This week the Journal of the American Medical Association reported that the incidence of young women presenting to doctors with Stage IV breast cancer has been climbing. For those affected by the disease between the ages of 25 and 39, the number who first learn they have cancer when it's metastatic -- spread beyond the breast and nearby lymph nodes -- has roughly tripled since 1976. The findings confirm the fact that breast cancer affects women of all ages. The trend applies to women of various demographic backgrounds including blacks, white and Asian women, people who live in cities and those in rural areas.
Whatever you may think about breast cancer treatment and sometimes overtreatment, awareness or hype, this is sobering news. Still, it's worth keeping in mind that the overall incidence of breast cancer in women under 40 has not changed much since 1975. The total disease rate for the age group held almost steady, in the range of 50 per 100,000 women affected per year, for 34 years. What's emerged, in part with the new study, is a pattern of young women with more aggressive and metastatic tumors who first receive oncology care with Stage IV disease.
My take on the new report -- which adds to the complex picture of breast cancer epidemiology, changing diagnostic methods, new treatments and a better understanding of disease subtypes in recent decades -- is three-fold: First, it's a reminder that we need better science on the causes of breast cancer, that we might prevent it; second, that we need better, less toxic treatments for all women who have disease that can't be managed without a small surgical procedure to remove it; and third, that all women with a breast lump -- at any age -- should be considered at risk. Mainly, it's a call to action.
Some oncologists and other commentators have suggested that delayed, fewer pregnancies among career-bound might account for the new findings. I doubt this; while a woman's reproductive history can influence her life-long risk for developing breast cancer, it's unlikely that it would explain a change in the tumor staging without significantly altering the overall incidence of the disease in younger women. What's much more likely is that environmental, chemical exposures -- hard to measure, and potentially beginning early, in the womb and decades before cancer becomes evident -- are relevant. Research in this burgeoning area of environmental oncology, hard-pressed by industry, needs be bolstered with funds and the public's ear.
For young women with breast cancer, the stakes of treatment are greater -- in terms of potential for life-years saved, and in terms of the risks of therapy. Because the overall rate of breast cancer in women under 40 is low, it's not reasonable to screen for the disease by mammography. The lack of screening for women in this age group is, surely, a factor in the tendency to find cases in advanced stage. Independent of that issue, the need for less toxic drugs is clear: Lopping off a woman's breast or breasts, or part of those, is crude and simple therapy. Just as we have better drugs for HIV, hepatitis C, and so many other conditions than we did in 1980, we should have much better medical treatments for breast malignancies than we do now.
Complacency and patience is not the way to move forward with this disease -- why I support the National Breast Cancer Coalition's Deadline 2020.
Finally, for those physicians who might be reading, and for any young woman who feels a lump, the findings are a reminder that breast cancer does, really, happen sometimes to young women. If you're lucky enough to notice a tumor before it's spread, you might be able to have it removed and treated successfully -- that you might lead a long and full life. As a practicing oncologist, I saw young women who died of this disease, as I have since, too many, in my community at large. Treatments are not yet what they should be, but if you do have breast cancer at any age -- it's too important to ignore.
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