Cancers in Women in Their 20s
Women in their 20s are most commonly diagnosed with thyroid cancer, melanoma, breast cancer, cervical cancer, Hodgkin lymphoma, and ovarian germ cell tumors, with the cancer distribution in this age group being distinctly different from both younger children and older adults. 1, 2
Most Common Cancer Types by Frequency
Epithelial Cancers (Increasing Sharply in the 20s)
- Thyroid cancer begins to increase sharply among young women in their 20s and is one of the most common cancers in this age group 2
- Breast cancer starts to increase sharply among young women in their 20s, though it remains relatively uncommon compared to older age groups 2
- Cervical cancer incidence begins rising in the 20s, with 4% of all cervical cancer cases diagnosed in women aged 25-29 years 4
- Only 0.8% of cervical cancer cases occur in women aged 20-24 years 4
- Ovarian cancer specifically ovarian germ cell tumors, occur more commonly in younger women between ages 10-30 years 4
Hematologic and Other Malignancies
- Hodgkin lymphoma is among the top cancers in the 15-29 age group 1
- Melanoma is a leading cancer type in this age group 1, 2
- Melanoma rates are significantly higher among females than males between ages 15-39 2
- Non-Hodgkin lymphoma occurs in this age group but is less common than Hodgkin lymphoma 1
Critical Age-Related Patterns
The Epithelial Cancer Transition
- Epithelial cancers become the predominant cancer type after age 25 years in women, representing a major shift from the non-epithelial cancers that dominate in younger adolescents 2
- This transition occurs much earlier in women (age 25) compared to men (age 40) 2
Racial Disparities
- Non-Hispanic White women have the highest overall cancer risk during ages 15-29 years 1
- However, Non-Hispanic Black women have significantly higher breast cancer incidence in their 20s and 30s compared to White women 3
- Asian and American Indian/Alaska Native women have the lowest overall cancer risk in this age group 1
Screening Implications for Women in Their 20s
Cervical Cancer Screening
- Begin cervical cancer screening at age 25 years according to the most recent American Cancer Society guidelines 4
- The burden of cervical cancer in women aged 20-24 is relatively small, with many cases occurring in high-risk immunosuppressed women 4
- Exception: Women with HIV should begin screening at age 21 or one year after sexual debut, whichever comes first 5
Breast Cancer Awareness
- Breast self-examination is an option for women starting in their 20s, though research shows it plays a small role in finding breast cancer compared to incidental discovery 4
- The key is for women to be aware of how their breasts normally look and feel and not ignore any changes 4
- No routine mammographic screening is recommended for average-risk women in their 20s 4
No Routine Screening for Other Cancers
- Endometrial cancer screening is not recommended for average-risk women in their 20s, as the median age at diagnosis is 60 years 4
- Ovarian cancer screening is not recommended for average-risk women in their 20s 4
Important Clinical Caveats
Causation in Young Women
- The majority of cancers in women under age 30 appear to be spontaneous and unrelated to environmental carcinogens or family cancer syndromes 1
- Family cancer syndromes account for less than 5% of cases in this age group 1
- Notable exceptions include melanoma (UV light), cervical cancer (HPV), and lymphomas (EBV, HIV) which have clear environmental/infectious causes 1
Prognosis Concerns
- Survival improvement trends for cancer diagnosed in the 15-29 age group have lagged behind all other age groups over the past 25 years 1
- Males have worse prognosis than females in this age group 1
- African American/Black women have 20% worse survival compared to non-Hispanic White women by 5 years after diagnosis 1