We Want Answers!

Posted on: August 25th, 2023 by admin 1 Comment
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recent paper in JAMA Network Open, entitled “Patterns in cancer incidence among people younger than 50 years in the US,” analysed data from the National Cancer Institute. A total of 562,145 patients diagnosed with early-onset cancer during a ten-year period between 1 January 2010 and 31 December 2019 were identified and included in the study. As can be seen at right (© JAMA), the cancer incidence for females was significantly higher than males while the incidence for females increased slightly and that for males decreased during the surveillance period.

When considered by organ system, breast cancer has the highest incidence and has increased slightly over the ten years (seen below left, © JAMA). This increase did not apply to older women, however, where there was no change. Rather, the rate of late-stage breast cancer diagnoses in women under the age of 40 increased by about 3 percent per annum for the study period.

These findings led to an article published earlier this week in The Washington Post entitled “More young women are getting breast cancer. They want answers.” As breast radiologist Dr Debra Monticciolo commented, “We have to get out of the idea of, ‘Hell, you’re young, it can’t happen to you.’ It does happen to young women, and clearly, it’s affecting their survival.” The problem, though, is that there are currently no guidelines for early detection of breast cancer in younger women. Mammograms are only recommended for women over age 40, while routine clinical breast examinations, either by the woman herself or by her doctor, have no proven benefit.

Monticciolo strongly believes all women should receive a risk assessment by a qualified professional at the age of 25. Those who are found to be at high risk should then have access to screening, either mammography or ultrasound or both imaging modalities. As highlighted in the article, younger women tend to be diagnosed with later stage and more aggressive breast cancers. It’s no wonder they want answers!

While genetics is a known risk factor, it does not explain the trend, but other contributing factors could include early menstruation and delay in getting pregnant until age 35. Further risk factors include diet, alcohol consumption, weight, and environmental exposures. An aggressive cancer in someone who is young can be particularly devastating. That’s why Dr Leticia Varella, a breast oncologist in Boston (seen right), is adamant more research on screening is needed, saying, “Young women should never be told they are too young to get breast cancer.”

One Response

  1. Daniel Kopans, M.D. says:

    The reason that the age of 40 is supported as the starting point for mammography breast cancer screening for women is that the randomized, controlled trials (RCT) only included women ages 40-74. The only data that the major guidelines groups will accept are from RCT’s. There is no magic in the age of 40. Years ago a study from Sloan Kettering in which women were screened in their late 30’s
    (Liberman L, Dershaw DD, Deutch BM, et al. Screening mammography: value in women 35–39 years old. AJR Am J Roentgenol 1993; 161:53–56.)

    They showed that the breast cancer detection rate was the same as for women in their early 40’s.