title: Breast cancer diagnosis in women < or = 40 versus 50 to 60 years: increasing size and stage disparity compared with older women over time.
abstract: BACKGROUND
  Women < or = 40 years account for 5% of new breast cancer diagnoses. Although there is increased awareness of genetic and other breast cancer risk factors, it is not clear whether this has resulted in earlier diagnosis in young women.
  
  
  METHODS
  A database review identified 8892 women treated for breast cancer from 1980 to 2002. We compared 925 women aged < or = 40 years with 2362 women aged 50 to 60 years. The mean and median tumor size and lymph node status were determined for each group.
  
  
  RESULTS
  There were significant differences in tumor size and lymph node status in younger versus older women. From 1980 to the mid 1990s, tumor size and nodal status did not differ. Since the mid 1990s, tumor size has decreased more rapidly for women aged 50 to 60 years than for those < or = 40 years. In 1998 to 2002, the mean tumor size reached a plateau of 1.8 cm in women 50 to 60 years, compared with a plateau of 2.4 cm in women < or = 40 years (P < .001). The median tumor size in 1998 to 2002 was 1.4 cm in women 50 to 60 years compared with 1.9 cm in women < or = 40 years (P < .001). Lymph node status was also significantly different during 1998 to 2002: 23.9% positive in women 50 to 60 years versus 35.2% in women < or = 40 years (P < .001).
  
  
  CONCLUSIONS
  Since the 1980s, women aged 50 to 60 years have enjoyed a greater decrease in tumor size and percentage with positive nodes. These data could be the result of ineffective screening of younger women or of more aggressive tumor biology. Further study is required to determine whether more effective identification and screening of young, high-risk women can result in earlier detection.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Yawkey 9, Boston, Massachusetts 02114, USA.
authors.forename: Katherina
authors.initials: K
authors.lastname: Zabicki
authors.forename: James A
authors.initials: JA
authors.lastname: Colbert
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Dominguez
authors.forename: Michele A
authors.initials: MA
authors.lastname: Gadd
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Hughes
authors.forename: Julie L
authors.initials: JL
authors.lastname: Jones
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Specht
authors.forename: James S
authors.initials: JS
authors.lastname: Michaelson
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Smith
mesh_terms: D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000473:pathology*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D013997:Time Factors