Breast cancer is rare in younger women. Fewer than five percent of all breast cancers diagnosed in the U.S. occur in women under 40.1 Even so, if you are a woman in your 20s or 30s, you may worry about your risk of breast cancer now and in the future.
This overview covers breast cancer basics for younger women, including risk, risk factors and screening recommendations. It also provides a summary of breast cancer diagnosis, treatment and survivorship issues for younger women.
Breast cancer risk in younger women
In general, the risk of breast cancer is low for younger women. For women 40 or younger, the chance of developing breast cancer over the next 10 years is less than two percent.1
However, the risk of breast cancer increases with age. Over a lifetime (up to age 85), women in the U.S. have a 12 percent (1 in 8) chance of developing breast cancer.1
Absolute risk of breast cancer in U.S. women by age
If current age is:
Absolute risk of developing breast cancer
in the next 10 years is:
1 in 1,732 (0.06%)
1 in 228 (0.4%)
1 in 69 (1.5%)
Source: American Cancer Society1
What increases breast cancer risk in younger women?
Most factors that increase breast cancer risk in older women (such as drinking alcohol) also increase risk in younger women. And, most factors that lower risk in older women (such as ever having breastfed) also lower risk in younger women.
We don’t know what causes breast cancer to develop in any one woman, no matter her age. However, a few factors are especially important to breast cancer risk in younger women. These include inherited gene mutations and African American ethnicity.
Learn more about breast cancer risk factors.
BRCA1 or BRCA2 inherited gene mutations
Certain genetic factors put younger women at an increased risk of breast cancer. BRCA1 and BRCA2 (BReast CAncer 1 and 2) are the best-known genes related to breast cancer risk. Women who have an inherited mutation in one of these genes have an increased risk of both breast and ovarian cancers.1
Breast cancers related to BRCA1 and BRCA2 mutations tend to develop at a younger age than other breast cancers. For this reason, younger women diagnosed with breast cancer may be recommended for genetic testing for BRCA1 and BRCA2 mutations.2 However, it is important to remember that most breast cancers, even among younger women, are not caused by gene mutations.
Learn more about inherited gene mutations and cancer risk.
Learn more about genetic testing.
African American ethnicity
After menopause, white women have higher rates of breast cancer than African American women. However, before menopause, African American women have higher rates of breast cancer.3 This may be due, in part, to differences in some reproductive factors that increase breast cancer risk. For example, African American women tend to start their periods at younger ages than white women.4-5
The biology of breast tumors in younger African American women may also be different from the biology of breast tumors in other women. For example, younger African American women are more likely than older African American women or women of other ethnicities to be diagnosed with triple negative breast cancers.6-9 The reasons behind these differences are under study.
Learn more about race/ethnicity and breast cancer risk.
Learn more about triple negative breast cancers.
Breast cancer screening for younger women
Screening mammograms are not recommended for women younger than 40 who are at average risk of breast cancer. For most women ages 20 to 39, clinical breast exam at least every three years is recommended.2,10-11
However, for younger women at a higher risk of breast cancer (such as women with a BRCA1 or BRCA2 gene mutation) more intensive screening may be recommended. These women may begin mammography at an earlier age and they may need breast MRI in addition to mammography and clinical breast exams.2,10-11
Because most young women do not get mammograms, breast cancer is most often first detected when a woman notices a lump or change in the look or feel of her breast, nipple or underarm area.12 A health care provider may also note a change during a clinical breast exam.
Although most changes in a young woman’s breast are not breast cancer, any change should be reported to a health care provider.
Learn more about breast cancer screening.
Learn about the warning signs of breast cancer.
How do breast cancers in younger women differ from those in older women?
Younger women are more likely than older women to have more advanced stage cancers at diagnosis. They tend to be diagnosed with breast cancers that are:13-14
Only estrogen receptor-positive (ER-positive) breast cancers can be treated with hormone therapy. Since ER-negative cancers lack estrogen receptors, they do not benefit from hormone therapy. This means there are fewer treatment options for ER-negative breast cancers. ER-negative breast cancers also tend to recur (come back) earlier than ER-positive cancers.14
Prognosis for younger women
Breast cancer treatment for younger women is often effective and survival is usually good. With treatment, most young women can expect to live many years.
However, prognosis tends to be worse for women under 40 than for older women because breast cancers that occur in younger women tend to be more aggressive. Prognosis may also be worse if there are delays in diagnosis.
Delays in diagnosis
Delays in diagnosis can lead to breast cancers being diagnosed at a later stage, when chances of survival are lower. The good news is that today most younger women do not have a delayed diagnosis of breast cancer.12 They see their health care providers shortly after they notice symptoms and are usually diagnosed within a month.14 However, some younger women with low income or a lack of insurance may be more likely than other younger women to delay seeking medical help when they notice symptoms.12
Factors related to breast cancer treatment for younger women
Age itself does not greatly affect breast cancer treatment options. However, a woman’s menopausal status does affect some treatment options. For example, ovarian suppression is a hormone therapy that can only be used to treat women before menopause. And, aromatase inhibitors are hormone therapy drugs that can only be used after menopause. Most non-hormonal breast cancer treatments (such as chemotherapy and radiation therapy) do not depend on whether or not a woman has entered menopause.
Learn more about factors that affect treatment options.
Clinical trials for younger women with breast cancer
Over the past 30 years, treatment of breast cancer has greatly improved due to lessons learned through clinical trials. Research is ongoing to improve all areas of treatment for younger women with breast cancer. After discussing the benefits and risks with a health care provider, young women diagnosed with breast cancer may want to consider joining a clinical trial.
BreastCancerTrials.org in collaboration with Susan G. Komen® offers a custom matching service. This matching service can help women find clinical trials recruiting younger women with breast cancer or clinical trials for fertility preservation. Women can also visit the National Institutes of Health's website to find a clinical trial.
Learn more about clinical trials.
Quality of life issues for younger women
Starting down the path of survivorship at a young age can be especially hard. At a time in life most often reserved for family and career, issues of treatment, recovery and survivorship suddenly take top priority.
Breast cancer impacts a woman’s quality of life and emotional well-being, as well as her physical health. Concerns about body image and sexuality are common. Moreover, early menopause can cause changes that decrease sexual pleasure.
These unique concerns can make younger survivors feel isolated. Because most women with breast cancer are older, it’s easy to feel alone even among other survivors. A support group tailored to younger women with any type of cancer may be more helpful than one for breast cancer survivors (where most members may be older). Younger women need to be able to share their thoughts and feelings with women who are at the same stage of life and are juggling similar priorities, such as raising a family and working. Some websites, such as the Young Survival Coalition, offer chat rooms and e-mail discussion groups for young survivors.
A main concern for some younger women being treated for breast cancer is loss of fertility. Chemotherapy can damage the ovaries and both chemotherapy and the hormone therapy drug tamoxifen can cause irregular periods or stop periods altogether, leading to early menopause. With tamoxifen, regular periods usually return after treatment ends. However, tamoxifen is taken for many years and over this time, natural fertility may decline. With chemotherapy, the loss of periods may be permanent.
There are things younger women can do to help preserve their childbearing options. Meeting with a fertility specialist as early as possible (before breast surgery) offers the widest range of options. For example, before treatment begins, a woman may store embryos (fertilized eggs). There are also clinical trials studying new methods of fertility preservation.
Learn more about fertility options for younger women diagnosed with breast cancer.
According to Ann Partridge, MD, MPH, Komen Scholar and Clinical Director of the Breast Oncology Center at the Dana-Farber Cancer Institute and Associate Professor of Medicine at Harvard Medical School, "When young women are diagnosed with breast cancer, they often are challenged by major medical and emotional issues. An increasing focus on the issues that are either unique to young women (e.g., fertility, diagnosis during pregnancy) or accentuated by their young age (e.g., beauty and body image concerns, psychosocial distress, genetic risks) has helped young women to have additional information, resources and support in order to get not only get through their diagnosis and treatment, but thrive long thereafter."
In women under 40, breast cancer is not common, but it does occur. Although we don’t know all the risk factors for breast cancer in younger women, having a BRCA1 or BRCA2 gene mutation greatly increases risk. Younger African American women also appear to have an increased risk compared to older African American women and younger women of other ethnicities.
Breast cancers that develop in younger women tend to be more aggressive than those in older women. However, with treatment, prognosis tends to be good and most younger breast cancer survivors go on to live full lives.
While a breast cancer diagnosis is a shock for any woman, younger women face special challenges. Treatment can cause early menopause and impact childbearing. For women who want to have a child after treatment, it is best to talk with a fertility specialist before treatment begins to have the widest range of options.
For younger breast cancer survivors, support may be especially important. Because so few younger women are diagnosed, it’s natural to feel alone. Although there are few support groups specific to younger women with breast cancer, there are support groups for younger women with any type of cancer. Online and phone sources of support are also available.
Komen Support Resources for Younger Women with Breast Cancer
What is Komen doing?
Since 1982, Komen has invested more than $8.5 million in grants to support research related to breast cancer in young women. These grants have support clinical trials as well as studies that address early onset breast cancer in disparate populations. Examples of research projects include:
- Identifying the genetic, lifestyle or behavioral factors that may contribute to early onset breast cancer and developing strategies that may help to reduce this risk
- Determining the factors that may affect the diagnosis, prognosis and survival of pregnancy-associated breast cancer
- Identifying fertility concerns in younger women that influence treatment decisions or steps taken to preserve fertility at diagnosis
- Improving tools that predict breast cancer risk in young women, particularly women of African American descent
Komen also supports a number of special programs and partnerships for young women with breast cancer:
- For the last few years, Komen sponsored the Annual Conference for Young Women with Breast Cancer hosted by the Young Survivor Coalition (YSC) and Living Beyond Breast Cancer, which served to support and inform young women impacted by breast cancer.
- In 2013, Komen provided support to the YSC to conduct a Research Think Tank, a new initiative aimed at driving change by refocusing the research community on the tough questions that will ultimately improve the quality and quantity of life of young women with breast cancer.
- In 2013, Komen established a collaboration with the Susan Love Research Foundation and YSC to conduct the Health Of Women (HOW) Study, which will document the short- and long-term physical and emotional side effects of breast cancer treatments. This study also aims to identify prevention strategies for, and causes of, breast cancer. Read more about this partnership.
Finally, read our recent blog post on breast cancer in younger women.
- American Cancer Society. Breast Cancer Facts & Figures 2013-2014, 2013.
- National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Breast cancer screening and diagnosis, Version 2.2013, http://www.nccn.org, 2013.
- American Cancer Society. Cancer Facts & Figures for African Americans: 2013-2014, 2013.
- Wu T, Mendola P, Buck GM. Ethnic differences in the presence of secondary sex characteristics and menarche among US girls: the Third National Health and Nutrition Examination Survey, 1988-1994. Pediatrics. 110:752-7, 2002.
- Anderson SE, Dallal GE, Must A. Relative weight and race influence average age at menarche: results from two nationally representative surveys of US girls studied 25 years apart. Pediatrics. 111:844-50, 2003.
- Carey LA, Perou CM, Livasy CA, et al. Race, breast cancer subtypes, and survival in the Carolina Breast Cancer Study. JAMA. 295(21):2492-502, 2006.
- Ihemelandu CU, Leffall LD Jr, Dewitty RL, et al. Molecular breast cancer subtypes in premenopausal African-American women, tumor biologic factors and clinical outcome. Ann Surg Oncol. 14(10):2994-3003, 2007.
- Lund MJ, Butler EN, Hair BY, et al. Age/race differences in HER2 testing and in incidence rates for breast cancer triple subtypes: a population-based study and first report. Cancer. 116(11):2549-59, 2010.
- Stark A, Kleer CG, Martin I, et al. African ancestry and higher prevalence of triple-negative breast cancer: findings from an international study. Cancer. 116(21):4926-32, 2010.
- U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 151(10):716-726, 2009.
- American Cancer Society. American Cancer Society recommendations for early breast cancer detection in women without breast symptoms. http://www.cancer.org/Cancer/BreastCancer/MoreInformation/BreastCancerEarlyDetection/breast-cancer-early-detection-acs-recs, 2014.
- Ruddy KJ, Gelber S, Tamimi RM, et al. Breast cancer presentation and diagnostic delays in young women. Cancer. 120(1):20-5, 2014.
- Partridge AH, Goldhirsch A, Gelber S, Gelber RD. Chapter 92: Breast Cancer in Younger Women, in Harris JR, Lippman ME, Morrow M, Osborne CK. Diseases of the Breast, 4th edition, Lippincott Williams & Wilkins, 2010.
- Freedman RA, Partridge AH. Management of breast cancer in very young women. Breast. 22 Suppl 2:S176-9, 2013.
Posted April 28, 2014