Young-Onset Breast Cancer

When you’re under 40, you often have denser breast tissue. This can make it harder to spot possible cancers. Your provider might recommend a 3D mammogram (also called a digital breast tomosynthesis). This screening mammogram is pretty much the same as a regular mammogram. It just takes more pictures of your breasts at different angles so your radiologist can see through the dense tissue better.

If your provider suspects cancer, you might have a diagnostic mammogram. This test uses X-rays to focus on suspicious areas in your breast. The imaging specialist usually takes several pictures at different angles to get a clear picture of any area in your breast that doesn’t look right or where you feel an abnormal lump or mass.

Your provider might also do the following:

Breast ultrasound

A breast ultrasound uses sound waves to take pictures of the inside of your breast. Breast ultrasounds are used when there’s a palpable (you can feel it) lump. This test can tell your provider if the lump is a solid mass or a fluid-filled cyst.

Breast biopsy

During a breast biopsy your radiologist uses a needle under imaging guidance to remove a small sample of your breast tissue. Our providers send these samples to our lab for testing. We use the latest breast biopsy techniques, including tests called stereotactic breast, ultrasound and MRI-guided biopsies. These procedures use imaging tools to find the suspicious area and guide the biopsy needle for precise results. During your biopsy, your radiologist will place a very small titanium clip in the biopsied area. This helps to identify this area during future imaging or surgery.

Breast MRI

This test uses powerful magnets to collect detailed pictures of your breast tissue. Breast MRI is helpful if you have a family history of certain cancers or a gene mutation (change). It can also give your provider a better idea of how big the tumor is and if it’s spread. 

Genetic testing

Sometimes young-onset breast cancer can be caused by a gene that malfunctions and causes cancer to grow in your breast. If you’re under 40 and diagnosed with breast cancer, your provider may recommend meeting with a genetics counselor. Treating these specific genes that have gone rogue can help improve your outcome. Even if you haven’t been diagnosed with breast cancer, we still might recommend genetic testing if you have a family history of certain cancers or a relative who had breast cancer at a young age.

Our genetic experts do special blood tests to check to see if you have a breast cancer gene. These blood tests look for abnormal changes to your BRCA1 and BRCA2 genes, as well as other breast cancer genes. Then, our genetic counselors answer your questions and guide you through treatment decisions.

Getting a second opinion for young-onset breast cancer

Learning that you may have cancer can be an emotional moment. You’ll want to make sure you’re working with a team of healthcare providers you trust completely to give you the best possible treatment. That’s why, at Cleveland Clinic, we encourage second opinions, and we work hard to get you in to see our specialists as soon as possible.

When you come in for your appointment, we’ll ask you to bring all of your medical records. Our team of experts will dive in and work together to help you through the process of finding the best personalized treatment plan. Getting a second opinion can give you peace of mind, knowing you’re in the most capable and compassionate hands.

Meet Our Team of Young-Onset Breast Cancer Providers

When you come to Cleveland Clinic, you work with a team of providers. They combine their knowledge and expertise to make sure you get the care you need. Throughout your journey, you may work with:

• Breast surgeons.
• Oncologists.
• Fertility specialists.
• Medical geneticists.
• Radiologists.
• Pathologists.
• Psychologists.
• Social workers.

Each breast cancer is unique — and so is your treatment. We’ll design a personalized plan for you based on your age, genetics and type of breast cancer you have. If you have questions or concerns about future fertility or a current pregnancy, we’ll take the time to talk you about those things, too. Our expert team is here to help with whatever you need related to your breast cancer diagnosis.

Breast cancer surgery

Our skilled breast surgeons have done thousands of breast cancer surgeries. Based on your physical exam, biopsy, lab tests, location and size of the cancer and whether the cancer has spread beyond your breast tissue, they’ll go over your treatment options, which may include:

• Lumpectomy: Also called a partial mastectomy, a lumpectomy removes only the tumor and small rim of healthy tissue around it. Your provider might recommend a lumpectomy if you have small, early-stage breast cancer.
• Mastectomy: There are several types of mastectomies, but all involve removing the entire breast.

Our surgeons also do oncoplastic breast surgery (combining lymphadenectomy with reconstruction to make both breasts look as similar as possible) and hidden scar surgery (when the incision sites are hidden, and you can’t see the scars when the incision heals).

Breast reconstruction

Deciding whether or not to have breast reconstruction after a lumpectomy or mastectomy is highly personal. If this is something you’d like to consider, you’ll meet with your breast surgeon and a plastic surgeon. They’ll go over everything you need to know about the process — what your options are, what to expect before, during and after reconstruction and what recovery looks like. Our plastic surgeons can do reconstruction right after breast cancer surgery, or you may decide to wait. It’s entirely up to you.

Breast cancer therapies

When you meet with our medical oncologists, you’ll review what medications they recommend to treat your type of cancer based on your cancer stage and the type of breast cancer you have. Your provider may recommend:

• Chemotherapy: This medication kills cancer cells. Sometimes you’ll just have chemo. Other times, we might combine chemo with immunotherapy or other targeted therapy. Your medical oncologist will help you decide if chemotherapy is best before or after surgery and help you manage side effects, like hair loss, nausea and fatigue (being really tired).
• Radiation therapy: This treatment option can keep cancer from coming back (recurring) in your breast tissue or lymph nodes after surgery. Our innovative radiation technology kills cancer cells with higher precision and shorter treatment times. If your provider recommends radiation therapy, we’ll go over what to expect and how many radiation sessions you’ll need.
• Endocrine (hormone) therapy: If you have hormone-receptor positive breast cancer (fueled by your hormones), hormonal therapy may help. As a person with young-onset breast cancer, your hormone levels can be different from those in people over 40, so we customize this treatment to meet your specific needs.

Fertility preservation

If you want to plan for a family after breast cancer treatment, our fertility specialists will talk with you about fertility preservation options. We specialize in:

• Egg retrieval and freezing.
• Embryo freezing.
• Ovarian tissue freezing.
• Hormonal treatments that protect the ovaries during chemotherapy.

Mental, emotional and social support

If you’re under 40, your life might be busy with your career, family and social activities. Young-onset breast cancer can often disrupt your lifestyle. Our patient support services can help you find ways to cope with the mental, emotional and social challenges breast cancer can bring.

Taking the Next Step

Feeling a lump in your breast and finding out it’s cancer isn’t easy. Our young-onset breast cancer specialists have helped many people with the unique challenges this often unexpected diagnosis brings. And we’re ready to help you, too. We’re ready to talk with you about next steps and what treatment options are best. Helping you live a life full of possibilities is our goal at Cleveland Clinic.