All women are at risk for breast cancer, but that risk doesn’t seem very real when we’re young. Although breast cancer most often occurs in women over the age of 50—mean age at diagnosis in the United States is 61—about 11,000 women under age 40 are diagnosed each year. The risk is particularly high for young women who have had prior radiation to the chest, have a personal or family history of breast cancer, or have an inherited BRCA gene mutation. Being of Ashkenazi Jewish, Hispanic or African American descent are also risk factors.
While no woman wants to hear that she has breast cancer, the physical and emotional effects can be devastating for young women who may be less resilient, or whose lives are focused on building job position or family. A career-oriented woman who is working hard to achieve her professional position may worry how her diagnosis and treatment will affect her work status. Will peers and co-workers be supportive or stand-offish? Will the knowledge of her diagnosis affect how she is perceived on the job?
A young woman diagnosed with breast cancer is also more likely to question her own self confidence and feel anxiety about her personal relationships. Breast cancer challenges even the strongest woman’s self esteem, making her question her own body image and raising disturbing issues about intimate relationships. Will she always be sick? How does she tell someone she is dating that she is losing her hair or missing a breast? What happens when her partner wants children and her treatment renders her infertile? These are very difficult issues for young women, who often feel they face them alone. Their older counterparts have plenty of resources for peer counseling and support, while younger women are more likely to fall into depression and have difficulty finding someone of their own age who understands firsthand what they are facing.
Experts suspect that the more a woman is exposed to estrogen, the greater her risk. That might be one explanation for the rising rates of breast cancer in younger women. Compared to 50 years ago, women today have a greater lifetime exposure to estrogen, beginning menstruation several years earlier, sometimes as early as age 9, and starting menopause later in life. Contemporary lifestyles may also expose women to more carcinogenic environments and lifestyle behaviors.
The best defense against breast cancer, no matter what a woman’s age, is to catch it early, yet there is really no way to effectively screen young women for early-stage breast cancer. Except for women at high risk, routine mammograms aren’t recommended for women under 40; their dense breast tissue is difficult to screen; it looks white on a mammogram, just like cancerous tissue. Unlike women over age 40, most young women discover their own breast cancers. One study from Harvard, for example, found that 71% of women diagnosed with breast cancer at age 40 or younger discovered their breast cancers by self exam. Most had never had a mammogram at the time of their diagnosis.
While most lumps are not breast cancer, they are often ignored by young women—and sometimes their doctors, who often believe their patients are too young to get breast cancer and decide to wait and see what happens. These delays can adversely affect a woman’s overall outcome, because by the time the cancer is finally discovered, it may have spread to the lymph system and other organs in the body, making treatment more difficult.
Breast cancer treatment, early menopause and pregnancy
Breast cancer treatment is generally the same, regardless of age, depending on the extent of the disease and the woman’s general overall health, but side effects can be drastically different for younger women. One significant consequence is premature menopause caused by certain chemotherapies and hormone-blocking medications. This is a tough pill to swallow for young women who look forward to future pregnancies. Coping with hot flashes, reduced libido and other menopausal symptoms, many women feel they are sacrificing their youth and fertility to treat their cancer.
Pregnancy is still possible for women whose treatment doesn’t interfere with the ability to conceive. Traditionally, most doctors recommend waiting at least two years after treatment is completed to become pregnant, because the risk of recurrence is higher during this period. But women seem to do just fine when they become pregnant after six months, and more physicians are changing their view on this. Women who want to become pregnant after breast cancer should discuss their treatment options with an oncologist and ask for a referral to a fertility specialist.
In rare cases, women can be diagnosed while they are pregnant. Although pregnancy-related breast cancers are often more advanced, moms-to-be appear to fare as well as other women during treatment, experiencing similar rates of recurrence and survival. Treatment depends on the type of cancer found and when it is diagnosed. During the first trimester, treatment is limited to a wide excision with a local anesthetic, because virtually any other treatment may harm the fetus, whose organs are not yet fully developed. Mastectomy performed under a general anesthetic and chemotherapy are safe by the second trimester, but radiation and hormone therapy, if needed, must wait until after the baby’s birth.
You may never face breast cancer during your life, particularly before the age of 40. But it is important to understand your risk and to be your own health advocate. Know the landscape of your breasts and alert your doctor right away if they look or feel unusual. After the age of 20, do a self exam every month, a few days after your period ends when your breasts are no longer tender or swollen. Have a clinical breast exam at least every three years. In the meantime, live your life, and don’t stress about your small risk.
If you are a young woman diagnosed with breast cancer, please also see our Quality of Life articles. Find more information online at the Young Survival Coalition and Pregnant with Cancer Network.