Radiologists chart ‘alarming’ uptick in late-stage breast cancer diagnoses across all age groups

Radiologists have unearthed an “alarming” uptick in late-stage breast cancer diagnoses across all age groups, sharing their findings Tuesday in Radiology [1]. 

Between 2004 to 2021, the biggest annual percentage increase in incidence of metastatic breast cancer at diagnosis was among women ages 20-39 (up 2.9%). Meanwhile, women 75 or older saw a 1.4% yearly uptick during the same time span.

Across all women, the annual percentage increase was 1.2%—a concerning figure, given that the five-year survival rate for metastatic invasive breast cancer is 31%. That’s compared to 86% for regional invasive and 99% for localized cancer cases. 

"The significant increase in metastatic disease at diagnosis among all U.S. women and across all age groups is an alarming new finding," lead author R. Edward Hendrick, PhD, a clinical professor in the University of Colorado Anschutz’s Department of Radiology, said in a statement from the Radiological Society of North America. "This finding is even more remarkable given the likely undercounting of advanced disease in 2020 due to the COVID-19 pandemic."

Researchers gathered their data from the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program, covering about 48% of the U.S. population. The retrospective analysis incorporated between 71 million to 80 million women annually, analyzing trends in late-stage breast cancer diagnosis over a 17-year period. Among women of the typical screening age (40-74) annual percentage increases of metastatic cases jumped 2.1% annually between 2004 to 2012. This number worsened from 2018 to 2021, increasing to a 2.7% clip, the authors found.

Native Americans had the largest annual percentage change in late-stage breast cancer incidence at diagnosis (3.9%), followed by Asian women (2.9%). Black and Hispanic women saw a smaller uptick at 0.86% and 1.6%, respectively. White women witnessed a 1.7% annual increase between 2004 to 2012, but the trend stopped after that. Incidence rates of late-stage breast cancer were about 55% higher among black women than their white counterparts. 

"During the pandemic, we saw steep drops in the number of older, minority women being screened," study co-author Debra L. Monticciolo, MD, past president of the American College of Radiology, said in the same RSNA announcement. “This population tends to get left behind when any stress occurs in the healthcare system.”

The study authors speculated on reasons for the increase, including the lack of a national screening program, inconsistent guidelines, rising obesity rates, reproductive trends, environmental factors, and poor access to healthcare. Further research is needed to better understand these trends. Monticciolo noted that fewer than 50% of women are currently screened, and current guidelines neglect women 75 and up and those under 40. 

In a corresponding editorial [2], experts charged that these “worrisome” findings should serve as a “call to action” for the specialty. 

“With rising rates of distant-stage breast cancer, more work must be done to identify groups for screening education and intervention so that all eligible women are able to get screened, with the goal of detecting breast cancer at an earlier and more treatable stage,” Eric Kim, MD, and Radiology Editor Linda Moy, MD, both with the New York University Grossman School of Medicine, wrote Dec. 10. “Future studies must also be done to continue analyzing the more recent trends in metastatic breast cancer incidence and breast cancer mortality rates.”