Breast cancer is not age-specific. It can affect young women as well as older women. But does it affect younger women differently?
News reports of singer Sarah Harding’s death at the age of 39 years in early September 2021 following a late breast cancer diagnosis brought breast cancer to the forefront once again. Not only did the news of her passing invoke sadness, but it also brought an awareness that breast cancer can — and does — affect younger women.
Although breast cancer can occur in men, it is most common in women over 50 years of age. Still, younger women are also at risk of the condition.
In this Special Feature, MNT investigates breast cancer in young women and how it differs in younger versus older women. We also talk with two experts about this important topic.
How prevalent is breast cancer in younger women?
The exact age considered “young” for having breast cancer varies. However, most scientific studies refer to younger women with breast cancer as those younger than 35, 40, or 45 years of age.
According to the Centers for Disease Control and Prevention (CDC), about 255,000 women and 2,300 men receive a breast cancer diagnosis every year in the United States.
Breast cancer is the second leading cause of cancer-related death among women and the leading cause of cancer-related death among Hispanic women. In addition, Black women die from breast cancer more often than white women.
CDC data also show that, in the U.S., 9% of all new breast cancer diagnoses occur in women younger than 45 years of age. Women in this age group are also more likely to experience poor outcomes from the condition.
Furthermore, the mortality risk for young women with breast cancer may vary depending on where they live, according to one study.
In research that appears in the journal Breast Cancer Research and Treatment, scientists examined data looking for differences in breast cancer incidence among women 20–49 years of age. In that age group, around 77% of breast cancer diagnoses occurred in women ages 40–49 years.
The researchers also found that in women younger than 45 years of age, breast cancer occurrence was higher among Black women. Additionally, Black, American or Alaska Indigenous, and Hispanic women had more late stage breast cancer diagnoses than white women.
What types of breast cancer occur in younger women?
Compared with breast cancer in older women, an overview article that appears in the journal Updates in Surgery suggests that breast cancer in younger women:
- may be more aggressive, invasive, and fast-growing
- tends to have reached a later stage at diagnosis
- has a higher likelihood of being triple-negative or HER2-overexpressing
- has a higher rate of recurrence
Triple-negative breast cancer is particularly challenging to treat because it lacks the hormone receptors present in other types. This means that doctors have limited choices when it comes to treatment options. However, chemotherapy and radiation therapy are usually effective against this type of breast cancer.
Risk factors
Many of the risk factors for breast cancer in older women apply to younger women as well. Risk factors for breast cancer at a younger age include:
- having close relatives who had breast cancer before the age of 45 years or ovarian cancer at any age
- having changes in breast cancer genes (BRCA1 and BRCA2) or having close relatives with these gene changes
- having Ashkenazi Jewish heritage
- receiving radiation therapy to the breast or chest area during childhood or early adulthood
- having previously had breast cancer or other breast health issues
- having dense breast tissue identified during a mammogram
In addition, some research indicates that obesity may also increase the risk of certain types of breast cancer in younger women.
For example, a review article reports that most studies have shown obesity to be associated with a lower risk of estrogen receptive-positive breast cancer and a higher risk of triple-negative breast cancer in premenopausal women.
Screening and diagnosis
Often, doctors diagnose breast cancer at a later stage in young women than in older women. The reasons for this are not fully understood.
One possible reason may be that many women are unaware that breast cancer can occur at a young age, which may delay diagnosis and treatment. Also, breast tissue in younger women can be denser, making it challenging to find tumors during breast self-exams and mammograms.
The U.S. Preventive Services Task Force (USPSTF) recommends that women ages 50–74 years who have an average risk of breast cancer get a mammogram every 2 years. The USPSTF also suggests that women ages 40–49 years talk with a healthcare professional to decide when to begin mammogram screening.
Still, other breast cancer screening guidelines vary slightly.
Dr. Richard Reitherman — the medical director of breast imaging at the Memorial Care Breast Center at Orange Coast Medical Center in Fountain Valley, CA — told MNT:
“[The USPSTF] has recommended that all women by the age of 30 have a family history-related genetic risk evaluation. The first step is taking an accurate family history of any relatives — no matter how distant — with breast or ovarian cancer. This history determines whether or not the woman should proceed to genetic counseling/testing. In many cases, the testing is ideally performed on the family member [who] has had breast or ovarian cancer and then perhaps on the woman herself if that test is positive.”
He added: “The main purpose of testing is to identify known mutations in the BRCA genes. If a woman has either a positive BRCA test or a negative test with a strong family history (breast cancer in a relative diagnosed under 50, breast and ovarian cancer, or bilateral breast cancer), she should likely begin a regular program of screening mammography and breast MRI at that time.”
Dr. Reitherman noted that breast cancer detected during a mammogram or an MRI is generally smaller in size and may, therefore, have a better outlook.
“Every woman should begin yearly screening mammograms by age 40. If she has increased risk factors, [this should be] by as young as age 30.”
– Dr. Richard Reitherman
However, mammograms are not foolproof, and they can miss breast cancer tumors. For instance, one study found that of 15 screening-detected breast cancers, mammograms missed seven cases on the initial screen.
Prevention
Preventing breast cancer at a younger age may be challenging due to the nature of the condition. However, knowing one’s risk factors and seeking preventive care are critical.
Dr. Halley P. Vora, an oncologist at Loma Linda University Health and an instructor at the Surgical Oncology Division at Loma Linda University School of Medicine in California, told MNT: “If a young woman has risk factors [for breast cancer at a younger age], then [she should consider] meeting with her physician to discuss high risk breast screening programs. These women can also benefit from consideration of genetic testing.”
Dr. Vora also noted that making certain lifestyle modifications — including “maintaining a […] healthy weight, getting regular moderate-level exercise, and limiting alcohol consumption” — may reduce breast cancer risk
In addition, she explained, “young women are encouraged to be aware of their breasts and should present to their physician with any new lumps, nipple changes or discharge, skin changes, or other changes.”
Treatment
Treatment for young women with breast cancer is similar to treatment for women who receive a diagnosis at an older age.
Depending on the type of cancer, the stage, and its location, some treatment options include:
- surgery to remove the cancer (lumpectomy) or the affected breasts (mastectomy)
- chemotherapy to reduce or eliminate cancer cells
- hormone therapy to treat cancer cells that thrive on hormones, such as estrogen and progesterone
- radiation therapy to target cancer cells
- biological therapy to assist the body’s immune system in fighting the cancer
Fertility and breast cancer treatment
Some medications and therapies for breast cancer can cause the ovaries to stop producing eggs or adversely affect a developing embryo. Because of this, some young women with breast cancer may want to discuss fertility preservation options when creating a treatment plan with a healthcare team.
There are a few discussion points to consider in this context.
According to a clinical review that appears in the journal JCO Oncology Practice, using gonadotropin-releasing hormone agonists before and during chemotherapy may reduce the risk of ovarian insufficiency.
Some women may choose to freeze their eggs, ovarian tissue, or embryos through cryopreservation methods.
For those who wish to become pregnant, treatments including tamoxifen and HER2 therapies require delaying pregnancy until a specified time after stopping the medications.
Birth control may also require modifications. For example, some hormone-based contraceptives — including birth control pills and specific intrauterine devices — may not be the best options for women who have or have had breast cancer. Instead, nonhormonal options may be the ideal choice.
After-effects of breast cancer in young women
For many women, breast cancer survivorship is a complex journey filled with physical and psychological challenges. Some of these challenges may be more pronounced in younger women.
The researchers who conducted the JCO Oncology Practice review explain that young women with breast cancer may experience significant symptoms related to reduced ovarian function, cancer treatment medications, and decreased estrogen. These may include:
- vaginal dryness
- fatigue
- reduced sexual desire
- an increased risk of bone fractures
- cognitive impairment
Additionally, younger women with breast cancer may be at higher risk of the following than older breast cancer survivors:
- anxiety
- depression
- a feeling of isolation
- difficulties with body image
- relationship challenges
- financial disparities
- work-related difficulties
Researchers suggest that these challenges indicate the need for a multidisciplinary approach when treating breast cancer in younger women.
A woman’s healthcare team could include oncologists, mental health professionals, dietitians, and professionals from any specialty who may help young women with breast cancer navigate their journey to wellness.
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