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December 31, 2024 — A groundbreaking new study has revealed a disturbing rise in the incidence of metastatic breast cancer diagnoses in the U.S. over the past two decades, with alarming trends among younger women and minorities. The findings, published in Radiology, a journal of the Radiological Society of North America (RSNA), underscore the urgent need for enhanced screening protocols and equitable access to healthcare for women across all demographics.
The study, led by R. Edward Hendrick, Ph.D., and Debra L. Monticciolo, M.D., analyzed data from the U.S. Surveillance, Epidemiology, and End Results (SEER) program, which covers nearly half of the U.S. population. It found that between 2004 and 2021, late-stage, invasive breast cancer—also known as metastatic breast cancer—has been diagnosed at increasing rates across all age groups and ethnicities.
Metastatic breast cancer, which occurs when the cancer spreads to other parts of the body, is known for its poor prognosis. According to the U.S. Centers for Disease Control and Prevention (CDC), the five-year survival rate for metastatic breast cancer is just 31%, a stark contrast to the survival rates of localized or regional breast cancers, which stand at 99% and 86%, respectively.
An Alarming Trend Among Younger Women
The study revealed that the most significant increase in metastatic breast cancer diagnoses was observed in women between the ages of 20 and 39, with an annual rise of 2.9%. For women aged 40 to 74, the incidence rates rose by 2.1% and 2.7% during different time periods, further emphasizing the growing issue.
Dr. Monticciolo, past president of the American College of Radiology, explained, “Women who present with distant metastatic breast cancer at diagnosis face much lower survival rates and more challenging treatment options. This trend is concerning, especially for younger women who often present with more aggressive forms of the disease.”
A Disproportionate Impact on Minority Women
The research also highlights the disproportionate impact of metastatic breast cancer on minority women. Native American women experienced the largest annual increase at 3.9%, while Asian women saw a significant rise at 2.9% per year between 2004 and 2021. African American women also faced a notably higher incidence, with rates 55% higher than those of white women. Among Black and Hispanic women, the annual percentage increase was 0.86% and 1.6%, respectively.
“The increasing incidence of metastatic breast cancer among women of color is a wake-up call,” said Dr. Hendrick, clinical professor at the University of Colorado Anschutz School of Medicine. “This underscores the need for targeted healthcare interventions and improvements in early screening access, particularly for underserved communities.”
The Role of COVID-19 and Screening Gaps
The COVID-19 pandemic exacerbated the situation, as disruptions in healthcare services led to a significant decline in breast cancer screenings, especially among older and minority women. Dr. Monticciolo noted, “During the pandemic, we saw steep drops in the number of older, minority women being screened. This population often gets left behind during times of stress in the healthcare system.”
The researchers pointed out that a lack of a national, organized screening program and inconsistent guidelines have led to under-screening, contributing to the late-stage diagnoses. The U.S. Preventive Services Task Force (USPSTF) currently recommends mammograms every two years for women aged 40 to 74, but no guidelines exist for women over 74, and younger women are often excluded from screening.
Call for Action
Experts emphasize the need for a more inclusive and consistent national screening strategy. “Fewer than 50% of U.S. women participate in annual breast cancer screening,” Dr. Monticciolo said. “This means many women miss the opportunity for early detection and are more likely to present with metastatic cancer.”
Additionally, researchers suggest that broader access to healthcare, addressing rising obesity rates, and improving reproductive healthcare could help curb the growing trend of advanced breast cancer diagnoses. The National Comprehensive Cancer Network recommends that women undergo a breast cancer risk assessment by the age of 25 to evaluate their risk for the disease, which may help in early identification and intervention.
As the study highlights, there is a critical need for further research, especially focusing on the Black population, who are disproportionately affected by advanced breast disease at younger ages. The findings call for urgent action in improving screening, accessibility to care, and addressing health disparities to save lives and reduce the burden of metastatic breast cancer.
For more details, see the full study: “Surveillance, Epidemiology, and End Results Data Show Increasing Rates of Distant-Stage Breast Cancer at Presentation in U.S. Women” in Radiology, published on December 10, 2024.
DOI: 10.1148/radiol.241397
