Aggressive breast cancers more likely to hit black and younger women

Younger women face elevated risks of developing breast cancers that are not only aggressive but also less responsive to treatment, a new study confirms. 

Researchers found that non-Hispanic black women were more than twice as likely as white women to be diagnosed with so-called triple-negative breast cancers, while women under 40 were nearly twice as likely to be diagnosed with the aggressive cancer as those aged 50 to 64, according to the study. 

In their analysis of more than one million cases of breast cancer between 2010 and 2014, the researchers also found that triple-negative cancers occurred more rarely than had previously been reported. 

The researchers did not respond to requests for comment but did supply a press statement. “We hope that this update on the epidemiology of triple-negative breast cancer can provide a basis to further explore contributing factors in future research,”  a researcher said in the statement. 

Noting that few previous studies had looked beyond the scope of a single state, researchers turned to the U.S. Cancer Statistics database, a population-based surveillance system of cancer registries with data that represents 99% of the U.S. population. The researchers identified 1.15 million cases of breast cancer between 2010 and 2014 in women from 39 states, including 96,749 cases (8.4%) of triple-negative cancer. 

Analyzing the data, the team found that non-Hispanic black women were 2.27 times more likely to be diagnosed with triple-negative breast cancer than non-Hispanic white women. Women under 40 were 1.95 times more likely than women aged 50 to 64 to be diagnosed with the aggressive cancer. 

The researchers also found that when women were diagnosed with a late stage cancer, it was more likely to be triple-negative.

The study confirms what cancer specialists have been seeing, said  a medical oncologist. Some of the increased risk in younger women can be tied to the BRCA1 gene, the Dr. said. “Besides BRCA1, we don’t have a clear cause for it in these women,” he added. 

Dr. was struck by the size of the study. “This is one of the larger, if not the largest, so far,” said a professor of medicine.

Another striking thing is triple-negative breast cancer was thought to be 15% of the total but this study found it was 8.4%.

That change could be due to a tightening of the definition of triple-negative breast cancer, the Dr. said. 

According to the U.S. National Cancer Institute, triple-negative breast cancer cells do not have estrogen receptors, progesterone receptors, or large amounts of a protein called HER2/.

While this study and earlier ones showed that triple-negative breast cancer is more common in women under 40, “I hear all the time from younger women that they were initially told by a doctor that they were too young to have breast cancer, said a Dr. “Most of them were symptomatic. They had lumps or discharge. A lot of times I see women who had lumps for 18 months before I saw them.” 

Since younger women aren’t screened regularly, the Dr. advises them to “be vigilant. Know your breasts and what is normal. Make sure you have a relationship with a provider who trusts you and who will work with you.” 

There’s a lot of misinformation out there about triple-negative breast cancer, the Dr. said. “The message on the internet is that this disease is like death sentence,” he said. “It has a higher mortality rate than other breast cancers, but 65% to 70% of people go on to be cured with conventional therapy.”

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New Research Finds Pregnancy Little Protection Against Breast Cancer Risk

A new study is challenging conventional understanding of the relationship between pregnancy and breast cancer risk, finding an elevated risk of the disease among women under 55 who had given birth, compared to peers who had not.

Previously, medical consensus was that pregnancy and childbirth offered protection against breast cancer. However, “that really comes from what breast cancer looks like for women in their 60s and beyond,” said  a researcher. “We found that it can take more than 20 years for childbirth to become protective for breast cancer, and that before that, breast cancer risk was higher in women who had recently had a child.”

Because breast cancer is more common in older women, with the average age of 62 in the US, most research into disease risk has, to date, focused on that age group, among which pregnancy and childbirth does correlate with a reduced risk. However, among women under 55, that is not the case, the research team found; in this age group, women who had had children were 80% more likely to develop breast cancer five years after giving birth, compared to peers who had not given birth.

Within this age group, risk varied, as well. Women who had given birth before 25 had no elevated risk compared to peers who had never given birth, while risk was higher, compared to peers, for women who had given birth for the first time after age 35.

However, the researcher stresses, “In this age group [under 55], breast cancer is uncommon. The risk of developing breast cancer is still low overall, even if you’ve had a child five years ago.”

The findings are especially pertinent in India, where “breast cancer … is different from that in the West. Here, it is affecting more young women and more than half of them present themselves in the advanced stages,” reported earlier this year. Lifestyle and environmental factors have so far been thought to be behind the comparatively earlier development of the disease.

The new study drew data from 15 studies around the globe that included 889,944 women. It was notable in that, while previous studies have suggested an increased risk in breast cancer in younger women after childbirth, they’ve not taken into consideration other factors that might impact risk, such as breastfeeding or family history of breast cancer, researchers said.

Breast feeding, along with pregnancy and childbirth, has been considered protective against breast cancer, but this study also found no pattern in the data to suggest the two are related.

The goal of the research was not to discourage women from having children, said Nichols. Instead, she hoped it would just be a reminder to women and their doctors not to overlook risks. “We need to recognize that the traditional risk factors for breast cancer do not always operate the same way at younger ages,” she said. “We want women and their doctors to not assume that recently having a child is always protective for breast cancer.”

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