A diagnosis of breast cancer can be a shock at any age, but breast cancer in young people presents unique challenges. In addition to managing a serious illness, younger people may also be early in their careers and raising, or planning to start, a family. They may also be concerned about finishing school, furthering a career, building personal relationships, or their body image.
Who is most at risk for breast cancer at an early age?
People assigned female at birth may have a higher risk of developing breast cancer at a relatively early age if:
- A first-degree relative developed breast or ovarian cancer before age 40, especially if more than one relative was diagnosed or if breast cancer occurred in a relative assigned male at birth.
- They have a mutation in a gene associated with breast cancer such as BRCA1 or BRCA2.
- They have previously received radiation therapy to the chest area.
There is not yet enough research to accurately determine the risk of breast cancer in transgender people, according to Fenway Health, a comprehensive community health center in Boston that provides a wide continuum of health care services to LGBTQ+ patients and others.
“Until more is known, we suggest screening based on physical structure and what is known about the risks of taking estrogen (people with breasts and people taking estrogen for at least 5 years should follow the screening recommendations for women),” the organization states.
Learn more: Take Dana-Farber’s AssessYourRisk Quiz to learn more about your personal risk of breast and ovarian cancer.
Should young people be screened for breast cancer?
The U.S. Preventive Services Task Force recently updated their guidelines for breast cancer screening to reflect evidence that suggests more cancer cases can be caught earlier with proper screening.
- People aged 18-40 years should undergo examination by a physician at their annual physicals. A mammogram typically isn’t needed. This type of scan is usually not as effective for younger people. However, if you have a significantly elevated risk, mammograms at a younger age and the use of MRI may be warranted.
- People aged 40-74 years should undergo mammograms every other year in addition to exams by a physician. Some people in this age group may also opt for annual scans based on discussions with their physician.
This represents an earlier start for mammogram screening than previously recommended and is based on modeling data that suggests more cancers could be detected earlier, particularly for Black people. The hope is that this new guideline will help to address a disparity between Black Americans and white Americans: Although Black people are less likely to be diagnosed with breast cancer than white people, they are more likely to be diagnosed with an aggressive form of breast cancer under the age of 50 and are 40 percent more likely to die from it.
These recommendations apply to people of average risk who do not have a genetic mutation or a strong family history of breast cancer, or other major risk factors. A physician can help determine the best screening routine for you.
Is breast cancer becoming more common in young people?
Yes, according to a recent statistical analysis by the U.S. Centers for Disease Control and Prevention (CDC). The CDC found that while the number of new breast cancer cases per 100,000 women declined an average of 0.3% annually between 1999 and 2018 for all women over age 20 in the United States, it rose 0.3% among women aged 20-39.
What can people do to lower their risk of breast cancer?
A good place to begin is to know what your risk is. A variety of tools are available to help people of all ages do that.
When possible, people with average risk of developing breast cancer can keep their long-term risk low through healthy behaviors such as:
- Exercising regularly
- Limiting alcohol consumption
- Receiving regular medical checkups
- Reporting any unusual breast lumps or bumps to their doctor, as well as any unusual nipple discharge, pain, or changes in the skin of the breast
Studies have not shown evidence that regular breast self-exams help reduce deaths from breast cancer, but people should be aware of changes in how their breasts look and feel and report any changes to their doctor.
Young people with a higher-than-average risk should talk to their doctor about scheduling regular, intensive screening exams, which may include MRI scans of their breasts.
At-risk younger people may also choose to pursue preventive measures such as:
- Removal of the ovaries, which lowers ovarian as well as breast cancer risk
- Removal of the breasts
- Drug therapies and other approaches currently being studied
Is breast cancer different in younger people?
Just like older people, the most common type of breast cancer in young people is estrogen receptor (ER)-positive, HER2-negative breast cancer. However, younger patients are more likely to develop HER2-positive or triple-negative breast cancer than older patients.
HER2-positive breast tumors have high levels of the protein HER2, which enables cancer cells to grow and spread quickly. Fortunately, they are likely to respond to treatments that target the HER2 protein.
Like HER2-positive breast cancer, triple-negative breast cancer grows rapidly. It’s called triple negative because the cancer cells lack receptors for the hormones estrogen and progesterone and don’t express a high level of HER2.
By identifying the specific type of breast cancer a person has, doctors can design a treatment plan most likely to be effective against it.
Do younger people with breast cancer receive different treatments than older people?
Treatment is generally the same regardless of age, with a few exceptions.
If, for example, a patient is premenopausal and their breast cancer is ER-positive — meaning its growth is fueled by estrogen or progesterone — they may receive treatment to suppress their ovaries, as well as the drug tamoxifen or drugs known as aromatase inhibitors.
Younger patients may also choose to undergo more aggressive interventions since they are more likely to tolerate them well.
Can young people with breast cancer have children after treatment?
While the chemotherapy used in breast cancer treatment can impact fertility, a variety of options are available for people who hope to have children in the future or wish to leave that possibility open.
The Adult Fertility Preservation (Oncofertility) Program at Dana-Farber Brigham Cancer Center and the Pediatric Fertility Preservation Program at Dana-Farber Boston Children’s help patients and their families navigate the medical, emotional, and financial aspects of fertility preservation. It is available to all adult and pediatric patients whose treatment might affect fertility.
What are the options if someone is diagnosed with breast cancer while pregnant?
In many cases, treatment can be scheduled and delivered in a way that enables a pregnancy to be carried to term. The Breast Cancer During Pregnancy Program at Dana-Farber Brigham Cancer Center includes a team of breast cancer oncologists and maternal-fetal specialists who work with patients to select treatment strategies that can be given safely, minimizing the risk of harm to a developing child.
A Dana-Farber study by researchers in the Young and Strong Program for Young Adults with Breast Cancer found that concerns about fertility often influence how young people with breast cancer approach treatment decisions and are a reason for declining or delaying hormone-blocking therapy. The findings underscore the need for physicians to talk with patients about their overall life priorities — not just cancer treatment priorities — including fertility-related goals. This helps patients to address them in treatment plans, not only at the start of treatment but during its entire course.
Ongoing research continues to outline safe ways to manage pregnancy and cancer treatment. For example, an international 2023 study led by Dana-Farber’s Ann Partridge, MD, MPH, founder and director of the Young and Strong Program, found that patients receiving endocrine therapy for hormone-receptor positive breast cancer can pause that therapy to pursue a pregnancy without raising their risk for recurrence.
How can breast cancer affect a person’s psychological and emotional well-being?
Young people with breast cancer may have concerns about how the disease and its treatment will affect their body image, sexual functioning, fertility, relationships, careers, and ability to care for their children and families.
While cisgender women do display the highest rates of breast cancer, transgender and nonbinary people also face challenges related to respectful medical care and the way breast cancer is framed as a “women’s” cancer.
“Screening for certain forms of cancer can be emotionally painful, especially if the person doesn’t identify with the anatomy being examined,” says Ole-Petter R. Hamnvik, MBBCh, BAO, MMSc, a Dana-Farber endocrinologist specializing in LGBTQ+ health. “This underscores the need for physicians to be knowledgeable and inclusive.”
By providing accurate information early on, physicians and mental health counselors can give patients a realistic picture of what to expect and provide strategies for coping with the physical and emotional challenges of treatment.
To help young patients navigate challenges, researchers at Dana-Farber developed an interactive web-based program called Young, Empowered and Strong, or YES. Patients using the program fill out electronic surveys about their physical and psychological symptoms and receive on-line educational materials on how to manage them. A few years ago, the program was piloted for people under 45 with newly diagnosed breast cancer, breast cancer survivors, and those living with metastatic breast cancer. Findings showed that most participants thought the information provided by YES was useful and helped them manage the side effects of treatment.
What services are available specifically for young people with breast cancer?
The Young and Strong Program at Dana-Farber Brigham Cancer Center provides comprehensive care, support, and educational services for patients diagnosed at age 45 and under.
Clinical services include genetic testing and counseling, fertility and reproductive services, education, and survivorship counseling. The care team is experienced in helping young adults manage breast cancer during pregnancy and in treating young patients with metastatic breast cancer.
The program offers a variety of support and educational resources geared to the needs of young adults, including a telephone support group, the SoulMates peer support program, a young adult support group, and more. Patients can also take advantage of resources such as nutrition services, integrative therapies, a sexual health program, exercise classes, and spiritual care.
What research is underway to help young people with breast cancer?
Researchers at the Young and Strong Program are engaged in a variety of studies to better understand the biology of breast cancer in young adults, develop more effective treatments, and improve outcomes for patients.
Prior to her recent hormonal therapy and fertility study, Partridge launched the first multi-institutional study of young women with breast cancer in the United States. Helping Ourselves, Helping Others: The Young Women’s Breast Cancer Study enrolled more than 1,300 women aged 40 and under with newly diagnosed breast cancer between 2006 and 2016. The goal of this ongoing study is to gain a deeper understanding of breast cancer in young women from diagnosis through treatment and into survivorship, including how biologic differences and psychosocial factors impact both short- and long-term health and quality of life.
About the Medical Reviewer
Dr. Partridge received her MD from Cornell University Medical College in 1995. She completed her residency in internal medicine at the Hospital of the University of Pennsylvania and went on to complete fellowships in medical oncology and hematology at DFCI, MGH and BWH. She also received an MPH from Harvard School of Public Health. She is a medical oncologist who cares for adults with breast cancer, with a particular focus on the unique needs of young patients with breast cancer. She also leads efforts to optimize cancer survivorship care and research at DFCI.