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Breast Cancer in Younger Women | Dr Sandra Krishnan

Dr Sandra Krishnan • Dec 11, 2020

Youth is strong. It is brave and adventurous. Full of belief and promise. But it is not invincible. I have learned this the hard way, with close friends being diagnosed with cancer, in particular breast cancer. The question is, what can we do?


I am a Sydney Breast Surgeon, and would like to shed some light on this aspect of breast cancer, when it occurs in younger women. I believe that understanding comes from knowledge and through understanding, empowerment. Let me take you through what we know about Breast Cancer, particularly for younger women.


How does Breast Cancer Occur?

When the genes that regulate cell growth change or mutate, cancer occurs. These changes affect the speed of cell division where the cells multiply in an uncontrollably accelerated manner. All the vital organs in the body may be affected, and this includes the breasts. 

 

Breast cancer develops in the breast tissues. The part of the breast that produces milk is the lobules, and the ducts are 'tubes' which allow passages of the milk from the lobules to the nipples. Cancer commonly affects the ducts or lobules of the breast; however, the fatty tissues and other tissues within the breasts may also be a source of malignancy. During the evolution of the disease, the lymph nodes located under the armpits may become involved, and cancer can spread to other vital organs through circulation.

"I am a woman less than 40 years, is it possible I may have breast cancer?"


The answer would be YES. There is a possibility that younger women can have cancer. Women make up most of the population who are diagnosed with breast cancer; however, a small percentage of the male population (1%) could have breast cancer as well. A woman's age the most significant risk factor of developing breast cancer. The older the woman gets, the higher the risk. 


Breast cancer is the most common type of cancer in Australia, especially for those who are aged 50 and above. An approximate number of over 900 young Australian women are diagnosed with breast cancer each year based on the data published by the National Breast Cancer Foundation (NBCF). 


Breast cancer in young women (women under 40 years) is relatively uncommon, however, they tend to have different characteristics and poorer survival outcomes compared to breast cancers in older women. 


"Who is at Risk of Developing Breast Cancer?"


Because of the increase in the number of young women diagnosed with breast cancer, awareness about risk factors is very important. Here are some of the most common risks in young women that help us in our aim for early detection:

1. Age.

The older a woman gets, the more she is at risk of having breast cancer

2. Being a Female.

Men can develop breast cancer too, but women are 100 times more likely to have the disease

3. Breast Density.

Women who have "mammographically dense breasts" are more likely to have breast cancer according to the American Cancer Society. Dense (looks white on a mammogram) breasts mean that the breast has more connective tissue than fat.

4. Mutation in the genes.

The genes such as the BRCA1 and BRCA2 are responsible for DNA repair in tissues like that of the breasts. However, when there is a mutation, there is an increased risk of developing breast cancer.

5. Breast Cancer Family History.

The risk of having breast cancer is higher if a one has multiple first-degree relatives who have been diagnosed with the disease.

6. Menstrual or Reproductive History.

The earlier a woman has her menarche (first period), the more she is at risk for developing cancer of the breast because of prolonged exposure of her body to hormones like oestrogen and progesterone. This also happens with women who start their menopause at a very late age.

7. Lifestyle Factors.

Young women with poor lifestyle practices like excessive alcohol intake, reduced physical activity and being overweight. These factors are modifiable; we can all do something about them now!

 

"What are the Early Symptoms of Breast Cancer that I should watch out for?"

These are the most common symptoms of breast cancer:

  1. Thickening of the tissues or a breast lump that has just recently appeared
  2. Pain in the breast/breasts
  3. Appearance of pitted skin over the breast
  4. Swelling in a part or the entire breast
  5. An unusual nipple or blood-like discharge different from breast milk
  6. Skin peeling, flaking, or scaling of the nipple or breast
  7. An unexplained and sudden change in the structure and size of the breast
  8. Pain and swelling under the armpits

 

Having some of these breast changes or symptoms may not always mean that it is breast cancer, it is essential to remember that not all lumps are cancer. The main thing is to confirm the diagnosis; a professional medical practitioner examines the breasts, a clinical examination. They can then organise further diagnostic procedures where required, i.e. triple test, which includes imaging and needle biopsy.


"What are the challenging situations that young women like me who have breast cancer will possibly be experiencing?"

Young adults diagnosed with breast cancer are an entirely different entity compared to their older counterparts. At this age, they encounter various unique challenges; these may drastically impact their quality of life. Some of the problematic situations faced are:

  1. Sexual dysfunction and the possibility of premature menopause due to breast cancer treatments
  2. Fertility issues because breast cancer treatment regimen may affect their ability to get pregnant
  3. The challenge of raising children while undergoing treatments like chemotherapy or radiation therapy
  4. The risk of developing anxiety disorders and depression seen in occasional breast cancer survivors
  5. Lowered self-esteem due to body image issues especially after surgical removal of a part or the entire breast
  6. Intimacy issues may be a problem with young women who are diagnosed with cancer of the breast
  7. Financial instability due to limited resources, workplace issues like lack or insufficient healthcare benefits, and the increasing cost of cancer treatments

"If I have some of the symptoms, how can I confirm that I have Breast Cancer?"


These tests and examinations give us further information on whether the tumour is malignant

Mammogram

Imaging procedure to visualise deeper into the breast tissues. Women who are in their forties can have mammograms with Breastscreen (depending on their risk profile). We can consider the test even for younger women who feel a lump in their breast.

Breast Ultrasound

This test makes use of sound waves in creating an image of the underlying tissues of the breast. This examination could help distinguish if the lump is a benign cyst or a solid lesion which could be cancerous.

Breast Biopsy

This examination confirms the diagnosis of cancer through histopathology. We take a sample of breast tissue using a fine needle or a core biopsy needle; the fluid or tissue is then sent to the laboratory to study the cells. Another method is by taking the lesion out surgically.


Everything is discussed at a multidisciplinary team, where all specialists discuss each individual patient. 

"What support is available to me as a young woman with breast cancer?"


Young women can access various support groups for cancer in general, and in particular So Brave is a Not for profit organisation exclusively for younger women with breast cancer in Australia. 


At the end of the day, the take home message is to 

  • be aware
  • be mindful 
  • be prepared

... together we can do this.

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