As young women we have been accustomed to think that breast cancer is a disease that has the chance of affecting us in our later years. This however, is far from reality. Young women can and do get breast cancer. We sat down with Dr. Ann Partridge, a medical oncologist and Founder/Director of the ‘Program for Young Women with Breast Cancer‘ at the Dana Farber Cancer Institute to discuss the struggles young women face when diagnosed with breast cancer, as well as methods of prevention and early detection.
What is the incidence of breast cancer in young women?
Breast cancer occurs in approximately 1/2000 women up to age 30, and 1/200 women up to age 40. Approximately 7% of breast cancers are diagnosed in women under 40, 16% in women under age 45.
What are the unique issues facing these younger women diagnosed with breast cancer?
There are a number of issues unique to young women or exacerbated by being young and getting breast cancer. There include fertility, genetics, psychosocial concerns such as body image, sexual functioning, finishing school, career launching, raising young children, being single or in young relationships, among others.
What specific types of treatment and associated side effects are of greatest concern for young women who survive breast cancer?
Both local (surgery and radiation) as well as systemic (chemotherapy, hormonal therapy, biologic therapy) can all cause both short and long term effects. For all patients, the risk of the very serious side effects like heart damage or leukemia are the most concerning. But the non-life threatening symptoms may be even harder on young women that older women including hair loss, inability to work during treatment–young women are less likely to be retired or have a nest egg–premature menopause and associated menopausal symptoms or infertility.
Most women will not get breast cancer, and most young women will definitely not get breast cancer.
What are the major risk factors for developing breast cancer?
This is a large topic of discussion. In short, being female, increasing age, family history, history of prior breast biopsy, early menarche and late menopause among others including newer risks such as breast density, increased alcohol intake, and weight gain after age 18.
How often should women be conducting monthly breast exams? What should they do if they find a lump?
Current data do not support routine monthly breast self exams–compared to not doing a standardized exam. With that being said, we generally recommend that women know the feel and look of their own breasts so that they can note any changes. If they find a change including a lump, skin changes, lumps under the arm, or nipple discharge, they call their healthcare provider and be evaluated.
As young women, our breasts can go through changes with menstrual cycles. How can we tell these changes apart from breast cancer?
Most lumps in young women will not be cancer and if lumps come and go with the menstrual cycle, they are often fibrocystic changes. But, if they stay and especially if they are growing, that is something a woman should talk to her health care provider about.
At what age should women start getting mammograms?
Recent guidelines from the American Cancer Society says 45 years of age, but depends on a woman’s reference and risk factors including family history. It is okay to start at 40, but it is also okay to wait until 45 too.
What are your recommendations for early detection of breast cancer?
Follow the evidence based guidelines regarding mammograms and note any suspicious changes and bring them to your health care provider’s attention.
Are there ways young women can prevent breast cancer?
We think that staying slim, exercise, not drinking alcohol beyond moderation (about one glass of red wine/day or less) is associated with decreased lifetime risk of breast cancer and with overall better health. This is what all women should do and it is never too late to make these lifestyle changes.
What is your take home message?
Most women will not get breast cancer, and most young women will definitely not get breast cancer. However, young women can and do get breast cancer so attention to their breast health and their unique concerns once they are diagnosed is important to both improve disease and psychosocial outcomes.
Dr. Ann Partridge is a senior physician at Dana Farber Cancer Institute and an Associate Professor of Medicine at Harvard Medical School in Boston, MA. She is the Director of the Adult Survivorship program and Founder/Director of the Program for Young Women with Breast Cancer at Dana Farber.