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What women under 40 should be doing to detect breast cancer

What are women in their 20s and 30s supposed to do to detect breast cancer?
/ Source: TODAY

Only weeks after having a clean physical, Trish Gauthier put her hands on her chest after coughing and discovered a lump. She was 37 at the time.

“I have no family history ... but I knew immediately that it was not right,” Gauthier, now 40, told TODAY.

Knowing her body is exactly what led Gauthier to aggressively pursue a diagnosis after discovering her lump. She said her doctor was doubtful, suggesting there was nothing there, but she insisted on getting a mammogram. Once a mammogram confirmed the lump, a subsequent biopsy confirmed that it was cancer.

Trish Gauthier, a breast cancer survivor, had to insist on a mammogram after her doctor initially dismissed her concerns.
Trish Gauthier, a breast cancer survivor, had to insist on a mammogram after her doctor initially dismissed her concerns.Janelle Brinegar / The Breasties

“I remember that day,” she said. “You always remember diagnosis day.”

Gauthier went through a lumpectomy, where doctors discovered the cancer had spread and was at stage 3. She went through five months of chemotherapy, five weeks of radiation and a hysterectomy before entering remission. She has since joined The Breasties, a group for women facing breast cancer or in remission to support one another.

“You know your body better than anyone,” Gauthier said. “If something feels off, investigate it.”

How common is breast cancer in women under 40?

While breast cancer continues to be extremely rare among women under 40 (only 1 in 1,479 will be diagnosed in their 20s, 1 in 209 will be diagnosed in their 30s), about 9% of all new cases of breast cancer in the U.S. are found in women younger than 45 years old according to the Centers for Disease Control and Prevention.

Women in that age range face a challenge when it comes to screening for the disease. Doctors do not recommend mammograms for patients under 40 — some suggest under 45 — unless they have an immediate family member with a history of breast cancer.

Why mammograms are not recommended for women under 40

While the Centers for Disease Control and Prevention (CDC) says women with dense breasts — meaning more fibro-glandular tissue in the breast — are more likely to get breast cancer, younger women tend to have dense breast tissue as it is. (As they age, estrogen levels drop and fatty tissue replaces the glandular tissue.) Dense breast tissue appears white on mammograms and camouflages a doctor's ability to detect cancer, which also appears white.

Dr. Kristi Funk, a breast surgeon and co-founder of the Pink Lotus Breast Center in Los Angeles, told TODAY that this is commonly why, aside from radiation concerns, mammograms are not typically recommended before age 40.

For women in their 20s and 30s with an elevated breast cancer risk, Funk explained that "an ultrasound or even MRI might be a better screening choice."

What women under 40 can do to minimize breast cancer risk:

If you're a woman under 40 concerned about her breast health, there are a few things you can do to take control.

1. Evaluate your breast cancer risk.

According to the CDC, women who are at high risk for early-onset breast cancer include those who:

  • Have a known BRCA1 or BRCA2 gene mutation.
  • Have a first-degree relative, second-degree relative (aunt, uncle, niece, grandparents) or third-degree relative (first cousins) with a BRCA1 or BRCA2 gene mutation.
  • Had radiation therapy to the chest between 10 and 30 years old.
  • Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes.

2. Consider genetic testing.

Understanding your family history can be a helpful way to understand and minimize your risk for developing breast cancer. If you do have a family member who had breast cancer, Dr. Brem, the director of breast imaging and intervention at the George Washington University Hospital in Washington, D.C., recommends screening yourself five to 10 years earlier from when that person was diagnosed.

If you have a first-degree relative who had breast cancer, or if your heritage include populations with a higher risk, Brem says you may want to consider genetic testing to see if you carry the BRCA1, BRCA2 or other gene mutations. Those interested can have that conversation with a primary doctor, OB-GYN or medical geneticist.

"It is also legitimate to not want to know," Brem told TODAY, as those who test positive will have to make difficult decisions, including whether or not to have preventative surgery. "There is no wrong answer."

3. Get to know your breasts a little bit better.

While the American Cancer Society states on its website that “research has not shown a clear benefit of regular physical breast exams,” as they can lead to false-positive test results, doctors stress women should be familiar with their breasts. Funk believes self-exams continue to be a woman’s greatest tool. Here's how to do it.

“I’ve seen far too many women with a self-detected lump or an intuition that things weren’t right … And sure enough, cancer,” Funk said. “I actually think if we all did a good breast self-exam consistently, we’d find more tumors at smaller sizes.”

If you feel something that’s hard and unmalleable, alert your doctor. Also call your doctor if you notice dimpling, discoloration of your nipples or any other changes in your breast from one month to the next.

Breast cancer in younger women tends to be more aggressive, Funk noted, which is why early detection is especially vital for those under 40.

“You know your body better than anyone. If something feels off, investigate it.”

Trish Gauthier

4. Get a breast exam annually.

According to the American College of Obstetricians and Gynecology, clinical breast exams may be offered every one to three years for women 25-39 years old. But Brem recommends women receive a breast exam at each of their annual wellness exams.

"What's the downside?" she said. "Here's an opportunity that's free and has no associated risk."

5. Stay active and avoid alcohol.

The American Institute of Cancer Research has found that the following three lifestyle habits can prevent one-third of breast cancer diagnoses in the country:

  • Maintain a healthy body weight to help prevent your body from increasing chronic inflammation, insulin and hormones that can promote cell growth.
  • Fit in 30 minutes of physical activity every day to help with body weight and also strengthen your immune system and gastrointestinal tract.
  • Avoid alcohol (or drink in moderation) as alcohol is a carcinogen that can increase hormones in your body.

6. Remain alert if you are pregnant or breastfeeding.

When Brekka Schultz was pregnant with her second child at age 26, she found a lump at the beginning of the third trimester, but she dismissed it thinking her body was just gearing up for delivery and the postpartum period.

Six months later, after noticing the lump had only gotten bigger, she decided to see her doctor, who told her she would need to stop lactating and wait an additional three months after doing so to get a biopsy. She did that, but after waiting only two months, the lump had grown to 10 centimeters and a biopsy confirmed she had stage 3 breast cancer.

Brekka Schultz cuddling with her daughter while undergoing treatment for breast cancer.
Brekka Schultz cuddling with her daughter while undergoing treatment for breast cancer.Brekka Schultz

“The surgeon said he’d never seen a mass grow so quickly,” she said. She went through five months of chemotherapy, a bilateral mastectomy and six weeks of radiation.

"We have definitely seen women diagnosed with breast cancer during pregnancy and immediately thereafter," Brem said.

Finally, listen to your body and trust your intuition. If something feels different, don't put off a visit to a doctor. If they dismiss your concerns, push for further testing if you feel it's necessary. You know your body better than anyone else, and you are your greatest advocate.

"Women should always be cognizant of their breast health," Brem said. "And if something is different, they should seek council."