The pink ribbon has made a difference, says Dr. Elizabeth Comen. Now, as Breast Cancer Awareness Month gets underway, the NYU Langone breast oncologist wants the message to reach the women it has missed, including a growing number who are under 50.

“I actually think that pink ribbon has done a lot,” said Comen, a medical oncologist at NYU Langone’s Perlmutter Cancer Center and co-director of the hospital’s Mignone Women’s Health Collaborative.

Comen acknowledged concerns about “pinkwashing,” when companies cash in on the cause without the money reaching research. But she credited groups like the Breast Cancer Research Foundation and Susan G. Komen with driving philanthropy “that has been behind almost every major advance” in the field.

The results show up in the data. U.S. breast cancer death rates have fallen 44% since peaking in 1989, averting an estimated 546,000 deaths, according to a 2024 American Cancer Society’s annual report. Comen credits both better screening and better treatment.

But diagnoses are moving in the other direction. Breast cancer incidence has risen about 1% a year over the past decade, and 1.4% a year among women under 50, the same report found.

“Where we are at today is making sure that awareness continues to translate to all the populations,” Comen said. That includes men, who can also get breast cancer, underserved communities, and “a rise in breast cancer among young women in the United States that we need to invest more research in.”

In 2024, the U.S. Preventive Services Task Force lowered its recommended starting age for mammograms from 50 to 40, advising screening every two years for women 40 to 74.

Comen’s advice for a 40-year-old in New York starts with a conversation, not a scan. She recommends asking a doctor to assess your personal risk, including with tools like the National Cancer Institute’s Breast Cancer Risk Assessment Tool. Some women at higher risk need to start screening before 40.

“We say start at age 40 if you’re average risk and talk about yearly mammograms at that age,” she said. Later adding that catching breast cancer early is “incredibly important” to improving outcomes.

“I don't think we know,” Comen said about the rise in diagnoses among younger women. “I think it's multifactorial, and that’s what we need to be studying.”

She listed the questions researchers are asking, such as: Are environmental exposures to blame? Diet and ultra-processed foods? A more sedentary lifestyle? And why are girls getting their periods earlier, giving them more lifetime exposure to estrogen?

That last trend is well documented. A 2024 Harvard study of more than 71,000 women in the Apple Women’s Health Study found the average age of a first period fell from 12.5 for women born between 1950 and 1969 to 11.9 for those born between 2000 and 2005. The share who started before age 11 nearly doubled, from 8.6% to 15.5%.

In her 2024 book, “ All in Her Head ,” Comen traces how medicine has long dismissed women’s symptoms. In breast cancer, she said, younger women bear the brunt of it.

“Oh, you’re too young, or oh, you’re pregnant, or this is mastitis from breastfeeding,” Comen said, describing what young patients are often told. "These are areas where we really don't want to be dismissing women."

Delays are common in this age group. In a Canadian study of 1,148 women diagnosed at 40 or younger , about one in three waited more than four weeks after noticing a symptom before first contact with the health-care system. Reasons included waiting for their next period and reassurance from another practitioner.