Breast cancer is hitting younger women. An NYU Langone oncologist says don’t wait to get checked.

“I actually think that pink ribbon has done a lot,” said Comen, a medical oncologist at NYU Langone’s Perlmutter Cancer Center and co-director of the hospital’s Mignone Women’s Health Collaborative.

Comen acknowledged concerns about “pinkwashing,” when companies cash in on the cause without the money reaching research. But she credited groups like the Breast Cancer Research Foundation and Susan G. Komen with driving philanthropy “that has been behind almost every major advance” in the field.

The results show up in the data. U.S. breast cancer death rates have fallen 44% since peaking in 1989, averting an estimated 546,000 deaths, according to a 2024 American Cancer Society’s annual report. Comen credits both better screening and better treatment.

But diagnoses are moving in the other direction. Breast cancer incidence has risen about 1% a year over the past decade, and 1.4% a year among women under 50, the same report found.

“Where we are at today is making sure that awareness continues to translate to all the populations,” Comen said. That includes men, who can also get breast cancer, underserved communities, and “a rise in breast cancer among young women in the United States that we need to invest more research in.”

Start the breast cancer conversation at 40

In 2024, the U.S. Preventive Services Task Force lowered its recommended starting age for mammograms from 50 to 40, advising screening every two years for women 40 to 74.

Comen’s advice for a 40-year-old in New York starts with a conversation, not a scan. She recommends asking a doctor to assess your personal risk, including with tools like the National Cancer Institute’s Breast Cancer Risk Assessment Tool. Some women at higher risk need to start screening before 40.

“We say start at age 40 if you’re average risk and talk about yearly mammograms at that age,” she said. Later adding that catching breast cancer early is “incredibly important” to improving outcomes.

Why are younger women getting sick?

“I don’t think we know,” Comen said about the rise in diagnoses among younger women. “I think it’s multifactorial, and that’s what we need to be studying.”

She listed the questions researchers are asking, such as: Are environmental exposures to blame? Diet and ultra-processed foods? A more sedentary lifestyle? And why are girls getting their periods earlier, giving them more lifetime exposure to estrogen?

That last trend is well documented. A 2024 Harvard study of more than 71,000 women in the Apple Women’s Health Study found the average age of a first period fell from 12.5 for women born between 1950 and 1969 to 11.9 for those born between 2000 and 2005. The share who started before age 11 nearly doubled, from 8.6% to 15.5%.

‘You’re too young’

In her 2024 book, “All in Her Head,” Comen traces how medicine has long dismissed women’s symptoms. In breast cancer, she said, younger women bear the brunt of it.

“Oh, you’re too young, or oh, you’re pregnant, or this is mastitis from breastfeeding,” Comen said, describing what young patients are often told. “These are areas where we really don’t want to be dismissing women.”

Delays are common in this age group. In a Canadian study of 1,148 women diagnosed at 40 or younger, about one in three waited more than four weeks after noticing a symptom before first contact with the health-care system. Reasons included waiting for their next period and reassurance from another practitioner.

“If you know your body and something feels different and often you are worried about it, and you feel like you’re being dismissed by a doctor, you have to see another physician,” Comen said.

The symptoms Comen noted are worth checking include any lump, painful or not, nipple discharge, skin changes, and lumps in the armpit or near the collarbone. Comen encourages women to feel their breasts regularly “so you are comfortable with what your normal feels like.”

Dense breasts and genes beyond BRCA

Since September 2024, federal rules require mammogram reports to tell women whether they have dense breast tissue. Dense tissue can hide tumors on a mammogram.

“If you’ve been told that you have dense breasts, you want to talk to your doctor about whether additional screenings such as a breast ultrasound or MRI may be necessary,” Comen said.

Genetic testing is also more than a BRCA question—which stands for breast cancer gene. Comen noted that most women diagnosed with breast cancer have no family history or known mutation. When doctors do look at family history, they consider any cancers on either parent’s side, not just breast cancer.

A 2021 study of more than 64,000 U.S. women found that about 5 percent of breast cancer patients carried a harmful variant in one of 12 known risk genes, compared with 1.6 percent of women without cancer. Beyond BRCA1 and BRCA2, genes such as PALB2 and CHEK2 also raised risk.

A gap that persists

Black women are diagnosed with breast cancer at slightly lower rates than white women but die of it more often. The national death rate is 26.5 per 100,000 for Black women versus 19.3 for white women, according to the American Cancer Society.

Comen pointed to biology and access, citing research that Black women are diagnosed more often with triple-negative breast cancer, a subtype that “can be harder to treat and more aggressive in some instances.” But barriers to care are “a huge driver,” she said.

Women need adequate screening and access to a specialist at a well-resourced hospital, “no matter their zip code or their background,” she said.

Living longer, and living better

Asked what has changed most since she began practicing, Comen pointed first to quality of life: fertility, sexual health, exercise, nutrition and the experience of treatment itself.

“That is so much more part of the dialogue as opposed to just saying, ‘Oh, you’re alive,’” she said. 

Doctors have also learned when to pull back. “Not everybody needs chemotherapy,” Comen said. 

For metastatic disease, Comen is most excited about deep genetic sequencing and repeat blood tests. At NYU Langone, she said, doctors use serial blood work “to monitor cancer in real time as opposed to just a snapshot in time.”

That approach got a boost last month. On Sept. 4, the FDA approved camizestrant for certain patients whose blood tests show a new resistance mutation during treatment. In the trial behind the approval, switching drugs when the mutation appeared extended the time before the cancer worsened from about nine months to about 16.

What survivors carry

For many patients, the hardest part comes after treatment ends. Comen described “the psychological trauma of going through a breast cancer diagnosis,” along with changes in body image, sexual health and hair.

Fear also keeps some women from getting screened at all, Comen said. Some dread the mammogram itself, and others fear the result. “We need to make sure that we are reminding women and helping them through that fear,” she said, “and that catching something early is always better.”

Her one ask for readers this month is simple: “Talk to your doctor about what cancer screening is appropriate for you based on your age and your family history.”

Asked about a patient who stayed with her, Comen said they all do.

“That’s part of the sacred part of doing my job,” she said. “It’s not the biology of the disease, but the experience and the narrative aspect of medicine and the window into their lives that my patients are brave enough to share with me.”