Are women under 40 at risk for breast cancer?
Younger women generally do not consider themselves to be at risk for breast cancer. Breast cancer can strike at any age: five percent of breast cancer cases occur in women under 40 years of age. All women should be aware of their personal risk factors for breast cancer. (A risk factor is a condition or behavior that puts a person at risk for developing a disease.) These risk factors have been incorporated into several risk factor models; the most well-known of these is the Gail Model.
There are several factors that put a woman at higher risk for developing breast cancer, including:
- A personal history of breast cancer
- Atypical cells found on biopsy
- A family history of breast cancer, particularly in a mother, daughter or sister
- A family history that is concerning for a genetic syndrome (such as the presence of breast and ovarian cancer in the same side of the family)
- History of radiation therapy to the chest
- Carrying a high risk gene (such as the BRCA1/BRCA2 mutation): Women who carry defects on either of these genes are at greater risk for developing breast cancer.
- Ashkenazi Jewish descent
- High risk as identified by breast cancer risk assessment models (eg Gail, Tyrer-Cuzick)
What is different about breast cancer in younger women?
Diagnosing breast cancer in younger women (under 40 years old) is more difficult because their breast tissue is generally denser than the breast tissue in older women. This makes it more difficult for the mammogram to tell the difference between normal and abnormal breast tissues. In addition, breast cancer in younger women may be more aggressive and less likely to respond to treatment. Women who are diagnosed with breast cancer at a younger age are more likely to have a mutated (altered) gene, such as BRCA1 or BRCA2. Another factor could be delays in diagnosing breast cancer at younger ages. Younger women who have breast cancer may ignore the warning sign — such as a breast lump or unusual discharge — because they believe they are too young to get breast cancer. Women may assume they are too young to get breast cancer and tend to assume that a lump is a harmless cyst or other growth. Some health care providers may also dismiss breast lumps in young women as cysts and adopt a "wait and see" approach.
Breast cancer poses additional challenges for younger women as it can involve issues concerning sexuality, fertility, and pregnancy after breast cancer treatment.
Can breast cancer in younger women be prevented?
Although breast cancer might not be prevented, early detection and prompt treatment can significantly increase a woman's chances of surviving breast cancer. More than 90 percent of women whose breast cancer is found in an early stage will survive. Women can reduce the risk of breast cancer by eating a healthy, well-balanced diet. Even small amounts of alcohol consumed on a regular basis have been associated with an increased risk of breast cancer. Women who are above their ideal weight are more likely to experience breast cancer. Thus, reducing alcohol intake and maintaining an ideal weight are important ways to prevent breast cancer.
Young women should report any breast changes to their health care provider (eg skin changes, nipple discharge, pain, tenderness of lump/mass of breast or underarm). Even women who are less than age 40 should understand their risk factors and be able to discuss breast health and an optimal screening strategy with their health care providers. For women with a family history that is suggestive of a hereditary predisposition for breast cancer, a referral for genetic counseling may be appropriate. Identifying such genetic conditions will allow for a more personalized discussion on screening and preventive treatment options.
Should women under age 40 get mammograms?
In general, regular mammograms are not recommended for women who are at average risk for breast cancer if they are under 40 years old, in part, because breast tissue tends to be more dense in young women, making mammograms less effective as a screening tool. However, breast cancer screening through imaging with mammogram, tomosynthesis (“3D mammogram”) or MRI may be recommended for certain high risk women under 40 years of age based on personal risk factors.