Breast Cancer at 30?

Amanda Butler and Isabella Bugatti, both just entering their 30s, were blindsided by a diagnosis that is on the rise among women their age: breast cancer.

They are not the only ones. A recent study in the peer-reviewed journal JAMA Network Open found that although most cancer in the U.S. occurs in people age 65 and older, cancer—especially breast, endocrine and gastrointestinal cancer—is on the rise in younger patients. The study also found that between 2010 and 2019, breast cancer rates significantly increased in women under age 40.

“We’ve had a surge of young patients, Amanda and Isabella among them,” said Yuan Yuan, MD, PhD, director of Breast Medical Oncology at Cedars-Sinai Cancer, who is treating both women. “Fortunately, even in the aggressive forms these young women have, breast cancer is a treatable, and often curable, disease.”

Butler, a fitness trainer from West Hollywood, was 32 when she felt a lump in her right breast about a year ago. She was diagnosed with triple-positive breast cancer, a form fueled by the hormones estrogen and progesterone, and a protein called HER2. She also tested positive for a BRCA2 genetic mutation.

“No one in my family had had breast cancer,” Butler said. “The diagnosis was a shock to me because I was the healthiest person I knew. I care so much about my health. I work in fitness and wellness.”

Bugatti, born at Cedars-Sinai and raised in Los Angeles, has worked in politics—all over the country, and most recently, in Washington, D.C. In May, the 30-year-old was in her Washington apartment chatting with a friend when she sat back, crossed her arms, and felt a lump in her left breast.

Her doctor referred her for a mammogram and an ultrasound. She was diagnosed with bilateral triple-negative breast cancer, and she moved back to L.A. for treatment. This diagnosis has taught Bugatti the importance of advocating for your own health. Although this fast-spreading, aggressive cancer type is more common in young women, it still only accounts for 10%-20% of all breast cancers. And because it lacks receptors for estrogen, progesterone, and the HER2 protein, it can be tricky to treat.

Despite some family history, Bugatti was unaware that she had a BRCA1 gene mutation.

“Breast cancer was not even on my radar,” Bugatti said. “My maternal grandmother had breast cancer, but my mom did genetic testing a couple of years ago and was negative for BRCA mutations, so we thought I couldn’t possibly be positive. It was a complete, complete shock. I never thought I could inherit this gene from my father’s side.”

Inheriting a BRCA1 or BRCA2 mutation comes with a 45% to 85% lifetime risk of developing breast cancer, and the mutation also increases risk of developing ovarian and several other types of cancer. Yuan urged women to seek out genetic testing if they have a first-degree relative—a mother, father, brother, sister or child—with a breast cancer diagnosis or a BRCA1 or BRCA2 mutation.

“Beyond that, young women are their own best road to early diagnosis,” Yuan said. “Mammograms work well for women ages 40 and up, but younger women’s dense breast tissue can hide small tumors. Young women who feel a lump in their breasts should seek medical attention and a diagnostic mammogram immediately, with a follow-up ultrasound if the mammogram is inconclusive.”

After chemotherapy to help shrink her tumor, Butler had a double mastectomy and radiation therapy in May. She will continue on low-dose chemotherapy to target any residual cancer cells until March. She is also enrolled in a clinical trial of a combination therapy to help prevent cancer recurrence.

Butler also founded a cancer support group and published an e-book about what to expect when undergoing chemotherapy. She is slowly resuming her work in fitness, and credits cancer with helping her face some deep-seated fears.

“Because of my diagnosis, I’ve faced the worst and I’ve seen the worst, and all of the things that I was worried about, I’ve dealt with,” she said.

Bugatti is finishing a course of immunotherapy plus chemotherapy—a major recent advance in treating triple-negative breast cancer—and then will have a brief break before her double mastectomy. While still on leave from work, she said she has been feeling well enough to do some hiking and try a few new hobbies.

“I’m in a much better space mentally now than when I was first diagnosed. Meeting with my amazing oncology team at Cedars and putting together a treatment plan helped me see that a life after cancer was possible,” Bugatti said. “My tumors are now undetectable on an ultrasound, and I’m truly just focused on making sure that I stay healthy, and on doing the things that make me happy.”

Learn more on the Cedars-Sinai Blog: Cancer Prognosticator