Early-Onset Breast Cancer

Around a third of women with breast cancer are diagnosed before they go through menopause. This is sometimes called early-onset breast cancer, and it's often more advanced when it is diagnosed, more aggressive, and harder to treat than breast cancer that begins at an older age.

This article discusses the unique challenges younger women with breast cancer are likely to face. It covers the types of breast cancer most common before menopause, symptoms, diagnosis, and treatment.

It also touches on the impact breast cancer and breast cancer treatment can have on women of child-bearing age who want to start or continue building a family.

Types of Breast Cancer in Young Women

Certain types of breast cancer are more common in younger women than in women who've gone through menopause:

• HER2-positive breast cancer occurs when a protein found on the surface of breast cells called human epidermal growth factor receptor 2 (HER2) grows uncontrollably.
• Triple-negative breast cancer does not have receptors for the hormones estrogen or progesterone or the HER2 protein.

What's more, breast tumors that develop before menopause are likely to reach a high grade by the time they're found. Tumor grade is a measurement of how quickly and aggressively cancer might spread, based on how abnormal the cells look under a microscope. Tumor grade ranges from 1 to 4, with grade 1 nearly normal and grade 4 highly abnormal.

Symptoms

In general, young women are likely to experience the same breast cancer symptoms as older women do. That said, routine mammogram screening is not recommended for most women under 40, and cancer is likely to be larger and more advanced when it's detected in young women.

By the time it's advanced, the tumor may cause obvious changes in the breast and nearby areas, including:

• Swelling
• Irritation, redness, scaliness, or thickening of breast or nipple skin
• Dimpling of the skin
• Pain in the breast or nipple
• Turning inward of the nipple
• Discharge of fluid from the nipple
• A lump under the arm

Causes and Risk Factors

All cancer develops when abnormal cells begin to grow out of control. It isn't clear what specifically might cause this to happen in women who haven't reached menopause.

However, there are several known risk factors for early-onset breast cancer, including:

• A known BRCA1 or BRCA2 gene mutation
• A family history of a BRCA gene mutation
• Radiation therapy to the chest between ages 10 and 30
• Li-Fraumeni syndrome, Cowden syndrome, Bannayan-Riley-Ruvalcaba syndrome, or having first-degree relatives with one of these syndromes
• Recent use of hormone-based birth control
• Past treatment with mantle field radiation for Hodgkin lymphoma
• First period at an early age
• A diet includes a lot of red meat

Diagnosis

Around four out of five young women with breast cancer are not diagnosed until they feel a lump, either accidentally (while showering, for example) or during a breast self-exam (BSE).

By the time a breast lump is large enough to feel, cancer is likely to have reached stage 2 or stage 3. Staging is a system used to describe how advanced cancer is.

After a younger woman discovers a lump in her breast or a growth shows up on a screening test, her doctor will take the same steps to diagnose it as they would for an older woman:

• Physical exam
• Imaging, either a mammogram or an ultrasound
• Biopsy to remove fluid or tissue from the breast to study under a microscope

The doctor also may consider other possible causes of a breast lump, such as a cyst, fibroadenoma, lymphoma, duct ectasia, and a wart-like growth called a papilloma, among others.

Treatment

The treatment for early-onset breast cancer will depend in large part on the type of cancer it is.

Surgery

Surgery can involve either a lumpectomy, in which only the tumor and a certain amount of healthy tissue surrounding it is removed, or a mastectomy, which is the surgical removal of the entire breast.

A mastectomy may carry a greater emotional impact than a lumpectomy, as it requires more extensive surgery and dramatically changes a woman's physical appearance.

A mastectomy can lower your risk of developing a second tumor in the same breast. However, it doesn't lower the risk of having a recurrence in other areas of the body, including the opposite breast.

For women with early-stage breast cancer, studies show that the rates of survival are the same with lumpectomy and radiation as they are with mastectomy.

Chemotherapy

Chemotherapy can lower the risk of breast cancer coming back, but it can cause a number of serious side effects. Some of these are unique to younger women, including infertility, a risk of pregnancy complications and birth defects, premature menopause, and other types of cancer.

Hormone Therapy

Removal of the ovaries (oophorectomy) or treatment with medications that suppress ovarian function is more commonly used as part of breast cancer management for younger women than for older women.

The complications include premature menopause and infertility, as well as a deficiency of estrogen, which can lead to osteoporosis and other conditions.

Targeted Therapy

HER2-targeted therapies, such as Herceptin, can often be used for the treatment of breast cancer that's HER2-positive.

With the approval of these therapies, the National Cancer Institute (NCI) upgraded the prognosis for stage I to stage III HER2-positive breast cancer from "fair" to "good."

Treatment Side Effects and Complications

Menopause-like symptoms can be difficult for young women being treated for breast cancer. Rather than the gradual onset of natural menopause, hot flashes and other symptoms tend to come on quickly and harshly soon after treatment starts.

Sexual side effects are common with lower estrogen levels, and these can be particularly bothersome for young women as well.

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Fertility and Contraception

Chemotherapy can increase the risk of birth defects and may decrease fertility. For women who want to have children in the future, there are options for preserving fertility, including freezing eggs or fertilized embryos.

Women who do not lose their fertility during chemo need to be especially careful not to get pregnant by using non-hormonal forms of birth control, such as condoms or an intrauterine device (IUD).

Long-Term

Some effects of breast cancer and its treatment take many years to develop. Young women, in general, are expected to live much longer than older women, making them more likely to experience the long-term effects of these treatments:

• Chemotherapy: Peripheral neuropathy, low bone density, osteoporosis, and bone fractures
• Radiation therapy: Risk of secondary cancers (cancers that develop due to the carcinogenic effect of radiation)

Prognosis

The survival rate for young women with breast cancer is lower than for older women with the disease. This may be true in part simply because early-onset breast cancer tends to be more advanced when it's diagnosed. It may also have to do with the fact that the types of breast cancer younger women develop are more aggressive.

What's more, when breast cancer recurs in younger women it is more likely to be a metastatic recurrence than a local recurrence.

Coping

Support groups and communities can be enormously helpful when you're going through early-onset breast cancer. It's important to look for groups that include younger women.

Emotional Concerns

Coping with the emotions surrounding breast cancer, as well as anxiety or depression, is difficult for anyone of any age. It's been shown that working with a cancer therapist may improve the chances of surviving breast cancer.

Parenting

Caring for young children can be challenging when you have breast cancer. At the same time that you are dealing with your own emotions, your responsibilities in taking care of your children can leave you little to no time for self-care.

Being involved in a breast cancer community with other young mothers can be valuable and may point you to useful resources in your community.

Summary

Breast cancer in younger women can be especially aggressive and hard to treat. Younger women are likely to be diagnosed later than older women and so their disease may be more advanced.

Early-onset breast cancer also involves unique challenges, as women who develop it are of child-bearing age and so must consider how treatment might affect fertility. Getting support from a group of other young women with breast cancer and working with a therapist can improve the prognosis for breast cancer that develops before menopause.

A Word From Verywell

It may somewhat help to know that many patients (and experts) say that a cancer diagnosis, while challenging, can change you in some positive ways in the end. Have a focused treatment plan, lean on those around you for support, and always keep the hope of the years ahead as a reminder of why you're fighting your fight.