Breast cancer strikes young Black women at alarming rate | Expert Opinion

In the summer of 2020, Tolulope “Tolu” Oyetunde was over the moon. At 26, she had just earned her master’s degree in public health and already had a promising career in the Philadelphia health department. Physically, she was in great shape, having completed a major fitness challenge.

Then she found a lump in her breast that felt “as heavy as a rock.”

She told herself it was likely not anything serious, but soon got a telehealth appointment and was sent for an immediate breast ultrasound.

“Within three months ... I went from being a normal 26-year-old who has never had health problems to [being diagnosed with] the worst type of breast cancer,” said Oyetunde, who lives in Philadelphia.

“First it was, ‘You’re diagnosed with breast cancer.’ Second it was, ‘It’s moved to your lymph nodes.’ Third, it was ‘We think it’s in your lungs and liver.’ Then we get the results from the liver biopsy: ‘OK, you’re at stage 4.’ "

What is surprising about Oyetunde’s case is the age at which she was diagnosed – 26. Nearly four years later, she is still living with a disease once thought only to strike older women. However, a 2024 study demonstrates that rates of breast cancer diagnoses among women under age 50 have increased over the past decade, especially among Black women.

Although breast cancer still is uncommon among those in their 20s, Black women in this age bracket have a 53% increased risk of breast cancer compared to their white peers, the same study found.

Oyetunde has been to enough support groups to see these statistics play out first hand. “You’re seeing 21-year-olds ... really young Black women with breast cancer,” she said.

Oluwadamilola “Lola” Fayanju, who leads Penn Medicine’s division of breast surgery, says even teens are being impacted by the disease. “My youngest patient with breast cancer is 17,” she said.

As this research is fairly new, it has changed the way I approach breast cancer in my clinical practice. The increasing rates of breast cancer among younger women, especially women of color, were not emphasized in my education, even though I graduated just two years ago. Now, as a resident physician training in emergency medicine, I may not provide routine primary care. But if a younger woman comes to the ED with breast symptoms, I am far more likely to consider cancer higher up on the list of diagnostic possibilities.

Why are we seeing breast cancer affect women younger and younger? Many factors are likely contributing, Fayanju said. Research has revealed the potential impact of chemicals, such as in pesticides and chemical hair straighteners, on breast cancer development. Environmental researchers have found abundant evidence that communities of color and those from economically disadvantaged backgrounds are disproportionately exposed to pollution of all kinds, perhaps most apparent in young children with severe asthma.

In the case of Black women specifically, one cannot ignore the potential impacts of racism on cancer development and severity. Scientists now know that repeated emotional trauma — such as generations of systemic racism and disenfranchisement endured by Black people living in America — also takes a physical toll, even leading to shorter life expectancy. “Moving through the world as a person who experiences discrimination can lead to allostatic load,” Fayanju said, referring to the cumulative burden of stressors such as racism and toxic stress. Increased allostatic load has been linked with accelerated cellular aging, potentially increasing cancer risk.

As is the case for many breast cancer patients, Oyetunde can’t point to family history as the reason she developed cancer so young. A few family members have had breast cancer, but they were all diagnosed much later in life, and their conditions were far less severe. Oyetunde underwent genetic testing, but the results came back negative for known genetic markers of breast cancer.

However, that could be because most cancer research has focused on white women, despite the fact that Black women tend to develop deadlier disease. “Black patients as well as patients from other racial ethnic minoritized groups are more likely to have a ‘variant of uncertain significance’ result on their genetic testing,” Fayanju said.

This means that even if a mutation in a DNA sequence was found, there are “not enough people and longitudinal observation of individuals with that particular mutation to be sure that it is actually associated with malignancy,” she explained.

This can have implications. For example, medications or prophylactic surgeries offered to women with well-known BRCA mutations may not be available to patients whose genetic anomalies aren’t as well understood. There is simply not enough data to know if those interventions would do more harm than good.

The roots of this underrepresentation run deep, reaching into a long history of distrust in the Black community for a medical profession that has mistreated patients of color. Though there are significant efforts to address disparities, Fayanju notes that inequities in representation are particularly seen in phase three clinical trials which specifically focus on the therapeutic nature of certain medications.

Oyetunde, who is Nigerian-American, has devoted her public health education and research initiatives to ameliorating these disparities, especially on a global scale. She is organizing a symposium to bring attention to the underrepresentation of African populations in cancer genomics and is planning a conference in Nigeria with key stakeholders to address barriers to screening mammograms there, as well as cultural stigma, and miseducation.

She has done this all while navigating intravenous chemotherapy sessions every three weeks, meaning long hours in clinic and days of difficult side-effects. “For the first one to two weeks, I am sick as a dog. Trying to teach and push through the nausea and vomiting is hard. For the last week when I feel better, I am working, trying to catch up with people, just trying to catch up on everything and it’s really difficult.”

But she hopes chemo helps contain the cancer. She learned this past year that it worsened in her lungs and spread to her brain. “I used to love to run. I’m not able to because I’m coughing every two seconds,” she said.

Oyetunde turned 30 a few weeks ago, defying an initial two-year prognosis. For her, quality of life takes priority and she hopes to switch to a more manageable chemo option, even if it isn’t as powerful.

“Dying doesn’t scare me as much as I thought it would. I think one of the things that is worse than dying is not being able to live my life in the way I want,” said Oyetunde.

When it comes to grappling with the realities of a challenging diagnosis, Oyetunde leans heavily on her Christian faith. “I believe in the healing power of Jesus ... I believe that he can heal me,” she said.

However, “God’s love is beyond my healing. If you read the Bible, sometimes God did the miracle and sometimes he didn’t. I don’t think that removes his love for us.”

Adeiyewunmi (Ade) Osinubi, M.D., is a resident physician in Philadelphia who has written for the Washington Post, HuffPost, Essence, Pediatrics, Teen Vogue, and other publications. Her documentary film “Black Motherhood through the Lens,” examines Black women’s with infertility, childbirth, and postpartum mental health issues.