Advanced Breast Cancer Striking More Younger Women

More young women are being diagnosed with metastatic breast cancer than three decades ago, according to a recent study in the Journal of the American Medical Association.

The researchers found the rate of metastatic breast cancer increased about 2 percent annually between 1976 and 2009 among younger women.

The metastatic breast cancer rate remains small, rising from 1 in 65,000 to 1 in 34,000 during that time period for women aged 25 to 39. The same trend was not seen among older women, according to the analysis.

The findings affect 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,” the researchers wrote.

Others are noticing the same thing. Archana Ganaraj, MD, breast cancer surgeon on the medical staff at Texas Health Presbyterian Hospital Dallas, said, “The risk of breast cancer in women under 40 is small, but we have seen an increase in younger women diagnosed with distant disease, meaning the cancer has already spread to other organs,” said. “Younger women tend to have a more aggressive form of breast cancer and therefore lower survival rates.”

She said the data from her hospital’s imaging center suggest an increasing proportion of breast cancer patients under 40 years old, rising from 2 percent in 2010 to more than 7 percent in 2012. However, she said she has not seen a proportional increase in Stage 4 cases among young women, which was the focus of the study.

Ganaraj said the increases have been seen nationally by other breast cancer surgeons. She refused to speculate on the reasons for the increase.

“We just don’t know. There are all kinds of guesses: diet, lack of exercise, increased hormone usage,” she said.

Breast cancer represents the most frequent cancer in young women, accounting for about one-third of cancer cases. However, because 93 percent of breast cancers occur in women who are 40 or older, screening is not common among younger women. Tumors in younger women are harder to detect with standard mammography because their breast tissue is dense.  As a result, women under 40 using standard screening mammography have high rates of callbacks for additional testing.

According to a study in the Journal of National Cancer Institute, a theoretical population of 10,000 women age 35-39, about 1,265 would need additional testing, and just 16 cancer cases would be found. That means one in eight breast-cancer screenings would result in false positives.

Most experts believe the breast-cancer risk among younger women is too low to justify the expense, radiation exposure, and anxiety from frequent false-positives. It is also a concern for insurance companies and government insurance programs because of the expense and repeated callbacks for additional testing.

The U.S. Preventive Services Task Force recommends screening every two years for women between the ages of 50 and 74. It does not recommend mammograms for women under 40. However, the American Cancer Society recommends doctors do clinical breast exams every three years beginning at age 20, and recommends annual mammography for women over 40.

Breast cancer is the most common cancer in women, killing 465,000 annually. Several factors place a woman at higher risk, including:

• A personal history of breast cancer or other non-cancerous breast disease.

• A family history of breast cancer, especially if it strikes one’s mother, sister or daughter.

• Significant radiation therapy prior to age 40.

• Evidence of a genetic defect.

• Lifestyle factors, such as tobacco or heavy alcohol use, high red-meat consumption and obesity.

Steve Jacob is editor of D Healthcare Daily and author of the new book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at steve.jacob@dmagazine.com.

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