Is Metastatic Breast Cancer on the Rise in Young Women?

Update: 3/2/2013: Ann Partridge, MD, director of the breast medical oncology at the Dana Farber Cancer Institute, with excellent questions on the study data and findings: see below.

Update:  On Thursday, February 28, #BCSM co-moderator Deanna Attai, MD added more clarity in this appearance on @MyFoxLA

Something long noted in breast cancer circles was study coming out today in the Journal of the American Medical Association that found a very small, but statistically significant, increase in the number of young women between the ages of 25 to 39 who are diagnosed with metastatic breast cancer.  

The change noted comes down to an absolute increase of 1.37 women per 100,000 women over 34 years, or approximately 2 percent per year. The same increase was not noted in older women and was consistent across all ethnic and socioeconomic groups.  One surprise is that there was a more pronounced increased in women with hormone sensitive breast cancer, rather than ER- cancer. 

Why this is happening is yet to be determined and was not the purpose of the study. We are left with more questions than answers.  

Studies are often complicated, and this one, a retrospective, observational analysis of three different sets of incidence and survvial rates from the US Surveillance, Epidemiology and End Results (SEER) program at the National Cancer Institute from l976 through 2009 - even more so. The collection of SEER data began in l973, yet the study years ran from 1976 - 2009.  Even the largest data set used, SEER 18, only comprises 28 percent of the US population.  SEER 9, by comparison, only includes 9.5% of the population, and the third set, SEER 13, 15 percent.  

Study author Rebecca Johnson, MD, Seattle Children's Hospital and University of Washington, wrote in the study that, "Whatever the causes - and likely there are more than 1 - the evidence we observed for the increasing incidence of advanced breast cancer in young women will require corroboration and may be best confirmed by data from other countries.  If verified, the increase is particularly concerning, because young age itself is an independent prognostic factor for breast cancer."

Vast improvements in diagnostic imaging between 1976 and now, staging work-ups and other factors come into play.  "The changes noted may be multifactorial," said Jennifer Litton, MD, of The University of Texas MD Anderson Cancer Center, "with changes in rates of incidence and younger women having more aggressive underlying biologies  coupled with potentially other genetic factors. What is much more clinically important than this would be changes in overall survival."

Breast cancer advocates concur. "These numbers do not change it for anyone who dies of this disease today," said Joy Simha, co-founder of the Young Survival Coalition. "We need to focus on finding the cause of breast cancer so we can make change happen."

Another aspect confirms what was discussed in last night's #BCSM discussion. "What the study enforces to me is the need for all young women to be aware of changes and to be proactive about their health," said Deanna Attai, MD, breast surgeon and #BCSM comoderator.  "Doctors need to be educated that there's no such things as "too young for breast cancer." No such thing."

For women with breast cancer today?  Nothing changes.  If you're in treatment today? Nothing changes.  But if you're watching the larger picture of cancer incidence in the United States in a population that already suffers unduly from a breast cancer diagnosis?  Heads up.  This is a signal we need to heed. 

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3/3/2013:  Comments from Ann Partdridge, MD:  breast medical oncologist from the Dana Farber Cancer Institute in Boston and medical advisor to the Young Survival Coalition: 

It is not clear from the study "whether the overall rate of breast cancer in young women is actually increasing," said Ann Partridge, MD, a medical oncologist from the Dana-Farber Cancer Institute and Harvard Medical School in Boston, Massachusetts. In other words, the study does not indicate whether the increase in advanced disease means that there is an overall increase in disease in young women.

That is important because other studies using SEER data have indicated that the rate of overall disease is stable in young women, said Dr. Partridge.

She pointed out that Dr. Johnson and colleagues found that the rates of localized and regional disease held steady in young women. Therefore, because they found an increase in advanced disease, thereshould be an overall increase in young women, she said.

However, the researchers "did not show/discuss data on overall rates of breast cancer in young women," Dr. Partridge wrote in an email. This omission, combined with the fact that the study findings might be in conflict with findings from other studies using SEER data, "leads me to wonder about the article," she said.

Check out the rest of the article and others: 

From Liz Szabo, USA Today:  "Deadly Breast Cancers are Rising in Young Women"

From the NYTimes:   "Study Finds More Breast Cancer at Young Age"

From NPR:  "Younger Women Have Rising Rate of Advanced Breast Cancer Study Says"