It has long been said that there are many more young patients today than they were years ago, and that breast cancer is increasingly common under the age of 40. But to have data on the real trend and confirm these anecdotal impressions, we know, it takes time. Because epidemiology is a complex science and trends can be read over the long term. Now, however, the first confirmations are starting to arrive, at least overseas, as we tell this week in the Health Breast newsletter (here the link to register for free). Rebecca Johnson, an oncologist at Mary Bridge Children’s Hospital in Tacoma, Washington, reports in an article on JCO Oncology Practice, one of the publications of the American Society of Clinical Oncology (Asco): data collected by the US Cancer Registries (SEER) indicate that the incidence of breast cancer between the ages of 15 and 39 has been increasing since 2004, and that most of this increase is represented by cases that already present with metastases at diagnosis. Which would suggest that this phenomenon is not explained only by a greater awareness of the importance of being checked and, therefore, by the increase in early diagnosis at a young age. Returning to the numbers, diagnoses under the age of 39 currently represent 5.6% of all cases of invasive breast cancer in the US: this is one case in every 196 patients.
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Different and more aggressive tumors
In these young women, the tumors are more often aggressive (such as triple negative and HER2 positive, ed.) And discovered at a more advanced stage than those that occur in women over 40. Again, the tumors are unknown. reasons for these differences, which however affect the possibility of survival: “For this – it says – young patients should be included in clinical trials, when possible, especially if they have a locally advanced or metastatic disease”.
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It also emerges that a significant percentage of these women present mutations that predispose to cancer, such as those of the BRCA genes. According to Johnson, it would therefore be necessary to subject all young women who get breast cancer to a genetic test, also because the result can influence both the type of surgery and medical therapy. And the moral, in general, is that more targeted studies are needed and urgent.
A trend that began in the 1980s
“This trend started in the 1980s and accelerated a lot,” Johnson says in an interview with MedPage Today: “The reasons are not yet known. Possible explanations include lifestyle changes or increased exposure. to environmental toxic substances compared to previous generations. We think of weight gain after the age of 18, the combination of consuming a high-calorie diet with a sedentary lifestyle. Obesity, for example, is a known risk factor for cancer advanced breasts even in young women “. Just as we now know that alcohol is.
It must be said that in the US there are many other cancers among young people – and more markedly than breast cancer – and especially those linked to obesity: we are talking about absolute numbers that are always very low, but the trend is clear, as shows an in-depth analysis on Jama Network Open. According to which, among other things, about 62% of cases of breast cancer in young people occur between the ages of 35 and 39.
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The data for Italy
“It would be important to have more detailed and more up-to-date data on breast cancer in women under 49, although we realize it’s not easy,” she says. Anna De Blasi, president of the YAC Italia (Young Women Against Breast Cancer) association, dedicated to patients under 45: “We know, however, that the incidence is also increasing in Italy. In part, certainly, because young women are more attentive and sensitized and they carry out more checks, also thanks to associations “.
Anna’s story
Anna founded YAC exactly 10 years ago, after she was first diagnosed at the age of 37. Since 2011 she has faced one relapse and 13 surgeries. “I was not familiar with any cancer, I have no mutation, I have never smoked or drank and I had two daughters, both breastfed. In short, they are one of those unexplained cases or, better still, for which the risk factors”.
The relapse had come after only three years, Anna continues to tell. “I knew why the tumor had returned: I had wanted to keep the areola and the nipple despite one of the three nodules being right under there, going against the advice of the breast surgeon. Today I know it was madness, but when you are young and you find yourself with a diagnosis of breast cancer it is difficult to remain lucid. What helped me most of all was helping other young women to understand what cancer was: my best medicine for fear and loneliness. And then I had my little girls to raise “.
An association for “AYA” patients
Young cancer patients are called AYA by doctors, from Adolescents and young adults, and there is a reason why they are distinguished from smaller and larger ones: they have, in fact, peculiar characteristics and needs, both from the point of view of the disease and for psycho-physical needs. Everything is different: the risk factors, the treatment, the prognosis and the issues concerning the quality of life, from the working to the emotional, family and reproductive spheres. This implies, for example, the need to always provide ad hoc counseling and paths to preserve fertility.
With her association, Anna and the other volunteers help women in this difficult path, but not only: they also take care of raising awareness among children, bringing senologists, nutritionists, sports doctors, psychotherapists to schools. And bringing the data, information on the importance of lifestyles, self-examination, which is often seen as a taboo, and early diagnosis. Not just breast cancer, but male cancers as well. “When the boys return home, they bring what they have learned into the family”, concludes Anna: “They are very sensitive to this issue and it has happened more than once that a mother discovered that she had breast cancer because her daughter pushed to do it. the controls”.
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