Nikita Chandrakant Shah, MD
Cancer – Hematology
Orlando Health

At only 41, the wife of Florida Gov. Ron DeSantis was diagnosed with breast cancer. Casey DeSantis, a mother of three, might seem young to have this disease. But is she?

Although it’s sometimes thought of as an older woman’s disease, breast cancer affects women of all ages. About one in eight women will be diagnosed with breast cancer in their lifetime. And about 9 percent of new breast cancer cases in the United States are diagnosed in women under 45.

Breast cancer looks different among these younger women. It is more often tied to family history and genetics, and it’s more likely to be serious.

A 2019 study that analyzed more than 1 million cases of breast cancer found that women under 40 were nearly twice as likely as those age 50 to 64 to be diagnosed with the aggressive forms of breast cancer known as triple-negative.

Understanding your personal breast cancer risk, along with testing and treatment options, may help ease the anxiety many women feel in the wake of Casey DeSantis’ diagnosis.

Breast Cancer and Genetics
If someone in your family has been diagnosed with breast cancer, you probably already know that certain forms of the disease have a genetic component. This means that if your mom, grandmother, aunt or sister had breast cancer, you may be at higher risk.

Since genetically driven breast cancers tend to happen at an earlier age, it’s important for younger women with a family history of the disease to be aware of their risk.

Some women may want to consider a BRCA gene test, which is a blood test that looks for mutations in your DNA that increase your breast cancer risk. You should talk to a genetic counselor before taking this test, though. They can determine whether you need it and help you understand your results if you do get tested.

Breast Cancer Risks for Younger Women
If you are under the age of 45, several factors may put you at a higher risk for breast cancer. These include having:

Close relatives who were diagnosed with breast cancer before 45 or ovarian cancer at any age. Your risk is higher if more than one relative was diagnosed or if a male relative had breast cancer.

Ashkenazi Jewish heritage.

Radiation therapy to your breast or chest in childhood or as a young adult.

Already had breast cancer or other breast health problems, such as lobular carcinoma in situ, ductal carcinoma in situ, atypical ductal hyperplasia or atypical lobular hyperplasia.

A mammogram that has shown you have dense breasts.

Should You Get a Mammogram?
Although the U.S. Preventive Services Task Force recommends that women get mammograms every two years from age 50 to age 74, many healthcare providers continue to urge women with an average risk of developing breast cancer to start screening at 40.

For women who are at higher risk, the American Cancer Society recommends a mammogram and breast MRI every year beginning at age 30. But breast MRIs aren’t suggested for all women. While this type of screening provides a detailed image, it also has a high rate of false positives, and may therefore be inappropriate for lower-risk women.

Breast Cancer Treatment for Younger Women
A major factor for determining how a woman will be treated for breast cancer is whether she has gone through menopause. For example, chemotherapy-based treatment is the same for both groups, but the type of hormone-blocking medications used is different. Pre-menopausal women can only be treated with a medication called tamoxifen, while post-menopausal women can take tamoxifen or a more effective class of drugs called aromatase inhibitors.

Worried About Breast Cancer? Talk to Your Doctor
If the news that Casey DeSantis has breast cancer is causing you to worry about your own risk, reach out to your doctor — even if you’re a younger woman. Together, you can discuss your testing and screening options, and figure out a plan that will give you peace of mind.