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Young Age Does Not Predict Diagnostic Delay

August 22, 2012

Written By Robin Warshaw
Reviewed By Cynthia M. Mojica, PhD

Being under age 40 does not by itself predict a delay in breast cancer diagnosis, a recent study found. Moreover, young age is only somewhat associated with higher disease stage.

The study, published in The Oncologist, was conducted by a team of researchers from six National Comprehensive Cancer Network (NCCN) cancer centers.

Background and Reason for the Study

Although women younger than 40 are far less likely to be diagnosed with breast cancer than women older than 40, young women are more likely to have larger and higher stage tumors at diagnosis.

Several possible reasons could contribute to these differences, including a delay in diagnosis. Delays in young women could be due to the similarity of some signs or symptoms to benign breast conditions or a lack of awareness of symptoms among healthcare providers and women.

The researchers wanted to determine the effect of being young on diagnostic delay and breast cancer stage. Other studies have shown varied results on the influence of age on delay in diagnosis. A delay of 60 to 90 days has been associated with worse prognosis, and a delay greater than 180 days (six months) has been linked to higher stage disease.

Study Structure

Researchers used data from 21,818 women who were newly diagnosed with stage I through IV breast cancer and treated at eight NCCN institutions from January 2000 to December 2007. Of those women, 2,445 were age 40 or younger at diagnosis.

The study compared the younger and older women to measure differences in:

  • Delay of diagnosis
    • A diagnosis was labeled delayed if more than 60 days passed from the first sign or symptom to diagnosis.
  • Stage of disease
    • Diagnosis with stage II, III or IV breast cancer was considered high stage.
  • Presenting symptoms
    • First indication of breast cancer was noted: lump found by doctor or self, bloody nipple discharge, inverted nipple, underarm mass, breast pain, detection by screening mammogram and more.

Findings

Average age at diagnosis was 35 for younger women and 57 for older women. When compared to the older women, the younger women were more likely to be:

  • Nonwhite
  • Premenopausal
  • More educated
  • Working or in school
  • Diagnosed with higher stage disease
  • Diagnosed due to a symptom

Delay in diagnosis was more likely to occur in younger women than in older women:

  • Delay of 60 days or more—35 percent younger, 25 percent older
  • Delay of 180 days or more—12.7 percent younger, 8.4 percent older.

The researchers analyzed the data, adjusting for factors that might relate to delay in diagnosis or stage of disease. They found that young age did not independently predict diagnostic delay and had only a modest effect on higher stage at diagnosis.

Delay was more common in both younger and older women if a sign or symptom of breast cancer was present. That could explain in part why young women—who more often have symptoms—have a higher rate of delayed diagnoses.

The researchers recommended improving recognition of breast cancer signs and symptoms among healthcare providers and women. This is important for all women, they noted, but especially for young women. Early recognition and diagnosis could mean a lower stage and less invasive treatment.

What This Means for You

Being diagnosed with breast cancer at age 40 or younger can leave you with many questions. This study better delineates the role of young age on diagnosis and disease stage. It may help you understand your own situation more clearly.

You may want to share the study information with other women or with your providers, to expand awareness of symptoms that many may overlook.

AH Partridge, ME Hughes, RA Ottesen, et al. The effect of age on delay in diagnosis and stage of breast cancer.The Oncologist, 2012; 17(6): 775-782.

 

This article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.

 

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