At some stage in their lives, about one in eight women in the United States will receive a diagnosis of breast cancer. This statistic from the American Cancer Society becomes even more concerning when considering that the frequency of breast cancer occurrences is persistently rising, increasing by roughly 1% annually from 2012 to 2021.
This rise is not uniformly spread out among all those affected, according to Adetunji Toriola, MD, PhD, a surgical professor and co-leader of the Cancer Prevention and Control Program at Siteman Cancer Center, affiliated with Barnes-Jewish Hospital and Washington University School of Medicine. Toriola’s research team recently evaluated two decades of data and observed that a greater number of women are being diagnosed with breast cancer at younger ages. “We are discovering that the occurrence of breast cancer is escalating in younger women, ages 20 to 49, with even more pronounced increases in the past decade,” he remarks.
But what is the reason?
Upon investigating this surge, Toriola’s group identified that a certain type of breast cancer was significantly more common among younger women. Incidents of estrogen receptor positive tumors, or malignancies fueled by elevated estrogen levels, rose sharply in the 20-49 demographic. During this timeframe, the rate of estrogen-independent tumors declined.
Various factors might heighten an individual’s likelihood of developing this type of tumor. One significant connection is a person’s lifetime exposure to estrogen, notes Toriola. In recent years, biological and reproductive trends have evolved in ways that may lead to increased exposure.
Toriola’s group is currently exploring how shifts in reproductive patterns are influencing the rise in estrogen receptor positive tumors among young women. Research indicates that girls are reaching menarche, or starting their menstrual cycles, at younger ages than in previous generations. Toriola is investigating this trend in depth and considering how additional months or years of estrogen exposure relate to cancer risk.
“We understand that a decrease of one year in age at menarche heightens the breast cancer risk by approximately 9-10%,” Toriola asserts.
The timing of a person’s first pregnancy, along with the number of pregnancies, also affects the probability of developing estrogen receptor positive breast cancer. Having a child before the age of 30 and having more children overall are both recognized to reduce the risk of these tumors. However, in the U.S., a growing number of women are postponing childbirth until their 30s and having fewer children overall.
“In recent years or decades, we’ve observed significant alterations in these risk factors within the broader population,” Toriola states. Together, these demographic changes may account for some of the rise in younger individuals facing breast cancer.
“Breast cancer prevention does not need to wait until your 40s. It is vital to begin educating individuals about proactive steps they can take early in life to address breast cancer and reduce risk.”
Adetunji Toriola
WashU researchers are examining these risks and more on multiple levels. They are investigating environmental influences and substances that might be causing girls to menstruate earlier. Toriola’s lab also studies the biology of dense breast tissue, since individuals of all ages with dense breasts demonstrate higher occurrences of breast cancer.
While women have limited control over their estrogen exposure, certain lifestyle choices can decrease breast cancer risk. For example, alcohol consumption can elevate risk — another potential factor in the increasing number of younger women facing the disease. “We’ve observed differing trends in alcohol consumption across generations. Younger women are now more likely to engage in binge drinking compared to earlier decades,” Toriola comments.
Other healthy practices, such as consuming adequate vegetables and fiber, maintaining physical activity, and preventing rapid weight gain, can all reduce risk. These habits can be adopted at any age.
“By the time women reach the recommended screening age at 40, it is essential for them to undergo screening and regularly discuss with their physicians which screening guidelines are most appropriate for them,” Toriola states. “However, breast cancer prevention shouldn’t be postponed until your 40s. There is an urgent need to increase awareness about what can be done early in life to consider breast cancer and mitigate risk.”
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