Women diagnosed with breast cancer at age 40 or younger can face delays at multiple points on the path to treatment, with lower-income women more likely to delay seeking care and the youngest patients more likely to experience diagnostic delays, according to a new study in CANCER.
The findings are important because breast cancer in women under 40 is often diagnosed at a later stage and tends to have more aggressive features than disease in older women. Young patients generally fall below the age recommended for routine breast cancer screening, making recognition and evaluation of symptoms particularly important.
Researchers analyzed 1,071 women diagnosed at age 40 or younger with stage 0 to IV breast cancer who participated in the Young Women’s Breast Cancer Study, conducted at 13 academic and community sites in the United States and Canada between 2006 and 2016.
The researchers examined delays at three points. A presentation delay meant at least 90 days between noticing a symptom and seeing a healthcare provider. A diagnostic delay was at least 90 days from that visit to a breast cancer diagnosis, while a treatment delay was at least 60 days between diagnosis and beginning treatment.
Among the women studied, 153 experienced presentation delays, 120 had diagnostic delays, and 228 had treatment delays.
Income emerged as an important factor. Women with annual household incomes below $50,000 were more likely to delay seeking care, even though this was a relatively well-insured population: 85% had commercial or managed-care insurance, and only 1.2% were uninsured.
“Our finding that presentation delays were more common among patients with an income of less than $50,000 underscores the impact of finances in shaping access to care, even within a well-insured cohort,” the authors wrote.
The youngest women were more likely to experience diagnostic delays after entering the healthcare system. Potential explanations include lower awareness of cancer risk among very young adults, attributing symptoms to other causes, and clinicians being less likely to suspect breast cancer in younger patients.
Tumor biology also influenced delays. Women with triple-negative breast cancer were less likely to experience diagnostic delays, and patients with more aggressive tumor subtypes generally started treatment sooner. The researchers suggested that aggressive tumors may be easier to detect or prompt greater urgency.
Presentation delays were associated with later-stage disease among women with HER2-positive luminal B tumors. However, delays were not independently associated with disease-free or overall survival.
“Although delays did not appear to alter survival outcomes on their own, the strong relationship observed between presentation delay and the likelihood of later-stage disease, notably in patients with HER2-positive luminal B tumors, highlights the need to increase patient and provider awareness,” the authors wrote.
The apparent disconnect may partly reflect a “survival paradox”: Aggressive cancers can be diagnosed and treated more quickly but still have poorer outcomes because their underlying biology plays a greater role in prognosis.
The study was limited by its predominantly White, insured, and relatively affluent population. Still, the findings underscore the importance of recognizing that breast cancer can occur well before routine screening age and ensuring that suspicious breast changes in very young women receive timely evaluation.
