Breast Cancer Prevention in Young Women: Risk Assessment, Lifestyle Modifications, and Early Detection Strategies

Breast cancer in young women, conventionally defined as those diagnosed before age 40, represents approximately 5%–7% of all breast cancer cases but carries a disproportionate psychosocial and prognostic burden. This narrative review examines evidence-based prevention strategies within a three-tiered prevention framework. Primary prevention strategies include maintaining a healthy body weight, regular physical activity, alcohol reduction, breastfeeding promotion, minimizing unnecessary hormonal exposures, and growing awareness of emerging risk factors, including cannabis use; public awareness and health literacy programs are integral to this tier. Secondary prevention encompasses risk-stratified screening approaches tailored to individual risk level; current guidelines now support mammography initiation at age 40 for average-risk women, while high-risk women benefit from earlier combined mammography and magnetic resonance imaging surveillance, with explicit acknowledgment of potential screening harms, including overdiagnosis. Tertiary prevention addresses management of hereditary cancer syndromes through genetic counseling, cascade testing, risk-reducing medications – recognizing that chemoprevention availability varies internationally – and prophylactic surgery. Risk assessment integrating family history, validated prediction models, and polygenic risk scores enables identification of individuals requiring intensified intervention. Implementation barriers, including limited awareness, provider knowledge gaps, healthcare access inequities, fertility concerns, and psychosocial distress, necessitate multilevel strategies and culturally tailored approaches. Future advances in precision prevention, digital health, and implementation science hold considerable promise for improving outcomes in this population.