- Early-onset breast cancer in females under 50 is increasing, a new report shows.
- Deaths from breast cancer are declining overall, but disparities among women of color persist.
- Aside from a genetic component in some people, breast cancer is highly influenced by diet and lifestyle factors.
- Maintaining a healthy weight, exercising regularly, following a healthy, balanced diet, and limiting exposure to environmental toxins are proven ways to reduce breast cancer risk.
Breast cancer mortality rates have fallen in recent years, but early-onset breast cancer is on the rise.
While breast cancer deaths have decreased by 44% in the past 30 years, the biennial update from the American Cancer Society warns of an uptick in breast cancer diagnoses in females under 50.
Moreover, disparities in mortality rates among women of color persist compared to white women. Black women face higher risks of triple-negative breast cancers and have the lowest survival rates for nearly every breast cancer subtype and stage, the report shows.
Driving breast cancer rates in all females, aside from any genetic predisposition, are myriad factors, many of which are modifiable byproducts of modern-day living.
Recent research has shown that, in 19 out of 30 types of cancer, nearly half of all cases in the United States are linked to modifiable risk factors. A significant proportion of these cancer cases affect females, including breast cancer.
Following lung cancer, female breast cancer is linked to the most modifiable risk factors.
One possible culprit? Alcohol. A progress report from the American Association for Cancer Research linked alcohol consumption to a higher risk for six cancer types, including breast cancer.
Other factors, such as overweight and obesity, difficulty following a healthy diet, and exposure to environmental toxins, also play a role in breast cancer development.
“It’s important to know that the breast organ itself is more vulnerable than other organs to cancer, which is why breast cancer is more common and the price more vulnerable,” said Marisa C. Weiss, MD, chief medical officer and founder of Breastcancer.org.
“If you look at modern life, where people are not having babies until later, they’re not breastfeeding, they’re drinking a lot, or they’re overweight and not exercising, they’re not eating well, or they’re using pharmaceutical hormones for an extended time, it’s a combined set of reasons why breast cancer is more common today than it used to be, including in young women.”
Healthline spoke with Weiss to learn more about early-onset breast cancer and some of the modifiable risk factors, plus other tips for breast cancer prevention.
This interview has been edited and condensed for clarity and brevity.
Risk factors influencing early-onset breast cancer
Weiss: Breast cancer used to be pretty rare 100 years ago, and it’s become the most common cancer to affect women. 1 in 8 women — 2.3 million globally — are affected by breast cancer each year.
The explanation for the increase in the incidence of breast cancer overall, especially in younger women, is multifold. When it comes to steps you can take that have been proven to drop your risk of breast cancer you should try to:
- maintain a healthy weight
- exercise regularly
- eat a mostly plant-based diet (i.e., the Mediterranean diet)
- limit or omit alcohol use
- reduce exposure to environmental pollutants
- consider non-hormonal birth control
- quit smoking
- sleep well
- socialize with others
- consider genetic testing for BRCA gene mutations
- consider further testing if you have dense breasts
Here’s a closer look at some of the main factors that may be affecting rising breast cancer rates in young females.
1. High prevalence of overweight and obesity
Weiss: Obesity or being overweight affects two-thirds of women. Carrying extra weight increases inflammation, which irritates the cells of the body and can make it more likely that a cancer cell could occur. Extra weight brings puberty on earlier, which is a risk factor for breast cancer.
For people carrying extra weight, it’s often harder to exercise, and they’re less likely to eat well. One study linked a 30% higher risk of breast cancer in postmenopausal women with obesity compared to those without obesity.
Of course, it’s very hard to get to and stick to a healthy weight, but getting there reduces the risk of breast cancer and the risk of recurrence if you’ve been diagnosed.
2. Increased exposure to environmental pollutants
Weiss: Pesticides and plastics, fragrances, and other types of pollutants — many of them are lipophilic, meaning they dissolve in fat after exposure.
If you had exposure to a pesticide years ago, let’s say DDT, you may still have residue of DDT in your fat tissue, which could raise your risk of breast cancer.
To reduce your exposure to pollutants, avoid products containing fragrances, and don’t cook in plastic.
4. Rising alcohol use among females
Weiss: Alcohol use in women is increasing. And the more alcohol you drink, the higher your breast cancer risk.
Recent studies show there’s no safe level of alcohol use. Any alcohol use can increase breast cancer risk, which is an unpopular reality. If you drink, limit how much you drink.
5. Hormones in conventional dairy products
Weiss: There are hormones in the products that we eat that could stimulate breast cancer cell growth.
The conventional dairy industry, not the organic one, keeps cows pregnant as often as possible because pregnant cows make more milk.
So, whatever’s in the pregnant cow’s milk is more likely to have hormones. Hormones generally live in the fat of the milk.
But in the organic milk industry, they’re not allowed to do that. They only take milk from pregnant cows at the beginning of the pregnancy, not toward the middle and the end, when hormone levels are higher.
If you want to avoid hormone exposure, buy organic fat-free milk. While it sounds elitist to say, ‘Just go out and buy organic,’ it’s true that organic products, including milk, are increasingly available in places like Walmart grocery stores or in other places that serve people with lower incomes.
6. Hormones in birth control, HRT
Weiss: The use of birth control pills is ubiquitous, particularly now, with access to abortion being limited.
Most people are trying to prevent pregnancy rather than have a baby, so the use of hormonal contraception is very effective and widely used.
But the longer you’re on it, the higher the breast cancer risk. That’s also true of hormone replacement therapy (HRT) — the longer you’re on it, the higher the risk of breast cancer.
Try to find nonhormonal methods of effective contraception, like an IUD that doesn’t contain hormones.
Why is it so important to limit or avoid alcohol?
Weiss: We already know girls who drink alcohol are more likely to have overgrowth of breast cells — hyperplasia — while they are still girls. While it may not be breast cancer, they’re more likely to have bumps and more likely to get a biopsy.
We don’t know exactly why alcohol increases the risk of breast cancer. It probably has to do with how the liver responds to it and maybe hormone levels that may increase.
It may be that we don’t know the whole story about why alcohol increases cancer risk. Still, there’s pretty strong evidence that says there’s an association between drinking alcohol and a higher risk of breast cancer, and the more you drink, the higher the risk.
But there’s an opportunity to modify your risk — you can drink a nonalcoholic beverage when you go to a party, like flavored seltzer in a wine glass, with a mint and a lime.
When you drink wine with food, you drink more slowly. When you go to a restaurant, put your hand over your glass to avoid being topped off.
Drinking less alcohol also makes a big difference in managing your weight. If you stop drinking alcohol, you will be consuming fewer calories from the alcohol.
Diet and nutrition tips for breast cancer prevention
Weiss: Modern life is full of all kinds of exposures that are not healthy for us. If you’re in the grocery store you have choices, you can choose to bring home food that’s healthy rather than not healthy.
For example, the Environmental Working Group (EWG) has a list of the ‘Dirty Dozen,’ which is the top fruits and vegetables that are most likely to be grown in the presence of pesticides and other junk. You want to buy those from organic sources like, just like you would milk.
The junk in the environment also concentrates as it goes up the food chain, which is why a bigger fish, like a tuna, is more exposed to junk like mercury throughout its life. So it’s a good idea to eat lower on the food chain.
I tell my patients that the main show on their plate should be fruits, vegetables, nuts, seeds, beans, grains, spices, and different colors of the rainbow. Your meat, fish, chicken, and pork should be more of a sideshow.
A vegetarian diet is still healthier even if it contains foods on the Dirty Dozen list. A Mediterranean diet is the healthiest diet even if you can’t afford to buy organic.
When you eat chicken, for example, take off the skin because that has a lot of the fat in it. When you eat fish, avoid the brown fat part underneath since it contains junk in it.
Enjoy tuna every once in a while, otherwise, enjoy smaller fish (i.e. sardines, anchovies) or even tilapia and flounder, which economically are cheaper than eating something higher on the food chain. The bigger the fish, the higher on the food chain and the more junk there is in there.
For people who can’t afford organic food, a vegetarian diet is still healthier even if it contains foods on the Dirty Dozen list. A Mediterranean diet is the healthiest diet even if you can’t afford to buy organic.
Are there any risks to soy consumption?
Weiss: Soy contains isoflavones, a protein with very weak estrogen levels. I think it’s fine to consume relatively unprocessed soy foods (e.g., edamame, tofu, tempeh, and soy milk).
“Economic vegetarians” who can’t afford meat or people who follow diets where their biggest source of protein is soy. Their risk of breast cancer is low.
What I do warn people against is concentrated pharmaceutical-grade soy protein powder. We don’t know if that’s safe, so I would say avoid it.
Dense breasts: What can you do to lower breast cancer risk?
Weiss: First, don’t panic. The new FDA rule says you’re required to know if your breasts are dense or not. It’s important to know that breast density is not a diagnosis, it’s just a description, and it’s based off your mammogram.
Half the women who get mammograms have dense breasts. Of the half — a quarter of the whole pie — have what we call heterogeneously dense breasts, or patches of dense tissue.
About a quarter of all breast cancers, which is half of the half who have dense breasts, have extremely dense breast tissue. This means that your risk of breast cancer may be a little higher, and it also means that it’s a little harder to find breast cancer in there because it’s like trying to find a polar bear in a blizzard. Then you might need some extra testing like an ultrasound or an MRI.
There’s a whole list of factors that influence your breast cancer risk. Breast density is just one of them.
So breast density, your family history, your weight, your alcohol consumption, whether you’re socially isolated, have uncontrolled diabetes, have been on extended use of HRT or birth control pills, etc. — you want to look at all those factors.
If you find out that you have dense breasts, it’s good to talk with your doctor or a genetic counselor about your overall risk.
It is also important to note that while uncommon, breast cancer also occurs in men. The condition affects about 1 in 800 men in their lifetime, compared with 1 in 8 women.
Takeaway
Early-onset breast cancer cases are on the rise. While overall breast cancer mortality is declining, disparities persist, with women of color still facing significant risks.
Key risk factors for breast cancer include obesity, alcohol consumption, hormone exposures, and environmental pollutants.
Maintaining a healthy weight, getting regular exercise, following a mostly plant-based diet, quitting smoking, and limiting or avoiding alcohol can help reduce breast cancer risk.
The role of genetic factors, particularly in women of color and those with a family history of breast cancer, should also be taken into account. Talk with your doctor if you have dense breasts or other risk factors for breast cancer. They may recommend genetic testing for personalized risk management.
