Wednesday, December 24, 2014

Women with Cancer: Is Metastatic Breast Cancer on the Rise in Young W...

Is Metastatic Breast Cancer on the Rise in Young Women?

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-

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."

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

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. 
#   #   #

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

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: