Breast cancer is often thought of as an older person’s disease, but while a diagnosis in a patient in their 20s or 30s is less likely, it is possible.
Breast cancer is the most commonly diagnosed cancer in women aged 20 to 49, according to the Canadian Breast Cancer Network. About five per cent of all breast cancer patients are age 40 or younger at diagnosis, according to the Canadian Cancer Survivor Network. In the U.S., more than 250,000 women under age 40 have been diagnosed with breast cancer.
More women younger than 40 die of breast cancer than any other type of cancer, partially because they are usually diagnosed in its later stages and the disease can be more aggressive in these younger patients.
Yes, breast cancer is less common in women in their 20s and 30s, but those groups have particular needs and concerns that are important to address.
What is breast cancer?
Breast cancer happens when breast cells begin to divide and grow out of control, eventually forming tumours. Breast cancer typically starts in either the cells of the milk ducts or the lobules (milk-producing glands).
The disease is more common in women but can also occur in men and non-binary or gender-fluid individuals, whether or not they have milk ducts or lobules.
There are many different types of breast cancer, and everyone’s prognosis and treatment plan are different based on a variety of factors including the cancer type and stage.
What are the risks at my age?
Breast cancer risk generally increases with age, with most diagnoses in Canadian women occurring in those who are 50 years old and over.
Some people who develop breast cancer have several risk factors; others may not seem to have any. Keep in mind that the amount of change in risk varies for each of these factors and is often statistically small, but worth learning about if they may affect you.
According to the Canadian Task Force on Preventive Health Care, factors that can increase your risk include a personal or family history of breast cancer; being a carrier of a gene mutation such as BRCA1 or BRCA 2, or having a first-degree relative with these gene mutations; or having had chest radiation therapy before 30 years of age or within the past eight years. Breast density is also a factor, with those with denser breasts having an overall higher risk.
Lifestyle factors can also increase breast cancer risk. According to the Canadian Cancer Society, these factors include alcohol consumption greater than a drink a day and physical inactivity at any age.
Reproductive history can also be a factor, according to the Canadian Cancer Society, because of the disease’s association with estrogen. Some of those risk factors include menstruation that begins at or before age 11, a first full-term pregnancy after 30, and the use (especially long term) of oral contraceptives containing both estrogen and progesterone.
If you know or suspect you may be at increased risk for breast cancer, speak with your medical care provider about your risk factors and their recommendations for screening. You can also seek a referral to a genetic therapist who can provide additional information based on your personal risk factors, which are different for all of us.
“Having relatives diagnosed with breast cancer earlier than age 40 or multiple first degree family members with breast cancer should prompt a discussion about genetic testing,” Dr. Candice Fraser, an OBGYN in New York City who works with Your Doctors Online, told HuffPost Canada. “Women should also mention a family history of ovarian cancer to their doctors.”
The unique challenges for young people
A young person’s breast cancer will most likely look different from an older person’s breast cancer, simply because they are at very different stages in their lives.
Some of the unique challenges young people with breast cancer may face include:
- Early menopause and sexual dysfunction
- Fertility issues
- Higher prevalence of psychosocial issues, including depression and anxiety
- Heightened concerns about body image after surgery
- Financial instability
- Lower survival rates
What are the screening recommendations?
According to the Young Survivor Coalition, there’s “no effective breast cancer screening tool yet for women under 40” because most young people have dense breast tissue that prevents mammograms from being effective.
Despite this, there are some things you can do.
“In women younger than 40 without any risk factors we recommend breast self-awareness,” said Dr. Fraser. “Breast self-awareness means being familiar with the shape, look, and feel of your breasts and noticing any changes.”
The current recommendations for mammography are that women aged 40 to 49 should not be routinely screened because the potential harms statistically outweigh the potential benefits.
The Canadian Task Force on Preventive Health Care’s screening recommendations apply to women aged 40 to 74 who are at average risk of breast cancer. However, it is important to know the recommendations for guidelines in your 40s so you can think about the decisions you will make before then.
For general guidelines, the Task Force does not recommend using magnetic resonance imaging (MRI), tomosynthesis (an imaging or X-ray technique), or ultrasound to screen for breast cancer in women who are not at increased risk.
What can I do to prevent breast cancer?
If you have a family member with the disease, or who has tested positive for a gene mutation like BRCA1, you can decide whether or not you want to get tested and talk to your doctor about preventative measures if you have a gene mutation.
Other prevention methods are less clear cut, but they will contribute to an overall state of health. The Canadian Cancer Society predicts that four in 10 cancers can be prevented with lifestyle changes.
Their recommendations include avoiding excessive alcohol consumption; not smoking or quitting if you currently smoke; eating a variety of healthy foods including fruits and vegetables; and maintaining a weight that is healthy for your body.
Which symptoms or changes warrant investigation?
Even if the risk of breast cancer for women in their 20s and 30s is low, it does happen, and early diagnosis can greatly improve prognosis and expand treatment options.
Part of getting that early diagnosis comes from getting symptoms of the disease checked in a timely manner. Some of the symptoms that should be mentioned to your doctor include swelling, redness, lumps, bumps, unusual pain, or liquid or discharge coming from the nipples when these changes are not related to a menstrual cycle, said Dr. Fraser.
The key is to know what is normal for you and your breasts and to bring up anything that is not normal. Some people — especially younger people — normally have lumpy or bumpy breasts, for example. Others may notice a lot of swelling at certain points in their menstrual cycle.
Having overall breast awareness means you’ll notice if something is unusual for you, and can act accordingly.
If I’ve been diagnosed, where can I find support?
Being a breast cancer patient is tough at any age, but younger patients may feel especially isolated or shocked. As previously mentioned, they also have particular concerns, such as future fertility and financial insecurity, that may not be a factor for older patients.
The Canadian Breast Cancer Network publishes a booklet, Never Too Young, that focuses on the needs of younger breast cancer patients in Canada.
Programs like PYNK in Toronto or similar ones elsewhere in the country are aimed specifically at younger patients and their needs. Your medical care provider may also be able to suggest a support group or other services aimed specifically at younger patients.
Lastly, if you know a loved one who is dealing with cancer, there are practical ways you can support them, including organizing meal delivery, attending appointments, and scheduling visits with friends and family.
Remember, you are not alone.
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