Breast Cancer in Young Women

Breast cancer is more common in older adults. At age 30, a woman’s risk of getting the disease is 1 in 227. By age 60, a woman has a 1 in 28 chance of receiving this diagnosis. Although the odds are much lower for younger women, they can and do get breast cancer. More than 13,000 women ages 40 or under will be diagnosed this year.

When breast cancer is diagnosed at a young age, it’s more likely to be aggressive and to spread quickly. Young women may not get a diagnosis right away because many organizations don’t recommend regular mammogram screenings until age 45 or 50. It’s also harder for doctors to find breast cancer in young women than in older women because younger women have denser breasts. This means that they have more breast tissue than fat tissue. Tumors don’t show up as well on mammograms in women with dense breasts.

Read on to learn about some of the unique challenges young women with breast cancer face and what to do if you’ve been diagnosed.


RISK FACTORS
Risk factors to consider
You may be more likely to get diagnosed with breast cancer at an early age if you have a mother, sister, or another close family member who was diagnosed with breast cancer before age 45.

You may also have a higher risk of diagnosis if you have the BRCA1 or BRCA2 gene mutation. The BRCA genes help fix damaged DNA. When they’re altered, the DNA in the cells can change in ways that lead to cancer. Experts link these mutations to an increased risk for breast and ovarian cancers.

Breast cancers that arise from BRCA mutations are more likely to start early and to be more aggressive. Up to 65 percent of women with the BRCA1 mutation, and 45 percent of those with a BRCA2 mutation, will develop breast cancer by age 70.

Treatment with radiation to the chest or breast as a child or teenager can also increase your risk.

TYPES
Which types of breast cancer are young women prone to getting?
Younger women are more likely to have higher grade and hormone receptor-negative breast cancers. Higher-grade tumors look very different from normal cells. They divide quickly and are more likely to spread. They often respond well to treatments such as chemotherapy and radiation, which destroy quickly dividing cells.

Hormone receptor-negative cancers don’t need the female hormones estrogen and progesterone to grow. Unlike hormone receptor-positive cancers, they can’t be treated with hormone therapies such as tamoxifen and aromatase inhibitors. Hormone receptor-negative cancers tend to grow more quickly than hormone receptor-positive cancers.

Triple-negative breast cancer (TNBC) doesn’t respond to estrogen and progesterone. It also doesn’t respond to a protein called human epidermal growth factor receptor 2. TNBC is more common in young women and African-American women. It also has lower survival rates.

TREATMENT
How does your age affect treatment?
Your doctor will help you choose the most effective breast cancer treatment based on the type, stage, and grade of your tumor. Treatments are generally the same for women of all ages, but a few exceptions exist.

Drugs called aromatase inhibitors aren’t recommended for women who haven’t yet gone through menopause. These drugs treat estrogen receptor-positive breast cancer by blocking the enzyme aromatase. Aromatase converts the hormone androgen into estrogen. Without estrogen, the tumor can’t grow. Women who haven’t gone through menopause still produce estrogen in their ovaries. This means that aromatase inhibitors will only work if you also take medicine to stop your ovaries from making estrogen.

If medically feasible, you may opt for a more conservative surgery, such as a lumpectomy. This removes the tumor but keeps the breast intact. Chemotherapy, radiation, or both are usually necessary after a lumpectomy. If you need to have a mastectomy, which removes the whole breast, you can ask your surgeon to preserve your nipple. If you plan to have plastic surgery afterward to reconstruct your breast, this can enable your plastic surgeon to create a more natural looking breast.

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FERTILITY
How does your age affect fertility?
In your 20s, 30s, and even early 40s, you may be thinking about starting a family or adding to an existing one. Breast cancer treatment can affect your fertility. Both chemotherapy and radiation can damage cells in your ovaries that produce healthy eggs. This damage can make it harder for you to get pregnant.

Hormone therapies such as tamoxifen can make your periods come less often or stop entirely. This can also stop you from getting pregnant. Sometimes, the damage to your fertility is temporary. You may be able to get pregnant after your treatment ends. In other cases, this damage is permanent.

Some breast cancer treatments affect your desire to have sex. They can dampen your sex drive or make you feel too nauseous or tired to be intimate. Having cancer can be so emotionally overwhelming that you find it hard to connect with your partner physically.

If you know you want to have a family, talk to a fertility specialist about your options before starting treatment. One option is to freeze your eggs or fertilized embryos and store them until you’ve finished treatment. You can also take a drug such as leuprolide (Lupron) or goserelin (Zoladex). These drugs shut down your ovaries during chemotherapy treatment to protect them from damage.

OUTLOOK
Outlook
The general outlook for those with breast cancer has improved dramatically in the last few decades. The five-year survival rate when this cancer is diagnosed in its earliest stages is 100 percent. When the cancer is diagnosed at stage 3, this rate is 72 percent. Clinical trials are testing out new treatments that could one day improve survival odds even more.

TAKEAWAY
What you can do now
Learn all you can about your cancer so you can make informed choices about your treatment. Ask your doctor how your age may affect your treatment options and the impact they may have. Look for resources for young women with breast cancer, such as Living Beyond Breast Cancer and Young Survival Coalition.

Seek help when you need it. See a counselor to discuss the emotional impact of your diagnosis. Visit a fertility specialist to talk about your reproductive options. Friends and family members can help you get through your diagnosis and treatment