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Breast Cancer in Young Women
Women in the 20’s and 30’s are on the fast track to full lives. They’ve completed college and many have earned advanced degrees. They have careers and are pursuing their intellectual dreams. Many women meet their life mates and plan long-term relationships for the first time. Thoughts turn towards starting families and children; How to balance all the facets of their busy and exciting lives? Endless possibilities exist and young women stand poised to move forward – strong and confident. But for many young women this forward progression comes to a screeching halt when they are diagnosed with breast cancer.
According to Surveillance Epidemiology and End Results (SEER) of the National Cancer Institute, It is estimated that 192,370 women will be diagnosed with and 40,170 women will die of cancer of the breast in 2009. 12.4 percent of the women diagnosed between 2002 and 2006, the last years for which data has been compiled, will be women under age 44.
“A young woman with breast cancer is pulled out of her peer group,” says Michele Burton, a young breast cancer survivor. “Her entire focus shifts from career and family to survival. Although friends and family members try to be supportive, they really can’t understand the impact that a cancer diagnosis has on a young woman. The body image issues alone are overwhelming.”
According to SEER, the median age at diagnosis for breast cancer is 61. Breast cancer support materials and groups target their information to women in or near this age group. Single survivors wrestle with telling a potential partners about their cancer and issues of intimacy. Young women attending these support groups seldom find answers to questions such as dating with breast cancer, fertility preservation and raising children while on chemotherapy.
The Challenges Young Breast Cancer Survivors Face
Pregnant at Diagnosis
One of the most difficult challenges that young women face is preserving their fertility and having children while battling breast cancer. Michele Burton found a lump in her breast on self-exam in 2001. Her gynecologist also felt the lump and referred Burton for a mammogram. She explained that Burton’s risk of having breast cancer was low because she was just 32 years old. Burton’s mammogram and additional ultrasound images showed “micro calcifications in her breast.” She did not receive treatment at that time and had a repeat examination in six months. At the re-examination a radiologist who specializes in breast disease was more suspicious of the spots on the mammograms and asked Burton to have a biopsy right then and there. The biopsy results showed that Burton had invasive stage one ductal carcinoma. Two weeks later she found out that she was pregnant.
“It was all so overwhelming,” says Burton. “Everyone I talked to said to terminate the pregnancy, but I didn’t want to do that. Finally I went to MD Anderson Cancer Center in Houston. Those doctors were the first and only ones to tell me that I could actually continue the pregnancy.” Burton had a lumpectomy with sentinel node biopsy in her first trimester and started chemotherapy in her second trimester. Three weeks after she completed chemotherapy, Burton gave birth to her daughter. One month after delivery, she had radiation therapy and Burton also completed five years of Tamoxifen therapy in 2008. To date Burton’s daughter has no known developmental problems. Time will tell if she has any fertility issues as a result of her mother’s chemotherapy.
A Window of (conception) Oppportunity
In May 2002 Audra Outlaw was 31 years old and had been married for eight months when she noted a lump protruding from her left breast. Mammography could not detect any tumor, but ultrasound revealed two tumors. Outlaw’s biopsy results indicated that she had very aggressive locally advanced invasive ductal carcinoma, between stage II and stage III. It had entered the lymph nodes and her doctors predicted that it would spread.
“It was a very emotional time,” says Outlaw who understood that her cancer treatments would likely leave her infertile. “I felt so badly that my husband would never have the family that we had hoped for. I wasn’t even sure how long we’d have together. It was also very difficult to imagine having both breasts removed. But I knew that it was the right thing for me to do. I couldn’t wait around monitoring the tumors and waiting to see if the cancer spread. I didn’t want the worry.”
Outlaw had her surgeries performed at MD Anderson Cancer Center in Houston, TX and her chemotherapy at home in Austin. Once again there was trouble. “I developed painful ovarian cysts while on the Tamoxifen. While it was blocking my menstrual cycles, it didn’t completely suppress them. That meant I had a chance at being fertile enough to have a baby.” It was a very narrow window, but according to Outlaw’s obstetrician, Mark Akin, MD, it was enough to try one cycle of Clomid. Outlaw took the medication and conceived. She delivered her son in June 2005, two years and two weeks after her breast cancer diagnosis. Outlaw conceived a second child naturally, and delivered a healthy baby in February 2007. There is no sign of her breast cancer recurring.
Shauna Martin’s course was a bit more complicated. Diagnosed with stage II breast cancer in her left breast in August 2005, Martin knew she wanted more children. At 33 years old and with a 19 month old son, Martin relentlessly researched how to preserve her fertility. She contacted Fertile Hope, a non-profit organization that provides information and support to cancer patients who risk losing their fertility to cancer treatment. Martin, who had an aggressive breast cancer that required aggressive treatment, had planned to freeze her eggs but learned eggs don’t freeze as well as embryos, so she had fertility treatments and preserved12 embryos prior to lumpectomy and chemotherapy.” Following all of her cancer treatments and five years of Tamoxifen suppression, she can try to conceive using the frozen embryos. She will be 40 years old.
One month after her diagnosis, her younger sister was diagnosed with the same aggressive breast cancer. Neither woman has the known breast cancer gene mutations, nor do other family members have breast cancer. Martin’s sister had both breasts removed and followed with chemotherapy. Martin had her right breast removed and both breasts reconstructed, and will likely have both ovaries removed in the future to completely suppress estrogen production and prevent tumor recurrence.
A centralized source of information, education and support that enables women to be active, knowledgeable participants in their healthcare. The center is open to the public and free of charge. The Pink Ribbon Cowgirls is a social network of young breast cancer survivors. This group specifically addresses the needs of young women 18-44 who develop breast cancer. Contact Runi Limary, Director of Young Survivor Services email@example.com.
A Non-profit organization dedicated to providing reproductive information, support and hope to cancer patients whose medical treatments present the risk of infertility. Founded by Lindsay Beck, a young cancer survivor, the organization focuses on raising awareness about cancer in young adults, providing educational resources to patients and practitioners, providing financial support for individuals undergoing fertility treatments prior to cancer therapy, emotional support and raising funds for cancer research.
A national network designed to support pregnant women with cancer by matching them with women who have already gone through a similar experience.
The Young Survival Coalition (YSC) is the only international, non-profit network of breast cancer survivors and supporters dedicated to the concerns and issues that are unique to young women and breast cancer.
Physicians and Practices
The University of Texas, MD Anderson Cancer Center
1515 Holcombe Boulevard
Houston, TX 77030
Kutluk Oktay, MD, Medical Director
19 Bradhurst Avenue, Suite 2700
Hawthorne, NY 10532-2170
Phone: (914) 493 – 2250
Note: Dr. Oktay is a pioneer in fertility preservation. He was instrumental in helping Shauna Martin produce and preserve 12 frozen embryos prior to undergoing cancer treatments. He welcomes inquiries from patients and physicians who wish to gather more information about estrogen free in vitro fertilization protocols or who have other infertility questions.
Thomas Vaughn, MD, Reproductive Endocrinology
6500 N. Mopac Expressway, Building 1, Suite 1200
Austin, Texas 78731
Phone: (512) 451-0149
In this story each of the breast cancer survivors discovered their own breast lumps. Monthly breast self-exams are the first step towards early detection of breast cancer and improved treatment outcomes and long-term survival.