Executive Summary of the Early-Onset Breast Cancer Evidence Review Conference

Abstract

The Centers for Disease Control and Prevention launched the Bring Your Brave campaign to increase knowledge about early-onset breast cancer, defined as breast cancer in women aged 18-45 years. The American College of Obstetricians and Gynecologists convened a panel of experts in breast disease from the Society for Academic Specialists in General Obstetrics and Gynecology to review relevant literature, validated tools, best practices, and practice guidelines as a first step toward developing educational materials for women's health care providers about early-onset breast cancer. Panel members conducted structured literature reviews, which were then reviewed by other panel members and discussed at an in-person meeting of stakeholder professional and patient advocacy organizations in April 2019. This article summarizes the relevant literature, existing guidance, and validated tools to guide health care providers in the prevention, early detection, and special considerations of early-onset breast cancer. Substantive knowledge gaps were noted and summarized to provide guidance for future research.

Fig. 1.. Breast-cancer-specific mortality by race over time.*SEER incidence and U.S. death rates^a, cancer of the female breast. Joinpoint analyses for whites and blacks from 1975 to 2016 and for Asian/Pacific Islanders, American Indians/Alaska Natives and Hispanics from 2000 to 2016. Source: Incidence data for whites and blacks are from the SEER 9 areas (San Francisco, Connecticut, Detroit, Hawaii, Iowa, New Mexico, Seattle, Utah, Atlanta). Incidence data for Asian/Pacific Islanders, American Indians/Alaska Natives and Hispanics are from the SEER 21 areas (SEER 9 areas, San Jose-Monterey, Los Angeles, Alaska Native Registry, Rural Georgia, California excluding SF/SJM/LA, Kentucky, Louisiana, New Jersey, Georgia excluding ATL/RG, Idaho, New York and Massachusetts). Mortality data are from U.S. Mortality Files, National Center for Health Statistics, CDC. ^aRates are age-adjusted to the 2000 U.S. Std Population (19 age groups—Census P25-1103). Regression lines are calculated using the Joinpoint Regression Program Version 4.7, February 2019, National Cancer Institute. Joinpoint analyses for Whites and Blacks during the 1975–2015 period allow a maximum of 5 joinpoints. Analyses for other ethnic groups during the period 1992–2015 allow a maximum of 4 joinpoints. ^bAPI=Asian/Pacific Islander. ^cAI/AN=American Indian/Alaska Native. Rates for American Indian/Alaska Native are based on the Purchased/Referred Care Delivery Area (PRCDA) counties. ^dHispanic is not mutually exclusive from whites, blacks, Asian/Pacific Islanders, and American Indians/Alaska Natives. Incidence data for Hispanics are based on NHIA and exclude cases from the Alaska Native Registry. *Mortality decreased over time for white and black women, with overall higher mortality for black women. Reprinted from Howlader N, Noone AM, Krapcho M, Miller D, Brest A, Yu M, et al, editors. SEER Cancer Statistics Review, 1975–2016. Bethesda, MD: National Cancer Institute; 2019. Available at: https://seer.cancer.gov/csr/1975_2016. Retrieved October 21, 2019.

Chelmow. Early-Onset Breast Cancer Executive Summary. Obstet Gynecol 2020.

Fig. 2.. The cross-over effect: age at diagnosis for women with breast cancer, by race.* *The proportion of breast cancer diagnoses by age for nonwhite patients with breast cancer peaks in the late 40s, while diagnosis of white patients peaks in their 60s. Reproduced with permission from JAMA Surg 2018;153(6):594–595. ©2018 American Medical Association. All rights reserved.

Chelmow. Early-Onset Breast Cancer Executive Summary. Obstet Gynecol 2020.

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