Senior Consultant, Medical Oncology, BLK-Max Super Speciality Hospital, New Delhi
Part 7 of 9 in Diagnosis and Management of Breast Cancer
Breast Cancer in Younger Women: Rising Incidence and Genetic Risk
March 2, 2025
Breast cancer is rising among younger women. In the age group up to 44, around 10% of all breast cancer cases now occur, a proportion that is increasing steadily; even the 20 to 34 age group is showing a slow, steady rise. This matters because most early screening programmes are not built around this younger population, making education about warning signs and self-examination especially important for them.
What raises the risk in younger women
Recognised risk factors include an increased body mass index and obesity, smoking, alcohol, physical inactivity (itself a contributor to obesity), higher socioeconomic status, certain contraceptive methods, a late first pregnancy or no pregnancy, and reduced breastfeeding. High-penetrance genes, BRCA1, BRCA2 and TP53 among them, along with other genetic factors, also raise risk, as does chest radiation received in childhood, for example for an earlier childhood lymphoma.
Genes that run in families
Every organ, from the digestive system to the ovaries, uterus, kidney and thyroid, has its own associated high-penetrance genes that can predispose family members to a higher chance of developing that specific cancer. For breast cancer, ATM, BRIP1, BRCA1 and BRCA2, along with a number of other genes, are the ones most strongly associated with this kind of inherited risk.
This article is based on a Jivo Masterclass session conducted by Dr. Sahil Bambroo, Senior Consultant, Medical Oncology, BLK-Max Super Speciality Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Sahil Bambroo taught doctors across Africa on March 2, 2025.
FROM THE LIVE Q&A
Dr. Morris Kumwama
Speaking of biopsy, from which specific region should the tissue sample be taken, and what is the sampling technique?
Dr. Sahil Bambroo
In early breast cancer, biopsy is usually a guided procedure taken directly from the lesion itself, using a simple technique: fixation of the tissue followed by histopathology, then immunohistochemistry to determine oestrogen receptor, progesterone receptor and HER2 status. If HER2 comes back equivocal on immunohistochemistry, a FISH test confirms it. In metastatic disease involving organs such as the lung, bone or liver, the biopsy is taken from whichever site is most accessible and least risky for the patient, often the liver or the lung. In patients too unwell for any other biopsy, such as those presenting with severe anaemia, a bone marrow biopsy can confirm metastatic breast cancer directly, including its subtype through immunohistochemistry on that same sample, allowing treatment to proceed with good results.
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Frequently Asked Questions
What are the causes and major signs of breast cancer?▼
The most common cause is advancing age; risk rises with it. Other contributing factors include early menarche, late menopause, never having children, having a first child after age 35, reduced breastfeeding, smoking, and alcohol consumption of any quantity. Genetic factors matter too: a first-degree relative with breast or ovarian cancer, or a positive result for high-penetrance genes such as BRCA1, BRCA2 or PTEN, raises risk. Chest radiation received for an earlier childhood lymphoma also raises the risk of a thoracic malignancy later in life.
Does an effective curative treatment for breast cancer really exist? If so, what is the therapeutic protocol, and if not, why are anti-cancer drugs used?▼
Definitive, curative treatment absolutely exists for early breast cancer: stage one and stage two patients see close to 100% results with protocols matched to the tumour's subtype, adjusted further for the patient's comorbidities and financial circumstances. For metastatic breast cancer, a cure isn't currently possible, but survival and quality of life have improved substantially compared with a few years ago. Breast cancer is the most common cancer among women, but most cancer deaths are actually from lung cancer, not breast cancer, which is part of why even stage four disease now sees meaningfully better survival than before. There is no single protocol; treatment has to be customised to the patient's age, subtype and disease status in each case.
Speaking of biopsy, from which specific region should the tissue sample be taken, and what is the sampling technique?▼
In early breast cancer, biopsy is usually a guided procedure taken directly from the lesion itself, using a simple technique: fixation of the tissue followed by histopathology, then immunohistochemistry to determine oestrogen receptor, progesterone receptor and HER2 status. If HER2 comes back equivocal on immunohistochemistry, a FISH test confirms it. In metastatic disease involving organs such as the lung, bone or liver, the biopsy is taken from whichever site is most accessible and least risky for the patient, often the liver or the lung. In patients too unwell for any other biopsy, such as those presenting with severe anaemia, a bone marrow biopsy can confirm metastatic breast cancer directly, including its subtype through immunohistochemistry on that same sample, allowing treatment to proceed with good results.
Is breast cancer becoming more common in younger women?▼
Yes. Around 10% of breast cancer cases now occur in women up to age 44, a proportion that is rising, and even the 20 to 34 age group is showing a slow, steady increase.
What genes increase breast cancer risk?▼
BRCA1, BRCA2, TP53, ATM and BRIP1 are among the high-penetrance genes most strongly associated with inherited breast cancer risk.
In This Series: Diagnosis and Management of Breast Cancer
- 1.Diagnosis and Management of Breast Cancer
- 2.Breast Cancer Warning Signs and How to Perform a Breast Self-Examination
- 3.Diagnosing a Breast Lump: Imaging, Biopsy and Why a Guided Biopsy Is Safe
- 4.Breast Cancer Types: Invasive, Non-Invasive and Receptor Subtypes
- 5.Staging Breast Cancer and What Each Stage Means for Prognosis
- 6.Treating Breast Cancer by Subtype: Surgery, Hormone Therapy, Chemotherapy and Immunotherapy
- 7.Breast Cancer in Younger Women: Rising Incidence and Genetic Risk
- 8.When Chemotherapy Can Be Avoided: Genomic Testing in Early Breast Cancer
- 9.Life After Breast Cancer: Menopause, Bone Health, Fertility and Reconstruction