Breast cancer staging, treatment burden higher in younger women

 Younger women with breast cancer, aged ≤ 45 years, are more likely to have a higher prevalence of later-stage disease at diagnosis, as well as higher within-stage costs, according to a report from RTI International recently published in the journal Breast Cancer Research and Treatment.

“Younger women diagnosed with breast cancer often face more aggressive treatment, and are therefore more vulnerable to financial hardships,” said Benjamin T. Allaire, report author and research economist at RTI, Research Triangle Park, NC. “This hardship leads some to forgo or delay necessary treatments, which may lead to immediate or future complications.”

In this study, Allaire and colleagues sought to estimate breast cancer costs by stage at diagnosis during the first 18 months of treatment in privately insured younger women. They analyzed data from the North Carolina cancer registry that was linked to claims data from private insurers from 2003 to 2010. They divided subjects into a younger cohort aged 21 to 44 years, and an older one aged 45 to 64 years. Using age, zip codes, and the Charlson Comorbidity Index, they matched women with and without breast cancer, and calculated mean excess costs in breast cancer patients compared with non-breast cancer patients at 6, 12, and 18 months.

In a full 40% of younger women, American Joint Committee on Cancer (AJCC) 6th edition stage II cancer was the most common at diagnosis, followed by stage I in 34%. In older women, stage 1 cancer was the most common at diagnosis (46%), followed by stage II in 34%.

At 12 months, excess costs for younger women were higher than for older women ($97,486 [95% CI: $93,631-$101,341] vs $75,737 [95% CI: $73,962-$77,512], respectively).

"Based on previous research, we knew that younger women cost more to treat than older women, but did not fully understand why,” concluded Allaire. “Our new research reveals that it is because they are diagnosed with later stage cancers and they require more intense treatment. The magnitude of these costs underscores the importance of maintaining insurance coverage.”

Allaire and colleagues called for further studies to determine what the drivers of these cost differences may be, and how they affect quality of life in younger women who are breast cancer survivors.