Is advanced breast cancer really increasing in younger women?


Debu Tripathy blog image

A high-profile article was published recently showing a small but statistically significant increase in the rate younger women, aged 25-39 diagnosed with breast cancer with distant metastasis. Published in the Journal of the American Medical Association (JAMA), it's made quite an impact (you can read the full article here). But what are we to make of this, and should anything be done? Should we be alarmed? Well, probably not at this point – it may not even be real. First of all, this information comes from cancer registry data, which is very good at capturing data at the time of diagnosis, but not long-term follow-up (other than death). So this is really looking at the less common situation of women who actually present with metastases at the time of their original diagnosis – which only happens about 5 to 10 percent of the time, and perhaps more so in women who do not have access to health care and present with higher stage cancers.Second, the overall numbers are very small – going from 1.53 to 2.21 cases per 100,000 women per year from 1976 to 2009. In the same period of time, there was an also an increase, although small, in this measure for women age 40-54, but not for those age 55 to 84. Finally, there has not been what would be an expected corresponding disproportional increase in death due to breast cancer reported among younger women over this timeframe, so other causes, such as more aggressive use of CT and PET scans in younger women could account for this - such that the true incidence is not changing, we are just being made aware of it more due to scanning.Of course, these data do not tell us WHY we might be seeing this increase, or whether we can even verify it. So for the moment we need to look at other information sources and worldwide statistics. We also have to determine if there might be addressable causes, such as limitations of access to care in this population, known as AYA (adolescent and young adult). AYAs do have more barriers to care and other studies have shown that they have not benefited as much with improvements over time in cancer mortality compared with pediatric and older adult populations. More AYAs have no or limited insurance. They are also more mobile and their medical follow-up may be inferior. While this report should not cause alarm or even affect any of our care guidelines, it may be a wake-up call to truly understand what might be driving this.

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