MEDIA

Why has breast cancer become so common among young women?

Breast cancer is the most common cancer of adolescents and young adult women aged 15 to 39 years, accounting for around 6% of all invasive breast cancer in women. In comparison to older women, younger women are more likely to have genetic predisposition, aggressive breast tumors, unfavorable biological characteristics, distant spread at diagnosis and adverse outcome.

Women who are under 40 years old may feel they are not at risk for breast cancer, but that is not true. Diagnosis can be more difficult in young women due to breast tissue density. Also since the stage of cancer in young adults are usually advance at the time of diagnosis, the outcome is relatively poor. Moreover, treatment in young adults can affect the fertility too.

Are women under 40 at increased risk for breast cancer?

Breast cancer is the most common cancer among women worldwide. The percentage of breast cancer increases rapidly in women during the third and fourth decades of life, from 2% at age 20 to more than 40% by age 40.

Younger women generally do not consider themselves to be at risk for breast cancer. However, breast cancer can strike at any age. All women should be aware of their personal risk factors for breast cancer. (A risk factor is a condition or behaviour that puts a person at risk for developing a disease.)

There are several factors that put a woman at higher risk for developing breast cancer:

• Family history of breast cancer.
• Suspicious lesion found by biopsy.
• A family history that is concerning for a genetic syndrome that may put them at a higher risk for breast cancer (breast cancer diagnosed before age 50, ovarian cancer at any age, triple negative breast cancer, bilateral breast cancer, male breast cancer, pancreatic cancer or metastatic prostate cancer).
• Obesity
• Sedentary lifestyle
• Lack of exercise and physical activity
• Junk food
• Fatty diet
• Late marriage
• Postponing first pregnancy
• Nulliparity
• Use of contraceptives pills
• Stress leading to Hormonal imbalance
• History of radiation therapy to the chest.
• Ashkenazi Jewish ancestry (one in 40 Ashkenazi Jews carry mutations in BRCA1 or BRCA2)
• Environmental
• Alcohol and Smoking
• Chemical exposure in various forms e.g.Cosmetics

What is different about breast cancer in younger women?

• Diagnosing breast cancer in younger women (under 40 years old) is more difficult because their breast tissue is generally denser than the breast tissue in older women, and routine screening is not recommended.
• Breast cancer in younger women may be more aggressive and less likely to respond to treatment.
• Women who are diagnosed with breast cancer at a younger age are more likely to have genetic mutations predisposing them to breast and other cancers.
• Younger women who have breast cancer may ignore the warning signs—such as a breast lump or unusual discharge—because they believe they are too young to get breast cancer. This can lead to a delay in diagnosis and poorer outcomes.
• Some healthcare providers may also dismiss breast lumps or other symptoms in young women or adopt a "wait and watch" approach.
• Breast cancer poses additional challenges for younger women as it can involve issues concerning sexuality, fertility, and pregnancy after breast cancer treatment.

Can breast cancer in younger women be prevented?

For women with a family history that is suggestive of a hereditary predisposition for breast cancer, a referral for genetic counseling may be appropriate. Identifying such genetic conditions will allow for a more personalized discussion on screening and preventive treatment options. For example, screening in BRCA mutation carriers begins at the age of 25.

Measures that all women can take to reduce breast cancer risk include:

• Achieving and maintaining ideal body weight
• Limiting alcohol consumption
• Getting regular exercise
• Breastfeeding

That being said, if breast cancer does develop, early detection and prompt treatment can significantly increase a woman's chances of survival. More than 90% of women whose breast cancer is found in an early stage will survive.

Young women should be counselled on breast awareness and to report any breast changes to their healthcare provider. These changes can include:

• Lumps
• Nipple discharge
• Lifestyle modification
• Skin changes

Should women under age 40 get mammograms?

In general, screening mammograms are not recommended for women under 40 years old. However, for women with genetic mutations, screening can begin at 25, and in women with a family history of breast cancer, screening is often initiated 10 years earlier than the first affected relative in the family. Breast MRI is often recommended to high risk women in addition to mammography. Even an Ultrasound can be of great help in doubtful breast lump.

Although breast cancer in young women is uncommon, it's the most common malignant tumor in young women. Risk of getting breast cancer at any time of your life is about 1 in 8.

So getting back to the beginning. Why are there more breast cancers among young women? Why do we hear about it more?

There isn't enough to explain all the increase in incidence in young ladies. Obesity increases the risk of breast cancer in women of all ages. And obesity in young women has increased dramatically over the last 2 to 3 decades.

We worry that there are environmental estrogens that may increase the risk of breast cancers. We know there are more synthetic chemicals that fetuses are exposed to in pregnancy and change the way that breast cells see estrogens or chemicals that adolescents are exposed to as the breast is developing. We also know that we are much more connected to people we barely know through social media and other media. So we hear much more about young women with breast cancer.

So, all in all, it seems as if breast cancer in young women is increasing. So what do we do about it? Well, you could turn off your social media and your contacts with your friends and family so you don't hear about it. But that isn't the way of women who are connected by the Woman Wide Web.

We can support research into the role of chemicals in our environment, our water, our cosmetics and our home that might increase the breast cancer risk or make breast cancer grow and spread faster.

We should be personally aware of our breast anatomy, promote breast self-awareness, and bring any new changes in our breast to the attention of our clinicians.

To provide optimal care to young ladies with breast cancer with breast cancer, we should engage multidisciplinary teams that offer fertility preservation, genetic counselling, physical and occupational therapy, nutrition, and psychosocial support, along with medical expertise in tailoring cancer-directed therapy and symptom management toward young women.

However, “Awareness is the key to Prevention” and we know very well that “Prevention is better than cure.”