Although breast cancer is generally associated with older women, 5 to 7 percent of cases occur in women 35 years and younger, and these cancers tend to be more aggressive than cancers in older women. When Biffl and colleagues noticed an unexpected number of Latina women among the younger patients presenting with breast cancer at their institution, they investigated the possibility that ethnicity could influence the severity of the disease and the age at which it first appears.

They analyzed data from all breast cancer patients who attended a major medical center in Denver between 1977 and 2000, and from all cases of breast cancer in Colorado between 1988 and 2000. As shown in the accompanying table, more than one half of the younger patients were Latina.

Overall, 7 percent of patients were 35 years or younger, but this percentage was significantly different in Latina patients (12 percent) compared with other patients (5 percent). Compared with other patients, Latina patients were significantly more likely to present at a young age, to have more advanced disease (38 percent had stage III or stage IV disease compared with 29 percent of other patients), and to have bilateral lesions (22 percent compared with 8 percent of other patients). Five-year survival was also significantly worse in Latina patients (63 percent compared with 83 percent of other patients). Only 20 percent of nonwhite younger women had a positive family history of breast cancer, compared with 50 percent of white women.

The authors conclude that Latinas comprise a disproportionate share of young patients with breast cancer and have a more aggressive disease process. This conclusion correlates with data from other studies. The authors do not believe that access to medical attention was a significant factor because most of their patients had Medicaid or used clinics for uninsured patients. The authors are concerned that cultural issues could influence the use of self breast-examination and decisions about seeking care and selecting treatment. Because mammography is not recommended for young women, the authors call on all physicians to be alert for breast disease in young Latinas and to educate these patients about self breast-examination and the importance of early presentation if they detect breast masses.

editor's note: We cannot assume from this study that breast cancer is more common among young Latinas because we do not know the size of the denominator populations from which the cases came. Nor can we assume that the findings in Colorado are true of all Latina groups, because these patients were predominately of Mexican descent and could have different risks than other Spanish-speaking groups. Nevertheless, the presentation of advanced disease in young women for whom we have no effective screening is very troubling. It is counter-intuitive that a group of women with relatively early menarche, high fertility rates, low family history of breast cancer, and non-Western diet should have high rates of breast cancer, especially young women. While the epidemiologists seek risk factors and screening tools, family physicians must be especially careful to monitor breast disease in Latina women and to have a higher level of suspicion for cancer when a mass is found.—a.d.w.