What You Should Know About a Recent Report of Increases in Breast Cancer Among Young Women

By Dr. Ellen Shaw de Paredes, M.D., FACR

A paper published in the February 27, 2013, issue of The Journal of the American Medical Association by Dr. Rebecca Johnson and colleagues of Seattle Children’s Hospital is entitled “ Incidence of Breast Cancer with Distant Involvement Among Women in the United States, 1976 to 2009. “ The authors analyzed data from the US National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) database which includes incidence and survival rates on women with breast cancer. Early SEER data included information from about 9.5% of the population, but more recent data includes about 28% of the population.

The incidence of breast cancer increases with age, and breast cancer screening is not generally performed in women under age 35 – 40. The average risk of a woman in the US developing breast cancer by age 40 is 1 in 173. Interestingly, breast cancer is the most common malignancy in adolescents and young women 15 to 39 years of age, accounting for 14% of all cancers in this age group. Overall, young women have more aggressive breast cancers than older women.

The authors reviewed SEER data from 1976 to 2009 and analyzed breast cancer incidence and survival rates as a function of age and extent of disease at diagnosis. The extent of disease is defined as localized (confined to the breast), regional (involving adjacent lymph nodes) and distant disease (metastases to other organs).

The authors found that the incidence of breast cancer with distant disease at diagnosis increased from 1.53/100,000 women in 1976 to 2.90/100,000 women in 2009 in the 25 to 39 year-old women. No other significant increase was seen in any other age group. The incidence of women with estrogen receptor positive subtypes increased more than for women with the more aggressive estrogen receptor negative subtypes. Those patients with estrogen receptor positive tumors and distant involvement have a five year survival rate greater than those with estrogen receptor negative tumors. The cause for this apparent increase in young women with breast cancer and distant disease at diagnosis is not known and may be multi-factorial. The 5-year survival rate for young women with distant disease is 31% versus 87% for those with only local or regional involvement by the tumor.

Conclusions of the article were that a small but significant increase in the incidence of breast cancer with distant involvement was observed for women aged 25 to 39 years. The authors emphasize the importance of more study to validate the data and if so, a search for potential causes.

My message to young women is to consider the following:
1) Know your risk factors (family history of breast cancer or ovarian cancer) and if you do have several family members on either your mother’s or father’s side, talk with doctor about having a mammogram and even possibly an MRI of the breast depending on your age and overall risk.
2) Perform monthly self breast exams and be aware of any changes in your breasts. If you feel a lump, see your doctor.
3) Have an annual breast exam by your doctor.
4) Lead a healthy lifestyle in terms of diet, nutrition and exercise. Limit alcohol intake
(more than 3 drinks a week is associated with an increased risk of breast cancer).

Johnson, Rebecca H., MD; Chien, Franklin L.. BA; Bleyer, Archie, MD; “Incidence of Breast Cancer With Distant Involvement Among Women in the United States, 1976 to 2009”; Journal of the American Medical Association, February 27, 2013, Vol. 309, No. 8: p 800-805.

Breast Implants Are Linked to Rare Breast Treatable Cancer, FDA Finds

On January 26, 2011 the New Journal Times published a story entitled “Breast Implants are linked to Rare Breast treatable Cancer, FDA Finds”.  The Food and Drug Administration released a statement linking breast implants to a small but significant increase in an extremely rare malignancy known as anaplastic large cell lymphoma.  This malignancy develops in the capsule of scar tissue that forms around the implant and was discovered because women developed symptoms long after they had healed from the implant surgery.  Described symptoms were lumps, pain, fluid buildup and swelling of the breast.

The FDA knew of 60 cases worldwide, so the incidence is very rare.  The FDA said that because the risk was so rare that the existing data “support the continued marketing and use of breast implants”.

FDA Approves the First 3-D Mammography System

On February 11, 2011 the FDA approved for clinical use the Selenia Dimension system, first digital mammography unit that provides 3D images of the breast for screening and diagnosis.

The Selenia Dimension system is an upgrade to Hologic’s existing 2D mammography system and can provide both 2D and 3D images of the breast.  As part of the approval process, two clinical studies were reviewed in which board certified radiologists were asked to review 2D and 3D images from 300 mammograms.  In both studies, the radiologists improved their ability to distinguish between cancers and benign cases by 7% when both the 2D and 3D images were reviewed.  The trade-off in improved accuracy was an increase in radiation dose to the patient by two times when the 2d and 3D images were obtained.

Alcohol and Breast Cancer: Increased Risk or Hype?

By Ellen Shaw de Paredes, MD

As I sit with patients in the office giving results of mammograms, many ask if there is something they can do with diet or lifestyle to reduce their risk of developing breast cancer. Actually – there is! Several studies (1-3) have shown an increased risk of breast cancer in association with alcohol consumption. Recently a study by Dr. Wendy Chen and her colleagues at Harvard Medical School was published in the Journal of the American Medical Association. The authors studied 105,986 female nurses who were followed since 1980 regarding their consumption of alcohol and their development of breast cancer. Every two years the nurses completed questionnaires that included questions about the frequency of, type of and amount of alcohol consumed. The women were also questioned as to whether they had been diagnosed with invasive breast cancer at any point during the study. The authors also studied data on other risk factors including age at menarche and menopause, number of pregnancies, and age at first birth, body mass index, family history of breast cancer, breastfeeding, cigarette smoking and history of benign breast disease.

The results showed that 7690 women were diagnosed with breast cancer between 1980 and 2008. The authors found that even a low level of alcohol consumption was associated with a modest but statistically significant increased risk of breast cancer. For women who consumed 5-9.9 grams/daily (3-6 glasses of wine /week) the relative risk was 1.15 which equals 333 cases of breast cancer/100,000 person years. This compares with an incidence of 281 breast cancer cases/100,000 person years in women with no alcohol intake. In women who drank the equivalent of 2 drinks per day the relative risk was ever higher (1.5) or the equivalent of 413 cases/100,000 person years. No significant difference in the effect of alcohol was seen in relation to menopausal status or the type of alcohol beverage consumed. A strong association between breast cancer risk and alcohol was observed in women who drank between ages 18 and 40 as well as in women over 40 years of age.

Although the exact mechanism for the increase in breast cancer is not clear, one explanation may be that alcohol can cause an increase in blood estrogen levels. This study also highlighted the importance of considering lifetime exposure to the effects of alcohol as well as other dietary factors in the carcinogenesis (development of cancers) process. The authors concluded that “an individual will need to weigh the modest risks of light to moderate alcohol use in breast cancer development against the beneficial effects on cardiovascular disease to make the best personal choice regarding alcohol consumption” (4).

References:

1. Hamajima N, Hirose K, Tajima K et al. Br J Cancer 2002;87(11) 1234-1245.
2. Smith-Warner SA, Spiegelnan D, Yaun S, et al. JAMA 1998;279(7):535-540.
3. Tjonneland A, Christensen S, Olsen A, et al. Cancer Causes Control 2007;18(6)361-373.
4. Chen WY, Rosner B, Hankinson SE, et al. JAMA 2011;306(17):1884-1889.