Rising incidence of breast cancer among young women in Sweden

Time Trends in Histopathological Findings in Mammaplasty Specimens in a Dutch Academic Pathology Laboratory

Reduction mammaplasties are often performed at a relatively young age. Necessity of routine pathological investigation of the removed breast tissue to exclude breast cancer has been debated. Past studies have shown 0.05%-4.5% significant findings in reduction specimens, leading to an ongoing debate whether this is cost-effective. There is also no current Dutch guideline on pathological investigation of mammaplasty specimens. Because the incidence of breast cancer is rising, especially among young women, we re-evaluated the yield of routine pathological investigation of mammaplasty specimens over three decades in search of time trends.

Methods

Reduction specimens from 3430 female patients examined from 1988 to 2021 in the UMC Utrecht were evaluated. Significant findings were defined as those that may lead to more intensive follow-up or surgical intervention.

Results

Mean age of patients was 39 years. Of the specimens, 67.4% were normal; 28.9% displayed benign changes; 2.7%, benign tumors; 0.3%, premalignant changes; 0.8%, in situ; and 0.1%, invasive cancers. Most patients with significant findings were in their forties (P < 0.001), the youngest patient being 29 years. Significant findings increased from 2016 onward (P = 0.0001), 86.8% found after 2016.

Conclusions

Over three decades, 1.2% of mammaplasty specimens displayed significant findings on routine pathology examination, with an incidence rising to 2.1% from 2016 onward. The main reason for this recent increase is probably attributable to super-specialization by the pathologists. While awaiting formal cost-effectiveness studies, the frequency of significant findings for now seems to justify routine pathological examination of mammaplasty reduction specimens.

Maternal and neonatal outcomes of dose-dense chemotherapy for breast cancer in pregnancy

OBJECTIVE

To estimate the effect of dose-dense chemotherapy during pregnancy on maternal and neonatal outcomes.

METHODS

This is a retrospective cohort study in which women were identified from the international Cancer and Pregnancy Registry at Cooper Medical School at Rowan University in Camden, New Jersey. A chart analysis was completed and Fisher's exact test and independent t test were used in comparing patient outcomes.

RESULTS

Ten women received dose-dense chemotherapy, received every 2 weeks, and 99 women received conventional chemotherapy, received with at least 3-week intervals, for breast cancer during pregnancy. Birth weight, gestational age at delivery, rate of growth restriction, congenital anomalies, and incidence of maternal and neonatal neutropenia were not statistically different between the two groups.

CONCLUSION

In the small cohort of women in our registry, dose-dense chemotherapy does not appear to increase the risk of fetal or maternal complications.

Chemotherapy for breast cancer in pregnancy: evidence and guidance for oncologists

It has been estimated that up to 3.8% of breast cancers may be diagnosed in women who are pregnant, with an estimated 1 in 3000-3500 deliveries occurring in women with breast cancer. Owing to the lack of large randomized trials available to guide our clinical practice, our decisions regarding adjuvant systemic management are based on retrospective analyses, case reports and a small number of prospective studies. A tailored approach to treatment is required with careful consideration given at all stages to the needs of the mother and risks to the foetus. Management is critically influenced by the stage of pregnancy, especially the first trimester. Anthracycline-based chemotherapy may be administered during the second and third trimesters, with apparently few short-term implications. Limited data shows the taxanes may also be given with few adverse events at these stages. Weekly fractionation regimens may allow closer monitoring of pregnancy with prompt termination of agents, if necessary. Data concerning the long-term risks of systemic anticancer treatment are limited. All stages of patient management should be discussed within a multidisciplinary team and a clear consensus of treatment options communicated to the mother. Delaying chemotherapy until after delivery may be reasonable in some cases, but where the delay is likely to be prolonged, a decision must be made on the basis of risks versus benefits.

Incidence trend for breast cancer among young women in Goiânia, Brazil

CONTEXT AND OBJECTIVE

It has been suggested that there has been a large increase in breast cancer incidence among young women over the last decade. The aim of this study was to describe the incidence of breast cancer among young women up to 39 years of age in Goiânia, between 1988 and 2003, and to compare this with other age groups.

DESIGN AND SETTING

Retrospective study using the database of the Population-based Cancer Registry of Goiânia, State of Goiás, Brazil.

METHODS

The incidence was calculated according to age groups: up to 39 years, 40 to 59 years and 60 years and over. Average annual percentage changes (AAPCs) were estimated for the different age groups using Poisson regression.

RESULTS

Over this period, 3,310 new cases were recorded. The standardized incidence was 2.89/100,000 in 1988 and increased to 6.37/100,000 in 2003 (R(2) = 0.52) for the group aged up to 39 years (p < 0.003). For the group from 40 to 59 years old, the incidence was 14.39/100,000 in 1988 and 41.70/100,000 in 2003 (R(2) = 0.85; p < 0.001). For the group aged 60 years and over, it was 17.62/100,000 and 28.49/100,000, respectively (R(2) = 0.67; p < 0.001). The AAPCs were 5.22%, 5.53% and 4.54% for the age groups up to 39, 40 to 59 and 60 years and over, respectively.

CONCLUSIONS

The incidence of breast cancer among young women in Goiânia has been increasing significantly, although this change was similar to the increase in other age groups.

Chemotherapy for Breast Cancer During Pregnancy: An 18-Year Experience From Five London Teaching Hospitals

Purpose

The rare association between breast cancer and pregnancy means that few oncologists gain an expertise in this area. In particular, there are few published data concerning the use of chemotherapy for breast cancer during pregnancy. In this retrospective case series, we describe the experiences of five hospitals in London, United Kingdom, and how they manage this condition.

Patients and Methods

Retrospective searches were performed at five London hospitals in order to identify women who received chemotherapy for breast cancer while pregnant.

Results

Twenty-eight women were identified who had received chemotherapy for breast cancer during pregnancy. Twenty-four women received adjuvant or neoadjuvant chemotherapy for early breast cancer, and four women received palliative chemotherapy for metastatic disease. A total of 116 cycles of chemotherapy were administered during pregnancy. Sixteen women were treated with anthracycline-based chemotherapy and 12 received cyclophosphamide, methotrexate, and fluorouracil. All but one of the women were treated after the first trimester. One spontaneous abortion occurred in the woman treated during her first trimester; otherwise, there were no serious adverse consequences for the mothers or neonates.

Conclusion

These data provide evidence that in terms of peripartum complications and immediate fetal outcome, chemotherapy can be safely administered to women during the second and third trimesters of pregnancy.

Childbearing and survival after breast carcinoma in young women

BACKGROUND

Many young patients with breast carcinoma have not started, or completed, their desired families. How childbearing after a diagnosis of breast carcinoma affects survival is of importance to these women and their families. The authors measured relative mortality among young patients with breast carcinoma with and without births occurring after diagnosis.

METHODS

The authors conducted a cohort study using data from three population-based cancer registries in the U.S. (Seattle, Detroit, and Los Angeles), linked to birth certificate data in each state. Four hundred thirty-eight women younger than 45 years of age with primary invasive breast carcinoma were identified as having births after diagnosis. In addition, 2775 comparison women, matched on the basis of age at the time of diagnosis, race/ethnicity, diagnosis year, disease stage, and presence of previous nonbreast primary tumors, were identified among those with breast carcinoma without births after diagnosis. Relative mortality was assessed using multivariable statistical methods.

RESULTS

After adjustment for stage of disease, age at diagnosis, study region, diagnosis year, and race/ethnicity, women with births occurring 10 months or more after diagnosis had a significantly decreased risk of dying (relative Risk [RR] = 0.54, 95% confidence interval [CI], 0.41-0.71) compared to women without subsequent births. Women pregnant at the time of diagnosis had a mortality rate similar to those who did not give birth (RR = 1.10, 95% CI, 0.80-1.60).

CONCLUSIONS

The results of the current study, in light of growing evidence from other studies using various methods, may provide some reassurance to young women with breast carcinoma that subsequent childbearing is unlikely to increase their risk of mortality.

Assessment of lifetime gained as a result of mammographic breast cancer screening using a computer model

A computer model for the simulation of breast cancer screening (MBS) is used to calculate the results of screening in terms of lifetime. To optimize breast cancer screening protocols, risk (lifetime lost due to radiation-induced tumours) versus benefit (lifetime gained due to early detection of breast cancer) analyses are performed for a simulated stable Swedish female population. The present study focuses on the results of different screening strategies employing single view mammography, including starting and finishing ages of screening, time interval between successive screening sessions as well as the influence of high detection screening and differences between different populations, based on lifetime lost or gained. To test the stability of the recommendations with respect to possible changes in the variables used in MBS, calculations are also performed for high risk factors for breast tumour induction using both the additive and multiplicative risk models, fast growing breast tumours, late incidence of breast tumours and age dependent survival. The results of the simulations expressed in terms of lifetime gained suggest that a theoretical benefit can be obtained employing starting and finishing ages of 35 and 75 years, respectively. In terms of number of fatal breast tumours, the favourable screening period is 40-80 years. It is concluded that the recommendations are stable for changes in the input variables of MBS. The benefits of higher detection screening are more marked for younger than for older women. A high screening frequency results in more lifetime gained, especially at relatively young ages, whereas for older ages the effect is only marginal.

Chromosome analysis of 97 primary breast carcinomas: identification of eight karyotypic subgroups

Chromosome banding analysis of 97 short-term cultured primary breast carcinomas revealed clonal aberrations in 79 tumors, whereas 18 were karyotypically normal. In 34 of the 79 tumors with abnormalities, two to eight clones per case were detected; unrelated clones were present in 27 (34%) cases, whereas only related clones were found in seven. These findings indicate that a substantial proportion of breast carcinomas are of polyclonal origin. Altogether eight abnormalities were repeatedly identified both as sole chromosomal anomalies and as part of more complex karyotypes: the structural rearrangements i(1)(q10), der(1:16)(q10;p10), del(1)(q11-12), del(3)(p12-13p14-21), and del(6)(q21-22) and the numerical aberrations +7, +18, and +20. At least one of these changes was found in 41 (52%) of the karyotypically abnormal tumors. They identify a minimum number of cytogenetic subgroups in breast cancer and are likely to represent primary chromosome anomalies in this type of neoplasia. Other candidates for such a role are translocations of 3p12-13 and 4q21 with various partner chromosomes and inversions of chromosome 7, which also were seen repeatedly. Additional chromosomal aberrations that give the impression of occurring nonrandomly in breast carcinomas include structural rearrangements leading to partial monosomies for 1p, 8p, 11p, 11q, 15p, 17p, 19p, and 19q and losses of one copy of chromosomes X, 8, 9, 13, 14, 17, and 22. The latter changes were seen consistently only in complex karyotypes, however, and we therefore interpret them as being secondary anomalies acquired during clonal evolution.

MBS: a model for risk benefit analysis of breast cancer screening

Breast cancer screening programmes employing mammography are being implemented in various European countries. Different screening protocols are used in demonstration projects and nationwide programmes. To evaluate and improve protocols, a computer model for the evaluation of breast cancer screening has been developed. The availability of such a model can be of great importance in obtaining a better insight into the influence of various parameters. The Monte Carlo computer model is based on random selection from distributions of relevant parameters including tumour onset, tumour growth rate, lifetime expectancy, tumour detection size for screening and spontaneous observation. The radiation risk is calculated for various screening protocols employing multiplicative and additive risk models combined with lifetime expectancy, number of females screened and absorbed dose per screening session. The benefit is calculated on the basis of the reduction in tumour size at detection due to screening compared with spontaneous observation and the survival as a function of tumour diameter. Data from the Swedish two-county study are used to validate the model in terms of prevalence, interval tumour rates and interval tumour diameter distributions. Except for the spontaneous tumour diameter distribution, the model can describe the Swedish two-county study. Specific information is presented on the distributions of relevant parameters.

Trends in breast cancer incidence in Sweden 1958-1988 by time period and birth cohort

Statistics from the Swedish National Cancer Registry based on all 110,658 cases of invasive breast cancer during the 31-year period 1958-1988 were analysed. Age-specific incidence rates increased over successive calendar periods. The average annual increase in the age-standardised incidence rate was 1.3%, with the greatest percentage changes among the youngest age groups. During the latter half of the study period, the rates of increase tended to diminish in the youngest age groups and even reversed significantly among women from 75 years of age. In analyses using age-period-cohort models, the best fit of the cancer incidence data was found for the full model which simultaneously considered the effects of age, period and cohort. Cohort effects were found to be more important than period effects, in terms of model fit. These effects emerged as a seemingly consistent, and in a logarithmic scale, fairly linear increase in the relative risk of breast cancer incidence with a 3-fold elevation in women born in the 1950's relative to those born in the 1880's. It is concluded that the rising breast cancer incidence in Sweden is explained chiefly by birth cohort effects, which indicate persistent secular changes in largely unknown risk factors associated with life style. We could not in the present data see any clear evidence for an adverse effect of contraceptive or replacement sex steroids on breast cancer incidence.

Chromosome analysis of 20 breast carcinomas: cytogenetic multiclonality and karyotypic-pathologic correlations

Short-term cultures from 20 breast carcinomas were analyzed cytogenetically. A normal female chromosome complement was found in 4 cases. Clonal chromosome aberrations were detected in 16 tumors. In 10 tumors, multiple cytogenetic clones were found; in 2 cancers the clones were related, reflecting clonal evolution, but in the remaining 8 tumors the clones were cytogenetically unrelated, indicating clonal heterogeneity in the origin of the tumor parenchyma. Correlation analysis between karyotypic and pathologic parameters indicated that cases with complex karyotypes and/or cytogenetically unrelated clones, when compared with cases with a single simple karyotypic abnormality, were generally of higher histologic malignancy grade, had more mitoses in the histologic sections, and also more often had carcinoma in situ lesions in the same breast.

The relationship between age and incidence of breast cancer. Population and screening program data

Despite extensive study of breast cancer incidence, including specific studies of the relationship between age and breast cancer incidence, the picture remains confusing. This article examines not only the relationship between age and breast cancer, but also trends over time related to this relationship to discern the underlying true age-incidence pattern. The age-incidence curve changes around the menopausal period, most likely due to hormonal changes 10 to 15 years earlier, flattens out in the 40 to 50 year old age range, and then increases as age increases. Recent data showing decreased risk of breast cancer incidence at older ages, e.g., older than 75 years of age, relative to younger ages, are likely an artifact of recent increases in breast cancer screening in the United States. This picture is consistent with increases in screening and with notions of lead time created by increased screening. The increase in screening that has changed the age-incidence relationship may eventually deliver benefits to United States women in terms of mortality deficits, but this is not guaranteed unless screening becomes routine practice and high-quality therapeutic intervention and follow-up occurs as well.

Increased catechol estrogen metabolism as a risk factor for nonfamilial breast cancer

The metabolism of estrone (E1) or estradiol-17 beta (E2) to catechols seldom has been investigated in biochemical studies related to the risk of development of human breast cancer, as a result of the extreme lability and reactivity of these hormones. A method of indirect calculation was developed in which estimated catechol estrogen excretion (ECE) from urinary excretion of E1, E2, and estriol (E3) was used, based on the obligate reciprocal relation between 16 alpha-hydroxylase activity (r3) and estrogen 2/4 hydroxylase function (r2). This relationship is expressed by r2 x r3 = K, the estrogen oxidative constant. From published data relating chiefly to 2-OH estrone excretion, K = 12.4 +/- 0.8 (standard error of the mean). Urinary E1 + E2 excretion rates reflect nonprotein-bound plasma ovarian estrogen concentrations available for cell metabolism, which influence the value of K. The equation: r2 = [E1 + E2] K/[E3 + 16 alpha OH E1] = ECE gives a median correlation coefficient between actual catechol estrogen excretion and ECE in micrograms/24 hours of +0.88 (range, 0.61 to 0.97). When tested against the best product isolation analysis of catechol estrogen excretion, ECE was 95% accurate. Using this method a metaanalysis was conducted of published fractional estrogen excretion collected from 2846 healthy women worldwide aged 15 to 59 years, with a risk of breast cancer varying fivefold. Overall ECE was 78% to 97% higher in high-risk women of all ages and menstrual cycle phases (P less than 0.001, by Wilcoxon test). With increasing cancer risk (as estimated by the authors), ECE rose linearly exponentially with a slope of 0.149 (follicular phase) and 0.136 (luteal phase). The correlation coefficient (R2) between the two variables was 0.77 and 0.57, respectively (P less than 0.05). These data derived from calculations of ECE in healthy women confirmed recent analytic results of a twofold increase in the ratio of 2-OH E1/4-OH E1 in healthy Finnish women compared with recent Japanese migrants to Hawaii. In Finnish women with breast cancer, this ratio increased further (almost twofold). Metaanalysis supported the conclusion that increased rates of oxidation of estradiol 17-beta to 2-OH catechols supply the principal proximal human mammary carcinogens active after menarche.

Proliferation and DNA ploidy in malignant breast tumors in relation to early oral contraceptive use and early abortions

In 175 premenopausal breast cancer patients, a history of oral contraceptive (OC) use before 20 years of age was significantly associated with higher tumor cell proliferative activity, as indicated by a higher S-phase fraction (SPF), and a higher fraction of DNA aneuploid tumors, compared with later or never users (P = 0.05 and p = 0.01, respectively). The higher SPF among early OC users was apparent in patients with aneuploid tumors but not in patients with euploid tumors. Abortions (spontaneous or induced) before the first full-term pregnancy also were associated with a higher SPF compared with other young patients with breast cancer (P = 0.03). Adjusting for parity and abortions or OC use, respectively, an early OC use was associated with a 43% higher SPF and early abortions were associated with 49% higher SPF. Younger patients had a higher SPF and a higher frequency of aneuploid tumors, but this was found to be because the users of OC had a lower median age at diagnosis. Among never users, no significant age relationship was seen for SPF or the frequency of aneuploidy. For the DNA analyses there is a selection of patients with breast cancer with larger tumors, and therefore the conclusions drawn in this article may not be generalizable to patients with smaller primary tumors, e.g., cases diagnosed at breast cancer screening. The higher tumor proliferative activity and frequency of aneuploidy in early OC users are in line with previously reported findings of worse prognostic indicators and a worse survival in early users of OC compared with other young women with breast cancer.