February 27, 2013

Younger Women Being Diagnosed With Advanced Breast Cancer At Alarming Rate

Lawrence LeBlond for - Your Universe Online

Breast cancer in the US is the second most deadly form of cancer in women and is expected to kill more than 39,000 Americans in 2013, according to the National Cancer Institute [NCI]. Many of those deaths could come from the younger generation as a new study points out an unsettling trend: an uptick in diagnoses of metastatic breast cancer in women ages 25 to 39.

While progress has been made in overall reduction of cancers in the US, the new study, published in the latest edition of JAMA (formerly known as the Journal of the American Medical Association), reports a small but statistically significant increase in the number of incurable breast cancer cases in young women.

The number of this young group of women who are diagnosed with metastatic breast cancer — cancer that has spread to other organs in the body by the time it is discovered — rose nearly 3.6 percent per year from 2000 to 2009, according to the study.

The authors, led by Rebecca H. Johnson, MD, of Seattle Children´s Hospital and University of Washington, Seattle, noted this trend is more unsettling due to the fact that they are not finding a corresponding increase in older women, something that they had expected to find. Also, they were not able to pinpoint what may have caused the apparent increase in breast cancer in this younger generation.

In background information included in the study, the authors wrote the following:

“In the United States, breast cancer is the most common malignant tumor in adolescent and young adult women 15 to 39 years of age, accounting for 14 percent of all cancer in men and women in the age group. The individual average risk of a woman developing breast cancer in the United States was 1 in 173 by the age of 40 years when assessed in 2008. Young women with breast cancer tend to experience more aggressive disease than older women and have lower survival rates. Given the effect of the disease in young people and a clinical impression that more young women are being diagnosed with advanced disease, we reviewed the national trends in breast cancer incidence in the United States.”


Metastatic breast cancer trends in young women began as early as the mid-1970s, yet the increases were very minute until about the last decade, when more and more cases began piling up.

"It is a big increase, and it's accelerating over time, and it's hitting the youngest women," Johnson, an oncologist at UW in Seattle, told Liz Szabo of USA TODAY.

Yet, she cautioned that young women shouldn´t be overly panicked, noting that breast cancer at any stage is not common before age 40. The number of cases of young women diagnosed with advanced stage disease rose from 250 per year in 1976 to about 850 per year in 2009, Johnson explained.

In the statistical study, Johnson and her colleagues found that the largest increases were in the youngest women, those from ages 25 to 34; slight increases were seen in women ages 40 to 54, but no increase was seen in older women.

The study results were compiled from 3 US NCI Surveillance, Epidemiology, and End Results [SEER] registries. The registries provide data spanning from 1973-2009, 1992-2009 and 2000-2009.

An alarming fact is that the age group experiencing this increasing metastatic breast cancer trend already has the “worst prognosis, no recommended routine screening practice, the least health insurance, and the most potential years of life,” according to the authors.

The researchers further found that the trend increased in all races and ethnicities assessed since 1992, the first year SEER data became available for that set. Increases occurred in both metropolitan and non-metropolitan areas, and remained statistically significant across African-American and non-Hispanic White populations. And incidence increased more in women with estrogen receptor-positive subtypes than in women with the negative subtypes.


Johnson acknowledged that the study needs confirmation by other researchers in the US. She said studies should also be conducted in other countries to see if data abroad match US statistics.

Dr. J. Leonard Lichtenfeld, deputy chief medical director at the American Cancer Society, said it is studies like this that “get your attention.”

"It may not be a big number today, but you have to wonder, 'Is this a trend that's continuing over time?' Then the numbers start to take on a new meaning," he said in an interview with USA TODAY.

Increases seen in any cancer is concerning, especially since the overall rate of cancer deaths of all types has fallen by 20 percent over the past two decades, he explained. And breast cancer incidence rates have generally been stable for the past few years.

Increased screenings have partly led to an influx in breast cancer diagnoses over the past 20 years. But from 2002 to 2003, there was a seven percent decrease in incidence of breast cancer. This has been attributed to millions of women who stopped using hormonal therapies after a landmark study linked the pills to breast cancer and heart attacks.

According to American Cancer Society data, there were an estimated 227,000 breast cancers of all kinds in American women in 2012.

Johnson said it is possible that doctors and younger women are less likely to look for signs of breast cancer because they do not expect to find such a disease in women under the age of 40. But many researchers are concerned that girls today are entering puberty much earlier than in the past. And when menstruation occurs at a younger age, the risk of breast cancer also occurs sooner. However, it is not known if this trend is directly related to the increase seen in metastatic cancer in younger women, noted Johnson.


Johnson was one of those younger women who were diagnosed with metastatic breast cancer. She said that cancers in younger women likely grow very quickly; and in her case, such was true. Diagnosed when she was in her mid-20s, the cancer had already spread to other organs at the time of diagnosis.

She said that breast cancer is more aggressive in younger women as well. Women in the 25- to 39-year-old age group are 40 percent more likely to die of their disease than postmenopausal women.

Many experts believe that breast cancer is a much different disease in younger women, perhaps caused by different risk factors, according to Patricia Ganz, a breast cancer specialist at the Jonsson Comprehensive Cancer Center at the University of California, Los Angeles [UCLA].

Pregnant women have huge hormonal fluctuations that could possibly fuel cancer, and these women are potentially at risk for developing breast cancer for up to five years after giving birth, noted Ganz. He added that women who have their first child at 35 have a much higher risk of breast cancer than if they had never given birth.

Although important advances have been made in the treatment of metastatic breast cancer, prolonging women´s lives for years, the disease itself is currently incurable. Most women (87 percent) who are diagnosed early, before the cancer has a chance to spread to other organs, survive five years or longer. But only 31 percent of those diagnosed with metastatic cancer live that long, according to Johnson´s study.


The only good advice Johnson and her colleagues currently have for young women are to see a doctor quickly if they find lumps, have pain or there are any other abnormalities. The biggest thing is for young women not assume they cannot have breast cancer because they feel they are too young and too healthy. Also, it is important for these young women to know that just because there is no family history of the disease it doesn´t mean they are safe from the disease.

Johnson noted, however, that there is no evidence that screening helps younger women who have an average risk for the disease and no symptoms.

“We´re certainly not advocating that young women get mammography at an earlier age than is generally specified,” she told Denise Grady of the New York Times.

Experts differ on when screening for breast cancer should begin; most agree it should begin at age 40, but others say at age 50.

But screening aside, more research is needed before doctors can be sure breast cancer rates are really on the rise.

Lichtenfeld himself believes the increase is real.

"We want to make sure this is not oversold or that people suddenly get very frightened that we have a huge problem,” he said. “We don´t. But we are concerned that over time, we might have a more serious problem than we have today.”

"We're left with an observation without an explanation," Lichtenfeld told USA TODAY.

He said that being diagnosed at such a young age is especially frightening because many young women are mothers with young children under their wing who depend on them.

"It's a terrible situation," Lichtenfeld said. "These women are mothers, wives, members of families. They are caregivers. They're just getting their lives started. That's what makes it so difficult."

Johnson said her own battle with cancer is what led her to look into the statistics on the disease in young women. Now, 17 years after being diagnosed, she said she is an advocate for young women everywhere who may be enduring their own battle with cancer.

“It just struck me how many of those people there were,” she told the NY Times.


Of interesting note, is the fact that the study findings only applied to women who had metastatic breast cancer at the time of diagnosis, and did not imply that women who already had early-stage cancer faced an increased risk of advanced disease, explained Michelle Esser, a spokeswoman for Young Survival Coalition, an advocacy group for young women with breast cancer.

“We´re looking at this data with caution,” said Esser. “We don´t want to invite panic or alarm.”

Dr. Silvia C. Formenti, a breast cancer expert and the chairwoman of radiation oncology at New York University (NYU) Langone Medical Center, also questioned the study. Although it found an increased incidence of advanced breast cancer, it did not find an accompanying increase in deaths that would be expected.