Younger women diagnosed with breast cancer have poorer prognoses and higher mortality compared to older women. Young black women have higher incidence rates of breast cancer and more aggressive subtypes than women of other races/ethnicities. In this study, we examined recent trends and variations in breast cancer incidence among young women in the United States.
Using 2004–2013 National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program data, we calculated breast cancer incidence rates and trends and examined variations in stage, grade, and tumor subtype by age and race/ethnicity among young women aged 20–49 years.
The majority of breast cancer cases occurred in women aged 40–44 and 45–49 years (77.3%). Among women aged < 45 years, breast cancer incidence was highest among black women. Incidence trends increased from 2004 to 2013 for Asian or Pacific Islander (API) women and white women aged 20–34 years. Black, American Indian or Alaska Native, and Hispanic women had higher proportions of cases diagnosed at later stages than white and API women. Black women had a higher proportion of grade III–IV tumors than other racial/ethnic groups. Across all age groups, incidence rates for triple-negative breast cancer were significantly higher in black women than women of other races/ethnicities, and this disparity increased with age.
Breast cancer among young women is a highly heterogeneous disease. Differences in tumor characteristics by age and race/ethnicity suggest opportunities for further research into personal and cultural factors that may influence breast cancer risk among younger women.
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American Indian or Alaska Native
Annual percent change
Asian or Pacific Islander
Human growth factor/neu receptor
International Classification of Diseases for Oncology third edition
National Program of Cancer Registries
Surveillance, epidemiology, and end results program
United States Cancer Statistics
Assi HA, Khoury KE, Dbouk H, Khalil LE, Mouhieddine TH, El Saghir NS (2013) Epidemiology and prognosis of breast cancer in young women. J Thorac Dis 5(Suppl 1):S2–S8
Narod SA (2012) Breast cancer in young women. Nat Rev Clin Oncol 9(8):460–470
Warner ET, Colditz GA, Palmer JR, Partridge AH, Rosner BA, Tamimi RM (2013) Reproductive factors and risk of premenopausal breast cancer by age at diagnosis: are there differences before and after age 40? Breast Cancer Res Treat 142(1):165–175
Chollet-Hinton L, Anders CK, Tse C-K, Bell MB, Yang YC, Carey LA, Olshan AF, Troester MA (2016) Breast cancer biologic and etiologic heterogeneity by young age and menopausal status in the Carolina Breast Cancer Study: a case-control study. Breast Cancer Res 18(79):5
Chen HL, Zhou MQ, Tian W, Meng KX, He HF (2016) Effect of age on breast cancer patient prognoses: a population-based study using the SEER 18 database. PLoS ONE 11(10):e0165409
1999–2013 Incidence, WONDER Online Database (2016) US Department of Health and Human Services. United States Cancer Statistics. http://wonder.cdc.gov/cancer-v2013.html. Accessed 24 Dec 2016
Ekwueme DU, Trogdon JG, Khavjou OA, Guy GP Jr (2016) Productivity costs associated with breast cancer among survivors aged 18–44 years. Am J Prev Med 50(2):286–294
Ekwueme DU, Allaire BT, Guy GP Jr, Arnold S, Trogdon JG (2016) Treatment costs of breast cancer among younger women aged 19–44 years enrolled in Medicaid. Am J Prev Med 50(2):278–285
Allaire BT, Ekwueme DU, Guy GP Jr, Li C, Tangka FK, Trivers KF, Sabatino SA, Rodriguez JL, Trogdon JG (2016) Medical care costs of breast cancer in privately insured women aged 18–44 years. Am J Prev Med 50(2):270–277
Richardson LC, Henley SJ, Miller JW, Massetti G, Thomas CC (2016) Patterns and trends in age-specific black-white differences in breast cancer incidence and mortality—United States, 1999–2014. MMWR Morb Mortal Wkly Rep 65(40):1093–1098
Brinton LA, Sherman ME, Carreon JD, Anderson WF (2008) Recent trends in breast cancer among younger women in the United States. J Natl Cancer Inst 100(22):1643–1648
Johnson RH, Chien FL, Bleyer A (2013) Incidence of breast cancer with distant involvement among women in the United States, 1976 to 2009. JAMA 309(8):800–805
DeSantis CE, Fedewa SA, Goding Sauer A, Kramer JL, Smith RA, Jemal A (2016) Breast cancer statistics, 2015: convergence of incidence rates between black and white women. CA Cancer J Clin 66(1):31–42
White MC, Espey DK, Swan J, Wiggins CL, Eheman C, Kaur JS (2014) Disparities in cancer mortality and incidence among American Indians and Alaska Natives in the United States. Am J Public Health 104(Suppl 3):S377–S387
Newman LA (2014) Breast cancer disparities: high-risk breast cancer and African ancestry. Surg Oncol Clin N Am 23(3):579–592
Dunn BK, Agurs-Collins T, Browne D, Lubet R, Johnson KA (2010) Health disparities in breast cancer: biology meets socioeconomic status. Breast Cancer Res Treat 121(2):281–292
Williams DR, Mohammed SA, Shields AE (2016) Understanding and effectively addressing breast cancer in African American women: Unpacking the social context. Cancer 122(14):2138–2149
Miller JW, Lee Smith J, Ryerson BA, Tucker TC, Allemani C (2017) Disparities in breast cancer survival in the United States (2001–2009): findings from the CONCORD-2 study. Cancer 123(S24):5100–5118
Thornton ML (ed) (2014) Standards for cancer registries Volume II: data standards and data dictionary, record layout version 15, 19th ed., North American Association of Central Cancer Registries. Springfield, IL
National Program of Cancer Registries and Surveillance Epidemiology & End Results (2016) NPCR and SEER incidence—USCS 2001–2014 public use database data standards and data dictionary, vol. 2017
National Cancer Institute (2017) Surveillance Epidemiology and End Results (SEER) Program. Population estimates used in NCI’s SEER*Stat software. http://seer.cancer.gov/popdata/methods.html. Accessed 26 Oct 2017
Young JL Jr RS, Ries LAG, Fritz AG, Hurlbut AA (2001) SEER summary staging manual—2000: codes and coding instructions, National Cancer Institute. In: NIH Pub No 01-4969. Bethesda, MD
Surveillance Research Program National Cancer Institute: SEER*Stat software (seer.cancer.gov/seerstat) version 8.3.4
Gomez SL, Von Behren J, McKinley M, Clarke CA, Shariff-Marco S, Cheng I, Reynolds P, Glaser SL (2017) Breast cancer in Asian Americans in California, 1988–2013: increasing incidence trends and recent data on breast cancer subtypes. Breast Cancer Res Treat 164(1):139–147
Kohler BA, Sherman RL, Howlader N, Jemal A, Ryerson AB, Henry KA, Boscoe FP, Cronin KA, Lake A, Noone A-M et al (2015) Annual Report to the Nation on the Status of Cancer, 1975–2011, featuring incidence of breast cancer subtypes by race/ethnicity, poverty, and state. J Natl Cancer Inst 107(6):djv048
Keegan THM, DeRouen MC, Press DJ, Kurian AW, Clarke CA (2013) Occurrence of breast cancer subtypes in adolescent and young adult women. Breast Cancer Res 15(5):R95
Horne HN, Beena Devi CR, Sung H, Tang TS, Rosenberg PS, Hewitt SM, Sherman ME, Anderson WF, Yang XR (2015) Greater absolute risk for all subtypes of breast cancer in the US than Malaysia. Breast Cancer Res Treat 149(1):285–291
Ambrosone CB, Zirpoli G, Ruszczyk M, Shankar J, Hong CC, McIlwain D, Roberts M, Yao S, McCann SE, Ciupak G et al (2014) Parity and breastfeeding among African-American women: differential effects on breast cancer risk by estrogen receptor status in the Women’s Circle of Health Study. Cancer Causes Control 25(2):259–265
Boyle P (2012) Triple-negative breast cancer: epidemiological considerations and recommendations. Ann Oncol 23(Suppl 6):vi7–vi12
Anstey EH, Shoemaker ML, Barrera CM, O’Neil ME, Verma AB, Holman DM (2017) Breastfeeding and breast cancer risk reduction. Implications for black mothers. Am J Prev Med 53(3s1):S40–S46
Trivers KF, Lund MJ, Porter PL, Liff JM, Flagg EW, Coates RJ, Eley JW (2009) The epidemiology of triple-negative breast cancer, including race. Cancer Causes Control 20(7):1071–1082
Brewster AM, Chavez-MacGregor M, Brown P (2014) Epidemiology, biology, and treatment of triple-negative breast cancer in women of African ancestry. Lancet Oncol 15(13):e625–e634
Shavers VL, Harlan LC, Stevens JL (2003) Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35. Cancer 97(1):134–147
Ademuyiwa FO, Gao F, Hao L, Morgensztern D, Aft RL, Ma CX, Ellis MJ (2015) US breast cancer mortality trends in young women according to race. Cancer 121(9):1469–1476
Amirikia KC, Mills P, Bush J, Newman LA (2011) Higher population-based incidence rates of triple-negative breast cancer among young African-American women: implications for breast cancer screening recommendations. Cancer 117(12):2747–2753
Liu P, Li X, Mittendorf EA, Li J, Du XL, He J, Ren Y, Yang J, Hunt KK, Yi M (2013) Comparison of clinicopathologic features and survival in young American women aged 18-39 years in different ethnic groups with breast cancer. Br J Cancer 109(5):1302–1309
Ooi SL, Martinez ME, Li CI (2011) Disparities in breast cancer characteristics and outcomes by race/ethnicity. Breast Cancer Res Treat 127(3):729–738
Howlader N, Altekruse SF, Li CI, Chen VW, Clarke CA, Ries LAG, Cronin KA (2014) US incidence of breast cancer subtypes defined by joint hormone receptor and HER2 status. J Natl Cancer Inst 106(5):dju055
Parise CA, Bauer KR, Caggiano V (2010) Variation in breast cancer subtypes with age and race/ethnicity. Crit Rev Oncol Hematol 76(1):44–52
Oeffinger KC, Fontham EH, Etzioni R et al (2015) Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA 314(15):1599–1614
United States Preventive Services Task Force (2016) Final update summary: breast cancer: screening. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening1. Accessed 26 Oct 2017
American College of Obstetricians and Gynecologists (2011) Practice bulletin no. 122: breast cancer screening. Obstet Gynecol 118(2 Pt 1):372–382
Hale PJ, Gilson deValpine M (2014) Screening mammography: revisiting assumptions about early detection. The Journal for Nurse Practitioners 10(3):183–188
International Agency for Research on Cancer (2015) IARC handbooks of cancer prevention, vol 15. Breast Cancer Screening, Lyon
Qin J, White MC, Sabatino SA, Febo-Vazquez I (2017) Mammography use among women aged 18–39 years in the United States. Breast Cancer Res Treat. https://doi.org/10.1007/s10549-017-4625-6
Ruddy KJ, Gelber S, Tamimi RM, Schapira L, Come SE, Meyer ME, Winer EP, Partridge AH (2014) Breast cancer presentation and diagnostic delays in young women. Cancer 120(1):20–25
Azim HA, Partridge AH (2014) Biology of breast cancer in young women. Breast Cancer Res 16(4):427
Malone KE, Daling JR, Neal C, Suter NM, O’Brien C, Cushing-Haugen K, Jonasdottir TJ, Thompson JD, Ostrander EA (2000) Frequency of BRCA1/BRCA2 mutations in a population-based sample of young breast carcinoma cases. Cancer 88(6):1393–1402
Greenup R, Buchanan A, Lorizio W, Rhoads K, Chan S, Leedom T, King R, McLennan J, Crawford B, Kelly Marcom P et al (2013) Prevalence of BRCA mutations among women with triple-negative breast cancer (TNBC) in a genetic counseling cohort. Ann Surg Oncol 20(10):3254–3258
Anderson KN, Schwab RB, Martinez ME (2014) Reproductive risk factors and breast cancer subtypes: a review of the literature. Breast Cancer Res Treat 144(1):1–10
Interagency Breast Cancer and Environmental Research Coordinating Committee (2013) Breast cancer and the environment: prioritizing prevention. https://www.niehs.nih.gov/about/boards/ibcercc/index.cfm. Accessed 26 Oct 2017
Institute of Medicine (2012) Breast cancer and the environment: a life course approach. The National Academies Press, Washington, DC
Ekwueme DU, Allaire BT, Parish WJ, Thomas CC, Poehler D, Guy GP Jr, Aldridge AP, Lahoti SR, Fairley TL, Trogdon JG (2017) Estimation of breast cancer incident cases and medical care costs attributable to alcohol consumption among insured women aged < 45 years in the U.S. Am J Prev Med 53(3s1):S47–S54
White MC, Shoemaker ML, Park S, Neff LJ, Carlson SA, Brown DR, Kanny D (2017) Prevalence of modifiable cancer risk factors among U.S. adults aged 18–44 years. Am J Prev Med 53(3s1):S14–S20
Fredholm H, Eaker S, Frisell J, Holmberg L, Fredriksson I, Lindman H (2009) Breast cancer in young women: poor survival despite intensive treatment. PLoS ONE 4(11):e7695
Centers for Disease Control and Prevention (2017) Bring your brave compaign. https://www.cdc.gov/cancer/breast/young_women/bringyourbrave/. Accessed 26 Oct 2017
Centers for Disease Control and Prevention (2017) Interpreting Race and Ethnicity in Cancer Data. https://www.cdc.gov/cancer/npcr/uscs/technical_notes/interpreting/race.htm. Accessed 26 Oct 2017
This research was supported in part by an appointment (M.L. Shoemaker) to the Research Participation Program at the Centers for Disease Control and Prevention administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the US Department of Energy and CDC.
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Conflicts of interest
The authors declare that they have no conflict of interests.
Availability of data
The dataset generated and analyzed during the current study is available in the U.S. Cancer Statistics repository, https://www.cdc.gov/cancer/npcr/public-use/index.htm.
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Shoemaker, M.L., White, M.C., Wu, M. et al. Differences in breast cancer incidence among young women aged 20–49 years by stage and tumor characteristics, age, race, and ethnicity, 2004–2013. Breast Cancer Res Treat 169, 595–606 (2018). https://doi.org/10.1007/s10549-018-4699-9
- Breast cancer
- Young women
- Health disparities
- Tumor subtype
- Triple-negative breast cancer
- Cancer registries