Although the overall incidence of cancer and cancer mortality are higher in men than in women, this pattern is reversed in people aged 20 to 49 years.
The International Agency for Research on Cancer (IARC) has recently pointed out that this increase in the incidence of cancer in women under 50 years of age occurs fundamentally at the expense of cancers of the breast, thyroid, cutaneous melanoma and cervix. The most recent cancer data from Spain show that the diagnosis of cancer among women between 20 and 49 years of age is quite frequent. Compared to men of the same age, women are 60% more likely to be diagnosed with an invasive cancer. Among young adult women, three types of cancer (breast, thyroid, cutaneous melanoma, and cervix) account for 70% of all invasive cancer diagnoses. The factors that lead to these findings are complex and diverse, as are the implications in terms of prevention, diagnosis, treatment, follow-up, and prognosis.
Since the risk factors for breast cancer in these women are not well known and the cancer often has different characteristics and a worse prognosis, it is important to facilitate access to early detection, adequate and quality treatment, that improves health outcomes and quality of life in these women. Diagnosis of breast cancer at an early age is considered an indicator of poor prognosis. Younger patients, for whom participation in the breast cancer screening program is not yet recommended, have more advanced cancers, with more aggressive tumor biology, with a higher proportion of hormone receptor-negative tumors, associated with lower survival rates, compared with older women. Some studies have shown that, in addition, people with a lower socioeconomic level are diagnosed in more advanced stages, and it has been suggested that these women have less access to the health system.
It is very important to increase young women awareness and health professionals that a diagnosis of breast cancer in this age group is not such a rare event, even during and just after pregnancy. Physicians should pay special attention to family history of breast cancer and other cancers to assess individual women’s risk and to early signs and symptoms that can be easily mistaken for benign findings. The prevalence of inherited genetic mutations associated with an increased risk of breast cancer is higher in young women.It is that in older women, however, the majority of young patients do not have these mutations. Lifestyle may also contribute to the risk of developing breast cancer in young premenopausal women. For example, the World Cancer Research Fund concludes that physical activity and breastfeeding may reduce risk, while alcohol consumption increases it.
A cancer diagnosis for a woman aged 20–49 years, when many are still completing their education, embarking on their professional life and/or starting a family, is a serious issue that can have a strong social and psychological influence and impact on their health , including those due to the effects of treatment.
Hay few studies characterizing in high detail the characteristics of invasive breast cancers diagnosed in young women and identify factors associated with survival, including individual and contextual factors.
It is necessary to carry out a risk assessment and personalized detection, to contribute to increasing primary prevention strategies, and to promote more research on breast cancer in this age group.
Dr. María José Sánchez Pérez is a professor at the Andalusian School of Public Health and scientific director of the Biosanitary Research Institute of Granada (ibs.GRANADA)