Breast Cancer Before 45 Is Different. Here’s Why

Breast cancer in younger women doesn’t get a lot of attention. It’s not surprising, considering that the average age of diagnosis in the United States is 62. Still, nearly one in 10 new breast cancer cases is diagnosed in a woman under 45.

Although the numbers are smaller, breast cancer at a younger age often comes with unique challenges that deserve more awareness. Younger women who are diagnosed with breast cancer face many of the same challenges as older women, while also dealing with unique age-related concerns.

Tumors tend to be more aggressive: Not all breast cancer tumors are alike, with some being more challenging than others. This is particularly true among women who are diagnosed before the age of 40. Unfortunately, this means younger women are more likely to have poorer prognoses, as they may be dealing with larger tumors that spread more quickly to other parts of the body. Younger women tend to present with higher-grade tumors, have larger tumors at diagnosis (due to delayed detection) and are more likely to be diagnosed with more aggressive tumor types such as triple-negative breast cancer and HER2-positive cancers.  Younger women also are more likely to have a recurrence of cancer within five to 10 years after completing treatment.

Younger women are less likely to recognize the disease in its early stages: This goes back to the fact that breast cancer isn’t considered a young person’s disease. Since women often do not start their regular mammograms until age 40, it can be more difficult to catch it in early stages, when there may be more treatment options with the potential for better outcomes. Younger women also often have denser breast tissue, which can make mammograms less sensitive.  This is why women are urged to begin regular self-exams as soon as they have breasts. A monthly self-examination can help with early detection.

There may be important genetic factors: About 5 percent to 10 percent of all breast cancers are related to inherited mutations. But in women diagnosed under 45, that percentage is significantly higher.

BRCA1 and BRCA2 mutations are the most common, but genes like PALB2, TP53, CHEK2, ATM, and other genes linked to a significant increase in breast cancer risk.

Genetic testing is recommended for all women diagnosed before age 50 with breast cancer. This matters for a variety of reasons. If you have a genetic mutation, it means you are at greater risk of developing cancer in the unaffected breast or elsewhere in your body, including your ovaries. This knowledge could affect decisions about removing the healthy organ before cancer develops. Or, at the very least, it will encourage more vigilant surveillance to detect future cancers as early as possible. This genetic information may also be important to siblings or children, who may share the increased risk. That’s why younger women are generally encouraged to get genetic testing after a diagnosis. Results may influence decisions about surgery (for example, choosing lumpectomy vs bilateral mastectomy). Results can guide future screening recommendations for both patients and their family members.

Cancer treatments can impact fertility and family planning: Younger women are often treated with chemotherapy, which is commonly recommended for more aggressive tumors. Unfortunately, some chemotherapies can cause temporary or permanent ovarian dysfunction, and in certain cases may lead to early menopause. For some women, a breast cancer diagnosis – and the subsequent treatment – occur before they’ve even given serious thought to family planning. It’s important to have a reproductive specialist involved early to explore options – including freezing eggs or embryos – that may be available.

The social and economic toll can be significant: When breast cancer is diagnosed later in life, women are generally in a better position – both financially and socially. A patient may already be retired and is more likely to have strong family network for support. An earlier diagnosis can affect a woman’s ability to work and could have a negative career impact. This only increases the financial toll of the disease. Undergoing treatment also can have a significant impact on quality of life by affecting your ability to spend time with friends and take part in social activities and sporting events.

Support groups can be a benefit for all women dealing with breast cancer. For younger women, these groups can help connect patients with other women their age and offer opportunities to share and to escape the feeling of being alone.

This content is not AI generated.