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Breast Cancer Diagnosis in Women 40 versus 50 to 60 Years: Increasing Size and Stage Disparity Compared With Older Women Over Time

¹ Department of Surgery, Division of Surgical Oncology, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Yawkey 9, Boston, Massachusetts 02114, USA
² Department of Pathology, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Warren 5, Boston, Massachusetts, USA

Correspondence: Address correspondence and reprint requests to: Barbara L. Smith, MD, PhD; E-mail: blsmith1{at}partners.org.

Background: Women 40 years account for 5% of new breast cancer diagnoses. Although there is increased awareness of genetic and other breast cancer risk factors, it is not clear whether this has resulted in earlier diagnosis in young women.

Methods: A database review identified 8892 women treated for breast cancer from 1980 to 2002. We compared 925 women aged 40 years with 2362 women aged 50 to 60 years. The mean and median tumor size and lymph node status were determined for each group.

Results: There were significant differences in tumor size and lymph node status in younger versus older women. From 1980 to the mid 1990s, tumor size and nodal status did not differ. Since the mid 1990s, tumor size has decreased more rapidly for women aged 50 to 60 years than for those 40 years. In 1998 to 2002, the mean tumor size reached a plateau of 1.8 cm in women 50 to 60 years, compared with a plateau of 2.4 cm in women 40 years (P < .001). The median tumor size in 1998 to 2002 was 1.4 cm in women 50 to 60 years compared with 1.9 cm in women 40 years (P < .001). Lymph node status was also significantly different during 1998 to 2002: 23.9% positive in women 50 to 60 years versus 35.2% in women 40 years (P < .001).

Conclusions: Since the 1980s, women aged 50 to 60 years have enjoyed a greater decrease in tumor size and percentage with positive nodes. These data could be the result of ineffective screening of younger women or of more aggressive tumor biology. Further study is required to determine whether more effective identification and screening of young, high-risk women can result in earlier detection.

Key Words: Early-onset breast cancer • Diagnosis • Young women • Screening • High risk