NEW YORK, Dec. 10 (UPI) -- The number of U.S. women with breast cancer that has spread elsewhere in the body by the time of diagnosis increased dramatically among all ages and ethnicities between 2004 and 2021, a new study shows.
The findings were [published Tuesday](https://pubs.rsna.org/doi/10.1148/radiol.241397) in Radiology, a journal of the Radiological Society of North America.
"Our study indicates that we are failing to find breast cancers at early enough stages in U.S. women of all ages," lead author R. Edward Hendrick told UPI.
"We have known this to be the case in women under age 40, but it is alarming that this is occurring in women over age 40, as well," said Hendrick, a clinical professor of radiology at University of Colorado School of Medicine in Aurora.
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Investigators observed sizable increases in distant-stage breast cancers among women ages 20 to 39 and 75 and older over the entire study -- from 2004 to 2021.
Significant upward trends in women ages 40 to 74 occurred from 2004 to 2010 and 2018 to 2021 -- the most recent data from Surveillance, Epidemiology and End Results, program is an authoritative source of information on cancer incidence and mortality in the United States.
"More late-stage disease means more breast cancer deaths," said Dr. Debra Monticciolo, co-author and an emeritus faculty member at Baylor Scott & White Medical Center in central Texas.
This data comes from 22 cancer registries that represent some 48% of the U.S. population.
"Early detection of breast cancer is one of the main reasons for our success in decreasing breast cancer deaths," said Monticciolo, a past president of the American College of Radiology.
For U.S. women, breast cancer is the second most-common cause of death from a malignancy after lung cancer, according to the Centers for Disease Control and Prevention. Five-year survival rates are 31% for metastatic breast cancers -- much lower than 99% and 86%, respectively, for localized and regional invasive breast cancers.
Between 2004 and 2021, the largest annual percentage increase in the incidence of metastatic breast cancer at diagnosis occurred in women ages 20 to 39 -- 2.9% -- the researchers noted.
For women ages 40 to 74 years, annual percentage increases were 2.1% and 2.7%, respectively, during two periods -- from 2004 to 2012 and 2018 to 2021. And for those 75 years and older, the incidence rate rose by 1.4% over the study period.
Breast screenings declined sharply during the COVID-19 pandemic, with steep drops among older, minority women.
Native American women had the largest annual percentage change in the incidence of metastatic breast cancer at diagnosis, 3.9%. The rate also increased significantly and rapidly for Asian women -- 2.9% per year between 2004 and 2021.
Among Black women, rates of distant-stage breast cancers were 55% higher compared to White women. Blacks women are more likely to experience advanced disease at a younger age, the researchers said.
Several factors may be at play, including inconsistent guidelines and the absence of national, organized screening, as well as rising obesity rates, reproductive trends, lack of access to quality care and environmental factors.
Fewer than half of U.S. women undergo annual screening. Women ages 40 to 74 should have a screening mammogram every two years, based on U.S. Preventive Services Task Force guidelines.
These recommendations don't include women older than 74, despite clear advantages of early detection. Meanwhile, the dearth of screening among younger women leaves them more vulnerable to a diagnosis of aggressive, fast-growing cancers, the researchers said.
The National Comprehensive Cancer Network recommends a breast cancer risk assessment by age 25.
Other experts praised the study for highlighting the rise in late-stage breast cancer diagnosis.
"The results are disheartening because it sounds like we're losing the race, meaning that women are presenting more frequently with stage 4 -- metastatic -- breast cancer than previously," said Dr. Ethan Cohen, an associate professor of radiology at The University of Texas MD Anderson Cancer Center in Houston. He was not involved in the study.
A late-stage diagnosis "is much less survivable and more challenging or difficult to treat because it has already spread throughout the body," Cohen said.
Other than a lump in the breast or under the arm, women should monitor for skin changes, such as color or dimpling, which may resemble an orange peel, said Dr. Lisa Abramson, an associate professor of diagnostic, molecular and interventional radiology at Icahn School of Medicine at Mount Sinai in New York City.
Changes in size -- swelling of one breast compared to the other -- deserve attention. Other signs include nipple changes -- retraction, or facing inward, flaking, redness or discharge, Abramson said.
"This study should galvanize us to take action" against gaps in screening, said Dr. Corey Speers, radiation oncology chair and co-director of the breast cancer program at University Hospitals Seidman Cancer Center in Cleveland.
"We must work to expand access to screening, ensure that every woman has the opportunity for early detection, and prioritize research to understand and mitigate the factors driving these trends," Speers said.