Editorial Note: The increasing prevalence of breast cancer among younger women poses significant challenges for early detection and treatment. At the 2024 Yixian Breast Cancer Conference and the 2nd China Young Breast Cancer Consensus Conference, Dr. Anqin Zhang from Guangdong Women and Children’s Hospital provided an in-depth analysis of the current status and issues surrounding breast cancer screening in younger populations. In an interview with Oncology Frontier, Professor Zhang shared insights from his extensive clinical experience and the latest research, addressing the challenges of breast cancer screening for young women, recommending effective screening methods, and proposing strategies to enhance participation and outcomes.

Oncology Frontier: With the increasing prevalence of breast cancer in younger women, what is the current status of screening in this population? What challenges and difficulties exist?

Dr. Anqin Zhang: We define young breast cancer as cases occurring in women under the age of 40. This group has a higher proportion of triple-negative breast cancer and unique factors related to fertility and breastfeeding. However, based on our data, the proportion of breast cancer cases in women under 40 has not significantly changed compared to previous years. Overall, the prevalence of young breast cancer has remained stable, while the proportion of cases in women over 40 continues to increase.

Although younger breast cancer patients generally have higher educational levels, their disease stages at diagnosis remain suboptimal. According to data from several hospitals, including Sun Yat-sen Memorial Hospital, Guangdong Provincial People’s Hospital, and our own, the proportion of Stage I breast cancer in women under 40 ranges from 32% to 48%, which is higher than the national average of 31%. For women screened through China’s “Two Cancers” program, the proportion of Stage I breast cancer cases is only 38.9%.

For this group, I recommend opportunistic screening rather than large-scale population-based screening, as the incidence of breast cancer in women under 40 remains low. Large-scale screening for this group would be costly and inefficient.

Oncology Frontier: What screening methods do you recommend for younger women, and how do these methods perform in terms of sensitivity and specificity?

Dr. Anqin Zhang: Globally, various breast cancer screening methods have been studied. In Western countries, where the median age of breast cancer diagnosis is later (around 63 years), and breast density is lower, mammography is the primary screening tool. Studies show that mammography can reduce breast cancer mortality. However, a Canadian study involving over 80,000 patients followed for 25 years found no significant difference in overall survival between mammography and routine clinical examinations. Despite this, most countries continue to support the benefits of mammography.

In East Asian countries, such as Japan and China, the median age of breast cancer diagnosis is earlier (around 48 years), and breast density is higher. The U.S. screening guidelines long refrained from recommending mammography for women aged 40–49, citing insufficient evidence. However, data from the UK Age trial suggested that women in this age group could benefit from mammography, leading the USPSTF in 2024 to recommend mammography for women aged 40–74. In Japan, the JSTART study demonstrated that combining mammography with ultrasound improved screening efficacy for women aged 40–49.

Since 2009, China’s “Two Cancers” screening program has primarily used ultrasound as its base method due to the high prevalence of dense breast tissue and limited access to mammography at the time. Data from this program show that ultrasound-based screening detects a proportion of Stage 0, I, and II breast cancers, but the detection rate for palpable breast masses is higher.

We are also exploring new screening methods, such as AI-assisted infrared imaging, rapid MRI, and liquid biopsies using tears or other body fluids. These novel approaches are less affected by the diagnostic limitations of mammography or ultrasound, offer greater standardization, and are easier to quality control. However, their effectiveness in large-scale screening remains to be validated through extensive studies.

Oncology Frontier: What suggestions or strategies do you propose to increase participation and effectiveness in breast cancer screening for young women?

Dr. Anqin Zhang: The main reasons for low detection and positive rates in screenings are insufficient coverage. Screening coverage in Western countries is around 70%, while a 2008 report from China showed coverage at only 18%, which has risen to just 30% in recent years.

To improve coverage, we have explored various approaches and found that implementing three strategies simultaneously—optimizing services, increasing public awareness, and adjusting screening costs—can raise coverage to 86%. Previously, we relied on television and radio to promote screening. Today, we should leverage multimedia platforms like WeChat and TikTok to reach more people and encourage participation.

Additionally, women under 35, who are not included in population-based screening programs, should proactively undergo opportunistic screening to enable early detection of breast cancer.

Dr. Anqin Zhang

• Chief Physician, Master’s Supervisor
• Director, Breast Center, Guangdong Women and Children’s Hospital
• Vice Chair, Breast Health Committee, Chinese Maternal and Child Health Association
• Chair, Breast Disease Prevention and Treatment Committee, Guangdong Thoracic Disease Society
• Vice Chair, Breast Disease Branch, Guangdong Medical Association
• Vice Chair, Breast Specialty Committee, Guangdong Medical Doctor Association
• Member, 1st Tumor Reconstruction Professional Committee, Chinese Anti-Cancer Association

Conclusion Dr. Anqin Zhang’s insights provide a comprehensive overview of the current state of breast cancer screening in younger women, highlighting the challenges, potential solutions, and innovative approaches to improve early detection. His recommendations emphasize tailored strategies and the importance of leveraging new technologies and outreach methods to optimize outcomes for this unique population.