The basics on breast cancer and young women

“I’m too young for breast cancer!”

This may have been one of your first thoughts when your doctor told you about your diagnosis. Women under 40 do develop breast cancer, although at a lower rate than older women.

While breast cancer in young women is less common and often overlooked, it is still a major health concern:

• Five percent of new breast cancers occur in women under 40. That’s a small percentage, but it represents a lot of women.
• Each year, about 11,330 young women are diagnosed with invasive breast cancer and 1,780 with in situ disease, according to the American Cancer Society.
• Understanding more about being diagnosed at a young age can help you move forward and make decisions that are best for you.

Young Age and Breast Cancer Risk

Because your breast cancer risk increases with age, your chances of developing invasive breast cancer are:

• under age 40 — 1 in 203
• age 40 to 59 — 1 in 27
• lifetime risk — 1 in 8

African-American women have a higher chance of being diagnosed before age 40 than non-Hispanic white women. (After age 40, non-Hispanic white women are diagnosed at a higher rate than African-American women.) Hispanic, Asian/Pacific Islander and American Indian/Alaska Native have lower rates of diagnosis overall, but they are increasingly diagnosed at younger ages.

It’s normal to question why you developed breast cancer. You may feel unlucky and angry, but the breast cancer is not your fault.

Some reasons you could have been at higher risk for breast cancer include:

• Your mother, father, sister or daughter was diagnosed with breast cancer, or you have other family history of breast or ovarian cancers on either your mother’s or father’s side.
• You have a mutation, or change, on the BRCA1 or BRCA2 gene. Having a BRCA mutation increases your risk of breast and ovarian cancer. Between 5 and 10 percent of breast cancers are due to BRCA1 or BRCA2 mutations.
• You had radiation therapy to the chest as a child, adolescent or young adult.
• You had a high-risk breast lesion or prior breast cancer.

Reasons young women develop breast cancer

In young women, certain factors can contribute to breast cancer development or create challenges for breast cancer detection or treatment.

Some of these age-related issues include:

• Ignoring a breast lump or discharge due to young age.
  • Healthcare providers and women may think a symptom is related to menstrual cycle changes, a cyst, a blocked milk duct or something else that is not breast cancer.
• Greater chances of delayed diagnosis until symptoms can be seen, and the cancer may be a higher stage.
  • Young women may be told to watch a lump instead of having it analyzed.
• More dense breast tissue, common in young women.
  • Density is due to the amount of gland tissue compared to fat tissue. It decreases as you age.
  • Lumps are difficult to feel in dense breasts. This increases the risk of breast cancer growing without being detected.
  • Mammograms are less effective at screening dense breasts.
• Higher incidence of BRCA1 or BRCA2 genetic mutations in younger women.
  • Having one of these gene changes increases your breast cancer risk.
• Higher staging at diagnosis for young women.
  • Higher stage breast cancer can be more difficult to treat.
• Tumor biology can be more aggressive and resistant to treatment.
  • A greater percentage of breast cancers in young women are hormone receptor-negative for either estrogen (ER-), progesterone (PR-), human epidermal growth factor negative (HER2-), or all three ( triple-negative).
  • Doctors cannot use some of the new targeted treatment options for triple-negative, ER- and HER2- breast cancers because they are not effective against them.
  • More African-American women have triple-negative breast cancer than other racial groups, contributing to lower survival.
• Lack of a good screening tool.
  • Most women younger than 40 do not have regular mammograms because it is not standard medical practice. Those who do get screening are usually at high risk for breast cancer due to family history or a BRCA1 or BRCA2 mutation.

Among women diagnosed with breast cancer before age 40, the five-year relative survival rate is lower than for those who are diagnosed when older. For younger women, 84 percent survive after five years, compared to 90 percent of women diagnosed after age 40.

Support After Diagnosis at a Young Age

Breast cancer is unwelcome at any life stage. That’s especially true when you’re young. You may be focused on your education, job and career, dating, developing a personal relationship, building a family or making plans for the future.

A breast cancer diagnosis can leave you feeling isolated as well as shocked and worried. You may be the only woman your age among your friends, co-workers or family members who has been affected.

Certain issues are of special concern to younger women after a breast cancer diagnosis, including:

• Fertility and pregnancy
• Your identity and sense of self as a young woman
• Premature menopause
• Long-term follow-up care
• Health status and future health risks because of cancer treatment
• Sexual health, intimacy, dating and body image
• Social life, finding support and community
• Navigating school, work and career advancement
• Family issues and roles
• Parenting and raising children while in treatment
• Finances and cost
• Legal concerns, including healthcare coverage.

In the young women section and throughout the website, you’ll find helpful information about these subjects and more.

To talk with another woman who has been there and understands, call our Breast Cancer Helpline. If you wish, we can match you with a Helpline volunteer who is your age or in a similar circumstance. Call us toll-free today: (888) 753-LBBC (5222).