Evolution of Breast Cancer Incidence in Young Women in a French Registry From 1990 to 2018

Towards a Change in Screening Strategy?

Yanis Hassaine; Emmanuelle Jacquet; Arnaud Seigneurin; Patricia Delafosse

Breast Cancer Res. 2022;24(87)

Results

Incidence

For the period 1990 to 2018, we selected 23,703 cases of invasive BC in the Isere department among whom 1343 were < 40 years at diagnosis.

Table 1 shows the incidence data for each age group. From 1990 to 2018, the AAPC of invasive BC was + 0,8% per year (95% CI 0,7; 1) for all age groups combined. For the 50–74 years group, targeted by organized screening, AAPC was + 0,7% by year (95% CI 0,4; 0,9) from 267,6 to 329,9 per 100,000. In the < 40 years group, a significant annual increase of 2,1% (95% CI 1,3; 2,8) was observed from 8,9 to 22,4 per 100,000. This is the highest rise in incidence compared to other age groups (Figures 1,2).

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Figure 1.

Average annual percentage of change of invasive breast cancer by age at diagnosis from 1990 to 2018 (France, Isere Department)

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Figure 2.

Invasive breast cancer incidence rate for women < 40 years from 1990 to 2018 (France, Isere Department)

From 2011 to 2018, all age groups combined, there was an increase in incidence of + 0,6% (95% CI − 0,4; 1,6), but the results are not statistically significant. In the < 40 years group, 35–39 year olds accounted for the largest proportion of cases (incidence rate of 81.3 per 100,000 or 60% of cases) and AAPC was + 2,1% (95% CI − 2,1; 6,2). For the 40–49 age group, AAPC was + 1.6% (95% CI − 1.4 + 3.2) with an incidence rate of 163 per 100,000 in the 40–44 age group (Table 2 and Table 3).

Regarding tumor subtypes in this period, there were 8.4% triple negatives, 14.3% HER2 amplified, and 74.8% luminal, all age groups combined. Among YW, there were 18.3% triple negative, 25.8% of HER2 amplified, and 54% luminal.

As shown in Table 4, AAPC was -0.8% (95% CI − 4,2; 2,6) for all age groups combined among triple negatives. Nevertheless, there is an increase in the incidence among YW (+ 1,4% by year, 95% CI − 8,2; 11) and those over 75 (+ 4% by year, 95% CI − 5,1; 13,2), but the results are not statistically significant.

The incidence rate of the luminal group seems to be slightly decreasing for all age groups except those over 75 one.

In the HER2 amplified group, there is a statistically significant increase in the incidence rate of 6% by year in all age groups, 7.4% by year among 40–49-year-olds, and 12.7% among those over 75 years old. Among YW, there is an increase in the incidence rate of 6,8% by year, but the results are not statistically significant.

Relative survival

From 1990 to 1999, 10-year relative survival was 74,6% (95% CI 69,6; 78,9) in YW group and 79,4% (95% CI 77,7; 81,0) in the 50–74 years group. From 2000 to 2008, 10-year relative survival was 78,3% (95% CI 73,7; 82,1) among women < 40 years and 88,3% (95% CI 87,1; 89,4) in the 50–74 years group. The smallest relative survival is found in the over 75 s at 67% (95% CI 62,2; 72,4) and 71,5% (95% CI 67,1; 73,4) from 1990 to 1999 and from 2000 to 2008, respectively (Table 5). Figure 3 shows the corresponding survival curve.

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Figure 3.

Relative survival for invasive breast cancer according to years at diagnosis by age (France, Isere Department)

Between 2011 and 2013, 5-year relative survival was slightly lower among triple negative (86,9%, 95% CI 75,6; 93,1) and luminal (97%, 95% CI 94,7; 98,3) in YW compared to other age groups, except those over 75 years old. The 5-year relative survival of YW is higher in HER2 amplified (99,6%, 95% CI 94,7; 99,9) compared to the 50–74-year-old group (Table 6). Figures 4, 5, and 6 show the corresponding survival curve.

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Figure 4.

5-year relative survival rates for non-metastatic triple-negative breast cancer among women diagnosed from 2011 to 2013 (France, Isere Department)

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Figure 5.

5-year relative survival rates for non-metastatic Her2 amplified breast cancer among women diagnosed from 2011 to 2013 (France, Isere Department)

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Figure 6.

5-year relative survival rates for non-metastatic luminal breast cancer among women diagnosed from 2011 to 2013 (France, Isere Department)

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Breast Cancer Res. 2022;24(87) © 2022 BioMed Central, Ltd.
Copyright to this article is held by the author(s), licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original citation.

Table 1. Standardized incidence rate per 100 000 women year of invasive breast cancer according to age from 1990 to 2018 (France, Isere Department)
	1990	1991	1992	1993	1994	1995	1996	1997	1998	1999	2000	2001	2002	2003	2004
< 40 years	8,9	9,2	11,8	14,5	14,5	12,2	13,2	12,8	16,4	10,8	17,7	10,8	12,0	11,0	15,2
40–49 years	156,3	178,8	181,0	151,5	193,9	173,8	185,2	152,9	182,2	173,1	178,7	176,5	199,1	208,6	192,6
50–74 years	267,6	275,9	279,5	273,4	260,8	268,2	284,4	325,8	287,9	272,5	318,7	346,2	356,6	360,9	356,9
≥ 75 years	250,8	270,4	249,3	272,6	320,8	256,4	300,2	288,9	316,6	284,1	279,4	293,9	247,5	307,9	347,2
All age	100,6	107,6	109,6	108,2	115,4	109,7	119,6	124,8	125,5	116,3	132,6	137,5	141,4	149,1	152,6
	2005	2006	2007	2008	2009	2010	2011	2012	2013		2014	2015	2016	2017	2018
< 40 years	13,6	16,5	16,8	22,6	18,0	15,2	19,1	14,9	19,1		17,4	14,5	19,4	16,2	22,4
40–49 years	207,3	198,2	193,6	206,7	211,0	168,8	213,2	184,9	188,8		184,6	200,1	204,7	186,2	229,2
50–74 years	324,8	328,4	320,3	345,2	319,1	307,8	323,1	328,6	322,1		320,6	320,5	341,4	323,5	329,9
≥ 75 years	342,5	271,7	288,9	310,0	348,9	337,0	361,3	325,3	306,8		340,3	345,0	354,4	346,7	376,5
All age	146,8	143,3	143,4	157,6	153,7	143,6	159,4	152,6	153,0		155,6	157,8	168,6	159,8	174,5

Table 2. Incidence rates by 5-year age group between 2011 and 2018
Age group	Number of case	Population	Incidence rate for 100,000 100 000
0–4	0	303,926	0,0
5–9	0	320,491	0,0
10–14	0	318,004	0,0
15–19	0	310,107	0,0
20–24	5	294,902	1,7
25–29	41	288,357	14,2
30–34	131	312,751	41,9
35–39	265	324,733	81,6
40–44	562	344,732	163,0
45–49	816	348,316	234,3
50–54	883	333,043	265,1
55–59	858	313,374	273,8
60–64	935	297,095	314,7
65–69	1052	263,594	399,1
70–74	864	200,111	431,8
75–79	576	170,320	338,2
80–84	537	150,328	357,2
85 +	598	175,446	340,8

Table 3. Average annual percentage of change by age from 2011 to 2018 (CI 95%)
Age group	Average annual percentage of change
< 40 years	+ 2,1% (–2,1%; + 6,2%)
40–49 years	+ 1,2% (–1,4%; + 3,2%)
50–74 years	+ 0,6% (–1,2%; + 1,3%)
≥ 75 years	+ 1,1% (–0,8%; + 3,4%)
All age group	+ 0,6% (–0,4%; + 1,6%)

Table 4. Average annual percentage of change according to age and tumor subtype from 2011 to 2018 (CI 95%)
	Triple negative	HER2 amplified	Luminal
< 40 years	+ 1,4% (–8,2; + 11,0)	+ 6,8% (–1,8; + 15,4)	–0,2% (–5,7; + 5,3)
40–49 years	–4,8% (–12,4; + 2,8)	+ 7,4% (+ 1,1; + 13,7)	–0,1% (–2,8; + 2,5)
50–70 years	–1,3% (–6,1; + 3,4)	+ 3,4% (–0,2; + 7,1)	–0,7% (–2,1; + 0,8)
≥ 75 years	+ 4,0% (–5,1; + 13,2)	+ 12,7% (+ 5,2; + 20,2)	+ 1,1% (–1,3; + 3,5)
All age	–0,8% (–4,2; + 2,6)	+ 6,0% (+ 3,2; + 8,7)	–0,1% (–1,2; + 1,0)

Table 5. 10-year relative survival of breast cancer by age from 1990 to 1999 and 2000 to 2008 (CI 95%)
	1990–1999	2000–2008
< 40 years	74,6% (69,6; 78,9)	78,3% (73,7; 82,1)
40–49 years	82,6% (80,3; 84,7)	87,3% (85,2; 89,0)
50–74 years	79,4% (77,7; 81,0)	88,3% (87,1; 89,4)
≥ 75 years	67,6% (62,2; 72,4)	71,5% (67,1; 75,4)

Table 6. 5-year relative survival of non-metastatic breast cancer by age according to tumor subtype from 2011 to 2013 (CI 95%)
	Triple negative	HER2 amplified	Luminal
< 40 years	86,9% (75,6; 93,1)	99,6% (94,7; 99,9)	97% (94,7; 98,3)
40–49 years	87,4% (79,7; 92,3)	99,9% (96,1; 99,9)	98,6% (97,5; 99,1)
50–74 years	88,7% (83,1; 92,5)	95,1% (90,6; 97,5)	98,4% (97,5; 98,9)
≥ 75 years	84,2% (72; 91,4)	90,7% (79,7; 95,9)	94,4% (91,3; 96,4)