Including risk factors to be aware of and expert info on the unique challenges young adults face when undergoing treatment.
If you think there’s such a thing as being “too young for breast cancer” (younger than 40, as screening guidelines suggest), you’re unfortunately mistaken. According to a study released in 2023, between 2010 and 2019, diagnoses among people aged 30 to 39 increased 19.4 percent. Among those aged 20 to 29, the increase was 5.3 percent. A study released this year reported that, while the overall breast cancer death rate in the U.S. has dropped since 1989, the incidence of breast cancer rose 1 percent each year from 2012 to 2021, especially in younger, white patients: “A steeper increase in women younger than 50 years (1.4 percent annually) versus 50 years and older (.7 percent) overall was only significant among white women.” For Breast Cancer Awareness Month, we’re putting a spotlight on this new data to better understand why young women are more at risk than ever before, what we can do about it, and how this trend might impact the future of breast cancer research.
In 2023, Katie Couric Media spoke with Patricia Ganz, MD, director of cancer prevention and control research at the UCLA Jonsson Comprehensive Cancer Center, about exactly what this data means and the future of breast cancer research. Therese Bevers, MD FAAFP, medical director of the Cancer Prevention Center at The University of Texas MD Anderson Cancer Center, spoke to us about risk factors. And Shari Goldfarb, MD, co-director of the Memorial Sloan Kettering Young Women with Breast Cancer program, enlightened us on the unique challenges that young adults face when they’re diagnosed with breast cancer.
Plus, in 2023, Katie herself took to IG Live and interviewed Ann Partridge, MD, MPH, a medical oncologist and clinical researcher at Dana Farber Cancer Institute in Boston. Dr. Partridge also talked about risk factors and potential causes of these troubling increases.
Why are rates of breast cancer rising among young women?
First things first: The median age of a breast cancer diagnosis is 62 and screening guidelines recommend first talking to your doctor about breast cancer at age 40. So when we say “young women,” we’re referring to the population that might not be concerned about breast cancer just yet — those under 40.
The biggest risk factor for having breast cancer is being female. That’s not changeable.
Young women aren’t to blame for an early-onset breast cancer diagnosis. Dr. Ganz pointed out that women can’t help their inherent breast cancer risk: “Breast cancer is the most common cancer in women,” she said. Yes, men can get breast cancer, but “it’s lifetime exposure to female reproductive hormones that make changes in the breast that then set the stage to develop cancer.” Dr. Goldfarb agreed that “the biggest risk factor for having breast cancer is being female. That’s not changeable.”
So then why are young women increasingly getting diagnosed with early-onset breast cancer? Dr. Ganz pointed out that a woman’s chance of being diagnosed with breast cancer increases the longer she’s exposed to reproductive hormones.“
In Western societies and in our country, the average age when women start to menstruate has gone down,” Dr. Ganz said. “So younger women are menstruating at an earlier age than they used to.” Why, exactly? “This partly reflects better nutrition and reaching an adult woman’s weight. When this occurs earlier, the likelihood of earlier menarche increases. In low and middle-income countries, menarche is still much later. The average age in the U.S. is about 11 years now, and in other countries could still be 14 or 15 years.”
Dr. Goldfarb added that more women are also inadvertently heightening risk by opting to prolong family planning in favor of professional advancement: “We know having more pregnancies at a younger age helps to protect against breast cancer.” That’s because pregnancy and breastfeeding reduce your lifetime number of menstrual cycles, which exposes you to fewer hormones. Plus, pregnancy and breastfeeding lead breast cells to mature, and mature cells might be more resistant to becoming cancerous.
“We’re now seeing the opposite trend where women are setting up their careers and having kids in their mid-30s or even later instead of in their younger years,” Dr. Goldfarb said.
Dr. Bevers made the point that body size and activity levels can put you at risk at any age: “An increase in obesity and a stark decrease in physical activity are risk factors. There’s increasing data that obesity sets up an environment that increases inflammation in the body. Inflammation seems to be a key factor in the development of cancer.” A 2023 study found an increase in rates of obesity from 32.7 percent to 40.9 percent of adults aged 20 to 44 (from 2009 to 2020).
According to Dr. Bevers, however, some risk factors can’t be prevented. “Whenever I see an early onset breast cancer, I do genetic testing,” she said. “A certain percentage of those women are going to have a gene that predisposes them to developing breast cancer at an early age.”
Speaking of risk factors out of our control — what about the chemicals and toxins that surround us as we move through everyday life? A 2018 study determined that more research is needed into a possible correlation between breast cancer and chemicals because it’s difficult to self-report exposure since people don’t always realize they’ve been exposed to a dangerous substance. Still, that 2018 study says the relationship between breast cancer and chemicals could be causal.
When speaking to Dr. Partridge, Katie asked, “Are there people studying some of these environmental risk factors?”
“The good news is, there are people studying the connection,” Dr. Partridge responded. “The bad news is we haven’t found a smoking gun in terms of an external environmental reason why we’re seeing increases in these young-onset cancers.”
In short: We don’t know for sure yet, but evidence suggests there may be a link.
What unique challenges do young women face during treatment?
If you’ve been fortunate enough not to see a loved one undergo cancer treatment (or undergo it yourself), you’ve probably gleaned some basic facts from movies and TV. You probably already know that chemo can make your hair fall out, surgery is common, and some stages and types of breast cancer are worse than others. When Katie Couric was diagnosed with breast cancer in 2022, she was told by her doctor, “Your tumor is hormone receptor-positive, Her2neu-negative, and highly treatable, particularly if it was detected early.” She wrote in detail about the ins and outs of sudden pre-op procedures and undergoing sessions of radiation each morning when treating her breast cancer last year.
Young women have all of this plus additional conflicts to contend with that are very specific to their lifestyles.
This is a population of women who are really in a difficult time in their lives where many of them are either trying to get pregnant, have young children, or are taking care of sick parents.
Young adults are often focused on their careers, and plenty are also focused on family planning. Cancer, of course, disrupts both of those. Dr. Goldfarb elaborated by clarifying that her program at MSK has a few goals for understanding how to properly treat this age group: “For these young women, we want to streamline their care, get better research done on this population, get them involved in multi-center clinical trials, and also to support them.”
“This is a population of women,” she continued, “who are really in a difficult time in their lives where many of them are either trying to get pregnant, have young children, or are taking care of sick parents.”
“One of the things we do is guide them through fertility treatments if they have not completed their family,” Dr. Goldfarb said. “When they’ll be in treatment, we also help them find care for their kids. And we also guide them through the challenges of how to talk to their kids about their diagnosis.”
As mentioned, career interruption can be painful for many women. According to Dr. Goldfarb, professional support is often necessary: “We provide career advice for patients who were on their way up in their career when they suddenly got diagnosed with cancer and now can’t work for a year. We offer advice on how to talk to their colleagues about their diagnosis.”
Dr. Goldfarb thinks it’s important to address that young adults tend to be busier. Between their jobs, their families, their friends, and hobbies that make them happy, they’ve got packed lives and numerous commitments. So, finding the time for daily appointments can be a bigger, albeit necessary, burden: “We can better streamline care. We want everything done quickly, but why don’t we preemptively reach out to them and organize genetic testing, an MRI, a surgery, and medical appointments on the same day? We now have a clinic on Wednesdays where we can streamline everything on the same day. Even when patients come in on other days or with other colleagues of mine, we try to streamline their care so they’re not feeling like they have to be here every day.”
Dr. Goldfarb also advocates for preventative care to keep patients from experiencing notoriously life-interrupting side effects of breast cancer treatment before they occur: “In addressing symptoms earlier, we can sometimes prevent them. We now give nausea meds before a patient is even starting chemo to try to prevent it. It’s the same thing with sexual health — patients are going to develop sexual dysfunction from treatment. We now start treating it proactively to try to prevent people from developing these symptoms.”
And on top of all of this, young women often have to receive more intensive treatment. Dr. Ganz clarified that younger women often find their breast cancer later, via self-exam: “In younger women, we’re not doing screenings. A lot of these cancers are found because the woman feels a lump in her breast.” The problem? Bigger tumors are more serious.
“If you can feel it,” said Dr. Ganz, “it’s the size of a quarter or larger. That’s a larger tumor. The risks for the seriousness of breast cancer really relate to the size of the tumor and whether it’s spread to the lymph nodes.”
What’s the future of breast cancer research and screening among young adults?
To narrow down the causes of early onset breast cancer, Dr. Ganz clarified that researchers are now delving into early girlhood to try and isolate risk factors: “Epidemiologists are actually starting to look at young girls. A lot of things actually are related to diet, lifestyle, and other exposures from a very young age. You can’t change your heredity, who your parents are, and so forth. That’s not going to change. But the things that we can change are in the environment.”
Dr. Goldfarb agreed that part of her work entails collecting data about how people with early-onset breast cancer have lived: “Part of what we’re doing here is building a registry of influences. We’re collecting data on nutrition, exercise, alcohol use, smoking use, and other lifestyle habits in these young women with breast cancer. Over time, as we collect enough data on patients, we’re going to try to look at some of the factors that could be causing cancer. We’re also looking at the genetics and the genomics to better understand why women are getting these cancers and why the biology of these cancers are worse.”
But as Dr. Goldfarb said, screening recommendations won’t necessarily change because of this growing body of research: “It’s hard to screen young women because their breasts are denser. When you do mammograms and MRIs, you get a lot of false positives that may cause a lot of anxiety.”
Dr. Ganz added that screening recommendations have recently changed, too: “The US Preventive Services Task Force this last year actually came out with new recommendations and they recommended screening at age 40.”
That said, Dr. Ganz recommended evaluating your personal risk — like keeping lifestyle factors in check and reviewing your family history (keep in mind, she says, that your father can also pass along a family history of breast cancer). She also recommends advocating for yourself firmly — because if your doctor says you’re physically incapable of getting breast cancer at a certain age, they’re wrong.
“I’ve seen a number of young women over the years who said, ‘I went to my doctor and he said that Asian women don’t get breast cancer.’ Or ‘my doctor said that I’m too young to get breast cancer.’ Don’t settle for being turned away by someone. If you have a lump in the breast, it can be easily evaluated with an ultrasound, which is a very non-invasive test. And if it looks suspicious, it should be biopsied.”
If you’re in the unfortunate position of receiving a diagnosis, Dr. Ganz also highly recommends seeking out a second opinion to avoid jumping the gun on irreversible medical procedures: “I can’t tell you how many young women I’ve seen who were usually seen by an older conservative surgeon who says, ‘You need that taken out tomorrow.’ When in fact, we know that you have several weeks or even months to get a treatment plan in place that would be optimal. So get a second opinion. Don’t rush into surgery.”
Dr. Goldfarb added that — if you’re a young woman — you may also need to prepare yourself to look for a second opinion if you’re being dismissed or ignored.
“You’re your own best advocate,” she said. “You know when something doesn’t feel right. If you’re feeling a mass and people aren’t taking you seriously, advocate for yourself. Go to a different doctor until someone’s taking you seriously.”
