Sometimes a cancer is unusual, not in itself, but in the situation which it occurs. Breast cancer is most common in women over 50; there are several cases in women in their 40s. It is far rarer in women under 40, but it does occur. We tend to be particularly shocked when it occurs in a young woman. In this situation it is detected as a lump, since generally, breast cancer screening through mammography is not done in young women.
Very often, a young woman gets misdiagnosed. She detects a lump and she is told it is just lumpy breasts and it is followed for a while until doctors realize it's something serious. Although this can be horrifying, in fact, it's quite understandable, since the vast majority of lumps in women under 35 are totally benign and the risk of cancer is very low. The fact that cancer is not diagnosed immediately doesn't mean that the young patient will die; since most breast cancers have been around 8 to 10 years, and whether it is diagnosed the minute you find it or six months later isn't the critical factor. We're so horrified when a young woman gets breast cancer that there's a disappointing number of lawsuits against doctors failing to find breast cancer in this population, because they're often misdiagnosed and because it's such a gut-wrenching situation. However, in most cases the doctors are not negligent. Still, doctors should be taught that young women can develop breast cancer and that doctors should remain vigilant.
Many doctors believe that breast cancer in a young woman is more aggressive than in older ones. Two studies have recently shed some light on this theory. Both studies showed that the mortality from breast cancer was higher in women who had been pregnant in the past four years. Risk was assessed to be higher right after pregnancy and decreased with each year, going back to normal after four years. Since young women are more likely to have been recently pregnant, they will show more of this effect. This suggests that it may not be the woman's age itself that affects aggressiveness but the changes in her immune system and hormones that go with pregnancy.
Breast cancer in young women is more likely to be hereditary. That makes sense - if you've inherited a gene mutation and you will only need one or two more mutations to get cancer, you're one step closer and you're likely to get there faster, whereas if you "acquire" breast cancer, you still need to get all the genetic mutations. That doesn't work all the time. Like older women, the majority of younger women with breast cancer have no family history. Nevertheless, if you have breast cancer in your family you are more likely to get it at a younger age than if you don't.
Overall, there is no evidence that breast cancer under 35 matched for prognostic features is any more aggressive than a cancer in an older woman. Younger women do, on the other hand, have a higher incidence of poor prognostic features. Still, a young woman and an older woman with the same tumors will have the same general prognosis.
Michael Russell Your Independent guide to Breast Cancer
