More Women Are Getting Breast Cancer In Their 20s: Expert Decodes The Crisis

“Breast cancer” was presumed to be a “disease of the elderly”. This might have been true almost a decade ago. But the disease has shown a significant shift in its trend in recent years.  In 2019, the incidence rate of breast cancer amongst young women, even in their 20s, was about 49 per 100,000, which is quite high compared to older statistics. More concerningly, women under 40 are nearly 40 per cent more likely to die from their breast cancer than older women. Younger women are more likely to develop an aggressive form of the disease called “Triple negative breast cancer (TNBC)” and HER2-positive variants.

Hence, let us start by understanding the causes of breast cancer at an early age. Even though we may not be able to control most of these causes, awareness about them will help to their early detection.

1. Family history: We all must be aware of any breast cancer history in our family, especially our mother, grandmother or aunt, especially anyone with breast cancer before the age of 50. Then there are other important histories like any males in the family with breast cancer; bilateral breast cancer; ovarian, pancreatic or metastatic prostatic cancer and Triple negative breast cancer (TNBC). Hence, discussing in the family and trying to find out any positive history is the simplest thing that we can do.
2. Hormonal contraceptives: They can significantly increase the risk of breast cancer.
3. Genetic mutations: Women with genetic mutations like BRCA1/BRCA2 and PALB2 are at much higher risk of developing breast cancer at a younger age.  Once aware, these women can start screening at a much earlier age. Other mutations in genes like PTEN, BARD1, STK11/LKB1, CDH1 AND CHEK2 can also increase the risk of breast cancer.
4. Reproductive history: Menarche before the age of 12 years has also been associated with increased risk. First pregnancy over the age of 30 or having no children at all. Pregnancy before the age of 30 and breastfeeding are both found to protect against breast cancer.
5. Lifestyle choices: Smoking, regular alcohol drinking and obesity/ sedentary lifestyles are also known to be associated or contributing factors.
6. Previous radiation therapy to the chest.
7. Precancerous breast conditions like atypical hyperplasia or lobular carcinoma in situ.

Importance of screening

Screening means checking for breast cancer even when there are no symptoms. While many of the above-mentioned causes are unavoidable, spreading awareness and screening can help in early detection and may also save the young lady from some treatments like chemotherapy, which may seriously affect her quality of life.

Fertility and early menopause are major concerns in young women. Detection of breast cancer at an early stage may save the patient`s breast and even any further treatments. 

Screening guidelines

• Monthly self-breast examination and annual clinical breast examination with their doctors are recommended for early detection. Any new palpable lump, change in the size of the previously known lump, change in any of the breast size, skin dimpling, nipple areolar complex changes, blood-stained spontaneous nipple discharge, or even any lump in the armpits must be viewed with concern and must be immediately investigated.
• After clinical breast examination, the first and safest investigation recommended in young women is ultrasound. 
• Although mammography is not recommended as a screening tool in young women, it may be recommended if needed for diagnosis. 
• MRI breast also plays a beautiful role, especially in young women with higher risk, as a screening tool and also as a diagnostic tool. 

So, what should be our protocol? The following are the recommendations for screening and diagnostic mammography and other investigations.

Breast Screening Recommendation from Breast Imaging Society, India

• High-risk group screening (mammograms along with breast MRI) is appropriate if there is a lifetime risk of breast cancer of about 20% according to risk assessment tools that are mainly based on family history, if woman has a known BRCA1 or BRCA2 gene mutation or has a first-degree relative with BRCA1 or BRCA2 gene mutation (and has not had genetic testing herself), if woman has a first-degree relative with premenopausal breast cancer, if she has had radiation therapy to the chest when she was between the ages of 10 and 30 years.

I would like to conclude by stressing the fact that it's imperative for us also to keep up with the shifting trends of the disease, be more aware of our bodies and be vigilant with our screening protocols. This will surely help us in nabbing the disease when it can be controlled with much simpler treatment options.  

Authored by Dr Namrata Singal Sawant, Director and Senior Breast & Women`s Imaging Consultant Radiologist at “Vcare Imaging Diagnostic Centre”, Mumbai. | M.B.B.S., M.D., Fellowship in Breast Imaging (U.S.).