Breast cancer in young women

If you’re a woman diagnosed with breast cancer before the age of 45, your medical and emotional concerns may be very different than those of women who are diagnosed when they are older. Body image, relationships, career, intimacy, fertility, and parenting are just some of the issues and life areas that can bring up questions for you.

This section of LBBC.org, a program of our Young Women's Initiative, is dedicated to bringing you tailored information and resources to help you face your diagnosis, understand treatment options, manage side effects, talk with your family and friends, and communicate with your employer. We’ll also help you connect with other young women impacted by breast cancer.  

And on this page, we’ll walk you through risk factors, symptoms and diagnosis, screening guidelines, and treatment options. We’ll also talk about common concerns for young women, including fertility preservation during breast cancer treatment.

Facts about breast cancer in young women:

  • 9% of all breast cancer cases happen in women 45 and under.
  • Young women may not get diagnosed right away: for women at average risk, regular screening mammograms aren't recommended until age 45.
  • Women ages 15 to 39 are less likely to be diagnosed at an early stage than older women.
  • Breast cancer is more likely to be aggressive and is less treatable in young women.
  • Young women tend to have dense breasts. Mammograms are less likely to find tumors in women with dense breasts.
  • Black women have a higher chance of being diagnosed with breast cancer before age 40 than white women.



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Risk factors 

Risk factors for developing breast cancer at a young age include:

  • Having a close relative who was diagnosed with breast cancer before age 45
  • Having a close relative who has had ovarian cancer
  • Having a personal history of breast cancer or some other breast problems that are not cancer
  • Having an inherited genetic mutation, such as BRCA1 or BRCA2, that increases breast cancer risk
  • Having a close family member with an inherited genetic mutation such as BRCA1 or BRCA2
  • Having had radiation treatment to the breast or chest as a child or teenager
  • Having Ashkenazi Jewish heritage
  • Having a previous diagnosis of breast cancer 
  • Having a diagnosis of LCIS, or lobular carcinoma in situ, a breast change that increases the risk of breast cancer
  • Having dense breasts, confirmed by a radiologist performing a mammogram

Heavy alcohol use increases a person’s risk of developing breast cancer at any age.

Symptoms

Common symptoms of breast cancer that are noticeable in or on the breast include:

  • A lump in the breast
  • Swelling of part or all of the breast
  • Skin dimpling or puckering, including an orange-peel appearance
  • Breast or nipple pain
  • A nipple that turns inward
  • Red, dry, flaking, or thickened breast skin or nipple
  • Nipple discharge that is not breast milk, with or without bleeding
  • Swollen lymph nodes under the arm or around the collar bone

If you experience any of these symptoms, it’s important to report them to your doctor.

The challenges of diagnosing breast cancer in young women

Younger women may not get diagnosed with breast cancer as early as older women do. Here are some reasons why:

  • Screening mammograms are not recommended for women at average risk until they are 45.
  • Mammograms are less likely to find tumors in women with dense breasts. Young women’s breasts tend to be denser than older women’s.
  • Since most women who get breast cancer are older, younger women sometimes dismiss symptoms. On the other hand, if you’re a younger woman experiencing a possible breast cancer symptom, it’s not uncommon for a doctor to be dismissive due to your age. For instance, some physicians recommend a “watching and waiting” approach for younger women.

Keep in mind that early detection leads to more successful treatment of breast cancer. No matter how old you are, it’s important to contact your healthcare provider as soon as possible if you notice a lump or another symptom of breast cancer. And if you feel you are not being heard, ask to be referred to a different doctor, or make an appointment to see a new doctor at a different healthcare institution.

The unique concerns of young women with breast cancer

A breast cancer diagnosis is concerning at any age, and everyone’s experience and situation is different. However, in general, younger women who have been diagnosed with breast cancer have concerns that are less likely to affect older women with breast cancer. Younger women:

  • May not have as many financial resources to treat cancer and receive support
  • Are more likely to face challenges at work (for example, taking time off and managing workplace relationships)
  • Are more likely to have concerns about fertility (the ability to get pregnant and have children)
  • Are more likely to be raising children at the time of diagnosis
  • Often experience losses of opportunities or educational experiences

Common types of breast cancer that affect young women

Some types of breast cancer are more common in young women, including:

  • Breast cancer with higher-grade tumors, which means the cancer grows quickly and is more likely to spread
  • Estrogen receptor-negative breast cancer, which grows faster than estrogen receptor-positive breast cancer
  • Triple-negative breast cancer, a fast-growing cancer that tests negative for hormone and HER2 receptors
  • Inflammatory breast cancer, an aggressive cancer with symptoms that can include breast swelling, breast redness, a heat sensation, and a dimpled orange-peel appearance on the skin

When to start screening

For young women, the age to start screening depends on whether you’re at average or high risk of breast cancer:

  • If you are at average risk: The American Cancer Society recommends mammograms once a year for women at average risk starting at age 45.
  • If you are at high risk: If you have a high risk of developing breast cancer, your doctor may suggest that you talk to a genetic counselor and get screened at an earlier age. The American Cancer Society recommends that women at high risk for breast cancer have a breast MRI and a mammogram each year, usually beginning at age 30. If you are at high risk for breast cancer, it’s important to talk with your doctor about your individual situation and screening plan.

Should you do breast self-exams?

Some people do a self-breast exam at home to look and feel for problems or changes in the breast tissue. But experts don’t think self-exams or clinical breast exams done by a doctor help find breast cancer early. Research shows you’re more likely to feel a lump or see an area of concern in your breast when bathing, getting dressed, or doing another day-to-day activity. However, it’s still important to understand what does look and feel normal and what doesn’t look and feel normal in your breasts. If something feels out of the ordinary, trust your gut and let your doctor know.

Treatment options

Treatment options for young women diagnosed with breast cancer include:

  • Surgery to remove the cancer (lumpectomy, mastectomy)
  • Radiation therapy
  • Chemotherapy
  • Hormonal therapy  
  • Targeted therapy
  • Immunotherapy

Learn more about treatment options.

How treatment affects fertility

In younger women, breast cancer treatment can affect fertility, the ability to get pregnant and have children. For example:

  • Chemotherapy can affect fertility by damaging the sacs in your ovaries that contain eggs.
  • Hormonal therapy, used to treat hormone receptor-positive breast cancer, can disrupt fertility because it’s usually recommended that it be taken for 5 to 10 years, often during a woman’s most fertile time of life. The good news is that for many women, there are ways to adjust the treatment schedule to allow for a pregnancy. Talk with your doctor if this is a concern for you.
  • Some treatments, such as ovarian suppression medicines, can temporarily stop the ovaries from producing estrogen and releasing eggs (ovulating).
  • Some treatments, such as hormonal therapy and targeted therapy, can negatively impact fetal development.

If you have been diagnosed with breast cancer and you think you would like to have children in the future, let your doctor know before you start treatment, if possible. You may want to ask to be referred to a fertility specialist who has worked with women being treated for breast cancer. If you did not have a conversation with your doctor about fertility and you’ve already started treatment, it’s important to know that options are still available. You can always have a conversation with your doctor or an oncology fertility specialist about your options.

How treatment can affect sexuality and body image

Breast cancer treatment can affect body image, intimacy, and sex in different ways:

  • If you were sexually active before treatment, the side effects of treatment can sometimes mean there are times when you don’t want to have sex, you’re not feeling pleasure from things that gave you pleasure in the past, or feeling pain with activities that used to bring you pleasure.
  • Breast cancer surgery, such as mastectomy or lumpectomy, can cause visible scars, hypersensitivity, or numbness in the breast skin.
  • Breast radiation therapy can cause short-term breast soreness and skin sensitivity. Over time, the tissue may start to feel tougher, like leather. For some people, it can also make the breast feel numb.
  • With some treatments, such as aromatase inhibitors, there can be menopausal side effects such as vaginal dryness that make sex painful or feel different than it did before.
  • If you’ve had treatments such as mastectomy or chemotherapy with hair loss, it can be challenging to adjust to changes in how you look, and these changes can impact how you feel about intimacy.
  • Other treatment side effects, such as fatigue and weight gain or loss, can affect feelings about sex and how you feel about your body.  
  • If you’re single, it’s very common to worry about how to tell a potential partner you’re interested in that you’ve been treated for breast cancer.

This sounds like a lot. But it’s important to know that there are many ways to manage sexual side effects, and there’s support available for concerns you might have about your body and your sex life. Your care team, a licensed professional counselor, and supportive connections with other young women going through similar experiences can all be great resources. Visit Sex and intimacy after a breast cancer diagnosis to learn more.

Clinical trials

Research is ongoing to improve breast cancer treatment and fertility preservation in young women. Participating in a clinical trial not only helps advance research that helps others, but it also can provide access to new and potentially promising treatments, as well as reduced-cost or free trial medicines. If you’re a young woman who has been diagnosed with breast cancer and you’re interested in joining a clinical trial, talk with your doctor about whether a trial might be right for you.  

Learn more about clinical trials.

What young women can do

We know that a breast cancer diagnosis can feel overwhelming — and if you’re young, there can be so many questions about how your diagnosis and treatment will affect you, now and in the future. But there are things you can do that can help you make informed decisions:

  • Learn about your cancer diagnosis and your pathology report by talking with your care team, reading resources offered here at LBBC, and connecting with others who’ve been diagnosed.
  • Ask your doctor about the impact of different treatment options.
  • Ask your care team for a referral to a licensed counselor experienced in the issues of young women facing a breast cancer diagnosis.
  • If you want to have children in the future, ask to be referred to a fertility specialist to talk about fertility preservation options, especially if chemotherapy or hormonal therapy have been recommended to you.
  • Explore news, information, and other young women’s stories available here at LBBC.org. You can also watch our Let’s Talk About It video series, created just for young women.

FAQ

What percentage of women with breast cancer are young women?
Breast cancer affects mostly older women; 9% of breast cancer happens in women aged 45 and under.

How young can a woman get breast cancer?
Although it is rare, breast cancer has been diagnosed in women as young as 15 years old.

At what age should you get a mammogram, especially if breast cancer runs in the family?
If you are at average risk, The American Cancer Society recommends mammograms once a year starting at age 45. If breast cancer runs in your family, your doctor may suggest you talk to a genetic counselor and get screened at an earlier age (usually about age 30), depending on the youngest age of breast cancer in your family and other risk factors.

When should you start screening for a BRCA genetic mutation or other high-risk breast cancer mutations?
There is no specific age at which to get screened for high-risk mutations such as BRCA1 and BRCA2. If you have one or more family members with either gene mutation, let your doctor know, and ask to be referred to a genetic counselor. The counselor can further assess your risk based on family history, discuss the pros and cons of testing, and arrange for BRCA testing if you decide it’s the right choice for you.

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