Why Are More Young Women Getting Breast Cancer?

Ali Feller, 38, was just days away from running a marathon and “in the best shape of my life” when she felt a lump in her breast. After finishing the race — in personal-record time, by the way — she went to the doctor. Tests soon revealed a devastating diagnosis: She had breast cancer. Frankly, she didn’t have time for this. “I'm a busy mom with a career that I love and I'm proud of and felt like [I] was peaking right when I got diagnosed,” she says.

As surprising as the news was for Feller, she’s among a growing group of young women being diagnosed with the life-changing disease. 

Why are more young women getting breast cancer? 

A recent study showed that cancer in general is becoming more common in Americans under 50 — especially women — and that breast cancer cases are climbing faster than most other forms of the disease. In fact, breast cancer accounts for 30% of all cancer diagnoses in women aged 15 to 39, making it the most common cancer among women in this age group. When it occurs in young women, it also tends to be more aggressive and advanced. This may be one reason why mortality rates in women under 40 with breast cancer haven’t improved while the rates for older patients have gone down. 

So, what’s fueling the rise in cases among young patients? The exact mechanisms are unclear, but experts have some working theories. One revolves around more women choosing to delay motherhood. “The older a woman is when she has her first full-term pregnancy, the higher her risk of breast cancer,” according to the National Cancer Institute. As you age, cells accumulate genetic damage. Pregnancy initiates a surge in breast cell growth, which may multiply this damage and increase the chances that cells become cancerous. “What we're seeing now is girls start to menstruate at younger ages and have delayed childbearing and go into menopause later,” explains Andrea Silber, MD, a breast oncologist at Yale School of Medicine. Altogether, this means women are exposed to estrogen for a longer total period of time, which has been linked to an increased breast cancer risk. Another factor may be that women are drinking more alcohol. Alcohol changes how the body processes estrogen and causes hormone levels to rise. Drinking even a small amount can increase the risk of breast cancer, says Silber.

Black women have a particularly elevated risk of developing breast cancer young and are also prone to particularly aggressive triple-negative breast cancer (TNBC). There’s no single reason for the disparity, but the prevalence of TNBC may be partially explained by lower rates of breastfeeding, as breastfeeding has been shown to offer some protection against this particular form of breast cancer. 

What’s more, because breast cancer tends to be associated with older women, it may be difficult to find a doctor who hears your concerns as a younger patient, according to Silber. Feller says she experienced this when she first saw a doctor who “felt [the lump] and said it's probably nothing — come back in six months.” She pushed for further testing because she knew in her gut that something was wrong. 

How patients are navigating their diagnosis

When Jasmine Grainger, 32, felt a lump in her breast last fall, she initially thought it was a clogged milk duct from breastfeeding her 10-month-old son. She decided to go to the doctor anyway “because I suspected I was also pregnant,” says Grainger. “[At the appointment] they confirmed my pregnancy, which was great, and then they also confirmed…a lump.” In just more than a week's time, she was diagnosed with breast cancer. 

In line with the broader trend, breast cancer is also the most common type of cancer detected during pregnancy. Managing it is a balancing act between delivering the most effective treatments and protecting the baby. Fortunately, Grainger delivered a healthy baby and, after undergoing surgery and multiple rounds of chemotherapy, is on her way to being cancer-free. She says the timing of her pregnancy and her diagnosis are a “blessing” because the treatments she received could make it difficult for her to conceive again. Even if you’re undecided about having kids, consider consulting a fertility doctor if you’ve been diagnosed with cancer to make sure you understand the risks of treatment and how you can potentially preserve your fertility, suggests Oluchi C. Oke, MD, a breast oncologist at MD Anderson Cancer Center who treated Grainger. 

There’s also the “business side of this disease,” as Feller calls it — trying to find a doctor and figure out how to stay in-network with insurance providers — if you even have insurance. Managing all these decisions early on left little time to process the diagnosis itself. “There was no time for me to cry about it. There was no time for me to think about what my future was going to look like,” she says.   

How you can be proactive

The current advice from the American College of Obstetricians and Gynecologists is for most women to wait until age 40 to start getting mammograms. This recommendation stems from research that says mammograms aren’t effective enough at detecting cancers in women under 40 to outweigh the potential pitfalls, including cost, false positives, and unnecessary radiation exposure.

But the rules for young women with an above-average breast cancer risk (factors include family history, ethnicity, or even when you got your first period) are different, and some are advised to start screening early — around  25 or 30, according to Oke. To find out your risk, some experts recommend getting a breast cancer risk assessment, which may include genetic testing by age 25. Once Feller was diagnosed, genetic testing determined she was positive for a mutation of the BRCA2 gene, “which was a shock because I didn't know we had a family history of breast cancer,” she says. 

As always, pay close attention to changes in your breasts, knowing there are many potential symptoms beyond just the well-known lump. “No change is too small to bring up to your doctor,” says Oke. You know your body best, and if you’re “noticing changes over a period of time, regardless of [your] age, [you] need to get it checked out,” adds Silber.

theSkimm 

As the rate of breast cancer increases in young people, more women are finding themselves fighting the disease amid such a pivotal stage of life.