Be aware of your breast cancer risks — Harvard Gazette

Breast cancer incidence rose 1% annually from 2012 to 2021 among all American women combined, but among women under 50 and Asian Americans and Pacific Islanders, according to a report released by the American Cancer Society. A more rapid increase was seen in women. biennial report Earlier this month, he announced the situation of the disease in the country.

Breast cancer is the second leading cause of cancer death in women after lung cancer. However, advances in treatment and early detection have reduced overall mortality rates by 44% since 1989.

But new statistics also show that significant racial and ethnic disparities still exist. For example, there has been no change in mortality rates for Native American women over the past 30 years. And although black women are 5 percent less likely to develop the disease than white women, they are 38 percent more likely to die from the disease. Divergence trend that started after 1980.

Laura Collins, a physician specializing in breast pathology at Beth Israel Deaconess Medical Center and a professor at Harvard Medical School, spoke to the Gazette about the report and its findings. This interview has been edited for length and clarity.

Did anything in the latest report surprise you?

The headline in this report was that the incidence of breast cancer in young women is increasing. It was interesting to see the data collected in this report. Admittedly anecdotally, we have diagnosed breast cancer in young women in cases of patients coming to our clinic. So in some ways it wasn't surprising, but in some ways it was surprising to see this documented in this important paper from the American Cancer Society.

Do we understand why?

People have different ideas about this. Certainly, there are lifestyle changes that can impact breast cancer incidence, such as having children later in life, increasing obesity rates, and people walking and moving less. We know that exercise prevents many types of cancer, but certainly for breast cancer.

And there are other environmental factors that we're less sure about, and they need to be investigated further. Microplastics are something people are concerned about these days. These chemicals are everywhere, and we know we ingest them too. Therefore, you need to understand what harm they cause and how you can avoid them.

Although the incidence among younger women is on the rise, the overall rate of increase in breast cancer cases appears to be fairly stable. Has progress been made or should we be concerned?

Although breast cancer remains one of the leading cancers in women and a leading cause of cancer death in women, widespread mammography screening has certainly increased its detection at earlier stages. is.

The incidence of breast cancer has certainly decreased due to improved diagnosis, treatment, and a better understanding of the different types of breast cancer that affect women. A decrease in mortality was seen. Although the incidence was decreasing in the 2000s, it is now slowly increasing again, and the increase is more pronounced in younger women.

Are there other groups of women who are at higher risk than others?

The report outlines different populations where the increases are more pronounced, but adds the caveat that ethnicity may not be as accurately captured as hoped.

There are disparities in rates between white, black, Asian, and Pacific Islander women, which are partially due to ongoing issues of systemic racism and access to care. . For example, black women often present at a higher stage and have biologically more aggressive cancers in that population.

Additionally, where a woman lives and her ability to access care can be a factor in the stage at which a woman's breast cancer is detected. These are challenges we need to understand and solve in order to provide equitable care for all.

What are the additional challenges faced by young women with breast cancer when it comes to diagnosis and care?

We think of breast cancer as a cancer of older and postmenopausal women, so if a young woman has a breast mass, we think it's benign and very unlikely to be cancerous. There is a tendency. And that's often the case. It is much more likely that it is a benign tumor rather than a malignant tumor.

But what this report tells us is that we cannot ignore these things. Young women cannot be fooled into thinking they have nothing to worry about. This report should be a matter of raising awareness, so that if a young woman presents with an abnormality, prompt follow-up with necessary measures, whether it be imaging or biopsy, can be followed up with pathological confirmation. This means that it is necessary to do so. It can be either benign or malignant.

And in case of malignancy, patients can be immediately referred for appropriate treatment. It is important not to delay treatment.

What advice would you give young women about breast cancer awareness and how to start advocating for themselves?

U.S. Preventive Services Task Force lowers age for biennial screening From 50 to 40 years old. If you're under 40, it's important to know if you have a family history of breast cancer, as you may have an increased genetic predisposition to cancer. That will be a conversation with your health care provider.

And knowing other risk factors, such as whether you have children in the future, your physical activity level, and your weight, are factors you and your health care provider should consider when guiding screening. If you notice any abnormalities in your breasts, be sure to consult your doctor. With breast cancer cases on the rise in young women, it's important to advocate for further testing and workup so you don't delay.

Why can we expect to continue to improve our ability and ability to detect and reduce the incidence of breast cancer?

A lot of research is being done in the field of breast cancer research. I know that Harvard University Hospital is dedicated to caring for young women with breast cancer. I think a lot of effort is being made to understand the biological differences between breast cancer that occurs in young women and breast cancer that occurs in older women. Its exploration and research is important to understanding how best to treat women with breast cancer.

Additionally, there are a variety of psychosocial factors that influence breast cancer in younger women compared to older women, including career implications, fertility concerns, and coping with cancer treatment while caring for young children. Addressing these issues is important because they exist, and the challenges are many. Work underway in those areas as well.