Currently, breast cancer is the leading cause of cancer death in women age 20 to 49 in the United States. Compounding this concerning issue, younger patients are being diagnosed at more advanced stages, according to doctors at NYU Langone's Perlmutter Cancer Center, and this points to a greater need for screening, prevention, and breast cancer education.
While this is a concerning trend, the quality of life for those diagnosed—even at stage 4, when it has spread to other parts of the body—is improving. Perlmutter Cancer Center is adapting to the landscape with the recent launch of the Early Onset Cancer Program, one of several programs aimed at targeting and tailoring treatment for people living with cancer.
This Breast Cancer Awareness Month, leading oncologists Elizabeth Comen, MD, co-director of the Mignone Women's Health Collaborative, and Mary L. Gemignani, MD, MPH, director of the Women's Early Onset Cancer Program and chief of the Division of Breast Surgery, answer the most important questions around the rise of cancer in younger adults.
What is early-onset breast cancer?
Dr. Gemignani: While the median age at the time of diagnosis is 62, we're seeing early onset at a much younger age than that. Around 10 percent of the patients that we see today are 45 and younger. Over the last two decades, there's been an increase in diagnoses in people age 20 to 29 and 30 to 39. We're also seeing more aggressive molecular profiles among our younger patients, which poses a greater risk for prognosis and outcomes. Triple-negative breast cancer, a particularly aggressive subtype without many targeted treatment options, is also more common in younger women. The American Cancer Society reported that women under 50 are nearly twice as likely to be diagnosed with cancer compared to men of the same ages. This is primarily attributed to increasing rates of breast cancer.
Who is at risk of early-onset breast cancer? How can people be proactive about this concerning trend?
Dr. Comen: Education about risk assessment and family history is crucial in addressing the increasing number of breast cancer diagnoses among young people. Patients should openly discuss their family medical history with their primary care physicians and consider taking a breast cancer risk-assessment test. Understanding your personal risk helps guide and tailor your care, regardless of whether you have a family history of the disease. For women at average risk, beginning routine screening at age 40 is generally appropriate. However, those at higher risk may need to start screening earlier. Additionally, women with dense breasts may benefit from supplemental imaging—such as ultrasound or breast MRI—in addition to standard mammograms. We advocate for grassroots education: start the conversation with your primary care provider, learn your family history, and collaborate with your doctor to monitor and manage any symptoms. If something feels off, speak up. Trust your instincts.
Dr. Gemignani: Health literacy and self-advocacy are also extremely important. Younger patients, whether they're undergoing screening, diagnosis, or treatment, are often navigating the healthcare system for the first time. A breast cancer diagnosis can be extremely overwhelming because there's so much terminology and medical language that people may not understand. Building a trusting relationship between the care team and the patient creates a safe space for questions and conversations, which empowers patients to make informed decisions about their care.
What does cancer treatment look like for people in their 30s and 40s?
Dr. Comen: At Perlmutter Cancer Center, we recognize that treating breast cancer goes beyond addressing the biology of the disease. It's also about supporting the whole patient experience. Every individual's journey is unique, and young women in particular may face distinct challenges related to their stage of life, including concerns about fertility, parenting young children, career demands, and family responsibilities. Our approach is focused not only on treatment, but also on preserving quality of life and helping patients maintain their roles and identities outside of their diagnosis. This includes addressing important issues such as nutrition, exercise, emotional wellbeing, sexual health, and overall functioning in daily life. Our goal is to provide care that supports the whole person—not only treats the cancer.
Dr. Gemignani: When we established the Early Onset Cancer Program, we were thinking about these types of lifestyle changes and priorities like family planning. In your 30s to 40s, your friends could be going on a night out, and you are buying a cold cap and getting ready for chemo. That is difficult for people. The Early Onset Cancer Program was designed with these moments in mind. Survivorship has really evolved into a holistic, individual, and personal experience, and our program honors that.
What is Perlmutter Cancer Center doing to advance the field of oncology for this age group?
Dr. Comen: There are several innovative programs we have invested in and now offer to oncology patients. One is the Oncofertility Program, which helps any cancer patient at NYU Langone understand and pursue their fertility options as part of their cancer treatment. Any provider in the health system—including nurses and physician assistants—can refer patients to a team of dedicated fertility nurse navigators.
Dr. Gemignani: We also launched the Cardio-Oncology Program in October 2024, enabling patients and their oncologists to create personalized care plans to protect and treat the heart for newly diagnosed patients, those actively receiving treatment, or cancer survivors. We also offer services for psychosocial distress, sexual health, rehabilitation, and sickness from hormone therapy, as well as exercise and physical therapy, yoga, and access to social workers as part of our Survivorship Program.
We are committed to providing younger cancer patients personalized care that meets their individual needs and gives them the best quality of life possible. There are more people living with cancer now than ever before, and the oncology field has come a long way in how we think about survivorship and treat the specific needs of younger cancer patients.
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