Dr. Susan Love Research Foundation | Breast Cancer

Breast cancer is most common in women over 50. But that doesn't mean it can't occur in younger women. There are many cases in women in their 40s. And while it's far more rare in women under 40, women in their 20s and 30s can get breast cancer too. But it is relatively rare. Less than 5 percent of all breast cancers occur in women under age 40.

All too often, a young woman may be misdiagnosed. She may detect a lump or a thickening, go in to see her doctor, and be told she just has lumpy breasts or "fibrocystic disease" and should be followed. And she is—until her doctors realize it's more serious than they initially believed. Then, they step into action. This is why even though the vast majority of lumps in women under 35 are benign, it's important for doctors to be vigilant and bear in mind that young women can develop breast cancer.

Like older women, the majority of younger women with breast cancer have no family history. But if you do have breast cancer in your family, you're more likely to get it at a younger age than if you don't.

The treatment for breast cancer in young women is pretty much the same as for older women, with the option of either breast conservation surgery with radiation or mastectomy with or without reconstruction. Often chemotherapy puts a young woman into menopause. The really young woman—in her 20s or early 30s—is less likely to have that happen than the woman in her late 30s or early 40s. That's because the closer you are naturally to menopause, the more likely it is that chemotherapy will push you there. Chemotherapy regimens that include cyclophosphamide (brand name Cytoxan) are more likely to induce menopause in women under 35 than are regimens that include doxorubicin (brand name Adriamycin).

There is considerable controversy over whether it is good for a young woman to get her period back after chemotherapy ends. Some data suggest that a premenopausal woman who has a hormone-sensitive tumor and whose period returns may benefit from an induced temporary menopause. This can be done with a drug like goserelin (brand name Zoladex) or leuprolide (brand name Lupron), which stop the ovaries from producing estrogen.

Fertility after treatment is a major concern for many young women. Because of the likelihood of chemotherapy-induced menopause, it is important that any woman concerned about fertility discuss her options with a fertility specialist who has expertise in treating women with cancer before undergoing chemotherapy.

Cancer During Pregnancy
Although it is rare, there are women who develop breast cancer while pregnant or breastfeeding. Most studies show that, stage by stage, a cancer that develops at this time is no more aggressive than any other breast cancer. The problem is that when you are pregnant, your breasts are going through a lot of normal changes, which can mask a more dangerous change. For one thing, breasts are much lumpier and thicker than usual. Similarly, when you're breastfeeding, you tend to have all kinds of benign lumps and blocked ducts, and you may not notice a change that would normally alarm you. Infections are common when breastfeeding and can mask inflammatory breast cancer, making a diagnosis of this form of breast cancer difficult.

Treatment options depend on what trimester you are in. In the first trimester, the most that can be done is a biopsy or a wide excision under local anesthetic. A general anesthetic (needed for a mastectomy), chemotherapy, and radiation cannot be used, as they can injure the fetus. In the second or third trimester, a mastectomy under general anesthesia becomes safe. So does chemotherapy. Radiation and hormone therapy cannot be given until after the baby's birth.

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