Young women in Canada were more likely to get breast cancer in recent years than three decades ago, according to a new analysis that shows the rates increased most among patients in their 20s and 30s.

The study, published Friday in the Canadian Association of Radiologists Journal, found that young women are still much less likely to develop breast cancer than senior citizens, but their risk is increasing in a way that mirrors findings about early onset cancer in other countries and other parts of the body.

“Twenty years ago, we saw women with breast cancer in their 20s so rarely that it would be something we would show in rounds,” said Jean Seely, head of breast imaging at the Ottawa Hospital and one of the study’s authors. “Now we’re seeing it on a regular basis.”

The rising rates of breast cancer among Canadian women in their 20s and 30s – when many are in the prime of life, completing post-secondary education, raising young children and scaling the career ladder – is part of a larger trend toward increasing incidence of early-onset cancers in developed countries the world over.

Early-onset cancer, which is usually defined as cancer in adults younger than 50, is becoming more common in at least 14 different types of cancer, including breast, colorectal and pancreatic, according to a 2022 study in the journal Nature that asked, “Is early-onset cancer an emerging global epidemic?”

A separate study in BMJ Oncology found that, globally, incidence rates of early-onset cancer increased by nearly 80 per cent between 1990 and 2019.

“It’s a mystery,” said Shuji Ogino, a professor of pathology at Harvard Medical School and one of the authors of the Nature paper. “But we know many risk factors already for adult cancer. We have good hypotheses.”

Topping the list of suspects is what Dr. Ogino calls the “modernizing lifestyle,” including an obesity-promoting Western diet laden with processed foods. Other suspects include a lack of exercise, increased alcohol consumption, modern sleep patterns, stress, and exposure to chemicals and pollutants.

The new paper drew on Statistics Canada population and cancer registry data to analyze breast cancer incidence in Canada over time, broken down by age group.

The researchers found that among those in their 20s, there were, on average, 5.7 cases per 100,000 people of breast cancer annually between 2015 and 2019, up from 3.9 cases per 100,000 between 1984 and 1988 – a 45.5-per-cent increase.

For 30-somethings, there was a 12.5-per-cent increase over the same time span. The rate rose to 42.4 cases per 100,000 in the 2015-2019 period from 37.7 cases per 100,000 in 1984-1988.

Rates also increased for some groups of older women, including those in their 40s, but at slower rates than for their younger peers. Fortunately, overall breast cancer mortality rates have fallen significantly during the same period in Canada as treatments improved and organized screening mammogram programs, primarily aimed at women 50 to 74, detected cancer earlier in older women.

When it comes to breast cancer, another factor could be the trend of delaying or forgoing childbearing in wealthy countries, including in Canada. The new paper notes that the average age at which Canadian women give birth rose to 31.6 in 2022, up from 23.5 in 1966. Hormone changes that occur during pregnancy and breastfeeding are believed to lower risk for breast cancer.

Anna Wilkinson, a GP-oncologist at the Ottawa Hospital and another author of the new study, suspects a “combination of factors” are behind the rising incidence of breast cancer in young women.

“We know things like alcohol exposure and physical inactivity can increase your risk,” she said. “We see that women are having their first child at a later age and they’re not having as many children. So those protective factors, like progesterone exposure during pregnancy and breastfeeding, are lessened.”

One factor that isn’t contributing to the increase is screening. That’s because regular screening mammograms are not recommended for average-risk women in their 20s and 30s in Canada.

Dr. Seely and Dr. Wilkinson, who have been vocal advocates of screening for breast cancer starting at age 40, say the disease remains rare enough in women below 40 that widespread screening wouldn’t be a sensible use of health-care resources. However, they urged younger women who notice changes to their breasts, including discolouration or lumps, to get their symptoms checked out.

In 2019, the most recent year included in the paper, the breast-cancer incidence rate was 140.76 cases per 100,000 for Canadian women in their 40s, 42.47 per 100,000 for those in their 30s and 6.07 for women in their 20s.

The Canadian Task Force on Preventive Health Care, which issues national recommendations to primary-care providers, currently recommends against screening mammograms for average-risk women age 40-49, saying the risks of false positives and overtreatment outweigh the benefits for that age group. The task force is due to publish a highly anticipated update to its guidelines this spring.

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Chronic back pain affects nearly eight million Canadians and is a condition that can become quite debilitating. For Dave Meyn, a clinical neuroscience patient at London Health Sciences Centre (LHSC), chronic back pain led to sciatica in his right leg, and extreme pain in his lower back.

“It was very debilitating, to the point that the shooting pain in my right leg caused me to stumble and fall,” said Meyn. “It was difficult to live with and started to negatively affect my day-to-day life.”

After many visits with his family doctor, chiropractors, and massage therapists, Meyn turned to LHSC and became the first patient in Canada to receive a robotic assisted surgery on his spine, called a direct lateral spine surgery, using the MazorX Spinal Robot. Schulich School of Medicine & Dentistry funded the original cost of the robot for research purposes, before transferring the equipment to LHSC for clinical use.

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“Usually, we would do this surgery from the back, which means the patient would lie on their stomach,” said Dr. Victor Yang, neurosurgeon at LHSC and professor of Neurosurgery, Medical Imaging, Orthopedic Surgery, and Medical Biophysics in the Department of Clinical Neurological Sciences at Schulich Medicine & Dentistry.

Because Meyn needed surgery in two spots on his spine, the surgical team was able to use this new robotic technology to perform a minimally invasive surgery from the side, called a direct lateral spinal surgery.

“Performing a surgery from this position can be quite challenging, but with the robot, it allows us to virtually see where the bone is within the patient’s body, and then the robot maintains the trajectory we need and guides us towards the right direction,” said Yang. “This meant we were able to perform two minimally invasive surgeries at once without having to also reposition the patient.”

Eliminating a second surgery also led to decreased surgical time and a faster recovery, meaning Meyn was able to go home in just a number of days.

“When I woke up from the surgery, the sciatica pain in my leg was immediately gone. It was amazing,” recalled Meyn. “The surgery definitely did its job.”

The Clinical Neurosciences team, which includes members from vascular surgery and neuroanesthesia, at LHSC has successfully performed six minimally invasive surgical spinal procedures using this state-of-the-art technology.

“I think the use of robotic assistance will become more common for this type of procedure as it provides more consistency and, in general, better outcomes and care,” said Yang.

For Meyn, it was an honour to be the first in Canada to receive this surgery, but what is even more exciting is what this means for his future.

“I am excited to get back to my everyday life and some of the things I enjoy and also have a summer that is not full of pain, but rather freedom to do the things I want.”

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Health officials report a laboratory confirmed case of pertussis (whooping cough) in the Peterborough, Ont., region.

Peterborough Public Health reported the case on Friday, advising that immunization is the “best way” to prevent getting sick with the bacterial respiratory infection. The disease is highly contagious and can spread through contact with droplets produced by an infected individual’s cough or sneeze.

The health unit did not state where the case was confirmed within its jurisdiction of Peterborough, Peterborough County, Curve Lake First Nation and Hiawatha First Nation.

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“People at greatest risk of severe illness include infants under the age of 1 and pregnant people,” the health unit cautions.

The lab-confirmed case follows last week’s notice of confirmed cases in neighbouring City of Kawartha Lakes, issued by the Haliburton, Kawartha Pine Ridge District Health Unit.

Early symptoms of whooping cough include mild cold symptoms such as runny nose, mild fever, and cough. After one to two weeks, a cough may be accompanied by “whooping” sound when breathing in, difficulty breathing, and vomiting due to extreme cough.

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The coughing can last up to one to two months.

“If symptoms present, residents should isolate themselves immediately and reach out to their healthcare provider for guidance on seeking treatment,” the health unit states.

The health unit advises residents to review their immunization records online and seek a pertussis vaccine if overdue.

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