Deadly breast cancer is surging in young women – with cases in people younger than 40 rising the fastest over nearly two decades.
Rates of new diagnoses of metastatic breast cancer – when the disease has spread from its original site – in patients 20 to 39 rose by nearly three percent from 2004 to 2021, compared to just a 1.4 percent rise among women in their 70s.
Radiologists affiliated with the American College of Radiology analyzed cancer diagnoses from 2004 to 2021, focusing primarily on women with aggressive breast cancer that had spread to other parts of their bodies.
Breast cancer begins in a specific spot in a woman’s breast but can spread to other parts of the body, drastically reducing the odds the patient will survive.
When breast cancer is detected early – before it has metastasized – through preventive screening measures like a mammogram, the chance of survival after five years is high – between 86 and 99 percent. However, once the cancer cells have migrated, the survival rate plummets to just 31 percent.
While cancer is typically seen as a disease that strikes the elderly – more than 60 percent of cancers are diagnosed in people older than 65 – US health authorities have been eyeing a troubling upward trend in the number of younger adults being diagnosed with the disease – often with more advanced cases.
Experts partly attribute this rise to current screening guidelines, which don’t recommend mammograms until 40, as well as delays in diagnosis and treatment because of the Covid-19 pandemic.
The researchers considered their findings ‘alarming’ and warned that current statistics are likely undercounts, given the pandemic’s effect on surveillance and diagnostics.
A recent study in JAMA found that breast cancer rates went up by about 0.79 percent each year during the study from from 2000 to 2019. From 2000 to 2016, the increase was slow, at about 0.24 percent per year. But after 2016, the increase became much sharper
While the study found metastatic breast cancer rates rose most sharply in young women compared to seniors, there were similar rates in middle-aged women.
From 2004 to 2012, cases in patients 40 to 74 increased two percent per year and from 2018 to 2021, there was a 2.7 percent increase per year.
In 2024, an estimated 311,000 women will be diagnosed with breast cancer and more than 42,000 will die.
Records included about 80million women annually.
Dr Debra Monticciolo, co-author and past president of the American College of Radiology, said: ‘It’s important to understand that these women presented with distant (metastatic or Stage 4) breast cancer at the time of diagnosis.
‘Women with this diagnosis have a much lower survival rate and are much harder to treat.’
Women who are diagnosed under the age of 40 are about 39 percent more likely to die from the disease compared to those diagnosed at 40 or older.
They are also more inclined to be diagnosed with biologically more aggressive breast cancers, such as triple-negative breast cancer and HER2-Positive breast cancer.
A 2009 report analyzing a cohort of about 22,000 women ages 20 to 69 who were diagnosed with invasive breast cancer between 1992 and 2005 showed the youngest women (20 to 34) had the lowest chance of surviving the cancer over the next five years.
Researchers attributed the increase to gaps in screening, noting that younger women are not generally advised to get a mammogram until they turn 40, unless they know they have a genetic risk
They also had the highest risk of dying compared to older women, with their risk nearly three times higher.
As women got older, their risk of dying from breast cancer decreased.
For women aged 35 to 39, the risk was 1.76 times higher, and for those aged 40 to 49, the risk was only 1.17 times higher.
They are also more inclined to be diagnosed with biologically more aggressive breast cancers, such as triple-negative breast cancer and HER2-Positive breast cancer.
Additionally, mutations on BRCA1 or BRCA2 genes, which increase cancer risk by as much as 84 percent, are more commonly seen in younger women. Six percent of all women with breast cancer carry BRCA gene mutations, but in breast cancer patients under 45, the number is closer to 12 percent.
This could be due to the fact that, because BRCA influences early-onset cancers, mutations are more common in young people, whereas cancers in older people can often be attributed to other factors including hormonal, lifestyle or environmental.
Researchers posit that isolation and quarantine measures adopted during the pandemic, which kept people from seeing their doctors for regular checkups and preventive care such as mammograms, could also be behind the rise in late-stage diagnoses.
In 2020 and 2021, millions of people were afraid to leave their homes for fear of getting sick or couldn’t get in to see their doctors because they were stretched thin with patients or working remotely.
Current screening protocols could also be a factor.
Federal guidelines for mammograms recommend the screening practice for women 40 and up, provided they have no family history of the disease, but many women may not know their risk, or falsely believe breast cancer is a disease that only strikes women of a certain age.
Maria Costa (pictured here during treatment), 35, was diagnosed with stage three breast cancer after a year of asking for a mammogram. She now fears she will be unable to date or have children
Holly McCabe, a 31-year-old nurse, always told her patients of the importance of self breast exams , but never performed her own until August 2023
In September, Ms McCabe began a treatment regimen that includes 16 rounds of chemotherapy, followed by a second cycle that will span 12 weeks
And sometimes, doctors can come under the same false delusion and may not recommend screening for younger women, even when those women are justifiably concerned.
This occurred in the case of Maria Costa, 33, who was diagnosed with invasive stage 3 breast cancer in 2022 after spending a year requesting a mammogram.
Despite having a family history of breast cancer — both her mother and aunt were diagnosed — her gynecologist dismissed her concerns, telling her she was too young, even after feeling a lump in her breast.
It wasn’t until 2022 she finally received a mammogram and was diagnosed with stage 3 invasive lobular carcinoma, a rare and slow-growing form of breast cancer that starts in the milk-producing glands.
This type of cancer makes up about 10 percent of breast cancers.
In its early stages, invasive lobular carcinoma has a nearly 100 percent survival rate, but that drops to as low as 22 percent if it spreads.
Now 35, Ms Costa said she had to fight for doctors to take her seriously, and believes if she had been diagnosed in 2021, her experience might have been different.
Following her diagnosis, Ms Costa underwent medically induced menopause to help lower estrogen levels, which can fuel the growth of cancer.
Doctors may also brush off concerns of young women as side effects of prescription birth control.
Sarah Citron, 33, was diagnosed with breast cancer earlier this year after noticing a lump in her armpit. Doctors originally blamed the lump on hormonal changes from having her IUD removed to try for another child
Actor Olivia Munn was diagnosed with breast cancer at age 42 and underwent a double mastectomy
Sarah Citron, a 33-year-old woman from California, was initially told the lump she noticed in her armpit was likely due to hormonal changes after having her birth control IUD removed.
Having a history of benign cysts in her breasts, she wasn’t overly concerned at first and believed the lump might be related to the recent removal or the Covid booster vaccine she had just received.
Her doctors reassured her that, due to her young age, breast cancer was highly unlikely, and suggested she monitor the lump.
However, after the lump didn’t go away, Mrs Citron pushed for further examination, ultimately convincing her doctor to perform a mammogram last year. The test revealed a mass, which was later confirmed to be cancerous through a biopsy and had spread to her lymph nodes.
And Holly McCabe, a 31-year-old nurse from Denver, Colorado, was diagnosed with stage 3 triple-negative breast cancer in September 2023 after performing her first breast self-exam.
As a nurse working in an oncology ward at St. Joseph Medical Center, McCabe often encouraged her patients to perform regular breast self-exams but had never done one herself until August 2023.
Roisin Pelan, pictured with her husband Michael, was diagnosed with breast cancer and given just three years to live
Her decision to check her breasts was sparked by a moment at work when she saw a patient completing their chemotherapy treatment, a milestone that reminded her to check her own health. During the self-exam, McCabe discovered a hard lump in her right breast.
Despite being young, healthy, and having no family history of breast cancer, McCabe’s self-exam led to several follow-up tests, which confirmed her diagnosis of stage 3 triple-negative breast cancer.
Her story and many others like it have highlighted the importance of screening and breast self-exams, regardless of age or family history, as a critical tool in early detection.
Dr Debra Monticciolo, a radiologist at the University of Colorado and co-author of the latest report, said: ‘Our research is showing that we are missing opportunities to diagnose disease early.
‘We’re missing them, and we really need to get women in to be screened. We need to have women, radiologists, and clinicians recognize these trends are not favorable and we have to reverse them if we’re going to save women’s lives.’
