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Incidence of advanced breast cancer increased among younger women
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The incidence of advanced breast cancer among women aged 25 to 39 years increased at a small but statistically significant rate during the past 3 decades, according to study results.
Researchers did not observe a corresponding increase in older women.
Breast cancer is the most common malignant tumor in females aged 15 to 39 years, and it accounts for 14% of all cancer in that age group. Young women with breast cancer tend to present with more aggressive disease and have lower survival rates than older women, according to background information in the study.
Rebecca H. Johnson
Based on a clinical impression that more young women are being diagnosed with advanced disease, Rebecca H. Johnson, MD, medical director of the adolescent and young adult oncology program at Seattle Children’s Hospital, and colleagues analyzed data from three SEER registries to identify national trends in breast cancer incidence.
Incidence of distant disease breast cancer among women aged 25 to 39 years increased from 1.53 per 100,000 in 1976 (95% CI, 1.01-2.21) to 2.9 per 100,000 in 2009 (95% CI, 2.31-3.59), an absolute difference of 1.37 per 100,000, Johnson and colleagues found. The change represents an average compounded increase of 2.07% per year (95% CI, 1.57-2.58) during the study period.
Researchers observed the trend among all races and ethnicities, including statistically significant increases among blacks and non-Hispanic whites. Incidence increased more among women with ER-positive subtypes than ER-negative subtypes.
“The trajectory of the incidence trend predicts that an increasing number of young women in the United States will present with metastatic breast cancer in an age group that already has the worst prognosis, no recommended routine screening practice, the least health insurance and the most potential years of life,” Johnson and colleagues wrote.
The data did not show increased incidence of locoregional breast cancer among young women or increased incidence of breast cancer — regardless of disease stage — among older women.
Five-year breast cancer survival rates as a function of age are lowest among women aged 20 to 34 years, according to the researchers. SEER data show 5-year survival among women aged 25 to 39 years with distant disease is about 31% vs. 87% for women with locoregional disease.
“Whatever the causes — and likely there are more than one — the evidence we observed … will require corroboration and may be best confirmed by data from other countries,” Johnson and colleagues wrote. “If verified, the increase is particularly concerning, because young age itself is an independent adverse prognostic factor for breast cancer.”
Perspective
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Stephen Y. Chui, MD
This report indicates an increase in the incidence young women found to have metastatic disease at initial presentation from around 250 cases per year in the mid-1970s to more than 800 cases per year by 2009. Do we need to worry, or is this report needlessly frightening women?
Breast cancer is not common in younger women, although when it does occur, the effects can be devastating to a woman and her family. Although the observations from this study are statistically significant, the small numbers of cases — an increase of 1.37 cases per 100,000 women — raises the obvious question as to whether this finding is “real”. There is a need to verify whether there is a worldwide trend of an increase in advanced breast cancer occurring in young women.
It should be noted that this study found an increased incidence of advanced disease, but it did not find an accompanying increase in deaths that might be expected as a result. One possible explanation for both of these observations is that the increased use and appropriate application of better upfront staging tests (CT scans, bone scans, etc) after a diagnosis of breast cancer has led to improved identification of those women who have metastatic disease at initial presentation.
Adolescents and young adults (AYA) are defined by the NCI as cancer patients between the ages of 15 and 39 years. Across the entire AYA cancer population, there has been very little improvement in cancer survival rates, and there even has been an increase in the rates of some malignancies over the past few decades. These observations are in stark contrast to the improvements seen in cancer-related outcomes for the overall cancer population in the United States over the same timeframe.
For young women diagnosed with breast cancer in particular, it has been long recognized that the disease is more aggressive and outcomes are worse compared with older women. This report reminds us of the importance of understanding and studying the rare “outlying” breast cancers that occur in the AYA age range. Research needs to be directed toward characterizing the distinguishing features of the biology of tumors that occur in young women, and also finding how genetic and environmental factors contribute to affect breast cancer risk in the AYA population.
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