to address concerns. A population-based cohort study has shown a consistently increasing trend of breast cancer patients < 35 years of age in China7. Researchers have utilized large patient datasets to compare the efficacy of different dosages of GnRHa, aiding both patients and physicians in selecting the most suitable option26. In addition, researchers conducted a comprehensive systematic review addressing the issue of incomplete OFS during GnRHa administration, thereby providing clinicians with insights that better understand and manage incomplete OFS27.
In March 2023 the first “YBCC Outpatient Clinic” was opened in the Breast Tumor Center of Sun Yat-sen Memorial Hospital. This clinic brings together expertise from genetics, breast surgery, plastic surgery, reproductive medicine, and gynecology, focusing on providing a “one-stop” comprehensive medical consultation for young breast cancer patients < 40 years of age. The YBCC Outpatient Clinic has now been expanded to 14 high-level hospitals in different cities across China. To date, > 50,000 patients have visited the YBCC Outpatient Clinic, demonstrating that YBCC is welcomed by patients and physicians alike. Implementing the YBCC consensus across different levels of hospitals is a complex task that requires systematic planning and multi-dimensional support. Recognizing the comprehensive and multi-disciplinary nature of these challenges is essential for achieving high-quality care of young breast cancer patients.
The future of YBCC consensus
Less
There are still many unanswered questions with respect to young breast cancer patients. With the number of young breast cancer patients growing, many clinical trials have begun to address the concerns and needs, although a large scale randomized trial is more difficult than trials involving elderly patients. Because China has the largest number of young breast cancer patients worldwide, the YBCC consensus, which is based on the clinical experience of Chinese experts, could also be helpful for young breast cancer patients outside of China. Currently, several studies focusing on young breast cancer patients are ongoing. The NCT06793306 and NCT06027541 trials are primarily analyzing the prognosis and molecular characteristics of young breast cancer patients, while the ChiCTR2300068147 and ChiCTR2500098174 studies are investigating the impact of a GnRHa on this patient population. In addition, research is being conducted on the development of Young Breast Cancer Patients’ Report Outcome Scale (YBCC-PRO) in China. These studies are expected to provide stronger evidence and guidance for the diagnosis and treatment of young breast cancer patients. It is hoped that with additional collaboration we can work together to offer more high-level evidence to address the questions and concerns of young breast cancer patients worldwide and provide more comprehensive and higher-quality medical care treatments.
Funding
Less
  • This work was supported by the National Natural Science Foundation of China (Grant Nos. 82230057 and 82272859) and the National Key R&D Program of China (Grant No. 2022YFC2505101).
References
Less
1.
Cathcart-Rake EJ,Ruddy KJ,Bleyer A,Johnson RH.Breast cancer in adolescent and young adult women under the age of 40 years.JCO Oncol Pract. 2021; 17: 305–13.
2.
Bray F,Laversanne M,Sung H,Ferlay J,Siegel RL,Soerjomataram I, et al.Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.CA Cancer J Clin. 2024; 74: 229–63.
3.
Chinese Society of Clinical Oncology, Experts Committee on Breast Cancer, China Anti-Cancer Association, the Society of Breast Cancer, Chinese Medical Association, Chinese Society of Breast Surgery.Expert consensus on the diagnosis and treatment of young breast cancer in China (2022 Edition).Zhonghua Yi Xue Za Zhi. 2023; 103: 387–403.
4.
Yang Y,Liu J,Peng M,Su F,Xie X,Liu Z, et al.Introduction of a multicenter online database for non-metastatic breast cancer in China.Sci China Life Sci. 2020; 63: 1417–20.
5.
Guo R,Si J,Xue J,Su Y,Mo M,Yang B, et al.Changing patterns and survival improvements of young breast cancer in China and SEER database, 1999-2017.Chin J Cancer Res. 2019; 31: 653–62.
6.
Yang Y,Wei W,Jin L,He H,Wei M,Shen S, et al.Comparison of the characteristics and prognosis between very young women and older women with breast cancer: a multi-institutional report from China.Front Oncol. 2022; 12: 783487.
7.
Wang X,Xia C,Wang Y,Qi Y,Qi X,Zhao J, et al.Landscape of young breast cancer under 35 years in China over the past decades: a multicentre retrospective cohort study (YBCC-Catts study).EClinicalMedicine. 2023; 64: 102243.
8.
Yap YS,Lu YS,Tamura K,Lee JE,Ko EY,Park YH, et al.Insights into breast cancer in the east vs the west: a review.JAMA Oncol. 2019; 5: 1489–96.
9.
Li WQ,Li R,Liu PF,Huang YB.Discussion of breast cancer screening model in China.Zhonghua Liu Xing Bing Xue Za Zhi. 2016; 37: 1039–43.
10.
Wu Z,Liu Y,Li X,Song B,Ni C,Lin F.Factors associated with breast cancer screening participation among women in mainland China: a systematic review.BMJ Open. 2019; 9: e028705.
11.
Wan Q,Su L,Ouyang T,Li J,Wang T,Fan Z, et al.Comparison of survival after breast-conserving therapy vs mastectomy among patients with or without the BRCA1/2 variant in a large series of unselected Chinese patients with breast cancer.JAMA Netw Open. 2021; 4: e216259.
12.
van den Broek AJ,Schmidt MK,van’t Veer LJ,Oldenburg HSA,Rutgers EJ,Russell NS, et al.Prognostic impact of breast-conserving therapy versus mastectomy of BRCA1/2 mutation carriers compared with noncarriers in a consecutive series of young breast cancer patients.Ann Surg. 2019; 270: 364–72.
13.
Su L,Xu Y,Ouyang T,Li J,Wang T,Fan Z, et al.Contralateral breast cancer risk in BRCA1 and BRCA2 mutation carriers in a large cohort of unselected Chinese breast cancer patients.Int J Cancer. 2020; 146: 3335–42.
14.
Kuchenbaecker KB,Hopper JL,Barnes DR,Phillips KA,Mooij TM,Roos-Blom MJ, et al.Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers.J Am Med Assoc. 2017; 317: 2402–16.
15.
Antoniou A,Pharoah PD,Narod S,Risch HA,Eyfjord JE,Hopper JL, et al.Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case series unselected for family history: a combined analysis of 22 studies.Am J Hum Genet. 2003; 72: 1117–30.
16.
Burns E,Koca E,Xu J,McLean E,Lee R,Patel T, et al.Measuring ovarian escape in premenopausal estrogen receptor-positive breast cancer patients on ovarian suppression therapy.Oncologist. 2021; 26: e936–e42.
17.
Bellet M,Gray KP,Francis PA,Láng I,Ciruelos E,Lluch A, et al.Twelve-month estrogen levels in premenopausal women with hormone receptor-positive breast cancer receiving adjuvant triptorelin plus exemestane or tamoxifen in the Suppression of Ovarian Function Trial (SOFT): the SOFT-EST substudy.J Clin Oncol. 2016; 34: 1584–93.
18.
Fisher B,Costantino JP,Redmond CK,Fisher ER,Wickerham DL,Cronin WM.Endometrial cancer in tamoxifen-treated breast cancer patients: findings from the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-14.J Natl Cancer Inst. 1994; 86: 527–37.
19.
Liu J,Jiang W,Mao K,An Y,Su F,Kim BY, et al.Elevated risks of subsequent endometrial cancer development among breast cancer survivors with different hormone receptor status: a SEER analysis.Breast Cancer Res Treat. 2015; 150: 439–45.
20.
Paluch-Shimon S,Cardoso F,Partridge AH,Abulkhair O,Azim HA,Bianchi-Micheli G, et al.ESO-ESMO fifth international consensus guidelines for breast cancer in young women (BCY5).Ann Oncol. 2022; 33: 1097–118.
21.
Sessa C,Balmaña J,Bober SL,Cardoso MJ,Colombo N,Curigliano G, et al.Risk reduction and screening of cancer in hereditary breast-ovarian cancer syndromes: ESMO Clinical Practice Guideline.Ann Oncol. 2023; 34: 33–47.
22.
NCCN Clinical Practice Guidelines in Oncology: breast cancer. Version 6.2024. National Comprehensive Cancer Network.Available from: https://www.nccn.org/.
23.
NCCN Guideline.Genetic/familial high-risk assessment: breast, ovarian, pancreatic, and prostate. Version 2.2025.National Comprehensive Cancer Network;2025.Available from: https://www.nccn.org/.
24.
Bedrosian I,Somerfield MR,Achatz MI,Boughey JC,Curigliano G,Friedman S, et al.Germline testing in patients with breast cancer: ASCO – Society of Surgical Oncology Guideline.J Clin Oncol. 2024; 42: 584–604.
25.
Oktay K,Harvey BE,Partridge AH,Quinn GP,Reinecke J,Taylor HS, et al.Fertility preservation in patients with cancer: ASCO clinical practice guideline update.J Clin Oncol. 2018; 36: 1994–2001.
26.
Lin J,Ouyang Y,Li Y,Jin L,Li S,Liu Y, et al.Different dosage forms of gonadotropin-releasing hormone agonist with endocrine therapy in premenopausal hormone receptor-positive breast cancer.J Natl Cancer Inst. 2024; 116: 1587–97.
27.
Lin J,Zheng S,Liu Q.Incomplete ovarian function suppression in premenopausal breast cancer patients treated with gonadotropin-releasing hormone agonists.Cancer Treat Rev. 2025; 133: 102879.
Appendix
Less
Year 2026 volume 23 Issue 1
PDF
7
4
Cite this Article
BibTeX
Article Info
doi: 10.20892/j.issn.2095-3941.2025.0523
  • Receive Date：2025-10-13
  • Online Date：2026-11-07
  • Published：2026-01-15
Article Data
Affiliations
History
  • Received：2025-10-13
  • Accepted：2025-11-24
Funding
This work was supported by the National Natural Science Foundation of China (Grant Nos. 82230057 and 82272859) and the National Key R&D Program of China (Grant No. 2022YFC2505101).
Affiliations
    1Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Breast Tumor Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, China
    2Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
    3The Clinical Medical Research Center of Breast and Thyroid Tumor in Xinjiang, Tumor Hospital Affiliated to Xinjiang Medical University Urumqi, 830000, China

Corresponding:

Correspondence to: Qiang Liu, E-mail:
References
Share
https://castjournals.cast.org.cn/joweb/cbm/EN/10.20892/j.issn.2095-3941.2025.0523
Share to
QR

Scan QR to access full text

Cite this article
BibTeX
Citations
表12种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
关闭全屏
  • BibTeX
  • EndNote
  • RefWorks
  • TxT
Links
Articles
Latest Articles
Most Read
Collections
Updates
Events
News
Multimedia
About
About Us
Contact
No. 86 Xueyuan South Road, Haidian District, Beijing
100081
010-62662699(Operation and Technical Support)
qkjq@cast.org.cn

Copyright © 2025 China Association for Science and Technology. All rights reserved. For all open access content, the relevant licensing terms apply.
Sponsored by the Office of the Leading Group for Cybersecurity and Informatization of CAST, and supported by Science and Technology Review Publishing House