Breast Cancer Concerns for Women Under 45

A breast cancer diagnosis is a life-changing experience for any individual. Breast cancer tends to be a disease that happens in older women however, the CDC estimates that around 9% of breast cancers occur in women under 45. This means that over 25,000 women under 45 are diagnosed with breast cancer each year in the United States. As an individual diagnosed with breast cancer under 45, there may be concerns that complicate your breast cancer diagnosis, treatment, and survivorship.

Screening and Diagnosis

• There is no proven or approved screening test for breast cancer in women under 40. This can result in younger women being diagnosed later.
  • Younger women who are at an increased risk of breast cancer due to family history or known genetic mutation may have screening before 40. Women at average risk do not.
  • Younger women often have dense breast tissue. This makes it harder to find cancer with a mammogram.
• You can advocate for yourself by:
  • Knowing your family history of breast and other cancers – in both men and women.
  • If you have a breast cancer diagnosis, educate the rest of your family so they can learn about their own risk.
  • Talk to your healthcare provider about your family history of breast and other cancers and if you should consider genetic testing.
  • Know your body. Examine your breasts regularly. Report any changes in your breasts to your healthcare provider. These can include dimpling or puckering of the skin, changes to the nipple, nipple discharge, lumps, or bumps.
  • Find out more about breast self-exams here.

Breast Cancer in Young Black Women

• Younger Black women have a higher incidence of breast cancer than white women in the same age group.
• Triple-negative breast cancers (those that are hormone receptor and HER2 negative) are also more common in younger Black women.
• Living in poverty increases the risk for later diagnosis, more advanced disease, and less access to medical care. This is more common in the Black community.
• There is a lot of research going on to try to improve outcomes for Black women with breast cancer

Treatment of Breast Cancer in Younger Women

Breast cancers in younger women can be more aggressive. As a result, younger women may receive more aggressive treatment.

• If you are pre-menopausal and your tumor is hormone receptor-positive, you may need treatment to stop your ovaries from working in addition to hormone therapy.
• In many younger women, the cancer has a higher grade (a rating of aggressiveness) and is often hormone receptor-negative. As a result, you are more likely to need chemotherapy than an older woman with breast cancer.

Relationships and Support During and After Cancer

Cancer can be a strain on any relationship. When you are diagnosed with cancer at a younger age, you may be in a new marriage, relationship, or dating. If you start a relationship after cancer, deciding when and how to share your diagnosis can be difficult. Talking with a social worker or therapist about these concerns can be helpful. They can provide you with support and communication strategies to help you.

Common Challenges for Younger Women

There are some challenges that can affect younger women differently such as changes to your body, fertility, and your own caregiving roles.

• It can be challenging to cope with the changes in your body and how they affect your relationships.
  • Before surgery, discuss your treatment plan with the surgeon and ask about options for breast reconstruction if this is important to you.
  • During treatment, it is very common to experience side effects such as vaginal dryness and decreased sex drive, which can affect intimate relationships with your partner. If these occur, talk to your doctor about ways to minimize these side effects. Communication with your partner is very important to support your relationship.
  • Many cancer treatments cause hair loss which can be very challenging for young women, in part because it is an outward sign of being sick. Talk to your care team about resources at your cancer center for assistance with scalp cooling, wigs, scarves, and support programs.
• You may also want to have children in the future. Fertility issues as well as temporary menopause caused by hormone therapy can make this harder.
  • Before starting treatment, talk with your healthcare provider about your wishes (or potential wishes) to have children and your options.
  • Find more information about fertility preservation here.
• Women under 45 are often in a sandwich — raising their children and caring for aging parents.
  • Work with your partner and other family members to get help with caregiving duties. You may also need to ask for help with your own tasks, which can be difficult when you are used to providing care to others.
  • Sharing your cancer diagnosis with your children can be difficult. Some social workers and therapists specialize in helping with these conversations and they may be helpful to you.
  • Talking with a peer who has gone through breast cancer can be helpful. Learn more about peer support organizations here. As a younger woman, it can feel like you are alone at most treatment centers where most patients are older. Connecting with a peer can help you know you are not the only young woman going through this experience.
  • There are many online blogs and support groups for young women with breast cancer. Some women find these to be helpful, while other people find them to be overwhelming. It may take some time to find out which methods of support work best for you.

Financial, Work, and Insurance Concerns

• You may face financial concerns as many younger women are still paying off student loan debt, paying a mortgage or rent, and trying to balance work with treatment and family. Maintaining health insurance coverage and understanding your insurance and the costs of cancer care can be hard.
• You may need to decide whether to work through treatment – or if taking time off is even an option. What do you tell your employer? How much do you share with co-workers? These are all very personal decisions.
  • An excellent resource for learning how to handle these concerns is Cancer and Careers.
• Because of your age at diagnosis, the financial impacts can last long after treatment.
  • It is important to maintain your health insurance during and after treatment if possible.
  • Many states offer extended Medicaid coverage under state-based Breast and Cervical Cancer Screening and Treatment programs. Ask your social worker or navigator if this could be an option for you if you are without insurance or at risk of losing your coverage.

Your care team can help answer your questions, connect you with the resources you are interested in, and provide support. When you are first diagnosed, it can feel like an emergency. In almost all cases you can take a few weeks to get an opinion or two from different doctors and practices. Find a team that you feel comfortable with asking questions, and whom you feel is meeting your treatment, support, and communication needs.

See our Resources for More Information: Breast Cancer article for information on breast cancer service and support organizations.