How Can Breast Cancer in Younger Women Be Prevented and Better Treated?

The statistics tell a compelling and concerning story. While breast cancer has traditionally been a disease of older women, a troubling shift is emerging: Breast cancer incidence is rising faster among younger women than in their older counterparts.  

Approximately 10 percent of all new breast cancer diagnoses now occur in women under 45, according to the American Cancer Society. At Baptist Health, the number is even higher — 13 percent. This accelerating trend over the past decade has left patients and healthcare providers grappling with what's driving the disproportionate increase. 

Two experts from Baptist Health Cancer Care — breast surgical oncologist Anastasia Tousimis, M.D., MBA, and medical oncologist Louise Morrell, M.D. — recently sat down to discuss the phenomenon for a Doc-to-Doc podcast. Dr. Tousimis is deputy director of Baptist Health Cancer Care, medical director of the Al and Jane Nahmad Women’s Cancer Center and chief medical liaison of the Memorial Sloan Kettering Cancer Center Alliance. Dr. Morrell is the medical executive of the Eugene M. & Christine E. Lynn Cancer Institute, part of Baptist Health, at Boca Raton Regional Hospital. 

Louise Morrell, M.D., medical executive of the Eugene M. & Christine E. Lynn Cancer Institute, part of Baptist Health, at Boca Raton Regional Hospital, discusses the trend of breast cancer in younger women with Anastasia Tousimis, M.D., MBA, deputy director of Baptist Health Cancer Care, medical director of the Al and Jane Nahmad Women’s Cancer Center and chief medical liaison of the Memorial Sloan Kettering Cancer Center Alliance

It’s important to understand that a woman is still most likely to get breast cancer between the ages of 60 and 80, but the increase in younger women is “a trend that nobody wants to see,” says Dr. Morrell. Breast cancer is the second-leading cause of cancer death in women (behind only lung cancer), killing more than 42,000 women a year in the U.S.  

Environmental Factors Raise Breast Cancer Risk

Researchers are investigating how our environment might contribute to the increase in young breast cancer cases. Various exposures in our daily lives — from chemicals and plastics in household products to dietary factors and lifestyle changes — likely play a role. 

“Radiation exposure is certainly one of the environmental risk factors for developing breast cancer,” says Dr. Tousimis. “Other implicated causes are toxins such as BPA and plastics and some pesticides. There’s also a lot of concern about alcohol consumption, and recent data has shown that drinking alcohol, even in smaller amounts, does increase your risk for breast cancer. Alcohol is also associated with other cancers.” 

An active lifestyle also helps lower breast cancer risk, says Dr. Morrell. That’s not a new finding. A study in the 1990s compared women who exercised three times a week to those who did not. Those who were active had a 40 percent lower rate of breast cancer, she says.  

The Role of Genetics and Family History

For women age 25 and up with a family or personal history of breast cancer, most organizations recommend genetic testing. Mutations in the BRCA1 and BRCA2 genes, as well as ATM, BARD1, CHEK2, RAD51C, RAD51D, PALB2, CDH1, TP53, NF1 and STK11, are known to increase the risk for breast cancer in all women. 

“Testing has become very easy and any woman with a family history should receive genetic testing,” Dr. Morrell said.  

Discovering genetic factors that place a woman at higher risk for breast cancer is valuable not only for identification purposes and family knowledge, but also because these findings can guide personalized screening strategies designed to detect cancer in its earliest stages. Additionally, proven interventions are available to help reduce overall risk, and, if a cancer diagnosis does occur, genetic testing is also used to develop individualized treatment plans. 

Who Should Consider Early Screening?

For women at average risk of breast cancer, the current guidelines by the U.S. Preventive Task Force recommend that screening begin at age 40. Typically, patients begin with screening mammograms. 

If you are at risk, it’s important to discuss screening with your physician. High-risk groups that should consider screening before age 40 include: 

• Women with genetic mutations 

• Women with a family history of cancer, particularly those who relatives were diagnosed young. For example, if your mother was diagnosed with breast cancer at age 40, you should begin screening by age 30. “But we don’t start before the age of 25 because younger women have dense breasts, which make it difficult to see cancer on a mammogram,” Dr. Morrell says. 

• Patients with previous chest-wall radiation 

Doctors may also recommend screening with MRI and/or ultrasound, depending on the patient. “You want to have a very accurate assessment of risk and then use the guidelines to say who should have ultrasound added or who should have additional imaging,” she says.  

Looking Toward the Future

Physician-researchers continue to discover ways to find cancers sooner, when they are most treatable. Dedicated breast radiologists at Baptist Health Cancer Care use artificial intelligence to help identify areas of concern in a mammogram. “At Lynn Cancer Institute, the addition of AI has led to a 23 percent improvement in the detection rate of breast cancer,” Dr. Morrell says.  

The newest advancement in breast cancer screening technology combines mammography with the enhanced detection capabilities of contrast imaging. Contrast-enhanced mammography (CEM) is available at several Baptist Health locations. While it has been approved by the Food and Drug Administration as a diagnostic tool, CEM has not yet received approval for screening use, although doctors expect the OK will come in the near future. 

Special Programs for Younger Patients

Baptist Health Cancer Care physicians are also attuned to the special needs of younger women with breast cancer. At Baptist Health Miami Cancer Institute, the Young Breast Cancer Program helps streamline care, coordinate multiple appointments and address vital concerns such as fertility preservation. Meeting with a multidisciplinary team is essential to develop an appropriate treatment plan. The Institutes also offer high-risk clinics for appropriate patients. 

VisitBaptistHealth.net/Mammoto learn more or schedule your breast cancer screening this Breast Cancer Awareness Month.

Louise Morrell, M.D., medical oncologist and medical executive of the Eugene M. & Christine E. Lynn Cancer Institute, part of Baptist Health, at Boca Raton Regional Hospital

Anastasia Tousimis, M.D., breast surgical oncologist, deputy director of Baptist Health Cancer Care, medical director of the Al and Jane Nahmad Women’s Cancer Center and chief medical liaison of the Memorial Sloan Kettering Cancer Center Alliance