Too Young to Screen: Breast Cancer in Younger Women
BYSeptember 28, 2020
If you’re under age 40, which is when it’s recommended that women begin having screening mammograms, you may think you are too young to get breast cancer—but that’s not true. While breast cancer in younger women is rare, it is the most common cancer among women ages 15 to 39. And certain kinds of breast cancer are on the rise among young women.
“While breast cancer is most typically diagnosed in post-menopausal women, this is a condition that can and does happen in young women, too,” says Yale Medicine radiologist Liva Andrejeva-Wright, MD, who specializes in breast imaging. “I have diagnosed women in their 20s with breast cancers.”
Overall, about 11% of all breast cancers occur in women younger than 45, according to the Centers for Disease Control and Prevention (CDC). An estimated 26,393 women under 45 are expected to be diagnosed with breast cancer this year. And every year, more than 1,000 women under age 40 die from breast cancer.
“While a majority of breast cancers that are found during annual breast cancer screening mammograms are in women over 50, women under 40 are generally too young to begin screening unless they have a mutation, a genetic reason or have physical symptoms, such as a mass or other breast changes,” explains breast oncologist Andrea Silber, MD.
When to start screening
“We recommend mammogram screening to start no earlier than age 40 and no later than age 50 for women of average risk for breast cancer, and continue through to at least age 74,” says Dr. Andrejeva-Wright. “Screening mammography should occur at least once every two years.” For women whose screening mammograms show they have dense breasts, an extra test—a breast ultrasound—is recommended.
Dr. Andrejeva-Wright says it is important to talk with a health care provider about when you should start getting mammograms, based on your unique health profile, and to make an appointment to see your doctor if you notice any unusual breast changes.
“Any time a woman feels a breast mass, which does not go away, while doing a breast self-exam at any age, she should get it checked out,” says Dr. Silber.
More than half of the time, women detect breast cancers themselves when they notice an unusual breast change. “Whenever there is a new mass or lump, tell your doctor—it should be evaluated by a clinical physical examination followed by breast imaging,” says Dr. Andrejeva-Wright. Other signs to be aware of include asymmetry of the breasts and nipple changes such as discharge or peeling skin around the nipple.
Says Dr. Andrejeva-Wright, “These symptoms don’t mean you have breast cancer, but it’s a reason to seek an opinion from a medical provider.”
While a breast cancer diagnosis at any age poses a variety of challenges, younger women with breast cancer tend to have a unique set of economic, reproductive, and body-image concerns.
The cost of breast cancer treatment for young women
“Everyone with breast cancer is at risk for suffering from ‘economic toxicity’ with the diagnosis,” says Dr. Silber. At the time they are diagnosed with breast cancer, younger women are less likely to be financially sound or to have established themselves in a career that provides sick leave and paid time off; they’re also likelier to have small children, she says.
“If you suffer from economic challenges prior to a cancer diagnosis, breast cancer is going to make that worse,” says Dr. Silber. That’s especially true for younger women who are from poorer socioeconomic backgrounds and don’t have access to the services or much leeway in terms of employment, she says.
“I take care of women who are young, poor, single mothers who may be working at jobs that don’t have good human resources support—like, for example, a young woman working at a mini mart at night,” says Dr. Silber. “She may be doing hard and not particularly safe work, and might not have health benefits.”
It can be a struggle to keep a job or get a raise—breast cancer patients may become semi-unemployable due to all the medical appointments they need, she explains.
Can a woman with breast cancer get pregnant?
For young women, a breast cancer diagnosis also creates uncertainty about having a family. Because cancer treatments can affect ovarian function, specialists with expertise in working with women with cancer can help preserve fertility before treatment begins by freezing eggs or embryos, through a process called cryopreservation. In Connecticut, insurance carriers cover the cost of cryopreservation for men and women under the age of 40 who have cancer.
It also may happen that a young woman is already pregnant when diagnosed with breast cancer, which requires careful conversations between the provider and patient.
“Breast cancer is the most common cancer we see in pregnant women,” says Dr. Silber. Because pregnancy brings about a variety of changes in the breast—and pregnant women aren’t getting mammograms—it may make the disease harder to diagnose, she notes, “but it doesn’t mean the prognosis is worse.”
In such cases, she explains, “Our goal is to do what we can to treat the cancer and protect the pregnancy,” adding that there are some types of chemotherapy treatments that can be given during pregnancy to treat breast cancer.
Body image in young women after breast cancer
Another hurdle young women face is how breast cancer treatments and their side effects affect body image.
“There are incredible demands placed on women in American society about their appearance,” says Dr. Silber, “and I would not be truthful if I didn’t say that a lot of women really struggle not only with treatment but with the aftermath. It’s hard because how someone looks can be a part of their self-worth. They may have lost their hair and gained some weight. Their breasts don’t look the same. To act like that’s not a thing is not fair—of course, it matters.”
Young women may be looking for a partner at a time when breast cancer treatment causes them to experience body changes that women generally don’t encounter until they’re older and postmenopausal: hot flashes and/or weight gain in the abdomen—the “meno-pot.”
“It’s different when these changes happen at 20 and 30,” says Dr. Silber, who explains that hormonal therapies are used for certain types of breast cancers to control tumor growth and discourage recurrence. But, this life-saving treatment, which a woman will need to keep taking as long as she lives, puts female breast cancer survivors into premature menopause—many years or even decades before their peers.
Detecting breast cancer in younger women
While there’s no way to predict who will get breast cancer, some factors put women at higher risk at a younger age. Breast cancer risk is higher in women with a family history (a mother or sister) of breast or ovarian cancers at a young age or who have an Ashkenazi Jewish heritage. Having had radiation therapy in the chest (for instance, for lung cancer treatment) is another important risk to know about.
There are some steps you can take, including discussing your family cancer history with your doctor and taking advantage of genetic testing for BRCA and other genetic mutations, if offered, based on your health and family history.
“Through research, we are learning more about cancer, genetics, and risk factors,” says Dr. Andrejeva-Wright. “Young women should be aware of their family history and keep their doctors updated over time as it changes.”
Also, while guidelines no longer call for monthly at-home breast exams, Dr. Andrejeva-Wright urges women of all ages to be “breast aware.” She advises women to do a breast self-exam at least quarterly (four times a year) and to learn all they can about their risk factors.
“Breast awareness entails knowing your family history of breast and other cancers,” says Dr. Andrejeva-Wright, “It also means knowing any behavioral factors that may increase your risk of developing breast cancer, such as weight gain and alcohol consumption (more than one alcoholic drink per day), and doing something about it.”
Because studies show that women who gain excess weight during adulthood are at risk for breast cancer, living a healthy lifestyle is also important to your overall health—and breast health, specifically.
“Maintain a healthy weight for your height throughout life with diet and exercise,” says Dr. Andrejeva-Wright. “Excess weight, particularly after menopause, is a significant risk factor for the development of breast cancer.”