Breast cancer at 40? Rare, but possible

Breast cancer doesn’t discriminate. Although it most often strikes women between ages 55 and 65, women of all ages should be diligent about screenings and be aware of their risk factors.

Diagnosing breast cancer in its earliest, most treatable stage is difficult in young women whose breast tissue is generally denser than that of older women, making mammogram and physical exam unreliable. There is also the common belief among young women that they’re simply too young to develop the disease, says Dr. Gale England, an Advocate Medical Group breast surgeon.

“In addition to age and gender, increased estrogen exposure also increases your risk of developing breast cancer,” says Dr. England who treats patients at Advocate Good Samaritan Hospital in Downers Grove, Ill. “If you had your first period at a young age, got pregnant later in life, have never been pregnant or began menopause later than average, you’ve been exposed to more estrogen than the average woman during the course of your life.”

Should women under 40 get screened?
In general, mammograms are not always reliable in screening women under age 40 because they tend to have denser breast tissue, which can hide lesions. But if you have increased risk factors, your doctor might recommend starting mammograms early and adding an MRI test to the screening.

Having an above average risk for breast cancer should prompt you to talk with your doctor. For patients who have a first-degree relative—a mother or sister—who was diagnosed with breast cancer before menopause or if they have the BRCA 1 or 2 genetic mutation, you should seek diagnostic imaging before turning 40.

Self-exams can help you understand what your breast tissue usually feels like.

“If you know what feels normal, you’ll be more likely to notice when something seems different,” England says.

Good technique is essential. Ask your doctor to teach you how to properly perform your self-exam if you’re not sure. Doing the self-exam in addition to your annual clinical exam at the doctor’s office is an important diagnostic tool.

Treatment options are available
Breast cancer treatment isn’t fundamentally different for women who are diagnosed younger than most, but some of the considerations are different. For women diagnosed in their 30s, preserving fertility is often a concern. Many younger women with breast cancer are otherwise healthy. Giving them a full course of chemotherapy treatment can permanently damage their fertility or induce early menopause, which can lead to hot flashes or even osteoporosis.

Support groups can help breast cancer patients of all ages manage their diagnosis and treatment.

“No matter your age, educate yourself and ask questions,” Dr. England says. “Breast cancer is the most treatable when detected early, so get screened and be persistent. You know your body best. If something’s changed, make an appointment with your doctor and insist it be checked out.”