The perception in the clinical practice of healthcare professionals is supported by scientific evidence: breast cancer diagnoses in young women are increasing and alarm bells have started to ring. If the median age of breast cancer diagnosis in Western countries is between 62 to 65 years, what can explain such an obvious increase in diagnoses 20 to 30 years before this age?
Num article published in January 2024 in the medical journal JAMA Network OpenShuai Xu and his colleagues reported that from 2000 to 2016 the incidence of breast cancer in American women between 20 and 49 years of age had an increasing but slow trend, averaging around 65 cases per 100,000 women, for more of a decade.
Starting in 2016, the incidence increased—dramatically, in the authors’ words—to nearly 75 cases per 100,000 women in 2019, the last year evaluated in the study. In the analysis, they add that it is the tumors with positive hormone receptors whose incidence has increased the most and the tumors in stages I and IV, therefore the extremes of the prognosis – better and worse, respectively.
Although the causes of this phenomenon are not completely understood, some have already been identified: advanced age at first birth, absence or fewer children and breastfeeding, use of oral contraceptives, alcohol consumption, overweight and physical inactivity or sedentary lifestyle. Despite the greater probability of identifying hereditary genetic changes in younger patients (for example, in the genes BRCA1/2) yet these cases remain a minority.
Some particularities exist associated with the diagnosis of cancer at a young age: the importance of preserving fertility, challenges in treatment, such as induction of early menopause, cases associated with pregnancy or greater likelihood of undergoing chemotherapy, or the negative impact on various levels – for example in the couple’s dynamics, limitations in the children’s key moments, absenteeism from work, the physical and psychological consequences of diagnosis and treatments, among many others.
No document “Breast Cancer Facts & Figures, 2022-2024” published by American Cancer Societyit is stated that the probability of a 40-year-old woman having breast cancer in the following 10 years is 1 in every 63 women, in contrast to the probability of a 70-year-old woman, which is 1 in every 24 women, reinforcing that one of the main risk factors continues to be older age. However, what has been seen is that the incidence of cancer in young women has increased more quickly than in older age groups. In contrast, the incidence of breast cancer in men has been stable over the last 30 years, at around 1% of cases, and population screening is not recommended (only individualized screening in cases of high risk, genetic or clinical, identified by Physician Assistants). ) .
In the United States, one of the countries with the best access to incidence and therapeutic data in the field of Oncology, the almost immediate recognition of the increase in breast cancer diagnoses at a young age led to, in April 2024, the US Preventive Services Task Forcean independent organization but funded by the American government, which issues recommendations, started to consider breast cancer screening in women aged between 40 and 74 years of age, with mammograms every 2 years, while the latest recommendations from this panel, from 2016, supported the initial age for screening at 50 years old. It is a significant change, if we consider that in many countries, including Portugal, screening starts from the age of 50, except in situations of increased risk. This individual risk can be assessed for a given woman using calculation tools according to different variables (e.g. the Gail Model) allowing for a personalized screening program. It is emphasized that the concept of screening is only applicable to asymptomatic people whose risk-benefit ratio favors carrying out tests in order to diagnose early, generally improving the prognosis and allowing less aggressive treatments.
However, since 2023, a review of national recommendations is expected, under the responsibility of the Directorate-General for Health (DGS), according to European Union guidelines, to start screening at least at the age of 45. It should be noted that it is not enough to expand screening, there must be adherence to it. According to the DGS national report on “Assessment and Monitoring of Population-Based Oncology Screenings” (2023), the screening adherence rate was only half of eligible women – 51%, equivalent to around 420,000 women screened -, corresponding to a decrease of 12% compared to 2017 figures, despite the rate geographic coverage of the tracking program is close to 100% – and these are indicators that should also concern us. Thus, a significant part of diagnoses in young women are made by self-palpation, which is a factor with a worse prognosis.
According to data collected by the CUF group, in the last 6 years, breast cancer in patients under the age of 50 reached practically 40% of diagnoses, with an increasing trend since 2020. Although it represents only a part of national diagnoses, it does not leave to be expressive, especially considering that it includes age groups below the minimum age of the screening criteria in force in Portugal.
Alarms are ringing. It is urgent to deepen and correct the potential causes and implications of breast cancer in young women, expand screening, promote breast health surveillance and boost quality research.
Use: Internationally renowned health professionals and allies will gather at CUF Tejo Hospital, in Lisbon, at the event International Conference on Young Women’s Breast Cancer and Health organized by the Breast Cancer in Young Women Foundation – it will be the first international conference dedicated to breast cancer in young women, to be held on the 29th and 30th of October this year, with the purpose of discussing the causes of the increase in the number of cases of breast cancer in young women and share emerging advances in this area.
