A recent nationwide study using registry data from all 50 U.S. states found that the incidence of breast cancer is increasing among women under 40. However, at this point, research has not been able to zero in on a single causative factor for breast cancer.
Multiple factors may play a role, including non-modifiable and modifiable risk factors, which is something you can’t and can control. Genetics is a big non-modifiable risk factor. Individuals with a strong family history may be at a higher risk themselves.
Women should be mindful of cancer history in their family and seek an earlier consultation with a professional if they have a strong family history, especially in first degree relatives or those with cancer diagnosed before onset of menopause. Although most cancers are sporadic, that is, they do not occur due to known pathologic mutations, about 10% -13% of women with cancer can carry a mutation that puts them at an increased risk.
At King County Hospital Comprehensive Breast Cancer Center, we offer genetic testing, including cascade testing, which means genetic testing of family members of relatives with known genetic mutations. As a breast cancer surgeon counseling my patients, I try to focus on modifiable risk factors, such as keeping an overall healthy lifestyle, maintaining a healthy weight by incorporating a well-balanced diet and exercise regimen as well as limiting their alcohol intake. Ultimately, though, it is important to reassure patients that if they develop breast cancer that it is not their fault and not something they did or did not do, because it is multifactorial where one in eight women develop breast cancer.
Women should undergo risk stratification starting at 25. Current recommendations call for annual mammography beginning at age 40 for women at average risk. Those identified as high-risk could begin screening earlier, with advanced imaging like magnetic resonance imaging. Access to care and early detection must be made available across diverse populations to ensure health equity.
And equity is the key word. While U.S. breast cancer mortality has dropped by nearly 44% since 1989, these gains have not been evenly shared. In my own practice, I often see Black and Caribbean women presenting with more advanced disease, not because of biology, but because of barriers to access. When stage is equalized, survival outcomes across races are similar, underscoring that disparity is less about genetics and more about geography, income, culture, and access to timely care.
Hope is not enough to reverse cancer rates. To meet this moment, we need two things:
- Earlier risk assessment — all women should have risk stratification by age 25.
- Equity in care — ensuring advanced screening technologies and specialized centers are accessible to underserved communities.
Breast cancer remains one of the most common cancers among women, but it does not have to remain one of the most feared. With smarter science, stronger policy, and a sharper focus on equity, we can light the way toward earlier detection, less toxic treatment, and a healthier future for the next generation of women.
Dr. Kseniya Roudakova is an Attending Physician Breast Surgical Oncologist at the Comprehensive Breast Center at NYC Health + Hospitals/Kings County.
