Rise in aggressive breast cancer among women under 40 may warrant public health attention

There’s been an uptick in late-stage and invasive breast cancer among women under age 40 over the last decade, a trend that may warrant public health attention, radiologists warned Wednesday.

This patient population is typically not screened for the disease, with some medical societies recommending regular mammograms starting as late as 50. Yet, analyzing data from younger women treated at New York-based Weill Cornell Medicine, researchers discovered some eye-opening findings, according to an analysis published in Clinical Imaging.

Only about 200 women under age 40 were treated for breast cancer at the institution between 2007 and 2018. But the proportion of that population diagnosed with invasive carcinoma leapt from 78% in the first five years, up to 91% between 2013-2018. There was also a higher proportion of patients diagnosed with an advanced form of the disease (stage 3-4) in the two periods, jumping from 2% up to 24% during the back-half of the study period.

While there was no statistically significant increase in the overall rate of breast cancer among younger women, first author Katerina Dodelzon, MD, and colleagues believe these numbers deserve additional scrutiny.

“Potentially due to increasing lifestyle risk factors contributing to breast cancer, this rise in more aggressive cancers may have detrimental effects both on the individual young woman’s morbidity as well as on a public health level,” Dodelzon, an associate professor and attending physician, and co-authors wrote March 31. “Further investigation of this increase as well as surveillance of a larger population to assess the overall incidence of breast cancer are warranted in order to support the most beneficial screening guideline recommendations.”

About 61% of the women included in the study were diagnosed at Weill Cornell, with the remaining cases were detected elsewhere and treated at the institution. Patients ranged in age from 23 to 39 at an average of 34. About 15% were diagnosed via early screening for reasons such as high-risk genetic predisposition or a close family member with the disease. The other 85% experienced symptoms such as palpable masses, nipple discharge, skin changes or pain.

Dodelzon et al. believe their findings support the argument that screening should start earlier, with risk assessments beginning at 30. They also cautioned that the study was limited by its retrospective and single-center nature, among other factors.

“The increasing incidence of more invasive and higher stage breast cancers in young women under age 40 seen in our study—coupled with consistent evidence that breast cancers diagnosed in women under age 50 tend to be more aggressive and have poorer prognosis—lend further support to the argument of the importance of starting screening earlier than age 50,” they wrote.

You can read the rest of the study in Clinical Imaging here.