The Economics of Breast Cancer in Younger Women in the U.S.

Breast cancers found in women younger than 45 years old are usually more difficult and expensive to treat. It’s important for younger women to take steps to reduce their breast cancer risk.

Other than skin cancer, breast cancer is the most common cancer among women in the United States. About 11% of new cases of breast cancer are found in women between 18 and 44 years old.

When breast cancer is found in younger women, the tumors are often large and aggressive, requiring expensive treatment. Breast cancer treatment may cause side effects such as early menopause, inability to have children, poor body image, loss of menstruation, and negative sexual changes. In addition, younger breast cancer patients are more likely to be depressed, have emotional distress and anxiety, and use mental health services. Because these women are in the workforce, cancer treatment may interrupt employment and have a lasting negative impact on their income.

These factors suggest that younger women with breast cancer often have a lower health-related quality of life (HRQoL) and higher financial burden than older women with breast cancer. The five articles in this supplement looked at the economic burden of breast cancer among younger women.

Health State Utility Impact of Breast Cancer in U.S. Women Aged 18–44 Years

This study compared health state utility (HSU) values for women with breast cancer who were 18 to 44 years old to HSU values for women of the same age with other cancers, and to older women with breast cancer. HSU values measure HRQoL on a scale from 0 to 1, with 0 representing death and 1 representing perfect health. Using data from CDC’s Behavioral Risk Factor Surveillance System (BRFSS), the study found—

• The HSU value of younger women with breast cancer was one-fourth that of older women with breast cancer.
• HSU was lower among younger women with breast cancer than among women the same age with other kinds of cancer.
• HSU was almost five times lower among younger women with breast cancer than among women the same age without cancer.

Breast Cancer in Young Women: Health State Utility Impacts by Race/Ethnicity

This study used BRFSS data to estimate the effect of breast cancer on HSU by age at diagnosis (18–44 years versus 45 years or older) and by race/ethnicity. The study found—

• Women who are diagnosed with breast cancer at younger ages have a lower HRQoL.
• HRQoL is lowest during the first year after breast cancer diagnosis.
• Black women who are diagnosed with breast cancer at younger ages have a higher HRQoL than women of other racial groups.
• Hispanic women who are diagnosed with breast cancer at younger ages have a much lower HRQoL than women of other racial groups. This may be due to difficulty getting health care, jobs that require manual labor and are hard to return to after treatment, and worries about the cancer coming back.

Medical Care Costs of Breast Cancer in Privately Insured Women Aged 18–44 Years

This study used data from the 2006 MarketScan® database, one of the nation’s largest administrative claims databases of people who have employment-based health insurance. Treatment costs for breast cancer patients between 18 and 44 years old were compared with a matched sample of younger women without breast cancer and those in active treatment. The study found—

• Younger women with breast cancer had $19,435 in additional medical care costs per year than women of the same age without breast cancer.
• Women in active treatment had a much higher cost, $52,542 per year.
• In the study, 94% of treatment costs happened in outpatient (non-hospital) settings.

Treatment Costs of Breast Cancer Among Younger Women Aged 19–44 Years Enrolled in Medicaid

This study estimated breast cancer monthly treatment costs for women between 19 and 44 years old who were enrolled in Medicaid in 2007. In this study, costs were reported by race/ethnicity (non-Hispanic white [NHW], non-Hispanic black [NHB], non-Hispanic other [NHO], and Hispanic) and by type of service (outpatient, inpatient, and prescription drugs). The study found—

• The total monthly medical cost of breast cancer was $5,711. Outpatient services cost $4,058, inpatient services cost $1,003, and prescription drugs cost $539.
• The total monthly medical cost was $5,838 for NHWs, $5,487 for Hispanics, $4,912 for NHBs, and $4,267 for NHOs.
• For outpatient services, NHOs had the highest monthly cost ($4,274), followed by NHWs ($4,265), NHBs ($3,781), and Hispanics ($3,225).
• For inpatient services, Hispanics had the highest monthly cost ($1,036), followed by NHWs ($900), NHBs ($767), and NHOs ($133).
• For prescription drug costs, NHWs had the highest monthly cost ($695), followed by Hispanics ($491), NHBs ($413), and NHOs ($352).

Productivity Costs Associated with Breast Cancer Among Survivors Aged 18–44 Years

This study used data from CDC’s National Health Interview Survey to estimate productivity costs, including work and home productivity losses, among younger (18–44 years old) and older (45–64 years old) women who had been diagnosed with breast cancer.

• Younger women with breast cancer lost $2,293 from missed work and $442 from missed home productivity per woman per year.
• Older women with breast cancer lost $1,407 from missed work and $368 from missed home productivity per woman per year.
• Total annual breast cancer-associated productivity costs were $344 million for younger women and $1.51 billion for older women.

In general, these studies found that although many younger women are surviving breast cancer, they have substantial medical expenses even with private or public insurance, have lower health-related quality of life, and have lost employment and home productivity due to poor health. These findings may help fill some of the knowledge gaps and make more people aware of the economic burden of breast cancer among younger women.

Citations

Ekwueme DU, Trogdon JG. The economics of breast cancer in younger women in the U.S.: the present and future. American Journal of Preventive Medicine 2016;50(2):249–254.

Brown DS, Trogdon JG, Ekwueme DU, Chamiec-Case L, Guy GP Jr., Tangka FK, Li C, Trivers KF, Rodriguez JL. Health state utility impact of breast cancer in U.S. women aged 18–44 years. American Journal of Preventive Medicine 2016;50(2):255–261.

Trogdon JG, Ekwueme DU, Chamiec-Case L, Guy GP Jr. Breast cancer in young women: health state utility impacts by race/ethnicity. American Journal of Preventive Medicine 2016;50(2):262–269.

Allaire BT, Ekwueme DU, Guy GP Jr, Li C, Tangka FK, Trivers KF, Sabatino SA, Rodriguez JL, Trogdon JG. Medical care costs of breast cancer in privately insured women aged 18–44 years. American Journal of Preventive Medicine 2016;50(2):270–277.

Ekwueme DU, Allaire BT, Guy GP Jr, Arnold S, Trogdon JG. Treatment costs of breast cancer among younger women aged 19–44 years enrolled in Medicaid. American Journal of Preventive Medicine 2016;50(2):278–285.

Ekwueme DU, Trogdon JG, Khavjou OA, Guy GP Jr. Productivity costs associated with breast cancer among survivors aged 18–44 years. American Journal of Preventive Medicine 2016;50(2):286–294.