Advanced breast cancer on rise in young women; experts weigh in

February 27, 2013 | by Tami Dennis

The headlines about a rise in advanced breast cancer cases among young women have been attention-getting, to be sure. Based on a study published in the Feb. 27 issue of the Journal of the American Medical Association, the coverage has both mirrored and fed the worry that many women have of the disease.


Advanced breast cancer is on the rise amid young women, new research finds. But sometimes, their symptoms aren't taken seriously. Advanced breast cancer is on the rise amid young women, new research finds. But sometimes, their symptoms aren't taken seriously.


“Advanced Breast Cancer Rising in Young Women?” – WebMD

“Breast cancer among young women increasing” – Los Angeles Times

“Study Sees More Breast Cancer at Young Age” – New York Times

Researchers from Seattle Children’s Hospital and the University of Washington found a small – but statistically significant – increase in the incidence of advanced breast cancer among women ages 25 to 49. “The trend shows no evidence for abatement and may indicate increasing epidemiologic and clinical significance,” they wrote.

Calling the study “very well-done,” Courtney A. Vito, M.D., assistant professor in the Division of Surgical Oncology at City of Hope, nevertheless cautioned that more research is needed before definitive conclusions can be drawn.{C}

“Overall, the total number of young women 40 and younger diagnosed with breast cancer remains low compared to older women over 40, and it is appropriate that mass screening efforts be focused on this older age group,” she told Breakthroughs.  “However, breast cancer awareness with high importance placed on education and access to care for younger women is paramount to combat this relatively uncommon but devastating disease.”

As she told HealthDay, many younger women with symptoms aren’t taken seriously: “"It is not unusual for a woman who is 25 to 39 with a breast lump to have sought consultation with multiple doctors before getting an appropriate work-up," she said.

Another City of Hope expert, breast cancer surgeon I. Benjamin Paz,  M.D.,  offers some additional context in this question-and-answer interview.

How significant is this study?

It is very significant. The incidence of breast cancer in young women was extremely rare in the '70s. Now we include in the differential for every new breast mass. The youngest I have diagnosed was 16 years old.

Did the findings surprise you or is this consistent with what you’ve found?

We have suspected the increase for some years since it is not rare to see young women in our clinics with the diagnosis of breast cancer. Previous attempts to demonstrate an increase had failed.

What, if any impact, might this have on treatment?

Young women pose significant challenges to the treatment of breast cancer. In general, they have more aggressive disease and often they have tumors that are estrogen independent, so they require chemotherapy as their primary adjuvant therapy. This requires that we address fertility and long-term loss of ovarian function, which affects sexuality and interpersonal relationships. Also, frequently young women are not in a stable relationship and the cosmetic effect of the breast cancer treatment might have an impact on their ability to establish new relationships.

What’s the take-home message from this study?

It is not clear the cause of this increase. This cannot solely be attributed to estrogen since frequently the tumors in this age group are estrogen independent. We see these tumors in women with children as well as without a history of pregnancies. Oral contraception does not seem to be a major factor. Finally, it's important to put these results into context since the incidence of breast cancer is still extremely low under the age of 40, with only two to three women affected per 100,000 per year. To put this in perspective, according to the U.S. Census, there are 68 million women in the U.S. Approximately 13,000 developed invasive breast cancer in 2011, which is 3.6 percent of the total breast cancers.

City of Hope's Roberta Nichols contributed to this article.

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