Some are small lumps which grow over time. Those are likely to be acquired when you are older. My mother (and grandmother) had that kind. Both were post-menopausal, both were slow growing, so could easily be treated. My grandmother, however, still died with metastatic breast cancer (it was not specifically what killed her, but it had spread throughout her body into her bones, which can be quite painful).
But even that is complicated. Given her history, my mother was quite careful about monitoring - both BSE (breast self-exam) and regular mammograms. She had had a mammogram within a month before finding the lump (more accurately my father found the lump - her own regular BSE did not). Once it was found, and they knew exactly where it was, the lump still did not show up on a mammogram - even when they used a needle during the mammogram to pinpoint its location. The doctors were certain it wasn't cancer, but did a lumpectomy anyway.
And, to make it more complex, she had fibrocystic breast disease - a condition which means there are tons of lumps in her breast all the time, and they change over time, so you also have to be adept at identifying new lumps from the ones which are there all the time - or which are new and different from the new fibrous ones.
My mother also had a second kind of breast cancer, discovered completely by accident. They did a minor surgical procedure to treat a different breast disorder and in the tissue they removed they found a 1 mm clump of invasive cancer cells in one of the milk ducts. She would not have felt that lump for years. (Likely slow growing, though, since it was also post menopausal - but that is how they start).
She has now had a double mastectomy - she could have gotten by, in each case, with a lumpectomy (and they were 10+ years apart) - but given her history which includes nearly a dozen lumpectomies, she was ready to be done with breast surgery.
My spouse also had an accidental discovery of cancer - one of the other kinds which people sometimes get preventative double mastectomies for. She had a lumpectomy - which turned out to be a cyst. But in the tissue they discovered LCIS (lobular carcinoma in situ). In situ means that particular cancerous clump would not grow - but when you have LCIS your risk for invasive breast cancer is 30-40% (as opposed to around 13% on average). She chose to be part of the Tamoxifen studies, which were cut short early when they had such dramatically positive results they determined it was unethical to continue "treating" one group with placebos. She still has both breasts, and no cancer.
And that gets us back to the question about this specific kind of cancer -
There are more than one kind associated with these gene mutations. Most of them often strikes young, before the age at which mammograms are routinely performed. Angelina Jolie is 37 - most mammograms start with a baseline at 40, but are not performed regularly until 50 (not sure on that - given my risk the routine ones started early). Mammograms aren't perfect - as my mother's experience shows - but they catch a lot of cancers early IF you have reached the age at which screening starts. And young people believe they are invincible - although I have regularly done BSE (partly because of my inherited risk), I would venture to say that only a small percentage of young women actually do.
And, any cancer which strikes early is typically more aggressive (grows faster) than other cancers. So - if you are not being screened, or if the screening fails like it did for my mother, are not doing regular BSE (or are and haven't figured out which of many lumps are old friends and which are new and cancerous) you may not find the small lump in time to treat it.
But - as to prevention - mastectomies are not perfect. This cancer can develop in any breast tissue. Mastectomies are not perfect - they always leave tissue behind. If you have a double mastectomy the motivation to be diligent about screening can fall off (after all, you've already taken care of the problem), so it may still sneak up on you.
It is not an easy decision - and not one I am likely to face since I am already past menopause - which means I will likely have the luxury of time. I don't know what I would do in Angelina Jolie's place - but given what I do know about breast cancer, it is not an unreasonable choice. (I do have one fewer ribs than I should, because one rib was removed to prevent larger deadly problems later that can sneak up silently - but on the opposing side with similar risks I still have the rib.)
Hope that helps - we often think of breast cancer as one thing, but it is really an entire collection of diseases. Some are slow growing, but others can grow fast enough that it would take a considerable amount of luck to catch them early enough to save your life.
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