young women and contralateral disease

I would like to express my sincerest gratitude for your past help. My wife is 32 yrs. old, premenopausal and treated (lumpectomy and radiation) for invasive ductal carcinoma stage 1a, er+, no family history of breast/ovarian cancer but a personal history of thyroid cancer. Our oncologist has recommended no further systemic treatment and believes her risk for recurrence to be about 5%.  We understand that chemotherapy in my wife's case doesn't make sense, but he doesn't really recommend tamoxifen either.  Most of the benefit she would derive would be from a reduction of risk of contralateral disease, and tamoxifen as prevention seems a little more complicated.  I

[CCF-RN,MSN-JS]

Dear Loub, In making decisions regarding recommendations for further treatment in breast cancer, various factors are taken into account.  These are called prognostic factors and may have some association with disease free or overall survival.  Some of the prognostic factors that are looked at when making recommendations for treatments are: the number of positive axillary nodes, tumor size, tumor grade, estrogen-receptor status of the tumor. How important each of these factors turns out to be continues to be studied. Young age has been reported to be an adverse prognostic factor by some investigators, not all.  In two large studies, breast cancer patients younger than 35 years of age had a worse prognosis than older patients.  At the 1998 Sixth International conference on Adjuvant Therapy of Breast Cancer, young patient age was first recognized as an adverse prognostic factor.  The conference proceedings were reported in The Journal of the National Cancer Institute 1998;90;1601by Goldhirsh et.al.

I have been unable to locate specific statistics that address young age and incidence of contralateral or ipsilateral disease.

As to whether an early on-set cancer can have a higher degree of genetic involvement and less environmental involvement, it