Madrid, 18 October 2023-. Breast cancer is the most frequent tumour among women in Spain1. It is estimated that, in 2023, more than 35,000 new cases will be diagnosed and incidence continues to increase1. In spite of the significant advances made over recent decades, which are offering new hope to those affected2, a study published in JAMA Network Open warned of the increase in cancer among young adults3, including those under 40 years of age. This trend also applies to breast cancer, where in the majority of countries women under 50 do not have screening programs. .
Silvia Pérez Rodrigo, head of the Breast Radiology Department at MD Anderson Cancer Center Madrid and representative of the Spanish Society for Breast Image Diagnosis (SEDIM), noted that young women normally have dense breasts and, as a result, a higher risk of suffering breast cancer. “Young people tend to have a larger quantity of breast tissue and therefore a denser breast which results in the mammography looking white. The breast nodules, whether good or bad, are like white balls, invisible against a white background. In other words, the dense breasts carry a greater risk of cancer, but also a greater risk of not being detected by the mammography when present”.
As a result, young women run a double risk: of not being included in screening programs, or if they are, that their mammography will not be sufficient for an early diagnosis of cancer before symptoms occur; that is to say the appearance of an interval cancer.
“An interval breast cancer is one which appears between two scheduled check-ups in the screening program and can have two explanations. Either, when despite being present in the first mammography, it was not identified (which may occur more easily in dense breasts) or because they are new and fast-growing cancers which were not there previously, emerging during the interval between this mammography and the subsequent one. This rapid growth makes the cancers more aggressive and normally the patient will visit a doctor because they have noticed symptoms, not because it has been detected with a radiology study”, explained the doctor, who maintains that “these hidden tumours” have become the “great challenge for the radiologists”.
Mammography, an insufficient tool in dense breasts
Faced with the complexity of detecting breast cancer in the dense tissue through mammography, Doctor Pérez Rodrigo pointed to the need to conduct additional examinations that will increase the probability of diagnosing incipient tumours. “It is essential to inform people that, in the case of dense breasts, mammography is insufficient. When mammography does not detect anything, sometimes more exhaustive studies should be performed, with ultrasounds, breast MRI scans or biopsies, which will help early detection of most cancers”.
Likewise, with a real increase in breast cancer among young adults, Doctor Pérez Rodrigo explained that international groups such as the American College of Radiology and the American Society of Breast Imaging now recommend an annual mammography after the age of 40.
“The reality is different in Spain. Here, screening is compulsory after the age of 504, although in some regions such as Castilla-La Mancha, Murcia and Andalucía they take place from age 45 onwards. We need to send another message to women: namely that exploration is helpful and should continue, but ideally we should have check-ups to detect cancer before it becomes apparent or is felt”, she highlighted.
Epigenetics and its relation to the increase in breast cancer in young people
Meanwhile Doctor Laura García Estévez, Head of the Breast Unit at MD Anderson Madrid, warns that epigenetics plays an important role in the increase of breast cancer in young women. Non-genetic factors related to the patient’s environment and habits, such as diet, rest, a sedentary lifestyle and the consumption of alcohol, may be influential in this rising number of cases.
“Obesity and a sedentary lifestyle, along with alcohol consumption, are key factors in the development of this type of early onset tumour”, warns Doctor García Estévez. “We need to raise awareness among the population of the impact of bad habits on our health. Everything we expose ourselves to will condition the risk”, she concluded.
References
- Cancer Figures in Spain 2023 - SEOM: Spanish Society of Medical Oncology. Available on: https://seom.org/images/Las_cifras_del_Cancer_en_Espana_2023.pdf. Last Access: October 2023.
- The Advances in Breast Cancer - SEOM: SEOM: Spanish Society of Medical Oncology. Available on: https://seom.org/los-avances-en-cancer-de-mama. Last Access: October 2023.
- Koh, B., Tan, D. J. H., Ng, C. H., Fu, C. E., Lim, W. H., Zeng, R. W., Yong, J. N., Koh, J. H., Syn, N. L., Wang, M., Wijarnpreecha, K., Liu, K., Chong, C. S., Muthiah, M., Luu, H. N., Vogel, A., Singh, S., Yeoh, K. G., Loomba, R., & Huang, D. Q. (2023). Patterns in cancer incidence among people younger than 50 years in the US, 2010 to 2019. JAMA network open, 6(8), e2328171. ttps://doi.org/10.1001/jamanetworkopen.2023.28171
- Spanish Ministry of Health - Professionals – Breast Cancer Screening Program. (s. f.). https://www.sanidad.gob.es/areas/promocionPrevencion/cribado/cancer/mama.html. Last Access: October 2023.
- Breast Cancer Forecast. (s. f.).Available on: https://www.contraelcancer.es/es/todo-sobre-cancer/tipos-cancer/cancer-mama/evolucion-cancer-mama. Last Access: October 2023.