Surgery Lag Harms Young with Breast Cancer

Young women with breast cancer don't live as long if they delay treatment 6 weeks or more, a new study finds. These delays occur about twice as often for young women who are black, Hispanic, poor, on Medicaid or uninsured. About 6% of breast cancers occur in young women. These cancers are more likely to grow and spread quickly than breast cancers in older women. Researchers looked at medical records for 8,860 women, ages 15 to 39. About 8% of white women and 15% of black and Hispanic women received treatment at least 6 weeks after diagnosis. About 80% of those who delayed treatment lived at least 5 years. That compares with 90% survival for those treated within 2 weeks after diagnosis. Fewer than 10% of women with private insurance had delayed treatment, compared with 18% of those who had Medicaid or no insurance. Survival after a treatment delay was particularly low, 57%, for young black women. About 69% of poor women lived 5 years after delayed treatment. Survival was 65% for those with Medicaid or no insurance. The journal JAMA Surgery published the study. Reuters Health news service wrote about it April 24.

By Robert H. Shmerling, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

It may surprise you to learn that up to 6% of breast cancers occur in women between the ages of 15 and 39. That's about one in 17 cases. It certainly surprised me.

Breast cancers diagnosed in these young women tend to grow and spread faster than in older women. As a result, they are more difficult to treat and survival rates may be lower.

Rapid diagnosis and early treatment are particularly important. A new study shows just how important. Researchers analyzed more than 8,800 cases of breast cancers occurring in young women. They wanted to understand the impact of rapid treatment or treatment delay.

For these young women, a delay in surgery of more than 6 weeks after the diagnosis was linked with a 5-year survival of 80%. Survival was 90% for those treated sooner.

Treatment delay was nearly twice as common among Hispanic and African-American women (15%) as among white women (8%). Delays also occurred more often among women who were poor or had public or no health insurance.

This new research emphasizes that:

• Although the condition is more common with advancing age, young women can and do develop breast cancer.
• Prompt treatment can be life-saving.
• Access to health care and good insurance coverage can have a big impact on the outcome of this condition.

What Changes Can I Make Now?

First, learn about the risk factors for breast cancer. Then, do what you can to reduce your risk. Risk factors include:

• Age -- Risk rises as women get older.
• Gender --Risk is much higher in women than men. But men can develop breast cancer.
• A personal or family history of breast cancer
• A history of radiation to the chest, as in treatment for lymphoma or other types of cancer
• Excessive exposure to estrogen -- This can be due to:
  • Menstruation starting before age 13
  • Menopause after age 51
  • Use of estrogen replacement for more than 5 years
• No pregnancies
• First pregnancy after age 30
• Excess weight
• Excessive alcohol consumption (3 or more drinks per day)
• Lack of exercise

Of course, some of these risk factors (such as age, gender and family history) cannot be changed. For others, however, you can take steps to reduce your risk of breast cancer (or its complications).

• Don't smoke.
• Keep your weight in a healthy range.
• Exercise regularly.
• Drink only moderate amounts of alcohol.
• Have regular screenings, including breast examinations and mammograms. The best time to start and how often to repeat these is uncertain. Discuss a screening plan with your doctor. Bring your prior mammograms with you or have all of your mammograms done at the same place. Then the radiologists can compare current with past results.
• Consider genetic testing if you're at high risk. But before having a genetic test, talk with your doctor about how this information could be useful.
• Be sure to see your doctor if you discover a lump. Fortunately, many lumps will turn out to be harmless. But if a lump is cancerous, waiting could reduce the success of treatment.

This new research shows that prompt treatment for newly diagnosed breast cancer is particularly important for young women. Regardless of age, however, it makes little sense to delay needed treatment.

What Can I Expect Looking to the Future?

In the future, I think we will know more about the causes of breast cancer and how to prevent it. For example, as more genes are linked with breast cancer, genetic testing may become routine. In addition, as we learn more about the genetic makeup of breast tumors, doctors may use this information to guide treatment.

In the meantime, there seems little doubt that early diagnosis and treatment of breast cancer can make a big difference. This new study demonstrates this point among younger women, who tend to have more aggressive disease. But it's likely that the same is true for some other types of cancer.

Some treatments can wait. But, for young women with breast cancer, the sooner treatment begins, the better. This new research clearly shows why.