Research shows need for earlier breast cancer detection

Young Australian females are almost twice as likely to have advanced breast cancer, rather than localised disease, at diagnosis.
 
Such were the findings of a new study, published in the Journal of Adolescent and Young Adult Oncology.
 
While the incidence of breast cancer in young women has remained stable, the percentage of those diagnosed at an advanced stage rose significantly over the study period, from 63% in 1997–2001, to 71% in 2011–14.
 
The study also found that Aboriginal and Torres Strait Islander adolescent and young adult females were more likely to be diagnosed with advanced breast cancer (82%) than non-Indigenous Australian females of the same age group (67%).
 
The research was a retrospective, population-based cohort study of 2337 females in Queensland aged 15–39 diagnosed with a first primary breast cancer between 1997 and 2014, with follow-up until 31 December 2016.
 
Despite the increase in advanced disease at time of diagnosis, the study found the five-year cause-specific survival increased from 85% to 92% for 2011–14, compared to 1997–2001.
 
Associate Professor Danny Youlden is a biostatistician from Cancer Council Queensland and lead author of the paper. He said the increased five-year survival rate was statistically significant for those with advanced disease, increasing from 79% to 88%.
 
‘The overall improvement in survival is probably not surprising, but it is certainly pleasing, particularly given the apparent trend toward more advanced disease,’ he told newsGP.
 
On the other hand, women of Aboriginal and Torres Strait Islander descent, those from disadvantaged areas or patients diagnosed with advanced stage had significantly worse survival rates.
 
Associate Professor Youlden said this research highlights the need to discover why young women in those cohorts are being diagnosed with breast cancer at a more advanced stage, rather than earlier in the disease process when a tumour is localised.
 
He said the exact cause remains unknown, but he does have some theories.
 
‘One possible contributor that has been suggested by other authors is the technological advances in diagnostic techniques over the last two or three decades, so that might mean they’re picking up advanced disease more often than they would have in the past,’ Associate Professor Youlden said.
 

Associate Professor Danny Youlden said the research shows a need for increased awareness of breast cancer in young women.

Another possible factor, he said, lies with the challenge of detecting breast cancer on mammography in younger women due to increased density of breast tissue in women aged under 50.
 
‘Those are the sorts of factors that could be feeding into this, but as to exactly why it’s increasing over time, we’re not exactly sure,’ he said.
 
‘More research is needed to identify those specific factors contributing to two-thirds of young women with breast cancer being diagnosed with advanced disease.
 
‘Once we have a better understanding of those factors, they can then be used to inform public health campaigns to assist with things like prevention and early detection.’
 
Associate Professor Youlden hopes this research leads to increased clinical awareness of breast cancer in young women.
 
‘The main thing here is raising clinical awareness, because cancer is obviously less common in younger people,’ he said.
 
He would also like more awareness of how risk factors for this disease vary by age.
 
‘For example, a higher weight is protective at younger age but is a risk factor for older women, so it’s the opposite,’ he said.
 
‘And it’s the same with fertility – not having children is protective in younger women but is a risk factor for older women.
 
‘So raising awareness for some of those issues is also important.’
 
Associate Professor Youlden would also like further research to lead to better understanding of this phenomenon.
 
‘If we can get some insight as to what those factors are, then we can actually do something about preventing it. Or for those that are diagnosed [with breast cancer], making sure they’re diagnosed as early as possible,’ he said.
 
According to the Cancer Council, breast cancer is the most common type of cancer in women in Australia (apart from keratinocyte skin cancers), and the second most common cancer to cause death in women, after lung cancer.
 
The new research noted that breast cancer is the most common cancer diagnosed among adolescent and young adult females worldwide.
 
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