By Linh Luong
Breast cancer is primarily diagnosed among older women, after menopause. Only 25% of cases occur in women under 50 years old (Ganz, 2003). However, in recent years, the cases in this age group have increased tremendously. Between 2010 and 2019, the number of diagnoses surged by 19.4% for individuals aged 30 to 39, while for those aged 20 to 29, the increase was 5.3% (Morris et al., 2023). This shift in demographic trends has raised significant questions and concerns within the medical community. Continue reading to learn about risk factors for breast cancer in young women, as well as information about diagnosis, treatment, and prevention.
Why is breast cancer in young women increasing?
There are several risk factors contributing to this increasing trend of breast cancer in young women. One noteworthy factor is the change in lifestyle, including oral contraceptive usage, delayed childbirth, and decreased breastfeeding.
Nowadays, women have a flexible choice when selecting their preferred birth control methods. Among these options, oral contraceptives stand out as a popular choice. These pills contain synthetic estrogen as a key ingredient, leading to concern about its potential influence on the development of cancer cells. According to the National Cancer Institute, current oral contraceptive users had a 24% increase in risk that did not escalate with prolonged use. Notably, this risk started to decline after discontinuance of oral contraceptive use, with no discernible risk increase after a decade of cessation. However, it is essential to emphasize that the overall risk of breast cancer from oral contraceptives remains very low, indicating that other factors may also be contributing to this phenomenon.
Pregnancy is one of the known factors that can influence a woman’s chance of getting breast cancer. Women who give birth at an early age have a lower risk of developing breast cancer as they grow older. On the other hand, pregnancy after age 35 is linked to an increased risk of breast cancer. During pregnancy, breast cells experience accelerated growth, meaning that any pre-existing genetic damage within these cells can initiate abnormal growth, which can lead to breast cancer. Meanwhile, the chances of having these damages can go up with age, which helps explain why a delayed first childbirth can result in an increased risk of breast cancer.
Breastfeeding is recognized for its role in reducing the risk of breast cancer in women. Research has shown that for every 12 months of breastfeeding, the relative risk of breast cancer decreases by 4.3%, which is in addition to the 7.0% decrease in risk for each birth (Stordal 2023). This protective effect is attributed to the hormonal changes that a woman experiences during breastfeeding, which may delay her menstrual cycle. This delay effectively lowers her exposure to hormones like estrogen, which is known to be associated with an increased risk of breast cancer. With that being said, the declining trend in breastfeeding has shown a potential correlation with an increased rate of breast cancer among young women.
Unique challenges for young women with breast cancer
Awareness: Younger women may not be as vigilant with self-exams or about recognizing breast cancer symptoms. They might associate abnormalities, such as breast lumps or unusual discharge, with hormonal fluctuations. Additionally, healthcare providers may also dismiss these symptoms in younger women with a “wait and see” approach.
Breast density: Cancer detection is more difficult because younger women’s breasts are denser than those of older women. Higher breast density makes it harder to detect abnormalities on mammograms, often resulting in false negative results.
Screening guidelines: The current U.S. Preventive Services Task Force (USPSTF) screening guidelines (2016) recommend biennial screening mammography for women aged 50 to 74 years. Of note, however, is that a possible update to the USPSTF guidelines is currently in progress, in which the USPSTF recommends mammograms starting at age 40. With mammograms not typically recommended for younger women, it’s more difficult to diagnose young women’s breast cancer early.
Different types of breast cancer: Younger women are more prone to developing more aggressive types, such as triple-negative breast cancer, which typically exhibits lower responsiveness to treatment.
Side effects of breast cancer treatment in young women
Breast cancer treatment in younger women can have various side effects, depending on the stage and type of breast cancer and the treatment used. Common side effects in younger women may include:
Dissatisfaction about appearance: Surgical procedures to remove breast cancer, such as lumpectomies and mastectomies, cause significant changes in a person’s physical appearance. Moreover, chemotherapy can also cause hair loss, and radiation can cause changes in skin color. These changes can lead to dissatisfaction with one’s appearance.
Cognitive dysfunction: Certain chemotherapy drugs can have direct effects on brain function (often called “chemo brain”), and changes in estrogen levels also influence cognitive function. These alterations can result in memory loss, difficulties with concentration, and low energy levels.
Fertility: Chemotherapy and radiation can damage the ovaries, causing them to stop releasing eggs and producing estrogen. Hormone therapy can disturb the menstrual cycle, which may affect women’s fertility. Medically-induced menopause and other fertility changes may be temporary or permanent.
Sexual health: Chemotherapy can lower estrogen levels, causing vaginal dryness and burning. In turn, this can lead to pain and discomfort during sexual intercourse. This issue significantly affects quality of life for affected individuals.
Psychological challenges: Younger women appear to experience more significant psychological distress than their older counterparts, largely driven by concerns about fertility loss, changes in body image, and sexual dysfunction.
Can younger women lower the risk of breast cancer?
While breast cancer in younger women cannot always be prevented entirely, there are steps individuals can take to reduce their risk and increase the chances of early detection:
Maintain a healthy lifestyle: Opt for a balanced diet rich in vegetables, fruits, and lean protein and low in saturated fat. Exercise regularly, aiming for at least 150 minutes of moderate-intensity exercise per week.
Breastfeeding: When done for an extended period, breastfeeding can help lower breast cancer risk.
Limit hormone replacement therapy or oral contraceptives: Minimizing changes in hormone levels can reduce the risk of breast cancer.
Limit alcohol consumption: Consuming even a small amount of alcohol has been associated with an elevated risk of breast cancer. Consider abstaining from alcohol entirely. If you choose to drink, it is recommended that you limit alcohol intake to no more than one alcoholic drink per day.
Genetic counseling: If you have a family history of breast cancer, it is advisable to seek genetic counseling and testing to learn more about your own risk of breast cancer.
Breast cancer presents unique challenges for young women. Diagnosing breast cancer as early as possible can have a significant impact. While it is less common in younger women, early detection can make a substantial difference in treatment outcomes.
By staying informed, maintaining a healthy lifestyle, and seeking timely medical attention for any concerning symptoms, we can empower ourselves to detect breast cancer at its earliest and most treatable stage. Breast health should be a priority for women in every stage of life.
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