Oncology
While international studies suggest there may be an increase in breast cancer diagnoses among younger women, the South African picture is less clear.
According to Dr Sarah Nietz, breast surgeon at Mediclinic Morningside, it’s important to separate perception from evidence.
“We have to differentiate between impressions and evidence,” says Dr Nietz. “There is growing international evidence that women are developing breast cancer at a younger age, particularly women under 50. But we mustn’t overstate this trend or imply that breast cancer is now primarily a disease of young women.”
“Age remains the strongest risk factor and most breast cancers still occur after the age of 50,” explains Dr Nietz.
She notes that while some local breast units have reported a slight increase in younger patients, these findings have not been statistically significant. Likewise, data from the National Cancer Registry has not demonstrated a clear upward trend.
That doesn’t mean younger women aren’t being diagnosed.
Dr Nietz explains that specialist breast units often see a higher number of younger patients because they are referral centres for more complex cases. These diagnoses also tend to leave a lasting impression because they affect women during some of the busiest stages of their lives, often while building careers, raising families or planning pregnancies.
What increases the risk of breast cancer in young women?
There is rarely a single explanation for why a younger woman develops breast cancer.
Inherited genetic mutations, particularly BRCA1 and BRCA2, significantly increase a woman’s lifetime risk of developing breast cancer. A strong family history of breast or ovarian cancer may also indicate an inherited predisposition.
However, genetics accounts for only a small proportion of breast cancer diagnoses.
Lifestyle and reproductive factors may also contribute to overall risk. These include obesity, physical inactivity, alcohol consumption, hormonal influences and reproductive history, such as having children later in life or not having children. Environmental factors continue to be studied, although researchers are still working to understand their exact role.
Importantly, many younger women diagnosed with breast cancer have no identifiable risk factors.
Breast cancer in young women can be more difficult to diagnose
Diagnosing breast cancer in younger women can present unique challenges.
Younger women generally have denser breast tissue, which can make abnormalities more difficult to detect on imaging. Because breast cancer is less common in younger age groups, breast changes may also be mistaken for benign conditions.
For this reason, Dr Nietz encourages women to become familiar with what is normal for their own breasts rather than relying solely on age as reassurance.
A healthcare professional should assess any persistent breast change, including:
- A new breast lump that doesn’t disappear
- Changes in the size or shape of the breast
- Skin dimpling or thickening
- A newly inverted nipple
- Bloody nipple discharge
- Persistent breast changes during pregnancy
- Swelling or lumps under the arm
While most breast lumps are not cancerous, they should never be ignored.
Family history, screening and early detection
Family history plays an important role in assessing breast cancer risk, particularly in younger women.
Women diagnosed at a young age, those with several close relatives affected by breast or ovarian cancer, or families with known inherited cancer syndromes may benefit from genetic counselling and testing.
Routine mammography is not recommended for all younger women because breast cancer remains relatively uncommon before the age of 40. However, women at higher risk may require earlier screening using mammography, breast MRI or other imaging techniques based on their individual risk profile.
Knowing your family history, attending recommended screening appointments and seeking medical advice promptly if you notice any breast changes remain some of the most effective ways to support early detection.
Breast cancer in young women requires specialised care
Treating breast cancer in younger women involves much more than removing the cancer itself.
Treatment decisions may affect fertility, pregnancy planning, menopause, bone health, cardiovascular health and long-term quality of life. Younger patients often face emotional and psychological challenges alongside the physical effects of treatment.
Dr Nietz says these women benefit most from multidisciplinary care, where breast surgeons, oncologists, radiologists, pathologists, fertility specialists, psychologists and specialised nurses work together to develop an individualised treatment plan.
“In our unit, we’ve got a patient support group and they offer psychological support and emotional support,” she says. “Those are very central components when we’re looking at the care of young women, rather than thinking of it as an optional extra.”
She adds that long-term survivorship care is equally important, including addressing fertility, menopausal symptoms, bone health, cardiovascular health and the late effects of treatment.
What every young woman should know about breast cancer
One of the biggest misconceptions surrounding breast cancer is that it only affects older women.
“I want people to know that breast cancer in a young woman is uncommon, but it isn’t impossible,” says Dr Nietz. “It’s about 15% of all breast cancers.”
She encourages women to become familiar with what is normal for their own breasts and not to dismiss persistent changes because of their age.
“It’s important that you know what is normal for your breasts and that you don’t ignore a persistent change just because you are young,” she says.
Dr Nietz also highlights the importance of investigating persistent breast changes during pregnancy, as these should not automatically be attributed to hormonal changes.
Although most breast lumps will not be cancer, every new or persistent lump deserves assessment. If a woman feels her concerns have not been taken seriously, she should seek further medical advice.
“If you feel that a concerning change has not been taken seriously, you should return for an assessment or even seek a second opinion,” she advises.
Ultimately, Dr Nietz hopes women leave the conversation feeling informed rather than fearful.
“The message really should not be one of fear. You have to have awareness and take appropriate action. Notice a change, have it assessed and make sure there is a clear diagnosis. Breast cancer, when detected early, is highly treatable and treatment outcomes continue to improve.”