For many women, breast cancer has been a worry reserved for later in life. But a troubling trend shows that women would be wise to pay attention to it earlier.
In women under age 50, there was a 1.4 percent increase in breast cancer diagnosis each year between 2012 and 2022, says Dr. Rebecca Kaltman, executive director of Inova’s Saville Cancer Screening and Prevention Center. “This is significant and concerning, because women under 40 diagnosed with breast cancer are almost 40 percent more likely to die from breast cancer compared to women over 40,” Kaltman says.
Understanding the Increase
Experts say the rise is multifactorial, and the shift obviously can’t be ascribed to genetics alone. It’s not just better detection that’s behind the trend, says Dr. Matthew T. Hueman, a breast surgical oncologist at Virginia Cancer Specialists. “We’re seeing real increases.”
Doctors point to reproductive patterns, lifestyle choices, and potentially even environmental exposures as risk factors behind the trend. Hueman says estrogen levels are a huge factor, and milestones like a woman’s first period and her age during childbirth are significant. “Societally, we’re seeing women have children later in life and often [having] fewer children. It’s certainly not a reason to have kids earlier — or at all — but we do know it lowers breast cancer risk,” Hueman explains.
Women who never give birth or who have their first child after age 30 face higher risk than those with full-term pregnancies before 30. Kaltman adds that “precocious puberty” is also a factor, noting that some girls now begin menstruating as early as age 9, adding extra years of hormonal exposure that may raise risk later in life.
Kaltman says that earlier onset obesity — and increased obesity rates in the U.S. in general —is another contributing factor.
Medical oncologist Dr. Kevin Diasti at Virginia Cancer Specialists recommends “a diet that’s rich in plants. That is, fruits, vegetables, having our fats be more associated with olive oils, and a lot of our proteins much more in the way of seafood rather than animal fats.”
Kaltman recommends getting an InBody scan, which she says is available at many area gyms, to get an accurate sense of your body composition (percent body fat versus muscle mass). Everyone who comes through Inova Saville Cancer Screening and Prevention Center gets one, she says. “For women, any percent body fat above 30 percent is considered a risk factor for cancer.”
Another incredible statistic: “Forty percent of cancers are preventable with lifestyle change alone,” says Kaltman. She recommends “minimizing alcohol, making sure you’re exercising, maintaining an ideal body weight, maintaining muscle mass, not smoking. Smoking is probably the biggest contributor to risk. … Lifestyle factors cannot be minimized. They really need to be focused on.”
A 2024 American Cancer Society study found that half of all cancer deaths in adults 30 years old and older in the U.S. could be attributed to modifiable risk factors. Cigarette smoking contributed to nearly 20 percent of all cancer cases and 30 percent of all cancer deaths.
Hueman says more comprehensive research is needed into potential factors leading to this increase, including more research on the impact of microplastics. Genetic/hereditary factors, he says, only explain about 10 percent of breast cancer cases in women.
Advocating for Yourself
Hueman recommends that, by the age of 25, women “find a trusted doctor to do a risk assessment so that they can determine whether they’re at a higher risk.”
Jillian Sanchez was only 30 when she was diagnosed with breast cancer in July 2024. “I had been feeling a lump the size of a small marble on my right breast for several months starting in early 2024 and brought it up with my gynecologist,” she says. “During that appointment, the doctor took my concerns seriously and ordered a mammogram and ultrasound.”
Sanchez had no direct family history of breast cancer and was not high risk. But she paid attention to the changes in her body. Now, she advocates for others to do the same. “I would encourage everyone to be familiar with their bodies and conduct monthly self-breast exams.”
She also recommends “using the Tyrer-Cuzick Risk Assessment Calculator or another similar test offered by your gynecologist or primary care doctor. It’s completely free and can shed light on risk factors based on your personal and family medical history,” she says.
Diasti also says to pay attention to your body. “If you notice any changes in your breast, whether it’s a new mass or lump that doesn’t go away, any skin changes, or anything that feels significantly different from what’s normal for you, I strongly recommend getting it evaluated.”
Kaltman says women need to make sure they are looking at their breasts. “My general recommendation is to look in the mirror once a month, generally about a week after your period. Make sure that things are not changing.” She says to look out for any changes or asymmetry in breast contour (though asymmetry in size is typical); nipple retraction, “if one of the nipples is pulling back in a little bit;” or “if there’s any irritation to the nipple.” Rashes are another red flag: “Rashes on the breast tissue, in and of itself, it’s a concern and something to be evaluated,” Kaltman says.
“Continue advocating for yourself with your doctors or find another one if you feel your concerns are not being taken seriously. Talk to your insurance provider to determine what diagnostic tests you can receive as part of your coverage,” Sanchez says.
Screening on Wheels
Inova is working to make cancer screenings more convenient for everyone in the community. Earlier this year, the Inova Saville Cancer Screening and Prevention Center debuted a state-of-the-art bus that provides onsite services like 3D mammograms, blood draws, Pap smears, and skin exams. Its first public stop was at Neighborhood Health in Alexandria. It aims for about two community events a week and supports uninsured patients through philanthropic funding. Learn more at inova.org or by emailing [email protected].
Feature image, stock.adobe.com
This story originally ran in our October issue. For more stories like this, subscribe to Northern Virginia Magazine.
