Study: More Young Women Being Diagnosed with Advanced Breast CancerFeb 26, 2013
Editor’s Note: Revised February 27, 2013 to add additional information.
An analysis of breast cancer trends in the US has found that new cases of advanced breast cancer are increasing among women ages 25 to 39. The finding is especially troubling because breast cancer in younger women tends to be more aggressive and has lower survival rates than breast cancer in older women.
Researchers from University of Washington, Seattle and Central Oregon and Oregon Health and Science University, Portland analyzed medical records from the US Surveillance, Epidemiology, and End Results (SEER) registries between 1976 and 2009. The SEER program of the National Cancer Institute collects data about cancer diagnoses and survival in the US.
The researchers found that since 1976, there has been a small but steady increase in cases of breast cancer that has spread to other organs (metastasized) at the time of diagnosis in women ages 25 to 39. The increase averages to a little more than 2% per year. According to lead researcher Rebecca H. Johnson, MD, there were about 250 cases of metastatic breast cancer among that age group in 1976, and about 800 cases a year in 2008-2009. The analysis focused on the numbers, but did not investigate the cause of the increase.
Johnson said, “I think it’s the subject of future studies to look at why this change is occurring. I think the rapidity of the increase suggests possibly the change could be due to something toxic in the environment rather than a genetic cause.”
Len Lichtenfeld, MD, deputy chief medical officer of the American Cancer Society, also believes more research is needed in this area. Lichtenfeld said, "It is important we continue research to understand what is contributing to this observation. Although the study’s authors and other experts—including those from the American Cancer Society—may have some thoughts, the reality is that at this point we do not have the facts to answer the question as to cause. Some reasonable areas for investigation may include childhood obesity, environmental exposures, and delayed childbearing among others.”
Too young for mammograms
Despite the increase, the chances of a young women developing metastatic breast cancer is still very low. Lichtenfeld said the evidence does not support regular screening mammograms for women before age 40.
"It is important to point out that this increase is only in the diagnosis of advanced disease, not in localized or regional stages of breast cancer in women under age 40,” said Lichtenfeld. “And of particular importance is that there is nothing in this study that suggests routine breast cancer screening for women in this age group at average risk is either appropriate or justified."
Johnson said that even though only 1 in 173 American women will get breast cancer before they turn 40, most people by the age of 40 will know someone else who did get it.
“The message is young women can and do get breast cancer,” said Johnson. “Women need to be aware that breast cancer can happen in this young population and act promptly if they find a lump or have other symptoms. If patients have symptoms, doctors need to evaluate them in a timely fashion and not watch and wait, because cancer can happen.”
Lichtenfeld agrees that women need to report any breast changes to a health care professional, and that health care professionals need to evaluate any changes carefully.
Women in their 20s and 30s should also have breast exams by a health care professional about every 3 years, according to American Cancer Society guidelines. The Society recommends having yearly mammograms and breast exams starting at age 40.
The study was published in the February 27, 2013 issue of the Journal of the American Medical Association.
Incidence of Breast Cancer With Distant Involvement Among Women in the United States, 1976 to 2009. Published in the February 27, 2013 issue of the Journal of the American Medical Association (Vol. 309, No. 8). First author: Rebecca H. Johnson, MD, Seattle Children’s Hospital, University of Washington, Seattle.