Breast Cancer Under Forty

Imagine finding a lump in your breast when you are only twenty-eight. You’d probably be a little nervous, but after your family doctor suggests it is not uncommon for women to develop lumps in their breasts in conjunction with their menstrual cycle you might be reassured. But what if your doctor was wrong? Now imagine you are sitting in the examination room of the oncologist’s office waiting to hear the results of a biopsy of that lump in your breast. Right about now you might imagine hearing the words, “you have breast cancer,” only you’re not imagining it because it’s true.

Breast cancer is a frightening disease. Not only does it threaten a woman’s survival, but it can also diminish self-esteem, sexuality, and spirit. Being diagnosed with this disease is devastating enough, but imagine hearing you have it when you are only in your twenties or thirties. The stereotypical understanding of breast cancer is that it predominantly afflicts older, post-menopausal women. In other words, our grandmothers might be at risk for developing breast cancer, but we’re not. Be advised, though, breast cancer does not discriminate based on age. In fact, it is projected that an estimated 11,000 women under the age of forty will be diagnosed with breast cancer during the course of a year (YSC, 2004). Unfortunately, the medical community still treats the incidence of breast cancer in young women as a rarity, and research on the specifics of the disease as it pertains to younger women is virtually nonexistent. Until the medical community becomes more proactive in this area, it is vital that women increase their own awareness and understanding of the disease. The focus of this article is to inform and educate younger women about the realities of breast cancer.

Breast cancer tends to be more aggressive in younger women, meaning the cancer cells divide and multiply at a higher rate. When this occurs, the odds of the cancer spreading beyond the breast sooner rather than later are increased. The paradox here is that a diagnosis of breast cancer in someone so young is often overlooked or dismissed by both doctor and patient. Unfortunately, time is of the essence for the young patient because her cancer may spread outside the breast and potentially metastasize elsewhere in the body much more quickly than in an older patient. For this reason, the survival rate in younger women with breast cancer is much lower than it is for older patients. The good news is that when it is detected early, younger women can anticipate a five-year survival rate of 82% (YSC, 2004). What is so critical about a five-year survival rate? Five years following the initial diagnosis, if there has not been a recurrence, a patient is generally considered “cured” so that any future diagnosis would be considered a new instance of cancer.

A more aggressive cancer and a lower survival rate are only two of the factors specific to pre-menopausal breast cancer patients. Certain treatments can affect fertility, and may even contribute to early menopause. And women who are already pregnant at the time of diagnosis will face additional difficulties. Beyond these health concerns, women of any age, but particularly younger women, will find their self-esteem and sexuality in crisis. For a young woman, losing either one or both breasts, or even a just a portion of a breast (as in a lumpectomy), can significantly alter a young woman’s view of her body. Imagine again you are that twenty-eight year old woman newly diagnosed with breast cancer and must now choose between having a lumpectomy or a mastectomy. While the lumpectomy can spare much of the breast, there is always the risk for recurrence and only a mastectomy can almost completely eliminate this risk.

In our culture women’s breasts are inextricably associated with their attractiveness, desirability, and sexuality. When women feel unattractive their self-esteem inevitably weakens and consequently they may become less confident. Unfortunately, breast size often plays a substantial role in how women feel about themselves. Why else would so many women voluntarily subject themselves to unnecessary cosmetic surgery simply to enhance their breast size? Given a diagnosis of breast cancer, the prospect of losing part or all of your breast(s) at such a young age can be devastating beyond the initial life threatening disease itself.

Following a lumpectomy or mastectomy, a young woman can opt to have reconstructive surgery, or even implants, but doing so will not necessarily negate the complexity of emotion that accompanies a breast cancer diagnosis. When any other woman opts to have breast augmentation surgery she is adding to what is already there, but for the breast cancer survivor, she may have had to first give up a part of herself. Additionally, breast implants often make mammogram screening more difficult because they block the natural breast tissue. For survivors who do proceed with cosmetic surgery there is the added concern that the implants will make it more difficult to detect other tumors, should they develop. Further, mammogram screening does not always detect every abnormality in young women because their breast tissue tends to be denser (YSC, 2004). Doctors are aware of this dilemma so they are not necessarily inclined to order a mammogram for a young patient who has detected a lump in her breast.

Right now there are many young women living with breast cancer, and there are many more still who have died from it. While the disease is more prevalent in women over the age of forty, the number of women with breast cancer below the age of forty is not small. Research, information, and resources specific to young women with breast cancer are scarce. This lack of information would suggest it is not a disease that afflicts the young, but for a few rare instances, yet this is simply not the case. Now imagine you are that newly diagnosed twenty-eight year old woman one last time. You would undoubtedly have many concerns, but the good news is that today’s treatment options are as numerous as they are effective and there is a comfortable treatment plan for every woman.

While no one can determine exactly why any one of us develops breast cancer, there may be preventative measures we can take to reduce our odds of developing this deadly disease. Additionally, there are different types of breast cancer and the risk of developing any one of them may be increased by specific factors in a woman’s lifestyle. For instance, certain aspects of our diet may either inhibit or encourage the growth of breast cancer cells. Various methods of contraception may also be influential in the development of cancer. Finally, by discussing the issue of breast cancer in young women we are encouraging education and awareness, which can only lead to additional research, resources, early detection, and most importantly – survival.

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