The Rising Rates of BC & MBC in Young Women, Including Pregnancy & Post-Partum Diagnoses
If you don't hear much about the rising rates of all stages of breast cancer, including MBC, in young women, you're not alone. De novo MBC rates (when Stage 4 MBC is found at the first diagnosis) are rising "exponentially", and fastest among women between the ages of 25 and 39, but not in older women. These trends are alarming to researchers. Perhaps most shocking of all: half of young women diagnosed with breast cancer under 45 have a postpartum diagnosis, defined as being within 10 years from their youngest child's birth, and that is something that rarely gets covered or explained. We'll explore it all in this episode, including the possible causes, recommendations for testing and even contraception for young women, and the research and clinical leaders working to make this a top priority in the BC & MBC space. It's difficult to consider, and dense, we know. But so important and important to share with all the young women in our lives. Not to scare them, but to inform and empower them.
EPISODE NOTES:
Rebecca Johnson, MD, Mary Bridge Children’s Hospital, Research:
2013 Article in Journal of the American Medical Association (JAMA)
2021 Article in the American Society of Clinical Oncology Journal/JCO Oncology Practice
Virginia Borges, MD, University of Colorado, Research: (with basic research led by Pepper Schedin, PhD, Oregon Health Sciences University)
Our speakers recommend the following reading order:
Time to mets Goddard: Demonstrates increased metastasis in postpartum breast cancer, how ER+ breast cancer in the background of a recent pregnancy “acts”’ more like TNBC, and how TNBC PPBC has especially poor prognosis
PPBC Lancet Oncology: Argues for cases diagnosed during pregnancy to be studied separately from cases diagnosed postpartum
Older Goddard paper (2017): Showing weaning-induced liver involution for the first time and human data suggesting that postpartum, the liver tissue environment changes (likely involution) creating a metastatic niche for circulating breast cancer cells
Bartlett human liver involution: Evidence for weaning induced liver involution in women
Jindal_et_al 2021-Nature_Communications: Evidence that PPBC is “sculpted” by the involution environment to be a more aggressive disease
Jindal_et_al 2020-npj: Jindal_et_al 2020-npj: A study of weaning induced involution in the human breast with the goal of understanding the duration of involution-as this is the window we want to target with our postpartum pill
Chick Mission refuses to let the emotional, physical, and financial cost of a cancer diagnosis stand between young women and a full life after going through cancer treatment. They provide young women newly diagnosed with cancer the option to preserve fertility through direct financial support, educational programs, and advocacy efforts.
Meet the Guests of the Episode
Virginia Borges, M.D.
Dr. Borges is a Professor of Medicine with Tenure at the University of Colorado Denver and holds the Robert C. and Patricia Young-Connor endowed Chair in Young Women’s Breast Cancer. Dr. Borges is the Deputy-Head of the Division of Medical Oncology, the Director of the Breast Cancer Research Program and the Director for the Young Women’s Breast Cancer Translational Program. Dr. Borges focuses on research in Young Women’s breast cancer, the interaction of breast cancer and pregnancy and the development of novel drugs for breast cancer.
Dr. Rebecca Johnson
Dr. Johnson is a physician in the division of Pediatric Hematology/Oncology at Mary Bridge Hospital in Tacoma, WA. Dr. Johnson founded the Adolescent and Young Adult (AYA) oncology program at Seattle Children’s Hospital and is now building an AYA program at Mary Bridge Hospital/MultiCare Health System. Her clinical and research interests include patient engagement, cancer epidemiology and unmet needs and barriers to care among AYAs. She chairs the AYA committee of the SWOG clinical trials group and serves on the advisory board of the Children’s Oncology Group (COG) AYA Committee.
