Breast cancer, while often associated with older age, can affect individuals in their 20s. A younger age diagnosis presents unique considerations for detection and management. Awareness of this possibility is important for early identification and timely medical evaluation. This article clarifies the prevalence, signs, risk factors, and next steps for breast cancer in this age group.
Prevalence in Young Adults
Breast cancer is rare in women in their 20s. Approximately 10% of new breast cancer diagnoses in the U.S. are found in women younger than 45. About 1 in 196 U.S. women under 40 receive a breast cancer diagnosis. For instance, in Australia in 2020, 85 women aged 20-29 were diagnosed, representing less than 0.5% of all female diagnoses that year.
Despite its rarity, incidence rates for women aged 20 to 29 have shown an annual increase of about 3.06% since 2001. Breast cancer in young adults tends to be diagnosed at later stages than in older age groups, partly because routine screening mammograms typically begin around age 40. This can mean more aggressive cancers are found.
Identifying Potential Signs
Nearly 80% of young adults discover their own breast abnormalities. A new lump or thickening in the breast or armpit is a common sign. While breast lumps are often painless and firm, they can also be soft.
Other signs include changes in breast size or shape, such as swelling, shrinking, bulging, or dimpling of the skin. Skin changes like redness, a rash, or thickening resembling an orange peel texture warrant attention. Nipple alterations, including inversion, flattening, or unusual discharge (especially clear or bloody and not breast milk), should be noted.
Persistent breast or nipple pain not linked to the menstrual cycle is another symptom, though breast pain rarely indicates cancer. Swelling or lumps in the armpit can also indicate breast cancer, as it may spread to lymph nodes there. Any new or concerning breast changes should prompt a medical consultation.
Understanding Risk Factors
Several factors influence the likelihood of developing breast cancer at a younger age. Genetic predispositions play a significant role, including mutations in genes like BRCA1 and BRCA2. These genes normally help repair damaged DNA, but their mutations can increase cancer risk, often leading to earlier onset. Approximately 5% to 10% of breast cancers are linked to inherited genetic mutations.
A strong family history of breast or ovarian cancer, especially if a close relative was diagnosed before age 50 or if multiple family members are affected, elevates risk. Individuals of Ashkenazi Jewish heritage also have an increased risk due to a higher prevalence of certain genetic mutations. Previous radiation therapy to the chest before age 30 is another established risk factor. Certain benign breast conditions, such as atypical hyperplasia or lobular carcinoma in situ, can also increase risk.
Lifestyle choices contribute to breast cancer risk. These include regular alcohol consumption (particularly with higher intake), being overweight or obese (especially with weight gain after age 30), a sedentary lifestyle, and a diet high in processed foods or red meat. Hormonal factors, such as starting menstruation before age 12, having a first full-term pregnancy after age 30, or never having a full-term pregnancy, can also influence risk. Having one or more risk factors does not guarantee a breast cancer diagnosis.
What to Do and Expected Outcomes
If concerning breast changes are noticed, consult a healthcare provider promptly. The diagnostic process begins with a clinical breast exam and a thorough review of personal and family medical history. Imaging tests, such as ultrasound or MRI, are commonly used for young women due to denser breast tissue, which can make mammograms less effective. If an abnormal area is found, a biopsy may be performed to obtain tissue.
The outlook for breast cancer depends more on the cancer’s specific characteristics and stage at diagnosis than on the patient’s age. While breast cancer in young women can be more aggressive and is often diagnosed at later stages, the five-year survival rate for invasive breast cancer that has not spread is high, at 91%. Early detection significantly improves the chances of successful treatment. Treatment strategies are tailored to the individual cancer’s stage and biological features. Young women diagnosed with breast cancer may also discuss fertility preservation options with their medical team before beginning treatment.