Breast cancer rates are up especially in those under 50, but death rates are down

CATHY WURZER: You may know that October is Breast Cancer Awareness Month. It's almost done, but we want to talk about this. There is actually some good news. Breast cancer deaths are declining. A new report from the American Cancer Society finds half a million lives have been saved since 1989.

But at the same time, breast cancer diagnoses are becoming more common, and they're rising fastest in women younger than 50 years old. Amanda Thiesen knows that personally. She got that phone call she'll never forget in 2021, when she was just 39 years old, that she had stage four metastatic breast cancer. Amanda's on the line to talk about it. Amanda, my friend, how are you?

AMANDA THIESEN: I'm good, Cathy. How are you doing today?

CATHY WURZER: Good. So far, so good, thank you. Also joining us to add some context to the story is Dr. Amy Krie. Dr. Krie is an oncologist specializing in breast cancer at Allina Health. Doctor, are you with us?

AMY KRIE: I am. Thanks for having me.

CATHY WURZER: Oh, just a pleasure to have you here. Thank you so much, both of you, taking the time to talk with us. Say, Amanda, I want to start with you. You are going on, by my count, about three years now, is that right, after getting that diagnosis?

AMANDA THIESEN: That is correct.

CATHY WURZER: And I know you call yourself not a survivor, but a thriver. Congratulations. I'm wondering how you're feeling right now.

AMANDA THIESEN: Well, the good news is I'm feeling really good. I had my last scan in August, and fortunately that came back clean again. So it's been about two and a half years now of scans that show no evidence of disease, which doesn't mean the cancer is completely gone. It's just at levels that aren't detectable by a PET scan or another type of scan.

CATHY WURZER: I know you and I have talked about this in the past, just how much of a shock the diagnosis was. You don't expect to find cancer at 39. And I believe you found-- you thought the lump, that you found it early, but that it already spread. I mean, my goodness sakes, what a horrible shock.

AMANDA THIESEN: Yeah, it was. And I didn't know much about metastatic breast cancer at the time, and I had no idea that you could be diagnosed with it on your first diagnosis. As you said, I found my lump in my left breast, and I went in right away to get a mammogram, ultrasound, and then had a biopsy after that. And when the doctor performing the biopsy said, I'm very concerned about this, I had a gut feeling that I was going to get that call, and I did about 24 hours later.

And then went through that series of tests, one of which was a PET-CT, to make sure that the cancer hadn't spread. And I thought, well, I caught it early, so hopefully it hasn't spread. But that wasn't the case for me. They found a spot on my hip bone, which I did have biopsied, and it tested positive for breast cancer. So it's rare, but I think it's about 10% of women who are diagnosed with breast cancer are diagnosed right away with stage four. So I happen to be one of those that fell into that 10% category.

CATHY WURZER: Mm. Wow. Dr. Krie, you're listening to Amanda's story. You're not her doctor, I know, but is what you're hearing matches what you're seeing in your practice as well?

AMY KRIE: Yeah, you know, we are seeing a higher number of young women with breast cancers. We are seeing more of these cancers being hormone-fed, actually.

CATHY WURZER: Hormone-fed. Is that what you just said?

AMY KRIE: Yeah. So there's three types of breast cancers. There's estrogen-progesterone receptor-positive, or what we call hormone-fed breast cancer. There are triple-negative breast cancers, and then there are cancers that are HER2-positive. So the majority of the increasing cases that we're seeing are the hormone-fed type of breast cancers.

CATHY WURZER: I wonder why that is. Are there any theories?

AMY KRIE: Yeah. We don't have a concrete answer yet, but even just looking at the women who are under 50, this faster-growing subset of women, we are seeing a predominance of ER-positive disease in these women. So we think it has a lot to do with, of course, lifestyle. So women are not having as many children. They're delaying when they have their first child. Less breastfeeding. Also, we're seeing an increase in obesity rates in women, and so seeing women overweight early on. And certainly that's not the cause in every case, but we think that's probably the cause of this trend that we're seeing.

CATHY WURZER: Then if young women are listening to us, I mean, Amanda went in to get her mammogram, and then there's this tumor, right, that has spread. The cancer has spread. Is this a good reason, then, for younger women to talk to their doctors and start doing screenings earlier?

AMY KRIE: Yeah, I think so. So the recommendations for screening are changing. So the US Preventative Services Taskforce just lowered their recommended age from 50 down to 40, because we are seeing this increasing incidence in younger women. We also tell women, the problem is screening under the age of 40, women often have very dense breast tissue, so the mammogram is often difficult to evaluate in that age range.

So if women have family histories of breast cancer, if there's a strong family history of breast cancer, we're urging women to get into any of the high-risk breast clinics in Minneapolis or in Minnesota, where some of these women are high enough risk that we're screening with even MRI at very young ages.

CATHY WURZER: Say, Amanda, what's your advice to young women when they hear your story?

AMANDA THIESEN: I would say the biggest thing is trust your instincts. Listen to what your body is telling you. I could have waited, and I'm so glad I did not. And I just think about, what if I would have waited later? How much further would the cancer have spread? And the other thing, too, is I fortunately had a great team of doctors that believed me from the start. I know that sometimes there's other women out there who are told, you're too young to have breast cancer, or maybe this is just a clogged milk duct, or it's probably benign, nothing to worry about.

But if you feel the opposite, if you're like, no, I need to get checked out, something is not right, go with your gut. Advocate for yourself, and make sure that you're getting the care that you need and the answers that you need in order to get the right line of treatment and prevent it from spreading. Or in my case, I'm now at a point where my cancer is manageable with the right line of treatments, so I'm hoping that will at least allow me to have a longer life expectancy and a better quality of life.

CATHY WURZER: Dr. Krie, are we at the point where you do have stage four breast cancer, and it is manageable? Will it become almost like a chronic condition somewhere along the line? Have you seen strides in treatment where it can be, as Amanda just said, something that you can continue to live with?

AMY KRIE: Yeah, that's definitely our hope. Mortality rates for breast cancer are down 44% in the last 20 years. And part of that is due to early detection, but a large part of that is due to new breakthroughs and new treatments that we're finding for breast cancer. So the hope is we can manage this like a chronic disease for many, many years, and these women can go on and live healthy and active lives with their families.

CATHY WURZER: You know, before we go, Amanda, I mentioned that you consider yourself a thriver, not a survivor. And I like that word. Have you thought a lot about the mindset that is needed, especially living with stage four metastatic breast cancer? How important is that?

AMANDA THIESEN: I think, for me, it's important because it puts things into a perspective for me where I'm not-- I'm trying to think of the right wording here. I'm not selling myself short. I know that this is not going to go away. I know I have an incurable disease. But at the same time, my treatment has been a course where it's almost been strategic in how I've been treated, where I haven't had to go through all of the side effects a whole range of chemo, surgery, radiation can throw at a patient. So I really appreciate how my doctors, my team have helped me realize that you can be strategic about, especially with stage four, how you treat it. So that way you do have a good quality of life, and you're not going through all of the symptoms that can really plague a cancer patient.

And as far as the thriver term goes, I use that knowing that my treatment is never going to end. I'm always going to be in some form of treatment. So as a lot of survivors may or may have not done, they get to ring a bell when they complete their treatment. I'm not going to get to do that, but I still have the outlook and the perspective that I can still have a good quality of life, even if I do have this disease for the rest of my life.

CATHY WURZER: Well, obviously, all of us, Amanda, wish you well. And Dr. Krie, we thank you for your work, and we thank both of you for taking the time to talk with us about this. It's a very important issue, obviously. Thank you so much.

AMANDA THIESEN: Thank you, Cathy.

AMY KRIE: Thanks.

CATHY WURZER: Thanks, Amanda. Dr. Krie, thank you, too. Amanda Thiesen is a stage four breast cancer thriver. Dr. Amy Krie is an oncologist at Allina Health.