A diagnosis of breast cancer can be a shock at any age, but breast cancer in young people often presents a unique set of issues. In addition to managing a serious illness, younger people diagnosed with breast cancer may also be early in their careers and raising families or planning to start a family in the near future. They may also be concerned about finishing school, furthering a career, and building personal relationships — not to mention, they may struggle with issues surrounding body image.
Programs such as the Young and Strong Program for Young Adults with Breast Cancer at Dana-Farber Brigham Cancer Center provide a variety of services to help patients manage challenges.
Who is most at risk for breast cancer at an early age?
People assigned female at birth, including cisgender women, with a first-degree relative who developed breast or ovarian cancer before age 40 may have a higher risk of developing breast cancer at a relatively early age. (Cisgender refers to people whose gender identity and expression matches the biological sex they were assigned at birth.) This is especially true if more than one relative was diagnosed or if breast cancer occurred in a relative assigned male at birth. Overall, about 15-20% of breast cancers are likely to have a family link.
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.
Other risk factors include:
- Inheriting a mutated form of a gene, such as BRCA1 or BRCA2, associated with breast cancer.
- Having received radiation therapy to the chest area earlier in life.
Is breast cancer different in younger people?
While breast cancer can take variety of forms, the most common type in young people is ER-positive, HER2-negative breast cancer, just like older people. However, younger patients are more likely to develop HER2-positive and triple-negative breast cancer than older patients.
HER2-positive breast tumors have high levels of a protein called HER2 and tend to grow and spread faster than HER2-negative breast cancers. They’re likely to respond to treatments that target the HER2 protein.
Triple-negative breast cancer cells lack receptors for HER2 and the hormones estrogen and progesterone. Like HER2-positive breast cancer, triple-negative tumors tend to be highly aggressive.
By identifying the specific type of breast cancer a person has, doctors can design a treatment plan most likely to be effective against it.
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 breast cancer incidence — the number of new cases per 100,000 women — declined an average of 0.3% annually between 1999 and 2018 among women age 20 and older in the United States, it rose 0.3% among women age 20-39.
What can people do to lower their risk of breast cancer?
A good place to begin is to know what one’s risk is. A variety of tools are available to help people of all ages do that.
People at average risk of breast cancer can keep their long-term risk low by healthy behaviors when possible, 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
Young people with a higher than average risk should talk to their doctor about scheduling regular, intensive screening exams, including MRI scans of their breasts.
Other options for at-risk younger people include the following, if applicable:
- 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
Studies have found no 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.
Is breast cancer treated differently in young people than older people?
Treatment for young people is generally similar to that for older patients, with a few exceptions.
If, for example, a patient is premenopausal and their breast cancer is hormone receptor-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.
When younger patients develop more aggressive forms of breast cancer they may also be willing to undergo more aggressive therapies.
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 open that possibility.
The Oncofertility Program at Dana-Farber Brigham Cancer Center and Boston Children’s Hospital helps patients and their families navigate the medical, emotional, and financial aspects of fertility preservation. Available to all adult and pediatric patients whose treatment might affect fertility, the program ensures that patients have the information and support to make informed decisions.
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.
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 as it relates to respectful medical care and the way breast cancer is framed as a “women’s” cancer. “Mammograms and check exams can be vulnerable experiences,” Laken Brooks notes in a Forbes article about how breast cancer campaigns fail transgender people. “Since many transgender people face harassment and invasive questions at their doctor’s office, they may avoid the additional discomfort of a breast cancer exam… Breast cancer campaigns are doused in pink, a color often associated with femininity. When campaigns limit their marketing to pink, they may dissuade transgender people.”
Healthcare professionals have an important role to play in helping patients cope with these issues. 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. Researchers piloted the program in women under 45 with newly diagnosed breast cancer, breast cancer survivors, and women living with metastatic breast cancer. At the 2021 San Antonio Breast Cancer Symposium, the researchers reported that the majority of participants in the study found 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 for Young Adults with Breast Cancer 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 for Young Adults with Breast Cancer 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.
In 2016, Ann Partridge, MD, MPH, founder and director of the Young and Strong Program, 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 age 40 and under with newly diagnosed breast cancer between 2006 and 2016. The goal of the study is to gain a deeper knowledge 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.
Most women with hormone receptor-positive breast cancer take hormonal therapy, such as tamoxifen or aromatase inhibitors, for five to 10 years after undergoing breast surgery, during which time they’re unable to become pregnant. Partridge also led U.S. participation in a study of whether premenopausal women with hormone receptor-positive breast cancer who temporarily stop taking hormonal therapy after 1½ to 2½ years to get pregnant have a higher risk of the disease recurring. Participants in the study, known as the POSITIVE trial, discontinue hormonal therapy for up to two years to become pregnant, deliver the baby, breastfeed, and start hormonal therapy again.
Another study by researchers in the Young and Strong Program found that concerns about fertility often influence how young women 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.
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. Later she received an MPH from Harvard School of Public Health. She is a medical oncologist focusing on the care of adults with breast cancer, and she has a particular interest in the psychosocial, behavioral, and communication issues in breast cancer care and treatment.