Breast cancer in young women: a breast specialist’s perspective

The overall incidence of breast cancer in the U.S. is rising by about 1% per year. Currently, for women under age 50 years old, it's 1.4%. We don't have a definitive explanation of why this is happening, but there are some theories.

Why are so many young women getting breast cancer

Cancer is generally associated with aging, but we now know there are many other risk factors for breast cancer. An increase in lifetime estrogen exposure may lead to a higher likelihood of breast cancer. Estrogen can increase in younger women due to:

• Excess body weight
• Delaying childbearing
• Having fewer children overall

Age to start screening for breast cancer

When you should start breast cancer screenings depends on many factors:

• If you're 40 years or older, you should have yearly mammograms
• If you're under 40 and have a family history of ovarian, pancreatic, prostate or colorectal cancer, you should consider genetic testing to help determine your best screening option
• If you have dense breast tissue, talk to your healthcare clinician about whether you need additional screening, like annual breast MRIs

Note: If you notice any changes — such as a lump, nipple discharge, skin changes or pain — you should see a breast specialist as soon as possible.

Genetic testing for breast cancer

If you're concerned you are at risk of breast cancer, you should talk with a genetic counselor if you're under 40 and have a family history of any of the following cancers:

• Breast
• Ovarian
• Pancreatic
• Prostate
• Colorectal

Based on your genetic assessment, your counselor may recommend genetic testing. If the test finds you have a genetic mutation, we usually recommend:

• Starting breast screenings earlier
• Seeing a breast specialist annually
• Possibly having breast MRIs or mammograms before age 40

If you're already diagnosed with breast cancer, I strongly encourage my patients under 50 who haven't done so to consider genetic testing. If a mutation like BRCA is found, we can tailor treatment and future screening based on your specific genetic risk profile.

Impact of breast cancer on quality of life

Every patient's concerns about breast cancer treatment are unique, but younger women typically share these top concerns.

Family planning

As medical and surgical treatments for breast cancer can affect fertility, many young adults ask about their options for family planning and fertility preservation. If a patient wants to have children in the future, we do our best to help by:

• Referring them to a fertility preservation specialist — usually a reproductive endocrinologist — before starting breast cancer treatment
• Connecting them to our breast cancer nurse navigators and social workers to help with coordination and securing coverage from the patient's insurance, though it's not always guaranteed

Early menopause

Some breast cancer treatments can induce early menopause, which can have significant impacts on your quality of life. Sometimes there's little flexibility in treatment options because of their survival benefits, but we always:

• Verify we understand what matters most to you
• Look for ways to lessen side effects
• Check in regularly to find out how treatments affect your life

Temporary menopause

For young women with estrogen-responsive breast cancer, ovarian suppression may be part of the treatment plan. This induces a chemical menopause that is usually not permanent.

Side effects can include hot flashes, but medications can help reduce their intensity. We work closely with medical oncologists and gynecologists to manage these side effects.

Cosmetic concerns

Looks are often especially important for younger breast cancer patients. For some, a lumpectomy with a small, discreet scar is possible. For others, a mastectomy may be necessary to remove breast tissue.

We work closely with plastic and reconstructive surgeons to minimize cosmetic changes. Our goal is to help people live long, healthy lives without daily reminders of their cancer treatment.

Breast cancer treatment

There are many types of breast cancer, and breast cancer in young women is often more aggressive than breast cancer in older women. We will discuss the best treatment options, considering your cancer and your lifestyle. Treatment usually includes a combination of hormone or targeted therapy, chemotherapy, radiation or surgery.

Evidence-based and proven practices

There are many exciting developments continually occurring in breast cancer treatment, especially when it comes to genetics. Learning more about genetic mutations that are passed down from one generation to another and the genetic makeup of breast cancer cells are fueling development of more targeted therapies, such as immunotherapy.

We always follow evidence-based treatment protocols. Unfortunately, there is a lot of misinformation online and on social media. It is very important that patients and families rely on credible sources. In breast cancer treatment, standard treatments give you the best chance at survival.

Managing your risk of developing breast cancer

Even if you're at high risk for breast cancer, there are things you can do to lower your risk:

• Maintain a healthy weight
• Exercise regularly
• Eat a healthy diet with minimal processed foods
• Avoid alcohol
• Do not use tobacco

Small daily changes can add up over a lifetime. While it's hard to pinpoint exactly what causes breast cancer, we do know that alcohol increases all cancer risk, including breast cancer. Environmental exposures also play a role, but it's rarely just one cause.

Sometimes even people with the healthiest lifestyles develop breast cancer, and we may never know why. The best approach is to focus on what you can control and to stay informed with evidence-based information.

Understanding cancer in young people

Main Line Health's clinicians and care team have additional insights on their approaches to diagnosing, treating and supporting young people with cancer.

Explore the full series

Next steps

Learn more about Elissa Dalton, MD

Learn more about cancer care at Main Line Health

Learn more about the Genetics and Risk Assessment Program

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