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February 26th, 2013
04:02 PM ET

Metastatic breast cancer rising in patients younger than 40

Diagnosis of metastatic breast cancer in women younger than 40 has increased 2% a year, every year, from 1976 to 2009, according to a study published Tuesday in the Journal of the American Medical Association.

The increase was seen in women aged 25 to 39 of all races and ethnicities, living in both rural and urban areas.

It's a devastating diagnosis, particularly because a woman younger than 40 who is diagnosed with breast cancer is more likely to have an aggressive form of the disease and face lower survival rates.

But for perspective, the overall population of women who are affected still remains small.

"If you project these data out to the number of people in the U.S., there were about 250 cases per year ... in 1976 and that's now risen to 850 cases of breast cancer per year," said Dr. Rebecca Johnson, the study's lead author and medical director of the Adolescent and Young Adult Oncology program at Seattle Children's Hospital.

Those numbers, she says, refer to metastatic breast cancer in women younger than 40. The rise, she says, was "really concerning."

Johnson is a breast cancer survivor. She found a lump in her breast and was diagnosed with the disease when she was 27. It was not metastatic.

In previous research, she found that a woman younger than 40 had a 1 in 173 chance of developing breast cancer. For this study, she wanted to look specifically at advanced breast cancer within that same population.

"Along with my colleague, Dr. Archie Bleyer, a couple of years ago, we just wanted to ask the question, how common is this? Because once I was diagnosed, I had friends and friends of friends getting diagnosed and I didn't know if this was happening more or if I was hearing about it more," she says.

Johnson and her team used three U.S. Surveillance, Epidemiology, and End Results (SEER) databases of the National Cancer Institute to obtain data about breast cancer incidence from 1973 to 2009, 1992 to 2009, and 2000 to 2009. They chose 1976 as their starting year.

Not only did they find an increase in incidence of metastatic breast cancer in women younger than 40, the team also calculated that the average age of diagnosis was 34.3 years of age in women aged 25 to 39.

"From a cancer point of view, it is an important study because it suggests an early signal that there's a significant increase, a sustained increase over a prolonged period of time," said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, who was not affiliated with the study.

"There's a suggestion this rate is accelerating and it could have a much greater impact so it's important we ... continue to monitor this, we try to understand what its influences are."

There is no solid explanation for what's driving the increased incidence, but  Johnson and her team suggest there's likely more than one cause.

Yet neither she or Lichtenfeld believe the study's findings should change current screening guidelines for breast cancer.

"If there is an action item, at this time it's awareness: Breast cancer can happen (in younger women) and if it gets to be metastatic by the time it's diagnosed, that's a problem," said Johnson.

Yet while the rate of breast cancer incidence in young women has increased, Johnson and her team found that mortality rates over the last 30 years have been stable.

"It's great, except it's not great - the five-year survival rate used to be 15%, and now it's 30%. So that's something to be thankful for, but it's still very bad,"  she said.

"If women could be diagnosed earlier (before the cancer spreads), then each individual woman that that happens to stands to do a whole lot better, stands a better chance of living."

Lichtenfeld agreed. "This study reinforced the message, know your body better than anyone else does," he said.

"If there is a lump on the breast ... swelling in the breast, discharge from the nipple, redness in the skin of the breast, or unexplained pain in the breast, see your doctor."


soundoff (49 Responses)
  1. sromansky,m.d.

    Another piece of information that makes one highly skeptical of the 2009 recommendations of the US Preventive Services
    Task Force, which recommended no routine mammograms before age 50. This task force should get its act together before
    making such far-reaching pronouncements. They've also made a similar recommendation with PSA testing, the only available
    test for Prostate Cancer. They do a disservice to both patients and physicians.

    February 26, 2013 at 16:55 | Report abuse | Reply
    • joysimha

      Incidence might be increasing because we are screening more young women. Are we better off because incidence is increasing. Mortality is the way we measure success and we know from many systematic reviews and prospective trials that screening does not decrease mortality and more women are harmed from screening than saved. We need to figure out why women get breast cancer and how we stop it and it's metastasis. That would be progress.

      February 27, 2013 at 11:27 | Report abuse |
  2. chrismorton82

    According to (http://www.dailyrx.com/metastatic-breast-cancer-incidence-increasing-among-women-under-age-40) Christopher O. Ruud, an MD with the Austin Cancer Centers, believes this is an opportunity . “Breast cancer is more aggressive in the young. It would be a fair assumption that most of these women present with palpable (can be felt with exam) disease. Only about 10 percent of all breast masses are malignant. Training physicians in managing breast masses could decrease mortality.”

    February 26, 2013 at 17:55 | Report abuse | Reply
  3. Mike

    I hope they look at the correlation of those taking oral contraceptives which are hormones and mess with the body's natural balance. These toxins are not good for the body.

    February 26, 2013 at 19:55 | Report abuse | Reply
  4. Rod

    BPA in plastic bottles and containers may be a contributing factor in young females. How could BPA affect the body? Here are some areas of concern.
    Hormone levels. Some experts believe that BPA could theoretically act like a hormone in the body, disrupting normal hormone levels and development in fetuses, babies, and children. Animal studies have had mixed results.
    Brain and behavior problems. After a review of the evidence, the National Toxicology Program at the FDA expressed concern about BPA’s possible effects on the brain and behavior of infants and young children.
    Cancer. Some animal studies have shown a possible link between BPA exposure and a later increased risk of cancer.

    February 26, 2013 at 22:21 | Report abuse | Reply
  5. Jose79845

    Anyone who has been following food news knows that GMOs (genetically modified organisms) are known to cause cancer. California tried to have GMOs labeled, but the GMO lobby spent more money defeating the bill than what it would have cost to change the labels.

    Corn now produces oils that are as carcinogenic as the oils that are now banned in transformers.

    When food was sprayed with carcinogenic pesticides, the pesticides had a chance to be washed away. GMOs produce pesticides that reside within the organism and are at full strength when the food is consumed.

    Marijuana has properties to prevent tumors from forming, but the government wil fight to keep GMOs legal and to keep marijuana illegal.

    This is symptomatic of a government who imprisons whistle blowers who reveal government torture. Welcome to our police state that is now involved in spreading cancer.

    February 27, 2013 at 07:55 | Report abuse | Reply
  6. Peter from CT

    As in so many instances, the juggernaut of medicine and media hypesters are using raw numbers to make a situation seem much worse than it actually is. US population has increased by 1% each year since 1976, thus unarguably explaining half of the 2% per year statistic used. see: http://www.demographia.com/db-uspop1900.htm Add to this the ever increasingly loud drumbeat for breast cancer awareness and it's easy to understand most of this "really concerning" rise. Remember, medical and media people bring in big money by keeping us focused on them. They are as adept at deceptive practices as many product marketeers and politicians are. Yes, CNN, this includes you.

    February 27, 2013 at 09:35 | Report abuse | Reply
    • KJC

      The article doesn't state whether it is based on raw numbers or per capitat. I am assuming a scholarly article would only report the 2% if it is a "per capita" number, but I could be wrong.

      February 27, 2013 at 16:03 | Report abuse |
    • Peter from CT

      KJC, I disagree with your assumption. If there were a caveat to the raw numbers stated in the fifth paragraph, any responsible journalist would have stated it. Regardless, 2% is 2%. 50 % of that is due to population increase. Dictionary,com's definition of Yellow Journalism: "dishonest in editorial comment and the presentation of news, especially in sacrificing truth for sensationalism".

      February 27, 2013 at 20:24 | Report abuse |
  7. joysimha

    We need to change the conversation. We need to understand what causes breast cancer and why it metastasizes. http://www.breastcancerdeadline2020.org is a strategic effort to bring everyone together to collaborate and figure out the answers to the most important questions. Join us!

    February 27, 2013 at 11:29 | Report abuse | Reply
    • Pam

      Thank you for mentioning the National Breast Cancer Coaliton's Breast Cancer Deadline 2020. It's a bold effort. Too much "breast cancer awareness" is happy clappy pink ribbon nonsense and very misleading! About 40,000 people a year die from breast cancer in US and that figure has been stable for years. The problem with early detection is that once detected, there is not currently a way to determine which cancer needs immediate treatment and which can be safely watched for years. So early detection does lead to alot of surgery that would be unnecessary if there were better assessment tools available. Breast cancer is not one disease and each lesion is as individual as the person being diagnosed is.

      February 27, 2013 at 14:42 | Report abuse |
  8. Sci0n

    1 in 8 women get Breast Cancer they need to start forcing mastectomies on all girls at birth, i mean 1 in 350,000 men suffer penile cancer and they use circ for that right? AAP and AMA logic dictates that you cut fist and forget about the child.

    February 27, 2013 at 18:18 | Report abuse | Reply
  9. mrowland74

    Very good blog on Cancer http://norvielcherry.com/2012/07/23/i-have-been-warned-so-have-you/

    February 27, 2013 at 21:02 | Report abuse | Reply
  10. joysimha

    There is a thorough review of the original JAMA article posted by The Young Survival Coalition at

    http://www.youngsurvival.org/blog/?p=2455#comments

    February 28, 2013 at 07:14 | Report abuse | Reply
  11. Peter from CT

    Joysimha, thanks for the link to the link to the review. It was very revealing. The Branch Chief for Data Analysis at NCI says that the number diagnosed was 84 in 2009, not 800 as extrapolated by the authors. Obviously, you knew of this huge error but are willing to let this vast overstatement of the numbers stand unquestioned because it serves your purpose of drawing attention (and thus $$) to your cause. You're as dishonest as anyone who indulges in distortion to further their agenda. Yes, even 1 life is important, but 10 lives are 10 times more important and will garner 10 times the attention, won't it? This review says that the graphs and charts in the article badly distort the data as well. Truth seems to have very little value to impassioned people whose passion has become their career.

    March 1, 2013 at 00:22 | Report abuse | Reply
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    Are there risks from cosmetics ingredients and that of breast cancer? This statement might sound crazy; however, can there be new additives that was not there as recent as 10 years ago? Can these products increase the autism rate, as well? We import billions of dollars of cosmetics and hair dyes and most are not inspected. Is there a link between cosmetics and hair dyes to that of beast cancer and autism?

    March 1, 2013 at 08:41 | Report abuse | Reply
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