More young women being diagnosed with breast cancer

Most cancers in the United States are discovered in people age 65 or older, according to the federal Centers for Disease Control (CDC), but a new study published in JAMA showed an alarming new trend in recent years. While cancers among older adults have shown a decline, cancers among younger people, especially women, are on the rise.

Breast cancer is one of the types of cancers that is on the rise, especially in women ages 30 to 39.

“I think the important thing is to raise awareness that we don’t have guidelines for screening mammograms under 40, but it is possible to get breast cancer under 40,” said Cape Cod Hospital breast surgeon Jill Oxley, MD, FACS, who is medical director of breast care services at the hospital. “Women younger than 40 account for 4 percent of invasive breast cancers diagnosed each year and one in every six cancers are diagnosed in women under 50.”

The lack of routine screenings for younger women means that when they do develop breast cancer, it is often discovered at a later stage and is therefore more serious. For that reason, Dr. Oxley stresses the importance of younger women knowing their own risk.

Risk Assessment

Three of the most prominent breast cancer groups (the National Comprehensive Cancer Network, the American Society of Breast Surgeons and the American College of Radiology) all recommend that every woman have a risk assessment at the age of 25 and no later than 30, especially Black women and women who are of Ashkenazi Jewish heritage.

The risk assessment increases the chances of cancers being found at earlier stages because of increased screening in those who are at risk.

“Someone who is going to be at high risk of breast cancer could start screening with MRIs as young as age 25 and with mammograms as young as age 30,” Dr. Oxley said. “And then a lot of major medical groups recommend a clinical breast exam every one to three years as well.”

A risk assessment can be done several different ways. A primary care doctor who is comfortable and knowledgeable about breast care can do one. Women can also get an assessment at their gynecologist. A third method is to visit Cape Cod Healthcare’s breast cancer awareness page and click on the link to take a risk assessment. There is also a link to schedule a mammogram. A woman can also be referred to the breast surgeons or nurse practitioner at Cape Cod Healthcare Breast Surgery - Hyannis or Cape Cod Healthcare Breast Surgery - Falmouth for a formal risk assessment.

Even though breast self-exams have fallen out of favor, several major medical groups recommend what is now called breast self-awareness, Dr. Oxley said. Breast self-awareness means becoming familiar with how your breasts look and feel. If you notice any changes, you can let your healthcare provider know.

Warning Signs

Dr. Oxley listed the following warning signs women should look for:

• Nipple discharge
• Nipple retraction
• Dimpling of the skin
• Any lumps
• Pain that persists
• Changes in size or shape of breasts
• Redness of the skin

What is Causing the Rise?

Doctors and researchers aren’t positive exactly why the number of younger women being diagnosed with breast cancers has gone up, but there are some theories, Dr. Oxley said.

One is related to exposure to hormones. Certain trends contribute to the amount of time women are exposed to hormones. For example, early menstruation and late menopausal age are considered possible contributing factors. So is a first pregnancy after the age of 30 or no history of pregnancy. Breast feeding is protective for the same reason.

“The essence is, the more uninterrupted menstrual cycles you have, the higher the risk,” she said. “A lot of the reproductive factors are going to increase the risk of hormone receptor-positive breast cancer. However, in younger women there are also higher rates of hormone receptor-negative breast cancer so that clearly doesn’t explain everything.”

Young women also tend to have dense breasts, which can make it harder to see a lump. Those women should be offered supplemental screening, she said.

A breast cancer diagnosis is hard on women at any age, but younger women have life circumstances that can make it even more difficult. Many younger women have to juggle work with childcare. Adding time-consuming treatments, like chemotherapy and radiation, can be daunting to those who already have a full schedule of obligations.

Younger women are more apt to suffer financially as well. If a woman with cancer is having any issues including financial, Dr. Oxley advises them to let their physician know. Even if they don’t have resources to help right at their fingertips, they know how to connect them to services that may help. The hospital has financial counselors and there are funds available for under-insured women. The Cancer Center also has social workers and the Cape Wellness Collaborative is another excellent resource.

“Someone who is having issues certainly should not be afraid to let their doctor know,” she said.