Young women and men can get breast cancer at any age, even as an adolescent or young adult. The most common cause of cancer-related deaths among younger women (under age 50) is breast cancer. This disease, which can develop in both men and women, is often a focus of women’s health due to a significantly larger incidence and mortality rate in women.

Differences in Breast Cancer in Young Women
When a young person receives a breast cancer diagnosis, their disease may be more advanced than if they were over 45. One reason for this may be that breast cancer in this age group might be more advanced when it’s found, as routine screenings for breast cancer don’t usually start until age 40. Additionally, young women might not recognize symptoms and alert their healthcare provider.
Breast cancers in women under 45 may also be aggressive and harder to treat based on tumor markers. Statistics from the American Cancer Society show that from 2012 through 2021, the breast cancer incidence rate among women rose by 1%, but for women under the age of 50, this rate rose by 1.4%. Despite this figure being relatively low, this population tends to develop larger tumors and more aggressive forms of this cancer. There is a clear need for patients, researchers, and health care providers to understand better these trends and their effects on women’s long-term health across the lifespan.

Early-Onset Breast Cancer
Early-onset breast cancer typically refers to breast cancer that is diagnosed when you receive a breast cancer diagnosis between the ages of 18 and 45. It is becoming more common in younger women, with about 10% of all new cases found in women under 45 years of age.
Why is breast cancer in young adults on the rise? This is something researchers are trying to understand. It is unclear why the incidence of early-onset breast cancers is rising, but some hypothesize that these early-onset breast cancer risks may be contributing factors:

    • Inherited genetic mutations: About half of early-onset breast cancers are related to BRCA1 and BRCA2 mutations. Mutations to the PALB2 and TP53 genes can also increase your risk for early-onset breast cancer. However, not all early-onset breast cancers are genetic.
    • No full-term pregnancies: The risk for breast cancer increases if a woman has no full-term pregnancies or has their first pregnancy after age 35. Statistically, women are having fewer children or having them later in life. This could influence more early-onset breast cancer diagnoses.
    • Family history: Your risk for breast cancer increases if you have a parent, sibling, or child with the disease.
    • Precancerous breast conditions: Your risk for breast cancer increases if you’ve been diagnosed with specific high-risk breast lesions, such as atypical ductal hyperplasia, atypical lobular hyperplasia, ductal carcinoma in situ, or lobular carcinoma in situ.
    • Dense breasts: Many young women have dense breast tissue. This means their breasts have more fibrous and glandular tissue than fatty tissue. During a mammogram, breast cancer can hide in the fibrous and glandular tissue. If you have dense breasts, you may need additional screening to detect and diagnose breast cancer.
    • Race: Studies show that Black women ages 20 to 39 are more likely to develop breast cancer of any subtype compared to younger women of other racial and ethnic groups.
    • Other possible risk factors include hormone therapy use in some instances, alcohol use, excess body weight, obesity, and sedentary behavior.
    • Researchers are studying whether specific environmental exposures and dietary factors influence breast cancer risk.

Even though more people are being diagnosed with breast cancer, it’s essential to know that they’re living longer. Experts believe this is due to earlier and more effective detection strategies, as well as advances in treatment. The more people are being diagnosed when cancer is in its earlier stages, the more we have improved survival. And many people with metastatic breast cancer are living longer because of new treatments.

Genetic Risk Factors for Breast Cancer
Inherited mutations in the BRCA1 or BRCA2 genes, which increase breast cancer risk, are more commonly seen in young women. While about six percent of all women with breast cancer are carriers of BRCA mutations, the number is closer to 12 percent in patients under 45 with breast cancer. Women of Ashkenazi Jewish descent are particularly vulnerable because BRCA mutations are more prevalent in this group.

A younger woman’s breast cancer risk is also higher if she
Has one or more family members who:

    • Was diagnosed with breast cancer before 50
    • Had cancer in both breasts
    • Had breast cancer as a man
    • Had ovarian, pancreatic, and metastatic prostate cancer
    • Had her first menstrual period before age 12.
    • Had her first pregnancy over age 30, or has not had children.
    • However, both pregnancy before age 30 and breastfeeding have been found to protect against breast cancer.

What Breast Cancer Symptoms to Look For?
Breast cancer symptoms can include:

    • Lumps in the breast or armpit
    • Breast pain
    • Skin changes to the breast ( swelling or thickening of the skin or nipple)
    • Inverted nipples
    • Nipple discharge
    • Swollen lymph nodes

Typically, mammograms are not recommended in women younger than 40 if they are at average risk for breast cancer, so young women need to practice breast awareness. This means you should be familiar with your breasts, and if you notice any changes, like a new lump, see a doctor right away.

Treatment For Early-Onset Breast Cancer
Studies have shown that breast cancer diagnosed in younger women tends to have a more aggressive disease biology. This means that the cancer may be found at later stages or harder to treat. Younger women are also more likely to be diagnosed with an aggressive type of breast cancer called triple-negative breast cancer compared to older women. Every breast cancer is different.

Mammogram Before Age 40
Most current screening guidelines recommend that women at average risk for breast cancer begin getting annual mammograms at age 40. Women at increased risk may need to start breast cancer screening earlier, get additional imaging tests, or be tested more often.
It’s important to talk to your health care provider about your risk for breast cancer, so they can determine when you should begin screening and how often you should be screened.

Lower Breast Cancer Risks

    • Avoid alcohol: For cancer prevention, it’s best not to drink alcohol. If you choose to drink, be aware of the risks, aim to drink less often, and have fewer drinks.
    • Choose to Breastfeed: It’s recommended to breastfeed for at least six months to help lower your breast cancer risk.
    • Get active: Aim to get at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week. Try to engage in resistance training for 30 minutes, at least twice a week.
    • Maintain a healthy body weight: By keeping your weight in a healthy range, you can avoid obesity, which is linked to breast cancer.

 

Cancer Treatments Pose Unique Challenges
Fertility is a significant worry for young patients who want to start or grow their families. At diagnosis, approximately half of younger women said they were worried about treatment-induced infertility, but few pursue fertility-preservation strategies. While such measures can be effective, they can also worsen the financial, physical, and emotional stresses young women already experience from cancer treatment.
Lifesaving cancer treatments can impact patients’ quality of life at any age. For young women in particular, breast cancer treatments such as specific chemotherapy and hormone therapies can cause temporary or permanent menopause long before it would naturally occur. Menopause symptoms after treatment can seriously affect a younger woman’s sexual and mental health, along with her sleep quality. While hormone replacement therapy may help relieve some symptoms, it isn’t an option for many breast cancer survivors since it can increase recurrence risk.
Also of note: Research has shown that some chemotherapy and targeted treatments can have a toxic effect on patients’ hearts years—or even decades—after treatment. Younger women who live many years beyond breast cancer treatment can develop long-term heart health complications that require surveillance and treatment.

Racial and Ethnic Disparities
Recent breast cancer trends are concerning because they suggest an increased cancer risk for younger women of specific racial and ethnic backgrounds. Researchers have noticed trends among Asian American and Pacific Islander (AAPI) populations, with rates rising by 2.5% to 2.7% per year since 2012. Within this demographic, specific ethnic subgroups are at an even higher risk, with Chinese American and Filipina American women having the highest risk of breast cancer. Asian American women of Chinese and Japanese heritage have lower mortality rates than white American women. In contrast, U.S.-born Filipina and Pacific Islander women have a higher mortality rate than all these groups.
Black women have a lower overall incidence rate of breast cancer, despite having the highest incidence rate amongst women ages 20-39 years. Black women experience a significantly higher incidence rate.
Breast cancer (133.7 per 100,000) compared to white women (127.8 per 100,000). These disparities in rates worsen when looking at populations under 50, where Black women are twice as likely as white women to die from breast cancer. Both Black and Hispanic women are also more likely to have prolonged periods of time between mammograms or other diagnostic tests compared to white women. This could be the result of the 6.9% of Black women and 15% of Hispanic women nationally who lacked health insurance coverage in 2023. Additional data on disease impact and influencing factors can be explored in the Breast Cancer section of the SWHR Women’s Health Dashboard. Addressing access to quality care for women across the country could help address the racial disparities that exist for those with breast cancer.

Death Rates
In 2023, a total of 2,209 women younger than 45 years died from breast cancer in the United States. From 2001 to 2023, non-Hispanic Black women had the highest breast cancer death rate compared to all other racial and ethnic groups. From 2001 to 2023, breast cancer death rates decreased 1.9% per year on average for non-Hispanic Black women, 1.5% per year on average for non-Hispanic White women, 1.5% per year on average for Hispanic women, and 1.6% per year on average for non-Hispanic Asian and Pacific Islander women. Trends among non-Hispanic American Indian or Alaska Native women could not be assessed because of limited data in some years.

SUMMARY
Summary Points

    • Early-onset breast cancer is breast cancer that is diagnosed in people younger than 45.
    • About half of early-onset breast cancers are related to BRCA1 and BRCA2 mutations.
    • It is essential to be familiar with your breasts and contact your doctor if you notice any new or unusual lumps.
    • Talk to your doctor about your breast cancer risk, so they can determine when and how often you should be screened.
    • Risk factors, reducing risk, and screening.
    • Although all women are at risk of getting breast cancer, some factors can raise a woman’s risk for getting breast cancer before age 45. Talk to your doctor about your family history and other risk factors.
    • If you have a higher risk of breast cancer, consider genetic counseling and testing. If you’re at higher risk due to a family history of certain cancers or have a genetic mutation that runs in your family, talk to your doctor about ways to lower your risk for breast and other cancers.
    • Learn more about the symptoms of breast cancer and see a health care provider if you notice any changes to your breasts. For women who are aged 40 to 74 and at average risk for breast cancer, the U.S. Preventive Services Task Force recommends getting a mammogram every 2 years.

Pay Attention to Your Body

    • Always pay close attention to your body. Reach out to your doctor as soon as you notice anything new or suspicious going on with your breasts.
    • Recently, more young celebrities have gone public with their breast cancer diagnoses, which may help bring awareness of early-onset breast cancer. Researching to better understand why more young people are getting breast cancer will help to continue to improve prevention and treatment strategies, giving patients a better outcome.

References
AACR (American Association for Cancer Research)
BCRF (Breast Cancer Research Foundation)
CDC (United States Cancer Statistics)
Cleveland Clinic
MD Anderson Cancer Center
Society for Women’s Health Research