Breast Cancer In Teens: Causes, Symptoms And Risk Factors

Breast cancer in teens is rare and may occur in boys or girls. It is the uncontrollable growth of cells in the breasts. Most breast cancer symptoms are due to hormonal changes rather than any malignant growth of cells. However, this may affect the nearby tissues and organs and spread to other body parts if left untreated.

Breast cancer usually affects women above 40 years. However, studies have also shown breast cancer cases being diagnosed in about five percent of women below 40 years (1). It can therefore occur at any age.

Read through the post as we discuss the symptoms, causes, risk factors, diagnosis, treatment, and prevention of breast cancer in teens, along with types of breast cancer.

Signs And Symptoms Of Breast Cancer In Teens

Not all breast changes are clinical features of breast cancer, especially in teens. You may seek medical care to confirm the exact cause.

The common symptoms and signs of breast cancer may include (2) (3).

• Breast pain that is more than the normal breast soreness felt during menstruation
• A breast lump felt during palpation
• A breast lump that spreads to the collarbone or armpit
• Swollen lymph nodes in the neck or armpits
• Swollen and reddish breast appearance; dimpling of the overlying breast skin
• Nipple tenderness
• Nipple discharge or secretions including liquid, pus, or blood
• Asymmetry of breast shape and size on both sides—slight asymmetries are often normal

Although these symptoms are seen in breast cancers, they can often be due to other causes, such as hormonal changes, in most teens and preteens. Therefore, seek an expert for the right diagnosis.

Causes Of Breast Changes In Teens

Small lumps on the breasts discovered by teenagers and young adults are often non-cancerous (benign) growths caused by infections or hormonal fluctuations. These non-cancerous lumps may often disappear without treatment. However, it is recommended to visit the doctor (4).

The common causes of breast changes in teens and preteens may include the following (2).

• A breast lump, which can be cysts or fibroadenoma (non-cancerous breast tumor). About 50% of fibroadenomas go away within five years, while others require treatment.

• Redness and acute breast pain on one side often due to infections

• Breast fullness and acute breast pain on both sides without redness, which may indicate pregnancy

• Recurrent breast pain with menstruation, which can be cyclic mastalgia

• Nipple discharge, including pus, clear fluid, milk, or blood, which can be due to breast infections, breast trauma, and galactorrhea

• Chronic breast pain not linked to the menstrual period, which can be caused by marijuana use, cysts, or fibroadenoma

• Premenstrual breast fullness and pain due to extra fluid in the body can be caused by hormonal changes. These
• may begin a week before menstruation and improve during menstruation. Many teens may feel better with ibuprofen and a supportive bra.

• Breast abscess, a pus-filled cavity, which is often caused by staph bacteria, can cause pain, redness, and lump (painful lump) on the breast. This may often occur after nipple injury, lactation, or nipple piercing and requires pus removal with needle and oral antibiotic therapy.

• Breast hematoma, which is the collection of blood in the breast due to injury

You may seek medical care if your teenage girl or boy complains of these symptoms. Although they may not be suggestive of breast cancer, some breast symptoms need medical treatment.

Risk Factors And Causes Of Breast Cancer In Teens

The exact cause of breast cancer is not known in many cases. However, the following factors may increase a teen’s risk of developing breast cancer (1).

• High-risk lesions on biopsy

• Family history of breast cancer, especially at an early age

• Previous radiation therapy to the chest area for childhood cancers such as Hodgkin lymphoma

• Family history of genetic syndromes, such as Li Fraumeni syndrome

Presence of genetic mutations such as BRCA1 or BRCA2—one in 40 people of the Ashkenazi Jewish ancestry carries either of the mutations

Note: Do not believe in misconceptions that using deodorants, wearing underwired bras, getting nipple piercings, or keeping mobile in the breast pocket increase the risk of breast cancer. These are not scientifically proven (5).

Although male breast cancer accounts for 1% of all breast cancers, the incidence in teenage boys is extremely rare (6). A breast examination may be recommended for teens with high-risk factors if they have any concerns about breast changes or lumps.

Complications Of Breast Cancer

The following complications are often seen in young women with breast cancer (7).

• Chemotherapy for breast cancer can lead to pregnancy and fertility problems. Some girls may have amenorrhea and may resume menstruation after months, while a few may develop premature ovarian failure (POF)

• Bone problems such as osteoporosis, osteopenia, and fractures are often seen after treatment with certain chemotherapy drugs and endocrine (hormones) drugs for breast cancer.

• Psychosocial issues due to distress from diagnosis or treatments such as breast removal surgeries may be seen.

• Complications of breast resection surgeries such as bleeding, seroma (collection of fluid), and hematoma (collection of blood) on the surgical site and risk for blood clots are seen in some cases.

• Heart diseases may also be seen even after many years due to chemotherapy drug effects.

• Recurrence of breast cancer or secondary cancer (metastatic cancer) that spreads to nearby tissues or other organs such as the lungs, brain, and bones

You may discuss with the pediatric oncologists to know the outcomes in your teen. The prognosis and treatment may vary depending on the onset of diagnosis, type of cancer, and its spread.

Diagnosis Of Breast Cancer

Teens are not included in the regular breast cancer screening since the incidence is rare during the adolescent years. However, you may talk to the family physicians if there is a family history of breast cancers or the teen is concerned about any breast changes.

Some of the following procedures and tests are done to diagnose breast cancer (8).

• Physical examination and health history to check the general health and learn about any health conditions or risk factors

• Clinical breast exams (CBE) to examine the breast for any lumps and to know its characteristics such as movability and texture

• Mammograms, which are X-rays of the breast, to look for any growth in the breasts

• Ultrasound exams, which use high-energy sound waves to visualize the tissues

• MRI or magnetic resonance imaging scans to get more detailed information of the breast and the surrounding areas

• PET or positron emission tomography, which uses radioactive glucose injections before imaging. Cancer cells absorb glucose in higher amounts than normal cells, and the procedure helps visualize metastatic tumors.

• Blood tests to determine the presence of cancer by looking for certain chemicals released by cancer cells in the blood

• Chest X-rays to learn about some types of breast cancers and examine the bones in the chest

• Biopsy, which involves the analysis of samples to determine the type of cancer

Not all tests are ordered at a time; the doctors may order imaging tests to confirm the diagnosis if they suspect breast cancer. MRI and PET scans are done after the initial diagnosis for clearer imaging and to know the spread of cancer. There is no standard method to stage childhood breast cancers, so the treatment and prognosis are decided based on the diagnosis.

Treatment For Breast Cancer In Teens

Various treatments are available for children and teens with breast cancers, including standard treatments currently in practice and new treatments tested in clinical trials. A multidisciplinary team of specialists, including pediatric oncologists, treat childhood cancers.

The following types of standard treatment are often recommended for teens with breast growths that are not malignant (8).

• Watchful waiting and monitoring of cancer and symptoms without any treatments. Some growths, such as benign tumors, may disappear over time.

• Surgery involving the removal of growth and not the whole breast in most cases.

Teens with breast cancer (malignant) may receive the following treatments (8).

• Surgical removal of the tumor. The whole breast is not removed in most cases.

• Radiation therapy with high-energy X-rays or other radiations is given to destroy specific cancer cells.

• Targeted therapy using specific chemotherapy drugs that only act on cancer cells may also be recommended. It is less harmful than general chemotherapy.

Treatments such as whole breast removal (mastectomy) are done if the tumor extensively spreads in the breast tissue and there is an increased risk for recurrence. You may discuss with the pediatric oncologists to know the best treatment option based on your teen’s breast cancer type and spread. Your teen’s doctor may recommend regular follow-up visits to check the outcomes and side effects of treatments and screen for secondary cancers or recurrence.

Can Breast Cancer Be Prevented In Teens?

Most cancers in teens, including breast cancer, cannot be prevented since there are no known causes. Limiting certain environmental risk factors, such as radiation exposure, may reduce the risk for future cancers in teens. However, this is often done only in unavoidable circumstances, such as to treat childhood cancer (9).

Removal of the breast tissue might help some teens with mutations for breast cancers. However, it is not commonly done, especially during teen years, since breast cancer is rare in teenagers even with risk factors.

Survival Rates Of Teens With Breast Cancer

According to Moffitt Cancer Center, survival rates for teenagers and young adults with breast cancer are high due to the availability of different treatment options and as most teens are healthy enough to tolerate aggressive treatments (4).

Types Of Breast Cancer

There are various types of breast cancers, and these are categorized based on the specific cells that are affected. A majority of the breast cancers fall under carcinomas, which are breast growths that begin in the epithelial cells, and more specifically, adenocarcinoma, which originates from the milk ducts or glands (lobules).

Breast cancer can be of the following types based on its spread (10).

• In situ breast cancer

In situ breast cancer originates from a milk duct and does not spread to other breast tissues. It is also called ductal carcinoma in situ, intraductal carcinoma, or DCIS. It is a non-invasive (does not spread) or pre-invasive breast cancer.

• Invasive breast cancer

Invasive breast cancer, also called infiltrating breast cancer, is a type of cancer that spreads or invades the surrounding breast tissue. Invasive ductal carcinoma (IDC) and invasive lobular carcinoma (ILC) are common types of invasive breast cancers.

Some invasive cancers have special features, and the treatment and outcomes may vary. These cancers are less severe but are often difficult to treat. Special types of invasive breast cancers include (10)

• Triple-negative breast cancer, which is an aggressive type of invasive breast cancer that lacks receptors that are commonly found in breast cancers.

• Inflammatory breast cancer, which is an uncommon, rapidly progressing type of invasive breast cancer that makes the breast red, swollen, and tender.

Less common types of breast growths may affect other cells on the breast than milk ducts and require specific treatment. Less common breast cancers include (10)

• Paget disease of the breast, a form of breast cancer that develops from the ducts and spreads to the areola and nipple.

• Phyllodes tumors, which are breast tumors that develop from the connective tissue. These are benign growths (not malignant or cancerous) that originate in the ducts or lobules.

• Angiosarcoma, which occurs in the cell lining lymph or blood vessels and may involve the skin and This may often occur due to previous radiation therapies.

Support And Encouragement For Teens With Breast Cancer

Teenage life has its challenges, and a cancer diagnosis can be devastating news to many teens. However, constant support from parents and loved ones can help many teens look at life positively.

Dr. Asher Marks, Director of the Adolescent and Young Adult Program and a Pediatric Hematologist and Medical Oncologist at Yale Medicine who helped create the Teen Cancer Care Center, says, “When adolescents and young adults are diagnosed with cancer, they sometimes end up being unable to relate to their peers, who are not dealing with such serious things.” Thus, “They crave interaction with other teenagers in the same situation,” he states.

He also opines, “We now know from research that patients without solid psychosocial support networks tend to do worse, prognosis-wise.” “There’s more depression, more anxiety, less compliance. And so, there actually is an effect on medical outcome (11).”  You may seek support from local organizations and online platforms to help your teen cope with the condition.

References

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Reviewer

Dr. Neema ShresthaMD

     

Dr. Neema Shrestha is a pediatrician with a special interest in the field of neonatology. She has an overall experience of five years working in the field. Currently working in Kathmandu, Nepal, she completed her MBBS from Kasturba Medical College, Manipal in 2008, Diploma in Child Health from D.

Read full bio of Dr. Neema Shrestha