Rani Bansal, MD: Breast Cancer in Young Women: Subtypes, Risk Factors, and Self-Advocacy

Of the 3 primary breast cancer subtypes (estrogen receptor [ER]–positive, HER2-positive, and triple negative), the recent rise in cases among younger patients is being driven largely by ER-positive disease, explained Rani Bansal, MD, a breast oncologist at the Duke University Cancer Center Breast Clinic.

But the picture shifts by race and ethnicity, as African American women, she noted, are disproportionately diagnosed with triple-negative breast cancer, a subtype that is harder to treat because it lacks the receptor targets that allow for more tailored therapies. According to the American Cancer Society, Black women have a 38% higher breast cancer mortality rate compared with White women, despite having a slightly lower incidence rate. This gap is driven in part by differences in subtype distribution and access to care, which remains a major barrier.¹

"Triple negative breast cancer is considered to be one of the more aggressive types," Bansal explains, and those patients are often facing multi-agent chemotherapy and immunotherapy regimens as a result.

Beyond biology, Bansal addressed the importance of awareness and self-advocacy. A pattern she sees repeatedly in clinic is young women being dismissed by providers when they flag a concern about their breast tissue, as they are often told they're "too young" to have breast cancer. However, breast cancer incidence among women under 50 has been increasing by roughly 1.4% per year since 2012, underscoring that age alone should not be used to dismiss a patient's concern.² She pushed back on that directly, urging young women to know their family history, ask whether relatives under 50 have had breast cancer or ovarian cancer, and raise those conversations with their primary care providers.

If something feels off, she tells women to push for the ultrasound or MRI, stating that they know their body best. High-risk breast cancer clinics exist precisely for this population, offering structured, proactive surveillance.

References

1. American Cancer Society. Breast Cancer Facts & Figures 2024–2025. American Cancer Society; 2024. Accessed May 8, 2025. https://www.cancer.org/research/cancer-facts-statistics/breast-cancer-facts-figures.html
2. Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025. CA Cancer J Clin. 2025;75(1):10-45. doi:10.3322/caac.21871