Breast Cancer in Young Women: Awareness Is Key for Your Health

Content medically reviewed by Harish Ahuja, MD

For decades, it was a commonly held belief that those under age 40 don’t need to worry about breast cancer. After all, the average age of diagnosis is 62, and the incidence of the disease in younger women is low. However, rates of breast cancer before age 50 have been steadily rising by more than 2% every year for the past five years.

“This trend is very concerning,” said Dr. Harish Ahuja, oncologist and hematologist at Essentia Health. “Although awareness is improving overall, knowing the risk factors for breast cancer in younger women is essential, especially for those in their 20s and 30s who may not be getting regular mammograms yet.”

Key Differences of Breast Cancer in Young Women

One of the most troubling aspects of the rising number of breast cancer diagnoses in women ages 20 to 49 is that those younger than 40 years old are more likely to have forms of the disease that are harder to treat. This is partly because breast cancer often does not cause symptoms in the early stages, and younger women are not yet getting regular screenings. Additionally, when symptoms do appear, younger women are more likely to ignore them.

One type more commonly diagnosed at a younger age is triple-negative breast cancer (TNBC), a rare, aggressive type of cancer. In TNBC, cancer cells don’t contain the three most common receptors that promote breast cancer growth—estrogen, progesterone, and HER2—which can complicate treatment.

Rates of metastatic breast cancer (MBC) have also increased in younger women in recent years. MBC is stage 4 breast cancer, which means it has spread to other areas of the body. Cancer originating in the breast can develop in other parts of the body months or even years after the initial diagnosis. Compared to older women, those who are younger are also at increased risk of breast cancer recurrence at five and 10 years after breast cancer treatment.

Screening and Staying Proactive

Recently, the U.S. Preventive Services Task Force and the American College of Obstetricians and Gynecologists changed their breast cancer screening guidelines to recommend regular mammograms begin at age 40 instead of age 50 for women at average risk. However, younger women at higher risk may begin sooner. If you are younger than age 40 and have risk factors, talk to your provider about whether you are eligible for early screening.

Typically, if you begin screening early, this means getting an annual mammogram and a breast MRI starting at age 30. Because MRIs can miss some cancers that mammograms can detect, women at high-risk should get both.

Risk assessment tools that determine a rough estimate of your five-year and lifetime breast cancer risk are also available through your provider. According to the American Cancer Society, women with a 20% to 25% or greater lifetime risk, according to tools that take family history into account, should be considered at high risk for breast cancer. Talk to your provider about options for risk assessment.

It’s also important to note that while age 30 is the typical age for early screening, you can develop breast cancer as early as your 20s. If you notice unusual symptoms, you should see your provider right away.

“Remember, you are your own advocate,” Dr. Ahuja said. “Whether you are in your 20s or your 60s, make your breast health a priority, and never be hesitant to reach out to your provider with questions or concerns.”

Knowing Your Risk Factors

“One of the most important things younger women can do is be aware of their personal risk factors,” Dr. Ahuja said. “Because many guidelines recommend women at average risk begin getting regular mammograms at age 40, younger women must be proactive and talk to their provider about whether they should begin breast cancer screening earlier.”

Women who are younger than age 45 and have any of the following may be at increased risk of breast cancer –

• Close family members who were diagnosed with breast cancer before age 45, especially if you have multiple family members or a male relative diagnosed, or a family member with cancer in both breasts or TNBC
• Mutations in BRCA1 or BRCA2 breast cancer genes or a close family member with these mutations
• Dense breast tissue as seen on a mammogram
• A family history of breast or ovarian cancer
• First menstrual period occurring before age 12
• No children, or first child born after age 30
• Past radiation therapy to the breast or chest during childhood or early adulthood
• A personal history of breast cancer or certain other breast conditions, such as atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, or ductal carcinoma in situ 

If any of these risk factors apply to you, talk to your provider. You may be eligible to begin breast cancer screening earlier. You may also benefit from a visit with one of Essentia Health’s High-Risk Breast Cancer Program providers.

Recognizing the Signs of Breast Cancer

“All women should be familiar with the symptoms of breast cancer,” Dr. Ahuja said. “If you are younger and notice any concerning signs, it’s important not to just brush it off because you think you are too young for breast cancer. Women of all ages need to be vigilant and make an appointment with their provider right away to discuss concerns.”

Because younger women aren’t yet getting regular mammograms, performing regular self-exams can help them become familiar with how their breasts look and feel. Each month, women should examine their breasts visually and note any changes to the shape, size, or appearance of the breast. They should also perform a manual exam of the breast by using the pads of their middle fingers and working in a small circular pattern, starting at the outside of the breast and working toward the nipple.

The most common breast cancer symptom is a new lump or mass in the breast or armpit, although most lumps are not cancerous.

Other symptoms of breast cancer include –

• Abnormal nipple discharge
• A change in the size or shape of the breast
• Dimpling or irritation of skin on the breast
• Nipple retraction (pulling inward)
• Pain in the breast or nipple
• Red, dry, or flaky skin in the nipple area or on the breast
• Swelling in part or all of the breast
• Swollen lymph nodes in the armpit or under the collarbone

Benign (noncancerous) breast conditions can also cause many of these symptoms. It’s important to have any changes in your breasts checked by your provider right away.