More women under age 40 are being diagnosed with breast cancer than ever before. While family history is a known risk factor, the rising incidence among women without a family history remains unclear.
What is known is that women with breast cancer in this era of life face unique challenges. They want to start or add to their family and are caring for mixed generations. They are also starting or hitting the formative years of their careers.
As part of our ongoing Conversations in Cancer series, Duke Health medical oncologist Diane Reidy-Lagunes, MD, talks to Rani Bansal, MD, a Duke breast cancer specialist, about what young women need to know and the resources available.
What do the statistics tell us?
According to the Breast Cancer Research Foundation, the breast cancer incidence rate in women under 50 is rising faster than in women over 50. While the number of young women with breast cancer is still low, women under 40 are nearly 40 percent more likely to die from breast cancer than women over 40. Currently, breast cancer is the leading cause of cancer death in women aged 20 to 49 in the U.S.
In addition, the Breast Cancer Research Foundation finds that rates of metastatic breast cancer in women under 40 have risen 3.5 percent each year between 2004 and 2017. Younger women are also more likely to experience a recurrence at five and 10 years after therapy compared to older women.
What risk factors or theories may explain this trend?
Family history is a known factor. Your risk increases if your mother, aunt, or a first cousin had breast, ovarian, or metastatic prostate cancer.
Black and Latina women are at higher risk for metastatic breast cancer. Black women, ages 20 to 44, are also nearly twice as likely to be diagnosed with triple-negative breast cancer as white women.
The care one receives and their access to the best screening and treatment play a role.
Obesity and lifestyle factors such as diet, exercise, and smoking are cancer risk factors.
Finally, the age at which menses, childbearing, and breastfeeding start may influence one’s risk.
What breast cancer types are more common in young women?
Because younger women are not screened regularly -- current recommendations have regular mammogram screening starting at age 40 -- tumors may be larger, more aggressive, and already spread to the lymph nodes.
Breast cancer tumors in young women are less likely to be fueled by hormones -- meaning triple-negative breast cancer. They are also more likely to test positive for the HER2 protein. These types of cancer are more difficult to treat. Recently, the increase we are seeing in breast cancer incidence in young women is in hormone receptor-positive breast cancer.
How is treating young women with breast cancer different than treating women over 40?
Life-saving treatments like chemotherapy and hormone therapy can significantly impact a young person’s life now and in the future. It can cause temporary or permanent menopause and can seriously impact a young person’s mental and sexual health, as well as their sleep quality. Long-term, these treatments can cause heart disease and other complications that require additional surveillance and treatment.
Some younger women haven’t started a family yet or may want more children. They may choose to freeze their eggs for future use, but that option can be costly.
Many young women are diagnosed with breast cancer while still in college or just starting their careers, and struggle with the financial, physical, and emotional stress.
What does Duke offer to young women with breast cancer?
We offer many resources to help young women from when they are diagnosed through treatment and beyond. Our cancer support program includes medical family therapists, sexual health therapists, genetic counselors, and social workers trained to address the unique needs of young people. We have child life therapists and programs for children whose parents are undergoing cancer treatment. We also connect young women with the experts in our fertility preservation program, as well as financial counselors who can offer resources.
The partnership between Duke’s BEYOND BC program (Boost & Empower: Young Onset Network at Duke for Breast Cancer) and our supportive care and survivorship center pairs a nurse navigator with young women when they are first diagnosed. They identify their needs, help them with treatment decisions, provide education, facilitate young adult meet-ups, and provide other cancer support resources. Right now, this program is available at the Duke Cancer Center in Durham but will soon expand to all Duke Cancer Centers.
We’re also implementing a research component. By following women who consent to be part of our database, we can track their outcomes, the effects of treatment, and get a better sense of what works and what doesn’t. We will also collect and analyze blood samples to better understand the disease.
What can young women do to reduce their risk?
Take action if breast cancer is in your family history. Undergo genetic testing if a family member was diagnosed with breast cancer before 50, or had ovarian, pancreatic, or metastatic prostate cancer. Women diagnosed under 50 years of age are more likely to carry an inherited mutation in BRCA1 or BRCA2 genes, which can increase breast cancer risk as well as the risk of other types of cancer. If genetic screening identifies an inherited mutation, you should undergo regular breast cancer screening as part of a high-risk program.
Know your body and the symptoms. Many young women might notice a change in their body but don’t think it could signal breast cancer. If you experience breast lumps, breast pain, changes in your breast skin or nipples, nipple discharge or swollen lymph nodes, talk to your doctor.
Advocate for yourself. That can be hard for some young women, who lack the experience and confidence to advocate for their health. And, unfortunately, some doctors still believe women under 40 are too young to get breast cancer. We are working to educate doctors about the need to screen for breast cancer if symptoms are present. If you feel you are being ignored, request a screening mammogram from another provider.
Maintain a healthy lifestyle. Obesity and drinking more than four alcoholic drinks per day can increase your risk. Following a healthy diet and maintaining a regular exercise program can help reduce your risk.
