According to research presented at the annual meeting of the Radiological Society of North America (RSNA), a study of data from seven outpatient facilities in the New York region revealed that women aged 18 to 49 accounted for 20–24% of all breast cancers diagnosed over an 11-year period.
“This research shows that a significant proportion of cancers are diagnosed in women under 40, a group for whom there are no screening guidelines at this time,” stated Stamatia Destounis, M.D., radiologist at Elizabeth Wende Breast Care (EWBC) in Rochester, New York. “Consideration must be given by physicians caring for women in this age group to performing risk assessment to identify those who may benefit from more intensive screening due to being higher risk.”
Age-based screening thresholds and risk stratification techniques need to be reevaluated in light of emerging national trends that show an increase in the incidence of breast cancer in younger women.
Beginning at age 40 and continuing until age 74, the U.S. Preventive Services Task Force advises mammography screening every other year for women at average risk. Although it is possible to begin between the ages of 40 and 44, the American Cancer Society recommends beginning yearly screening mammography by the age of 45. There are presently no recommendations in place for younger women; however, women who are at high risk for breast cancer due to specific characteristics may benefit from a breast MRI and a mammogram annually, usually beginning at age 30.
In a community practice comprising seven outpatient sites within a 200-mile radius in the Western New York region, Dr. Destounis and her colleague Andrea L. Arieno, B.S., research manager at EWBC, set out to discover malignancies identified between 2014 and 2024. They gathered data from clinical imaging reports and identified every breast cancer in the 18–49 age range.
“We specifically collected details on how the cancer was found (screening or diagnostic), the type of cancer, and other tumor characteristics,” Dr. Destounis stated. “We excluded cases that were not primary breast cancer. We analyzed trends over time by age subgroups, detection method, and tumor biology. This helped us to identify how breast cancer presents in this patient population, how frequently it occurs, and the types of tumors found.”
1,290 women between the ages of 18 and 49 had a total of 1,799 breast cancer diagnoses. The mean age at diagnosis was 42.6 years (range 23-49), and the number of annual breast cancer cases in this cohort varied from 145 to 196. Of them, 1,068 (59%) were found during diagnostic examination, while 731 (41%) were found during screening. There were 347 cases of non-invasive cancer (19.3%) and 1,451 cases of invasive cancer (80.7%).
“Most of these cancers were invasive, meaning they could spread beyond the breast, and many were aggressive types—especially in women under 40,” Dr. Destounis stated. “Some were ‘triple-negative,’ a form of breast cancer that is harder to treat because it doesn’t respond to common hormone-based therapies.”
Even though women under 50 made up 21% to 25% of the patients who were screened yearly, they consistently accounted for one out of every four breast cancers found each year.
“This is striking because it shows that younger women not only carry a stable and substantial share of the breast cancer burden, but their tumors are also often biologically aggressive,” she stated. “That combination—steady incidence plus disproportionately aggressive biology—directly challenges age-based screening cutoffs and strengthens the case for earlier, risk-tailored screening approaches.”
Dr. Destounis noted that an important factor about the research is that the numbers stayed remarkably stable over the study period; even though fewer young women may have been seen overall, the absolute number of breast cancers in this group remained constant or increased.
“That means this problem is not going away,” she said. “It is here to stay and needs to be addressed on a larger scale. Research such as this supports earlier and tailored screening to allow for earlier detection and better treatment outcomes. This data reinforces that women under 50, especially those under 40, shouldn’t be seen as ‘low risk’ by default and can absolutely benefit from risk assessment being performed as early as possible.”
Dr. Destounis cautioned that younger patients should be informed to be aware of changes in their breasts and to start screening in certain cases.
“Those with a strong family history or genetic mutation, as well as certain minorities and ethnic backgrounds, are at higher risk for breast cancer at a younger age,” she said.
Dr. Destounis emphasized that the biggest takeaway of the study is that breast cancer in younger women is not rare, and when it does occur, it is often more serious.
“We can’t rely only on age alone to decide who should be screened,” she said. “Paying closer attention to personal and family history, and possibly screening earlier for some women, could help detect these cancers sooner.”
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