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The Challenges of Early-Onset Breast Cancer

The Challenges of Early-Onset Breast Cancer
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Published on July 20, 2020

Early-Onset Breast Cancer and the Challenges it Presents

During a routine check-up when she was 37 years old, Gina Olivo’s doctor felt something “unusual” in one breast — a tightness that didn’t seem normal. She was sent for a mammogram and biopsy that confirmed the worst: Gina found herself among the 11% of breast cancer cases in the U.S. that fall into the category of early-onset breast cancer, defined as breast cancer occurring in women under the age of 45. After working for more than a decade on the Susan G. Komen 3-Day® to support breast cancer research and programs, the irony of this diagnosis was not lost on Gina.

A breast cancer diagnosis at a young age brings with it a host of unique challenges, and Gina was no exception. From the aggressiveness of the tumor(s) and treatment to the challenges of family life and career obligations, the early-onset breast cancer journey can be an overwhelming one. While each patient’s experience is unique, we’ll explore some of the common difficulties faced by younger women after receiving a breast cancer diagnosis.

MK 2020 105 95 A v2Later Diagnosis

Since recommendations for annual mammograms begin between the ages of 40 and 45, younger women aren’t undergoing the same routine screenings as their older counterparts. Young women also may be unaware of their breast cancer risk factors, such as changes in breast cancer genes (BRCA1 and BRCA2), family medical history, or having dense breasts. A combination of factors like these often leads to cancer being discovered at a later stage in younger patients.

To help educate young women about breast cancer, the Centers for Disease Control and Prevention (CDC) launched the awareness campaign “Bring Your Brave” in 2015. The website shares important information about risk factors and symptoms as well as stories of women under 45 who have been impacted by breast cancer. 

The CDC has also awarded a grant to The American College of Obstetricians and Gynecologists (ACOG) to create health care provider materials addressing early-onset breast cancer.

More Aggressive Cancer & Treatment

Not only is early-onset breast cancer likely to be discovered at a later stage, but it is also more likely to be more aggressive than cancer discovered in older patients. Oncotype DX, the leading genomic test for breast cancer recurrence, actually provides a different scoring scale for women under age 50 versus women over age 50, with chemotherapy recommended at a lower score threshold for the younger set.

In Gina’s case, what was originally believed to be a diagnosis of Ductal Carcinoma in Situ (DCIS) — cancer that is contained within the milk ducts of the breast — turned out to be invasive in two spots. Her surgeon confirmed that the cancer had infiltrated a large portion of her breast, so Gina underwent a mastectomy.

After receiving a high score from Oncotype DX testing (indicating that the cancer is aggressive and the chance of recurrence high), she followed the surgery with both chemotherapy and radiation treatment.

Treatment in cases like Gina’s isn’t over after radiation sessions. Her doctors recommend that Gina take Tamoxifen for a full 10 years following her diagnosis.

Tamoxifen is the first choice for hormonal therapy medicine for premenopausal women, and while it can reduce the risk of cancer recurrence in premenopausal women by 30-50%, it brings with it a slew of very difficult side effects. From hot flashes to nausea, fatigue, and depression, the challenges posed by long-term hormone therapy are profound.

MK 2020 105 95 CCareer & Family

Being at a busy point in their career is another challenge faced by many younger breast cancer patients. They may be just starting in their career or working hard to prove themselves and move up the ranks when suddenly faced with balancing their job duties and professional goals with cancer treatment. In Gina’s case, she was grateful to work remotely from home with some flexibility in her schedule, have supportive colleagues and good health insurance. Not all young women are so lucky.

Perhaps one of the most emotional aspects of a breast cancer diagnosis for a younger woman relates to her family. A younger breast cancer patient may not yet have started a family, and if she plans to have children in the future will have concerns about the effects of treatment on fertility. While doctors may be able to provide options for preserving fertility before treatment begins, this is certainly a complex and emotionally difficult layer of the breast cancer journey.

For younger breast cancer patients who do already have children, their kids are likely to be younger as well. This was the case for Gina, who had a five-year-old son and two-year-old daughter at the time of her diagnosis. While it was easier to shelter the kids from the reality of cancer earlier in her treatment, they started understanding what was happening to mom when the more obvious physical changes began — like losing her hair from chemo.

Maintaining a sense of normalcy and the same daily involvement in the kids’ activities was important to Gina. From volunteering at her son’s kindergarten Halloween party as the only mom with no hair to continuing her work at Komen 3-Day events while in the middle of chemotherapy treatments, Gina worked hard to create a new normal for herself and her family.

MK 2020 105 95 BSupport Systems & Self Care

For any cancer patient, no matter the age, having a good support system is key. Gina did some research on local support groups in her area and had difficulty finding one with women of a similar age; the local groups tended to be filled with women who were 20-30 years her senior, facing a different stage of life and different challenges than she was. Thankfully there are more and more virtual resources coming available for young women who find themselves in the same situation. Organizations like Bright Pink provide an online community and support network for younger women facing a breast cancer diagnosis.

Thankfully Gina had incredible support from family and friends who were eager to help. Cards, texts, and phone calls with words of encouragement flooded in. Her mom took notes during Gina’s doctor appointments, friends and family traveled in to sit with her during chemo sessions, her husband drove her to her daily radiation treatments, and while recovering from reconstructive surgery, her son’s kindergarten teacher dropped him off from school each day. A village surrounded her with strength and love that she will never forget.

The challenging thing for active, independent young women like Gina to remember is that it’s ok — and necessary — to ask for and accept help. The desire to do it all doesn’t disappear with a breast cancer diagnosis, but it’s important to slow down, rest, and allow your body to recover from all it has undergone.

The good news for all breast cancer patients is that, as advances continue to be made, treatment is no longer a one-size-fits-all plan. As research and resources continue to improve, a more personalized approach can be taken to address the unique issues facing patients of any age.

~Cheryl Stern

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