Before You Begin This Training

This training is part of The Family Medicine Education Consortium’s (FMEC) Supporting Young Breast Cancer Survivors (YBCS), Metastatic Breast Cancer (MBC) Patients, and Their Families Project (“the YBCS Project”). The YBCS Project is supported by the National Association of Chronic Disease Directors (NACDD) through funding from the Centers for Disease Control and Prevention (CDC) Young Breast Cancer Survivors Program.

To help FMEC collect important data for this project, please gather and submit the following information:

Information to Collect

• Date of Presentation
• Number of Participants
• Audience Makeup

How to Submit

You may submit this information in either of the following ways:

• Email directly to the FMEC Project Manager: rebecca.bouck@fmec.net
• Use the online form https://forms.gle/5XC7dsHT76XvQfCy7
• Scan the QR code to access the form on your device

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Thank you for supporting this project and helping us improve training for clinicians and teams working with young breast cancer survivors and metastatic breast cancer patients.

Supporting Young Breast Cancer Survivors: �A Family Medicine Training

About This Training

The Family Medicine Education Consortium (FMEC) Young Breast Cancer Survivors (YBCS) Project is supported by the National Association of Chronic Disease Directors (NACDD) through funding from the Centers for Disease Control and Prevention (CDC) Young Breast Cancer Survivors Program.

Training Overview

Agenda and Session Flow

• Session Introduction
• Ground Rules and Reflection Tools
• Breast Cancer in Younger Women: Scope and Survivorship Reality
• Education Initiatives & Policy, Systems, and Environmental (PSE) Strategies
• Interactive Skill Practice
• Tools and Resources Introduction
• Q&A and Action Planning

Who This Training Is For—and Why It Matters

• Designed for family medicine faculty, residents, and clinical teams who care for young breast cancer survivors, including those diagnosed before age 45
• Focuses on young breast cancer survivors (YBCS), a population representing an estimated 33,280 U.S. breast cancer diagnoses each year in women under age 45, with long-term survivorship needs that extend well beyond active treatment
• Centers psychosocial and survivorship needs rather than oncology treatment, reflecting the critical role of primary care in continuity, coordination, and trust across decades of survivorship
• Recognizes significant variation in patient experiences and outcomes, including among young Black women, who experience higher breast cancer incidence at ages 20–29 (1.3 to 1.5 times higher than white women of the same age) and an age-adjusted mortality rate before age 40 that is twice that of white women
• Addresses survivorship realities for patients living with metastatic breast cancer and others facing ongoing treatment, uncertainty, and cumulative psychosocial stressors
• Emphasizes practical, feasible changes that fit real clinical settings and support equitable, patient-centered survivorship care

Sources: Baquet (2008); Edmonds (2025); Lyons (2024); Muzzatti (2020); National Cancer Institute (2024); Nnorom (2022); Recio‑Saucedo (2016); Vuong (2024); Xu (2024); Zhu (2023)

Learning Objectives and Expected Outcomes

• Understand the risk and incidence of breast cancer in young women and recognize the unique psychosocial needs and barriers that affect health outcomes for young survivors, including the disproportionate impact on Black women.
• Identify challenges survivors face in accessing ongoing care, psychosocial support, and essential services, and apply Policy, Systems, and Environmental (PSE) strategies to strengthen clinical and community support structures.
• Recognize key components of clinical processes related to breast cancer screening, referral to genetic counseling and testing, and survivorship care – including the use of Survivorship Care Plans (SCPs), patient navigation, peer support, and group interventions – and identify opportunities to strengthen these approaches in your setting.
• Practice fair, respectful, audience-appropriate, and personalized communication to ensure all patients feel heard, understood, and supported throughout their care journey.
• Enhance staff skills in patient education and resource navigation and identify practical tools and community resources that support young breast cancer survivors and other cancer survivors.

Sources: Allison (2021); de Belvis (2021); Nardin (2020); Nolan (2018); Timko Olson (2024); Zhu (2023)

Setting the Stage for Today’s Session

• We aim to create a respectful, supportive learning space
• Engage with curiosity and openness
• Share at a level that feels comfortable
• Listen actively and make space for all voices
• Assume positive intent; honor lived experience

Preparing to Examine Our Experiences

Throughout this training, you’ll be invited to:

• Reflect on your clinical experiences
• Consider how your background shapes your approach
• Explore moments of uncertainty or growth
• Identify opportunities to strengthen communication with survivors

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There are no “right” reflections — the goal is awareness.

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Tools to Support Equitable Participation

Today’s optional facilitation tools:

• Five Toothpick Rule
• Doorknob Check

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Five Toothpick Rule

• A simple structure to encourage balanced participation:
• Each person receives five toothpicks (or tokens)
• Each time they speak, they place one in the center
• After using all five, they shift to listening
• Helps ensure all voices are heard

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Doorknob Check

A quick way to gauge how participants are arriving or leaving:

Share one word or phrase:

• “What are you bringing into the room?”
• “What are you taking with you today?”

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Why Survivorship Support Matters in Family Medicine

Survivorship Support Matters Because You are Seeing These Patients

• Over 90% of cancer survivors see a PCP annually; more than half rely primarily on primary care for ongoing care.
• In a national study, only 17% of primary care clinicians reported receiving formal training in cancer survivorship care.
• Most survivors continue long‑term follow‑up in primary care — by 5–10 years post‑treatment, the majority of breast cancer survivors are primarily seen in primary care, not oncology.
• Primary care visits far outnumber oncology visits after the first 1–2 years, reflecting where survivors actually receive ongoing care.
• Common survivorship issues are routinely managed in primary care, including fatigue, pain, endocrine therapy side effects, mental health concerns, chronic disease prevention, and care coordination.

Sources: Alessy (2022); Barnett (2016); Joly (2019); Lawrence (2016); Love (2022); Townsend (2023)

Survivorship Support Matters in Family Medicine Because You Provide Patient-Centered Care

Long-term Primary Care Role

Family medicine clinicians provide ongoing care after cancer treatment, supporting survivors through continuity and long-term relationships.

Addressing Psychosocial Needs

Primary care teams attend to emotional, cognitive, and social challenges survivors face during major life transitions after treatment.

Navigating Complex Systems

Survivors rely on family medicine providers for help with referrals, insurance, and access to community resources.

Focus on Consistent, Patient‑Centered Care

Family medicine addresses challenges faced by younger patients and those with advanced disease to ensure reliable, high‑quality survivorship care.

Sources: Collaço (2024); Heins (2022); Pinheiro (2022); Vos (2024)

What Has This Looked Like in Your Practice?

Caring for young breast cancer survivors can raise complex clinical, emotional, and system‑level challenges.

• What has felt hardest or most uncertain?
• Which conversations tend to feel most challenging?
• Where do gaps in support or coordination show up?

Breast Cancer in Younger Women: �Scope and Survivorship Reality

Breast Cancer in Younger Women: Scope and Survivorship Reality

• About 10% of all U.S. breast cancer diagnoses occur in women younger than 45.

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• Of the 4.3 million U.S. breast cancer survivors, several hundred thousand were diagnosed before age 45

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• Breast cancer incidence increased during the most recent decade of data (2012–2021) by 1% annually overall, with a steeper increase among women younger than 50 (1.4% annually)

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• More than 150,000 U.S. women are living with metastatic breast cancer, and three in four were originally diagnosed at an earlier stage

Sources: American Cancer Society(2024); American College of Surgeons (2025); Grabinski (2022); Morgan (2024); Obeagu (2024); Wagle (2025)

Long-term survival patterns in young survivor

• Early‑stage breast cancer has 90–100% five‑year disease‑specific survival in young women.
• Survivors diagnosed in their 20s–40s typically live well beyond the five‑year mark, with most entering long-term survivorship.
• Young survivors have many more decades of life to live, according to research on long-term outcomes and aging effects in young cancer survivors.

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These patterns support a realistic interpretation: many young survivors will spend 30–50 years in survivorship, navigating late effects, chronic disease risk, reproductive health, and psychosocial transitions across adulthood.

Sources: American Cancer Society (2026); Vuong (2024)

Core Psychosocial Domains for Young Survivors

Mental Health Challenges

Anxiety, depression, and fear of recurrence are common and may persist long after treatment.

Fertility and Relationships

Fertility concerns affect identity, family planning, and intimate relationships.

Caregiving Roles

Many young survivors balance treatment and recovery with parenting, partner responsibilities, or caring for other family members.

Family & Social Support Networks

Support from partners, family, friends, and community networks can buffer stress but may also introduce role strain or shifting expectations.

Survivors may navigate changing dynamics, including needing more help than they are used to or feeling pressure to “be strong” for others.

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Sources: Arem (2024); Fiser (2021); Gormley (2022); Halpern (2023); Hovén (2021); Keller (2024); Lehmann (2022); Marsh (2020); McGrady (2024); Oncology Nursing Society (2023); Osmani (2023); Thakur (2022); Vila (2020); Young (2019)

Core Psychosocial Domains for Young Survivors

Financial and Employment Strain

Medical debt, job disruption, and insurance instability create significant financial stress.

Body Image and Social Impact

Changes in appearance affect self-esteem and social interactions for survivors.

Sources: Arem (2024); Fiser (2021); Gormley (2022); Halpern (2023); Hovén (2021); Keller (2024); Lehmann (2022); Marsh (2020); McGrady (2024); Oncology Nursing Society (2023); Osmani (2023); Thakur (2022); Vila (2020); Young (2019)

Variation in Patient Experiences and Care Needs

• Young breast cancer survivors experience different barriers and realities that shape care
• Young Black women face higher mortality, more aggressive disease, and greater barriers to support
• Differences reflect structural and access factors, not biology alone
• Survivors living with metastatic disease often manage ongoing treatment, uncertainty, and cumulative stress
• Personal, family, community, and historical experiences influence trust, communication, and help‑seeking
• Person‑centered care means avoiding assumptions, asking what matters most, and adapting support

Sources: Gordon (2022); Malhotra (2024); Nnorom (2022); Prakash (2020); Wilkerson (2024)

Reflecting on Resources and Gaps in Your Setting

Take a few minutes to think about your own clinical environment.

• What survivorship supports or resources are already available to young breast cancer survivors?
• Where do gaps or breakdowns in support most often occur?
• What feels hardest to address during routine visits?

This reflection will help identify opportunities for small, realistic improvements in care coordination and support.

Sources: Gordon (2022); Malhotra (2024); Nnorom (2022); Prakash (2020); Wilkerson (2024)

Education Initiatives and PSE (Policy, Systems, and Environmental) Strategies

Using PSE Strategies to Strengthen Survivorship Care

Policy, Systems, and Environmental (PSE) strategies focus on improving the structures that shape everyday clinical care.

Rather than relying on individual clinicians to fill gaps, these approaches aim to:

• Make survivorship care more consistent and coordinated
• Clarify roles, workflows, and referral pathways
• Reduce missed opportunities to support patients

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PSE strategies emphasize shared responsibility and practical changes that fit within real family medicine settings.

Core PSE Strategies for Family Medicine

Survivorship Care Plans

Standardized documents summarizing treatment history and follow-up needs enhance care continuity across specialties.

Audience-Appropriate Care Training

Training helps clinicians recognize assumptions and adapt communication to individual patient contexts.

Patient Navigation Support

Structured assistance helps survivors access follow-up care, psychosocial support, and community resources.

Survivorship Care Plans: Clarifying Follow Up and Roles

• Survivorship Care Plans help coordinate care between oncology and primary care by clearly summarizing treatment history and follow‑up needs
• Clear SCPs outline what follow‑up is needed, when it’s due, and who is responsible, reducing missed or delayed care
• Standardized SCP templates support continuity by ensuring key information is documented and shared consistently
• Survivors who receive SCPs report better understanding of their treatment history, long‑term effects, and recommended surveillance

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Sources: CDC (2024); Joshi (2021); Lewis (2020); Mikles (2021); Tarver (2025)

Audience Appropriate Care: Addressing Psychosocial Needs

• Audience‑appropriate care means avoiding assumptions, recognizing structural barriers, and tailoring conversations to patients’ lived experiences
• Clear, respectful communication supports trust, engagement, and shared understanding—especially for young survivors navigating long‑term survivorship
• Normalize and validate difficult conversations.
• Ask open-ended, anticipatory questions about work, school, fertility, and quality of life.
• Normalize sensitive topics (sexuality, body image, fertility, fear, isolation).
• Encourage survivors to bring up concerns early and often.
• Provide clear expectations about treatment effects and long‑term risks.
• Use permission-based language (“Would it be okay if we talk about…?”).

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Sources: Breastcancer.org (2025); Franzoi (2025); Hasan (2024); Joshi (2021); Ke (2024); LaGrego (2025); Nardin (2020); Tabari (2023); Valente (2024)

Patient Navigation Support: Connecting Survivors to Care

• Patient navigation provides structured support to help survivors access follow‑up care, psychosocial services, and community resources
• Navigation can reduce barriers related to insurance, referrals, scheduling, and care transitions
• Even light‑touch navigation (clear referral pathways, resource lists, warm handoffs) can improve continuity and reduce missed opportunities for support
• Navigation reinforces the role of family medicine as a trusted hub for survivorship care

Sources: Chan (2023); Haroen (2025); Keegan (2025); Kokorelias (2021); Mikles (2021); Teggart (2023)

Applying PSE Strategies in Your Setting

Consider how these approaches could work in your own clinical environment.

• Where could survivorship care plans be better documented, updated, or shared?
• What communication or training gaps affect how psychosocial needs are addressed?
• How do patients currently navigate follow‑up care, referrals, and support resources?

Focus on small, realistic changes that could improve coordination or reduce missed opportunities for support.

Interactive Case Study and Role Play

Role Play — Practicing Survivorship Conversations

This activity is an opportunity to practice communication skills in realistic, low‑stakes scenarios.

• You will work in small groups with clear roles (clinician, patient, observer)
• Scenarios reflect common survivorship challenges in family medicine
• The focus is on approach, not perfect answers

This is a learning exercise. Curiosity, respect, and reflection are encouraged.

Practicing Communication + Resource Navigation

During your scenario, focus on:

• Communication: validate emotions, ask open questions, and check understanding
• Common survivorship challenges: adherence, work stress, anxiety, fertility, family risk conversations
• Resource connection: identify 1–2 realistic supports (counseling, peer support, financial/genetic counseling, community resources)

After the role play, we will debrief:

• What helped the conversation move forward?
• What felt challenging or easy to miss?
• What “next step” felt realistic in a real visit?

Activity: Interactive Case Study and Role Play

• Case One: "A 34‑year‑old woman, two years post‑treatment for Stage II breast cancer and currently on endocrine therapy, comes in for a visit. She reports ongoing fatigue, joint pain, and cognitive fog that are affecting her job performance, and she recently received a warning at work. She admits she has been skipping doses of her endocrine therapy due to side effects and uncertainty about its importance, and she feels embarrassed to bring this up because past clinicians seemed rushed or dismissive. She also shares anxiety about recurrence, difficulty navigating multiple specialists, and confusion about who coordinates her care. She has not received a Survivorship Care Plan and is unaware of available support resources and sometimes avoids appointments due to time and financial restrictions."

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• Case Two: “A 36‑year‑old mother of two, one year post‑treatment, reports ongoing anxiety, intrusive thoughts about recurrence, and guilt about not having the energy she used to. She struggles to balance caregiving, work, and her own health needs. She has not been screened for emotional and mental health concerns since completing treatment and is unaware of available survivorship or mental‑health supports.”

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• Case Three: “A 33‑year‑old woman, three years post‑treatment for HER2‑positive breast cancer, shares concerns about early menopause symptoms, body image changes, and uncertainty about future fertility options. She reports feeling isolated because her friends expect her to be “back to normal.” She has difficulty accessing a specialist who can address survivorship‑related reproductive questions and feels her concerns are minimized during routine visits.

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• Case Four: “A 31‑year‑old woman, about a year post‑treatment, recently learned she may have a hereditary breast cancer risk. She feels anxious about how to share this information with her sisters and teenage daughter, especially because health issues are rarely discussed openly in her family. She worries about causing fear, being misunderstood, or placing a burden on relatives who already face financial and access barriers. She has not met with a genetic counselor and is unsure how to guide her family toward appropriate testing or support.”

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Present a case:

Debrief: Interactive Case Study and Role Play

Discussion Questions

• What helped the conversation move forward, and what felt challenging or easy to miss?
• What moments felt most authentic or impactful during the role play or debrief?
• How did you create space for the patient’s story, emotions, and context?
• What barriers surfaced—emotional, logistical, financial, or communication‑related?
• Where did you tailor your communication or approach to the patient’s lived experience?
• What systems‑level challenges did you notice?
• What next step felt realistic in a real visit, and what resources or supports would you connect this patient to?

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Tools, Resources, and Action Planning

Practical Tools and Community Resources

This part of the session recaps the tools that help turn good intentions into action during real clinic visits.

Examples of supports you may already use—or could build on—include:

• Survivorship Care Plan templates to clarify follow‑up and responsibilities
• Referral pathways for mental health, financial counseling, social work, genetic counseling, and peer support
• Community and national organizations that complement clinical care
• Resource platforms that help identify psychosocial supports quickly

You are not expected to memorize resources. The goal is to feel more confident in finding and introducing support options when needs arise.

Activity: Using EmpowerHER Connections

Practice finding and recommending psychosocial resources for young breast cancer survivors.

Group Activity

1. Choose a brief survivor scenario based on something you’ve encountered in your own clinical experience or a topic area you’re interested in exploring further. (Please select a new example rather than reusing the earlier case studies.) Examples might include:
• Navigating financial stress
• Fertility or family‑building concerns
• Mental health or coping needs
• Relationship or caregiving strain
2. Use EmpowerHER Connections to identify at least one relevant resource https://ybcs.chronicdisease.org/
3. Be ready to share:
1. The resource you selected
2. How you would introduce it to a patient in a respectful, personalized, and empowering way

References, Tools & Resources

Scan the QR code to access a folder with:

• The full bibliography for all citations used in this presentation
• Downloadable tools and templates (e.g., survivorship care plans)
• Resource lists and navigation supports for young breast cancer survivors

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https://www.fmec.net/young-breast-cancer-survivors

Reflection, Q&A, & Action Planning

Reflection, Q&A, and Next Steps

Using the tools and resources we just reviewed, take a moment to reflect:

• What’s one need you hear most often from young breast cancer survivors in your setting?
• What’s one resource or tool you could introduce more consistently? (SCP template, referral pathway, community support, resource platform)
• What’s one small workflow change that would reduce missed opportunities?

Action Plan:

• Write down one step you will try in the next week (or next clinic session).

We will close with Q&A and a few shared takeaways.

Your Feedback Supports This Work

Please scan the QR code to complete a brief evaluation.

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Your feedback helps FMEC and our partners:

• Strengthen survivorship education
• Ensure this training meets the needs of family medicine teams

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We appreciate your time and insights.

Thank You for Your Commitment to Survivorship Care

Thank you for the care you provide, and for taking time to reflect, practice, and strengthen how we support young breast cancer survivors and their families.

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Small, intentional actions in primary care, clear communication, coordinated follow‑up, and thoughtful resource navigation, can make a lasting difference across decades of survivorship.

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This training was developed by the Family Medicine Education Consortium (FMEC) in partnership with the National Association of Chronic Disease Directors (NACDD), with support from the Centers for Disease Control and Prevention (CDC). This project is part of the Supporting Young Breast Cancer Survivors, Metastatic Breast Cancer Patients, and their Families which is supported by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) under CDC/HHS as part of a financial assistance award totaling $460,000, with 100% funded by CDC/HHS. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC/HHS.