Challenges of Breast Cancer in Young Adults

Breast cancer is often thought of as an older woman’s disease. Although breast cancer in young women before age 40 is rare, it can and does happen – and it can be just as devastating as breast cancer in older women.

The Role of Genetics in Breast Cancer

Genetics plays a significant role in breast cancer risk. While breast cancers are mostly sporadic and account for 85% of breast cancers, in younger women it is important for physicians to have a higher index of suspicion for an underlying genetic predisposition.

Young women with a family history of breast cancer or a known genetic mutation should be vigilant about their breast health. The best-known genetic mutations are BRCA1 and BRCA2, which are more prevalent among Ashkenazi Jewish women. Research has also shown that African American women tend to develop triple-negative breast cancers earlier in life.

Genetic testing is a valuable tool for helping young women to understand their risk and create a plan for proactive management. Testing is becoming more accessible and affordable, with the cost of testing dropping dramatically in recent years. Prior to 2014, the cost to test only the BRCA1 and BRCA2 genes for mutations was approximately $3,500. Now, in 2023, 200 genes can be checked for around $200 and multiple companies offer genetic testing and genetic testing panels.

Early Detection is Critical

There is no doubt that the earlier breast cancer is detected, the better the chances of successful treatment. That’s why it’s essential for young women to be aware of the signs and symptoms of breast cancer, have regular breast exams, and know their family history.

I diagnosed my youngest breast cancer patient when she was only 21 years old. She came to me for a second opinion after an abnormality on her ultrasound. In taking her history, I learned both she and her mother were BRCA carriers, and her mother had already had prophylactic surgeries.

Rather than taking a wait-and-see attitude, I advocated for a biopsy, which came back positive for breast cancer. Following chemo and surgery to remove the tumor – which was already sizable – the young woman had reconstructive surgery, regained her health and resumed her plans to attend medical school.

I am seeing multiple other patients in their 20s and 30s who are BRCA carriers but are not ready for surgery. We keep them under increased surveillance with ultrasound and MRI until they are ready for prophylactic surgery. As needed, we also refer those patients for gynecologic oncology consultation to learn about ovarian cancer prevention and prophylactic surgeries.

Treatment Challenges

Being diagnosed with breast cancer at an early age comes with a unique set of concerns. Many young women are focused on building careers, starting families, and enjoying life, and having cancer can disrupt these plans.

Treatments like chemotherapy, radiation, and surgery can have side effects that impact body image, fertility, and relationships. For example, aggressive estrogen reduction treatment can bring on precocious menopause, whose side effects include vaginal dryness, hot flashes, weight gain, and mood swings. That is a hard sell to any young person. Hair loss brought on by chemotherapy can be especially devastating to a young woman of dating age or one who is preparing for a wedding. Not all women treated with chemotherapy will experience hair loss, as now there are options available, such as Cool Cap, that minimize hair loss in selected patients.

Miami Cancer Institute offers a range of patient support groups and individual psychological counseling to help patients cope with side effects and resume their regular life after treatment.

The individualized approach to not only to the type of breast cancer, but to the patient and her specific needs, are part of the holistic approach to cancer care.

Preserving Fertility and Protecting Pregnancy

We discourage pregnancy for five years after cancer treatment. If a woman is 35 at the time of her treatment, that means trying for a baby at 40. Some women may never resume fertility after treatment.

Oncofertility consultation can help young patients understand options and make decisions about timing a pregnancy attempt around cancer treatment. Fertility preservation options such as egg harvesting or embryo freezing are expensive, however, and not all patients can afford them.

For women who receive a cancer diagnosis during pregnancy, no treatment of any kind is advisable during the first trimester due to the risk of causing teratogenic malformations in the fetus. Certain types of chemotherapy, including Adriamycin, can be administered safely in the second trimester, with surgery and radiation to follow after delivery. Optimal breast cancer treatment during pregnancy requires the expertise of a multidisciplinary team to assure safety of the mother and the unborn baby.

The Bottom Line

Breast cancer is a serious disease that can happen to women of any age, even those in their 20s or 30s. I counsel young women that they should know their own body, advocate for themselves, and seek medical attention if they notice any changes. With the right resources and support, young women with breast cancer can navigate their diagnosis and treatment and move forward in their lives.