Breast cancer on the rise among younger women

Fewer people are dying from breast cancer thanks to decades of progress in treatment for the disease as well as early detection through screenings. But as death rates have fallen over the past 40 years, a new report shows that more younger women are being newly diagnosed with breast cancer.

Breast cancer mortality rates fell by 44 percent since 1989, which translates to about 517,900 lives saved. The number of new breast cancers, however, has increased by 1 percent each year between 2012 and 2021. For women younger than 50, the increase is even steeper—climbing 1.4 percent per year during that time, according to Breast cancer statistics 2024, an October 2024 American Cancer Society report published in CA: A Cancer Journal for Clinicians.

Breast cancer cases among Asian American/Pacific Islander (AAPI) women of any age also increased 2.5 to 2.7 percent each year between 2012 and 2021, the ACR report showed. But among AAPI women younger than 50, rates of breast cancer surged by 50 percent since 2000—higher than the rate in Hispanic, American Indian and Alaska Native (AIAN), and Black women in the same age group.

Addressing longstanding health disparities

Breast cancer death rates have been falling for decades but not evenly across all groups of people. Among AIAN women, death rates have not changed for 30 years, the ACS report found. And even though breast cancer incidence is 10 percent lower among AIAN women, their death rates are 6 percent higher than white women.

The ACS points out that only 51 percent of AIAN women ages 40 and older had a mammogram (an x-ray of the breast and the gold standard for breast cancer screening) within the past two years compared to 68 percent of white women.

Black women also continue to have a 38 percent higher breast cancer death rate than white women—even though their incidence of the disease is 5 percent lower. Black women also have lower survival rates than white women for each breast cancer subtype and stage except localized disease (cancer that hasn’t spread beyond the breast).

Closing the gap on these health disparities would require understanding, confronting, and working to undo system racism and bias in health care. It would also require expanding access to care, particularly among the most vulnerable groups facing significant barriers, including cost, lack of transportation or paid time off, and social isolation, the ACS explains.

Why younger adults are getting cancer

Longstanding health disparities don’t fully explain the reason why more younger adults are getting breast cancer. The likelihood of developing this type of cancer also depends on certain risk factors. These are things that increase your odds of getting a disease. Some you may be able to control, others you can’t.

Risk factors for breast cancer that you can’t control include:

• Getting older: The risk of breast cancer goes up over time as you age.
• Your genes: Mutations so certain genes, such as BRCA1 and BRCA, are tied to an increased risk of breast and ovarian cancer. About half of breast cancers diagnosed before age 45 are related to BRCA1 or BRCA2 gene mutations.
• Having dense breasts. People with dense breasts are also more likely to get breast cancer.
• Family history of breast or ovarian cancer. Having a family history of breast cancer may increase the risk for breast cancer.
• Previous treatment using radiation therapy. Women who had radiation therapy to the chest or breasts before age 30 have a higher risk of getting breast cancer later in life.

Other risk factors you can control:

• Being sedentary. Women who are not physically active are more likely to develop breast cancer.
• Being overweight. Obesity is tied to a higher risk for breast cancer—but this risk is specifically for older women who have gone through menopause.
• Taking hormones. Certain oral contraceptives (birth control pills) may increase the risk for breast cancer. Hormone replacement therapy that includes both estrogen and progesterone taken during menopause can increase breast cancer risk—if it’s taken for more than five years.
• Reproductive history. Never having a full-term pregnancy, getting pregnant for the first time after the age of 30, and not breastfeeding can raise breast cancer risk.
• Drinking alcohol. Even light-to-moderate alcohol intake has been linked with a higher risk for certain forms of cancer, including breast cancer.

Considering these risk factors, more sedentary behavior and other lifestyle factors may help explain this trend. But it’s likely not the whole story. Other studies have shown that cancer is on the rise in younger adults. One large July 2024 study, published in The Lancet Public Health examined differences among U.S. adults born between 1920 and 1999. The researchers found incidence rates for 17 types of cancer—including breast cancer—rose steadily in each younger generation. Another type of cancer the study found to be on the rise among younger adults: colorectal cancer.

Colorectal cancer is now the leading cause of cancer death in men younger than 50 years old, and the second leading cause of death for women in this age group, according to a January 2024 ACS report. In 2021, the worrisome trend prompted experts to drop the recommended screening age for routine colonoscopy (the gold-standard screening test for colorectal cancer) to 45 from 50. (Some people with certain risk factors may need to be screened even earlier.)

Scientists are still working to understand why more people are being diagnosed with certain types of cancer at younger ages. There may be genetic mutations that have not yet been identified, or possibly something else in our food, water, air, or elsewhere in the environment—such as microplastics, heavy metals, or “forever chemicals” called per- and polyfluoroalkyl substances (PFAS)— that are contributing to the increase. Research to find a cause (or a combination of causes) is ongoing and more studies are needed to find answers.

When to be screened for breast cancer

Right now, for women with an average breast cancer risk, none of the four major organizations that provide screening recommendations for breast cancer advise starting regular mammograms before age 40. The recommendations are as follows:

1. American Cancer Society (ACS): Women can start screening between ages 40 and 45 if they choose. Beginning at 45, the ACS recommends annual mammograms. At 55, getting screened every one or two years is recommended as long as you are healthy and expect to live at least another decade.
2. American College of Obstetricians and Gynecologists (ACOG): At age 40, average-risk women should be offered the option. By 50, all women should be screened every one or two years.
3. National Comprehensive Cancer Network (NCCN): Yearly mammograms should start at 40.
4. United States Preventive Services Task Force (USPSTF): According to a statement issued on April 30, 2024, the USPSTF advises that women begin screening at age 40, with mammograms every other year until age 74. (Previous guidance from the USPSTF recommended that screening start at age 50.)

Keep in mind, mammography recommendations are different for women at a higher risk of breast cancer, such as those with certain genetic mutations or a personal or family history of the disease. These people should typically begin regular screenings earlier and may have them more frequently.

Speak with your healthcare provider (HCP) about what cancer screenings you need and when to get them.

Other steps you can take to protect your health

It’s important to control what you can. If you have risk factors for breast cancer that you can change, take steps to protect your health. This may include eating more fruit and vegetables, avoiding alcohol, getting regular exercise, and losing extra weight.

It’s also important to be aware of warning signs of breast cancer, such as:

• Changes in the size or shape of the breast
• A new lump in the breast or underarm (armpit)
• Pain anywhere in the breast
• Thickening or swelling of part of the breast
• Irritation or dimpling of the breast skin
• Redness or flaky skin anywhere on the breast
• Nipple that starts to pull inward or retract
• Nipple discharge other than breast milk, including blood

If you notice any of these symptoms or changes, see your HCP right away. These symptoms could happen for reasons other than cancer. But it is important to not ignore them. The sooner cancer is detected, the better. It is usually easier to treat when it is found early.