More Young Women Developing Advanced Breast Cancer

Metastatic breast cancer incidence increasing among women under age 40

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Breast cancer should not show up in women in their 20s and 30s. But it does. And the disease shouldn't be more deadly in younger women than it is in older women. But it is. The trends for these sad facts aren’t looking good.

Advanced breast cancers that have spread into other areas of the body are becoming more common in women ages 25 to 39. The number of women diagnosed with this life-threatening cancer has steadily increased over the past 34 years.

When breast cancer shows up in young women, it’s more aggressive and more deadly than the disease that appears in women over the age of 50.

One breast cancer expert thinks physicians should be trained to manage breast lumps - a move he says could save lives.

"Whatever your age, if you notice any changes in your breasts, see a doctor right away."

Rebecca H. Johnson, MD, of Seattle Children's Hospital and University of Washington, Seattle, led a team of researchers who looked at the incidence of breast cancer and survival rates as a function of age and severity of disease at the time of diagnosis.

Researchers looked at data from three US National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) registries for the years 1973-2009, 1992-2009, and 2000-2009.

The registries define localized breast cancer as being confined to the breast. Regional breast cancer is disease that has spread to nearby tissues, such as lymph nodes and chest wall. Distant disease is breast cancer that has spread to the bone, lungs, brain or other organs.

Here’s what the study discovered:

  • In women 25 to 39 years old, incidence of distant breast cancer has nearly doubled, climbing from 1.53 per 100,000 in 1976 to 2.90 per 100,000 in 2009.
  • These rates equate to a compounded 2.07 percent per year increase over the 34-year study period.
  • The greatest increases in distant breast cancer were seen in the 24-34 age range - 2.24 percent per year.
  • Incidence of distant disease declined at five-year intervals until no significant increase was seen in patients aged 55 and older.
  • Increases were seen in all races and ethnic groups since 1992, when ethnic data was first gathered.
  • Upward trends were seen in women living in both metropolitan and non-metropolitan areas.
  • Breast cancers driven by estrogen – estrogen-receptor positive (ER+) – grew faster than ER negative breast cancers.
  • Five-year survival for distant disease in 25- to 39-year-old women was 31 percent according to the latest SEER data, compared to an 87 percent five-year survival rate for women with local or regional breast cancer.
  • The lowest five-year survival rates were seen in 20- to 34-year-old women.

Breast cancer specialist Christopher O. Ruud, MD, of the Austin Cancer Centers, thinks this is an opportunity for physicians. “Breast cancer is more aggressive in the young. It would be a fair assumption that most of these women present with palpable (can be felt with exam) disease. Only about 10 percent of all breast masses are malignant. Training physicians in managing breast masses could decrease mortality,” Dr. Ruud told dailyRx.

The outlook is not good. “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,” the authors wrote.

This study appeared February 26 in JAMA. A Seattle Children’s Guild Association Teen Cancer grant helped to fund this research.

Two of the authors reported financial relationships. Dr. Johnson has served on a board for Critical Mass Young Adult Cancer Alliance and has been a speaker at the Leukemia and Lymphoma Society AYA Survivorship Conference. Dr. Bleyer is a consultant and speaker for Sigma-Tau Pharmaceuticals.

Reviewed by: 
Review Date: 
February 26, 2013
Last Updated:
August 14, 2013