Findings challenge breast cancer screening norms

Researchers report that an analysis of data from outpatient facilities in the New York State region revealed that 20-24% of breast cancers breast cancers diagnosed in an 11-year period were found in women age 18 to 49.

“This research shows that a significant proportion of cancers are diagnosed in women under 40, a group for whom there are no screening guidelines at this time,” said Stamatia Destounis, M.D., radiologist Elizabeth Wende Breast Care (EWBC) in Rochester, New York.

The findings were reported on Dec. 1, 2025 at the Radiological Society of North America (RSNA) annual meeting.

The investigators retrospectively identified cancers diagnosed from 2014 through 2024 in a community practice consisting of seven outpatient facilities over a 200-mile radius in the Western New York region.

“We specifically collected details on how the cancer was found (screening or diagnostic), the type of cancer and other tumor characteristics,” said Destounis. “We excluded cases that were not primary breast cancer. We analyzed trends over time by age subgroups, detection method and tumor biology. This helped us to identify how breast cancer presents in this patient population, how frequently it occurs and the types of tumors found.”

The analysis revealed that 1,799 breast cancers had been diagnosed in 1,290 women, aged 18 to 49. Annual breast cancer diagnoses in this group ranged from 145 to 196. The mean age at diagnosis was 42.6 years (range 23-49). Of these, 731 (41%) were detected on screening and 1,068 (59%) on diagnostic evaluation. There were 1,451 invasive cancer cases (80.7%), and 347 (19.3%) non-invasive cancer cases.

“Most of these cancers were invasive, meaning they could spread beyond the breast, and many were aggressive types—especially in women under 40,” Destounis said. “Some were ‘triple-negative,’ a form of breast cancer that is harder to treat because it doesn’t respond to common hormone-based therapies.”

Even though women under 50 made up 21% to 25% of the subjects screened yearly, they accounted for one out of every four breast cancers found each year.

“This is striking because it shows that younger women not only carry a stable and substantial share of the breast cancer burden, but their tumors are often biologically aggressive,” she said. “That combination—steady incidence plus disproportionately aggressive biology—directly challenges age-based screening cutoffs and strengthens the case for earlier, risk-tailored screening approaches.”

The authors concluded, “Women under 50 consistently represent a substantial portion of the breast cancer burden at our center. A significant percentage of these tumors are invasive, high-grade and triple negative, particularly among those under 40. These findings support the need for ongoing vigilance in imaging protocols and consideration of earlier or more intensive screening for higher-risk younger populations.”