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Can you get breast cancer in your 20s?

You can get breast cancer at any age, even as an adolescent or young adult.

Early-onset breast cancer typically refers to breast cancer that is diagnosed in people younger than 45.

Why is breast cancer in young adults on the rise?

This is something researchers are trying to understand. We have identified some factors that may increase a person¡¯s risk for early-onset breast cancer.

Risk factors for early-onset breast cancer

• Inherited genetic mutations: About half of early-onset breast cancers are related to BRCA1 and BRCA2 mutations. Mutations to the PALB2 and TP53 genes can also increase your risk for early-onset breast cancer. However, not all early-onset breast cancers are genetic.
• No full-term pregnancies: The risk for breast cancer increases if a woman has no full-term pregnancies or has their first pregnancy after age 35. Statistically, women are now having fewer children or having them when they¡¯re older. This could influence more early-onset breast cancer diagnoses.
• Family history: Your risk for breast cancer increases if you have a parent, sibling or child with the disease.
• Precancerous breast conditions: Your risk for breast cancer increases if you¡¯ve been diagnosed with certain high-risk breast lesions, such as atypical ductal hyperplasia, atypical lobular hyperplasia, ductal carcinoma in situ or lobular carcinoma in situ. 
• Dense breasts: Many young women have dense breast tissue. This means their breasts have more fibrous and glandular tissue than fatty tissue. During a mammogram, breast cancer can hide in that fibrous and glandular tissue. If you have dense breasts, you may need additional screening to detect and diagnose breast cancer. 
• Race: Studies show that Black women ages 20 to 39 are more likely to develop breast cancer of any subtype compared to younger women of other racial and ethnic groups.
• Other possible risk factors include hormone therapy use in some instances, alcohol use, excess body weight and obesity and sedentary behavior.
• Researchers are studying whether certain environmental exposures and dietary factors influence breast cancer risk.

Even though more people are being diagnosed with breast cancer, it¡¯s important to know that they¡¯re living longer.

Experts believe this is due to earlier and improved detection strategies as well as treatment advances. The more people are being diagnosed when cancer is in its earlier stages, the more we have improved survival. And many people with metastatic breast cancer are living longer because of new treatments.  

What breast cancer symptoms should young people look out for?

Breast cancer symptoms can include:

• Lumps in the breast or armpit
• Breast pain
• Skin changes to the breast, like swelling or thickening of the skin or nipple
• Inverted nipples
• Nipple discharge
• Swollen lymph nodes

We typically don¡¯t recommend mammograms in women younger than 40 if they are at average risk for breast cancer, so it¡¯s very important for young women to practice breast awareness. This means you should be familiar with your breasts, and if you notice any changes like a new lump, see a doctor right away.

Do you approach treatment differently for early-onset breast cancer?

Studies have shown that breast cancer diagnosed in younger women tends to have a more aggressive disease biology. This means that the cancer may be found at later stages or harder to treat. Younger women are also more likely to be diagnosed with an aggressive type of breast cancer called triple-negative breast cancer compared to older women.

Every breast cancer is different, so at MD Anderson, we personalize treatment for each patient. We have expertise in treating rare types and even the most aggressive types of breast cancer. We often use a combination of treatments to get the best results for our patients, and we¡¯re constantly researching to find better personalized treatment options.

Physical and psychological impacts of treatment

When we survey young breast cancer patients, many list treatment-related infertility as a major concern. Cancer treatment, after all, can affect your fertility. And if you¡¯re diagnosed with breast cancer at a young age, you may not be at a point where you¡¯re ready to start a family.   

That¡¯s why I think it¡¯s important to know your fertility preservation options before starting cancer treatment. Fertility can increase the financial, physical and emotional stress in young people who are already facing challenges from a cancer diagnosis. Ask your doctor for a referral to a reproductive endocrinologist so you can discuss your fertility preservation options as early as possible.

Breast cancer treatment can also change the way your body looks. Body image is a critical issue for many young breast cancer patients.

If you¡¯re an MD Anderson patient, some of the resources we have to support you include:

• Adolescent and Young Adult (AYA) Program offers help with body image, sexual health, fertility, quality of life issues and more.
• Psychiatric Oncology Center offers a sexual health clinic where patients can focus on how cancer can affect their sexual health.   

Can I get a mammogram before age 40?

Most current screening guidelines recommend that women at average risk for breast cancer begin getting annual mammograms at age 40.

Women at increased risk may need to start breast cancer screening earlier, get additional imaging tests or be tested more often.

It¡¯s important to talk to your health care provider about your risk for breast cancer, so they can determine when you should begin screening and how often you should be screened.

Lower your breast cancer risk

Here are some ways you can lower your risk of developing breast cancer.  

• Maintain a healthy body weight. By maintaining a healthy body weight, you can avoid obesity, which is linked to the development of breast cancer.
• Get active. Aim to get at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week. Try to engage in resistance training for 30 minutes, at least twice a week.
• Avoid alcohol. For cancer prevention, it¡¯s best not to drink alcohol. If you choose to drink, be aware of the risks, aim to drink less often and have fewer drinks.
• Choose to breastfeed. It¡¯s recommended to breastfeed for at least six months to help lower your breast cancer risk.

Pay attention to your body

Always pay close attention to your body. Reach out to your doctor as soon as you notice anything new or suspicious going on with your breasts.

Recently, more young celebrities have gone public with their breast cancer diagnoses. I think that helps bring more awareness of early-onset breast cancer. We¡¯re still researching to better understand why more young people are getting breast cancer. As we learn more, we can continue to improve our prevention and treatment strategies, giving patients a better chance for optimal breast health. 

, is a breast medical oncologist at MD Anderson.

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