The right test for the right woman at the right time
Over 600,000 women die of breast cancer every year. In the majority of those cases, the cancers are occurring in women older than 50, though recent research focusing on younger women points to some surprising new findings.
According to an article published in Radiology Business at the start of April, there has been a rise in aggressive, invasive breast cancer cases among women under 40.
The article reported that between 2007 and 2018, of the 200 women under 40 who were treated for breast cancer at Weill Cornell Medicine, a New York-based institution operating under Cornell University:
- There was a 13% increase in those diagnosed with invasive carcinoma in the second half of the study period, bringing the total percentage up to 91%
- The proportion of women diagnosed with an advanced stage of breast cancer (stage 3 or 4) increased during the second half of the study period, rising from 2% to 24%
Together, these statistics indicate an escalation in invasive, late-stage cancers in young women — a population often excluded from breast screening guidelines which usually focus on women from age 40 and up.
Given that only 15% of the 200 women surveyed over the study’s 11 years were diagnosed via early screening due to their family history and high genetic risk, 85% of the study population had their diagnosis after experiencing palpable masses and other painful symptoms, frequently indicative of later stage breast cancers which are significantly more deadly than early stage breast cancers.
Catching cancers earlier is the key to increasing the survival rate. This means shifting from away from age-based screening recommendations to risk-stratified screening programs that aim to get each woman the right test at the right time. Risk assessments take into account a multitude of risk factors, including a person’s breast density, which is now thought to be one of the most important risk factors in developing breast cancer and which can only be assessed through a screening exam.
Women in the US are increasingly being recommended for risk assessments, including genetic testing in some cases, to supplement traditional mammography screening. Most notably:
- The US Center for Disease Control is promoting risk and genetics testing and has recently launched a new marketing campaign
- The American College of Radiology and other groups are recommending risk assessment at age 30 to set down screening protocols
- Many insurers are now reimbursing for MRI and genetic testing for high-risk women
- The US government, as part of its value-based care initiative — Merit-based Incentive Payment System — has included conducting breast cancer risk assessment as a key quality metric that can contribute to a positive adjustment to annual Medicare reimbursement
Reaching women earlier than the current screening age also requires bringing risk assessment into more care settings. Primary care physicians and OB-GYNs need to be better educated and engaged on breast health, breast composition, and cancer risk assessment to guide their patients on personalized prevention pathways. A personalized approach is essential to decrease the number of women needing aggressive surgery, chemotherapy, and radiation.
At Volpara, we support this personalized approach to breast screening as part of our mission to save families from cancer. As this latest paper suggests, to achieve that mission we need to not only help increase screening attendance but we also need to bring risk assessment to women under 40.
To that end, Volpara and CRA Health’s newly combined software aims to help save lives by managing these risk assessments. CRA Health is a Boston-based breast cancer risk assessment company that conducts over two million risk assessments annually — some of those to patients under 40 — thanks to CRA’s tight integration with the major Electronic Health Record (EHR) companies. Together, we take great pride in covering over 32% of the US screening market and providing an ever-increasing number of risk assessments to women at younger ages.