Breast cancer in younger women: signs and factors to notice

Oct. 14—Although most cases of breast cancer occur after the age of 50, 5% of cases are diagnosed in women under the age of 40, according to the Cleveland Clinic.

And according to the ASCO Post, a newspaper partnered with the American Society of Clinical Oncology, breast cancer is the most common malignancy in adolescent and young adult women age 15 to 39 years, and it has been on the rise in this age group since 2004.

Dr. Todd Weinstein, General Surgeon at the Logansport Memorial Hospital, said breast cancer in younger women has been increasing at about a rate of 3% per year over this century, and the rise has been very significant in the last 20 or 30 years. Dr. Lindsey Fleshman, a fellow General Surgeon at the Logansport Memorial Hospital, said a recent article by BMJ Oncology has also reported that in the past 30 years, cancer diagnoses in patients younger than 50 have risen by 70% in industrialized nations. These are for the most common cancers: breasts, lung and tracheas, stomach and colorectal, Fleshman said.

While there is not a definitive cause and effect for breast cancer's rise in younger women, medical director of the Adolescent and Young Adult Cancer Center in Washington Rebecca Johnson, MD, said in her interview with the ASCO Post, there are a few factors that can play into it developing at a younger age. Fleshman said it is multifactorial, and Weinstein believes one factor to be diet.

"... red meats, that sort of a fatty diet, is not good for you from the standpoint of breast cancer. Fruits, vegetables would be more protective," Weinstein said. "And I think probably we don't eat as good a diet as we did years ago."

Another factor includes early menstruation, as estrogen goes up during the onset of menstruation, according to Weinstein. Over decades, women have been reaching the onset of menstruation earlier than they used to, and the earlier the onset of menstruation, the more problems one can have with breast cancer, he said. Fleshman said this leads to women being exposed to estrogen for longer periods of time. Other contributing factors include lifestyle, activity and exercise, he said. Fleshman said genetics, tobacco, alcohol use and obesity can also serve as factors.

"So, for breast cancer specifically, patients who are actually overweight, their estrogen gets stored in your fat cells. So, those patients actually have a higher percentage of estrogen in their body, and that typically affects especially breast cancers that are hormone sensitive," Fleshman said. "So, the more estrogen you have in your body, theoretically the... risk is that it increases your risk for breast cancer."

Fleshman said while symptoms of breast cancer do not differ because of age, there are differences in how it is detected. According to Weinstein, younger women's breasts are usually denser and firmer than older women's, and because of that, smaller lumps may not be as apparent when it is smaller and is not detected until it is a larger size and in a more advanced stage. In addition, Fleshman said yearly screenings and mammograms can catch lumps early. However, she said breast cancer screening and physical exams annually start when women reach age 40 and younger women are typically not getting yearly screenings done.

"Now, routinely, young healthy patients don't go to the doctor. They're not on prescription drugs... I mean, it's hard enough for women to go in to get their Pap smears, but... you know, after you have your kids, well, you may not go to the doctor. You may not get your Pap smears, you may not get, have detection, right? Have a physical exam performed by a clinician," Fleshman said. "So, typically what happens is masses or changes in your breast, which might be caught on a physical exam, have [been] missed because they're not following with a clinician. And then typically what comes in is patient's partners have noticed lumps, right? My husband, my boyfriend, whatever. They've felt a lump and they've noticed it and it's been there for several months, and... people are embarrassed to go get it checked out, but the older women, typically, they're getting screening mammograms done. So, we can catch early things on mammograms before we even feel a lump, whereas younger women aren't getting those screenings done."

Signs to look for are swelling, nipple discharge, palpable masses, swollen lymph nodes and skin changes, according to Fleshman. She said changes can be detected by women performing monthly breast exams on themselves for breast awareness, and to seek medical treatment if there are any changes in the exam. If a woman discovers a lump, Weinstein also said to get it checked out sooner rather than later.

"I think [the symptoms are] the same sorts of things as any woman should be alert for. But I think one problem that plays out repeatedly is women think, 'well, gosh, you know, I'm in my twenties, this can't be cancer. This has to be just a cyst or something.,'" Weinstein said. "And I mean, frequently it is, but still it needs to be taken seriously, and as Dr. Fleshman said, you need to get images done frequently, an ultrasound, and then based on the results of that, if it looks suspicious, get a biopsy done. Don't just write it off to being something benign because you're so young."

Ways to prevent breast cancer include exercising, eating right, drinking in moderation and not smoking, Weinstein said. In addition, women with a family history of breast cancer should get screening and physical exams done early, Fleshman said.

"You obviously can't change your genetics, so if you do have a family history of breast cancer, you should be following with a clinician and discuss with them if... you're at an increased risk and if so, what would that mean as far as earlier screenings and start screening early and physical exams, et cetera, things like that," Fleshman said.

The Logansport Memorial Hospital offers up-to-date equipment such as a 3D mammography machine, a biopsy machine, ultrasound machines and up-to-date MRIS, Weinstein said. He and Fleshman are available for appointments to answer concerns women may have about their breasts, alongside radiologists, radiation oncologists, breast surgeons and oncologists.

Resources are also available for women to help offset costs of screenings if they need financial assistance, Fleshman said. Vice President of Planning and Development at the Logansport Memorial Hospital Vicki Byrd said they provide screening mammograms at no cost to women that do not have insurance or insurance does not fully cover the cost.

"We provide, I don't know, anywhere from 10 to 20 or more per year on those. I mean, that number's decreased because it really is more readily available to women in terms of insurance. But then if it's found that someone needs a diagnostic exam, which is your next exam after you've had your screening, the hospital foundation will also assist with that cost," Byrd said. "And then, of course, just working with hospitals, set[ting] up payment plans and those kinds of things as well. So, you know, [Fleshman's] right, there's really no reason to put it off because you think you can't afford it. We'll, you know, work with the patient and help them determine how to make it happen."

To learn more about breast cancer resources at the Logansport Memorial Hospital, visit logansportmemorial.org/breast-care.