Breast cancer in U.S. women <40 years of age: Disparities in disease incidence and severity, 1999-2003

A16

Introduction: Breast cancer is the leading cancer diagnosed and leading cause of cancer death among women 20-39 years in the United States. In general, breast cancer diagnosed at a young age has a more aggressive biological behavior leading to a poorer prognosis compared to older women. African American women in this age group are frequently diagnosed with more advanced cancer and are more likely to die of breast cancer compared to white women. This population- based study describes racial and ethnic disparities in breast cancer incidence for women under age 40.
 Methods: The data for this study were derived from the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology, and End Results (SEER) surveillance systems. This data set includes data from 36 state-wide cancer registries, representing 86.4% of the U.S. population for the years 1999-2003. Age-adjusted incidence rates (2000 U.S. Standard) by race, rate ratios, and their corresponding 95% confidence intervals were calculated using the SEER*Stat software package.
 Results: A total of 50,746 cases of breast cancer were reported among females younger than 40 from 1999-2003. Among these women, 78.7% were white; 14.5% were African American; 4.4% were Asian and Pacific Islanders (API); and 0.5% were Native Americans (NA). The incidence rates for breast cancer were highest among African American women (16.3/100,000) followed by white (14.1/100,000), API (11.9/100000), and NA (7.1/100,000) women. Larger proportions of African American women were diagnosed with regional and distant stage cancer than white, API, and NA women. They also had more poorly differentiated tumors than other women.
 Conclusions: This study confirms the findings of previous studies suggesting that African American women present with more advanced disease than do white, API, and NA women. While our findings do not support calls for breast cancer screening in this age group, they do suggest the need for health education and health promotion activities focused on breast health and breast cancer risk factors for women in the target population. Program coordinators for the National Breast and Cervical Cancer Early Detections Program and the National Comprehensive Cancer Control Program may collaborate to conduct breast health education activities at the state level.