New Study – Young Women and Breast Cancer

I haven’t been following the news quite as closely as I used to about breast cancer, but this story from NPR’s Morning Edition caught my attention this morning.  

Johnson decided to do a national study. It’s published this week in the Journal of the American Medical Association.

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It found that metastatic breast cancer — disease that spread to the bones or other organs — tripled in incidence among women younger than 40 between 1976 and 2009. These are women whose cancer had already spread by the time it was diagnosed.

The study just shows what many have suspected — the incidence of breast cancer in young women is increasing.  It does not say why, although Dr. Len Lichtenfeld of the American Cancer Society did speculate.

[O]ne thing that famously distinguishes women of this generation is that they’ve been delaying childbirth. And most of the cancer increase involves tumors that are sensitive to the hormone estrogen, levels of which soar during pregnancy.

“There is some thinking on our part that this is related to perhaps delay in childbirth or to the actual effects of pregnancy itself in this age group,” he says. “That may have something to do with the hormonal relationship.”

Lichtenfeld says another possible cause is toxic chemicals in the environment. Or possibly increasing obesity — though obesity in adolescents and young women may actually protect against breast cancer.

Something I want to point out about reporting of this story.  NPR said that these are women whose cancer had already spread by the time it was diagnosed.  Reading the JAMA article, I’m not sure that’s true.

Since 1976, there has been a steady increase in the incidence of distant disease breast cancer in 25- to 39-year-old women, from 1.53 per 100,000 in 1976 to 2.90 per 100,000 in 2009.

It doesn’t say that the initial diagnosis was metastatic breast cancer (mbc), at least by my reading.

EDIT:  According to Jody (in the comments), this was a study of those who were initially diagnosed with mbc, so I stand corrected.  However, that just leads me to wanting more information, like about how many women diagnosed with early stage cancer went on to develop metastatic disease?  

Only that these women had mbc, or distant disease breast cancer as they call it here.  Why split hairs?  Because many in the cancer advocacy world fight against the ubiquitous perception that breast cancer caught early is curable.  That was the common wisdom behind the campaign for early detection.  The reality is much more complicated, as Dr. Susan Love explains.

Some of them are so “good” that they will never metastasize (spread throughout the body). And that means it doesn’t matter when you find them. They just don’t have the ability to cause someone to die of breast cancer. Others are very “bad” and so aggressive that no matter when you find them—which means even if you find them when they are still very small—they have already begun to wreak havoc. These are the types of cancers that cause women to die of this disease. Still others, probably about 30 percent, have the potential to become “bad” if not stopped early.

Still, this false perception, or perhaps incomplete perception, perpetuates.  I understand why – we want to believe that cancer is predictable and that we can control it if we do it all according to the textbook.  The reality is unsettling.

In an indirect way, I feel that NPR’s reporting of this story undermines the truth of breast cancer by subtly reinforcing this idea that the cancer is caught late.  Sometimes when a cancer is diagnosed, it has already metastasized.  But sometimes, a women is diagnosed with an early stage breast cancer, does everything “right,” and it still returns as metastatic breast cancer.

Additionally, this article makes no mention of mortality at all.  If you didn’t know better, you might think that metastatic breast cancer is curable.  As the JAMA article points out, “[t]he most recent national 5-year survival for distant disease for 25- to 39-year-old women is only 31 percent according to SEER data.”  The flip side of that statistic, virtually ALL breast cancer deaths are from metastatic breast cancer.

I know it’s hard to get all that information in a short news story, but as this makes its rounds in the media outlet, let’s keep in mind what is not being said.

(1) We don’t know why this is happening.
(2) We don’t know which breast cancers will metastasize and which won’t.
(3) Very little research is done on metastatic breast cancer, despite it’s deadly nature.
(4) While this rise is concerning, in real numbers it’s pretty rare.  Don’t panic.

1 thought on “New Study – Young Women and Breast Cancer”

  1. I wrote on this yesterday. There was a weird blip in the language of this study. The authors used the SEER language (I have the actual study in front of me): “We used the SEER historic stage A definition of extent of disease at diagnosis, with localized referring to disease confined to the breast, regional to continguous and adjacent organ spread (eg., lymph nodes, chest wall, etc) , and distant disease to remote metastases (bone, brain, lung, etc).

    So unfortuantately yes, they were talking about an very small (but statistically significant – approximately two percent per year) increase of metastatic disease in women 25 – 39 between the years of l976 through 2009. Simple improvements in diagnostic imaging leading to better detection of metastatic disease could explain some of the rise in and of itself. Delayed childbearing? I know the ACS believes this is a factor; and maybe it is, but the increasing incidence of triple negative and disproportionate representation of African American women in this subset makes me wonder.

    The night before Julie Gralow, MD was on #BCSM discussing breast cancer in young women. She had some incredible slides she sent to me which I can’t share: but in essence, in women < <35 with breast cancer 51% are African American. What also struck me with the study: the increased incidence of first diagnosis as metastatic did NOT occur in older women. This more than likely is due to the advent of screeening mammography. It’s a retrospective analysis of data; an important marker; and a lot of further studies need to be done. But it’s a very important flag, and I totally agree with your conclusions. The study wasn’t about determining any whys; only determining whether or anecdotal reports and observations are in fact, true. It looks as if they very well might be. jms

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