|Breast Cancer In Young Women|
|Breast Cancer In Young Women|
|Understanding Breast Cancer||Survivorship Phases|
|Understanding Metastatic Breast Cancer||Survivor Stories|
|Young Women at High Risk||Statistics and Disparities|
|Getting Back That Evening Dress Look||Living Your Best: Quality of Life|
|Handling the Details||Research|
|For Caregivers||Healthcare Professionals|
|Partners And Sponsors|
Some of the symptoms include:
Please consult your doctor if you are unsure about a symptom.
Despite the prevailing opinion that young women don't get breast cancer, the reality is that they can and do. In fact, one in every 229 women between the ages of 30 and 40 will be diagnosed with breast cancer in the next 10 years. Following are some other startling facts about breast cancer in young women:
YSC does not endorse the practice of a formal BSE, which you can read more about in our YSC BCYW_Research&Trials_Position_Papers Position Paper on Breast Self Examination (BSE) and Early Detection. Instead, until there are reliable early detection and high-risk screening methods, YSC recommends young women be familiar with their breasts and be able to detect any change from the norm. We recognize that performing self exams might be the best way for some women to become familiar with their breasts, and therefore we do not discourage women from doing so. However, it is important that young women know the facts about breast cancer and the limitations of current early detection methods.
There are essentially four types of biopsies:
Breast pain is most commonly associated with the menstrual cycle and therefore is referred to as cyclical pain. It is thought to be related to hormone activity in combination with a reaction from the breast tissue. Studies show that most women are more concerned about the possibility of cancer than the pain itself. There are treatments available to help with this pain. Some physicians may recommend limiting consumption of caffeine or reducing salt intake. If necessary, doctors can offer medicinal interventions.
Non-cyclical breast pain is much less common and can be caused by a trauma such as an injury or a breast biopsy. In both cases, if you are experiencing breast pain it is important to take the time to find a breast specialist to examine your breasts and determine what steps should be taken, if any.
Cysts – These are fluid or tissue filled sacs occurring most commonly in women approaching menopause. These are often observed by doctors over time or drained using fine needle aspiration. There are several types of cysts as described below:
Stop, react, adjust, and make a game plan. Allow yourself moments alone to give yourself time to process your thoughts and be in touch with your feelings – get away to places that make you feel calm, relaxed and good about yourself. Don't necessarily do anything yet. Moments alone will allow you to get your head clear enough to understand what it is you want to do next, determine with whom you need to share your news, in what order, how and when. Begin to make lists of all the questions you want to ask your doctor and all the people who can possibly help you or might know something about your diagnosis.
It is normal to have trouble dealing with your diagnosis and treatment. Many women find talking face-to-face with a group of other women who are living with breast cancer helps. Support groups are not for everyone, so you need to try different things to determine what is helpful to you. Some young women find that going to a support group where everyone is significantly older is isolating. Some areas have support groups specifically for young women, but many do not. Fortunately, there are other options to reach other young women living with breast cancer besides local support groups. You may meet them online on a bulletin board, such as the ones in the YSC Community. Discussion rooms allow you to find other young women to e-mail or speak with on the phone. Ask your hospital social worker if he or she knows of groups in your area or other young women who wish to talk with others. Visit <link to Get_Involved_Affiliates>YSC’s Affiliate</link> page to find out if there is a YSC support group near you.
The following is a list of the many doctors you may encounter during your breast cancer experience:
Choose an NCI designated Comprehensive Cancer Center or a large teaching/university hospital. Ask everyone you know – doctors, family, friends, co-workers – even if you think they've never known anyone with breast cancer. Talk to other survivors and call breast cancer organizations to get referrals. You will hear certain names over and over. Those are the doctors you want to consult. Remember that treatment for breast cancer is a process and you will have many decisions to make along the way, so you need to find a doctor whose judgment you trust. Positive attributes to look for in a doctor can be:
You and your surgeon will decide upon a lumpectomy (also referred to as breast conservation) or a mastectomy, based upon many factors such as:
Taking into account all these factors, your surgeon will propose the best course of treatment for you. Sometimes he or she might offer you a choice, and sometimes the recommendation might be strongly directed to one or the other alternative. You must make the final decision yourself. Some women opt for a mastectomy even though their doctors say that lumpectomy will suffice, because it provides them with more emotional comfort.
There are several different types of mastectomies.
To see pre- and post-reconstruction images please visit: Susan Love MD or order: Show Me Photo Collection of Breast Cancer Survivors': Lumpectomies, Mastectomies, Breast Reconstructions and Thoughts on Body Image, Third Edition.
Technically referred to as an axillary node dissection or sentinel node dissection, the removal of one, some, or all of the lymph nodes under your arm on the side of the affected breast provides significant information to the oncologist in determining what type of treatment may be required beyond surgery. Breast cancer cells can travel and spread through the lymph nodes or the bloodstream. Since the lymph nodes from the chest area are connected through the underarm area before dispersing out to the body, the surgeon can remove a sampling from that area to determine if any cancer cells have spread beyond the chest. If no cancer cells are identified in the lymph nodes, the doctors may conclude that the cancer was locally contained, meaning it had not spread beyond the breast. Alternatively, if there are cancer cells in the nodes, doctors may want to treat the cancer more aggressively to kill those cells that have traveled beyond the chest and prevent the further spread of carcinogenic cells to other organs and promote cancer growth in other areas of the body.
In some cases, a radioactive dye will be injected into the tumor site during surgery. After a few minutes, the surgeon can track how the dye reaches through the lymph nodes. The first, or sentinel, node that the dye reaches is then the only one removed. The theory is that if cancer cells are migrating to the body from the breast, they would also travel to this node first. While the patient is still under anesthesia, a pathologist analyzes the sentinel node. If it is free of cancer, the surgeon might remove one or two more nodes surrounding that sentinel node just to be sure, but can conclude with 95% accuracy that the others are negative. The woman then keeps most of her lymph nodes intact and is spared the lymphedema and cellulitis risks of axillary node dissection.
If, however, the sentinel node contains cancer cells, the surgeon will continue with an axillary node dissection to determine the extent of the cancer spread.
While there are no known ways to prevent lymphedema, the best defense against complications is to be extra careful about preventing injury, trauma, infection or cuts on the hand and skin of the arm. Here's how:
Lymphedema, a chronic swelling of the hand and/or arm, is caused by blockage in the lymph system to the arm. Lymphedema is unlikely following sentinel node dissection but more common after axillary node dissection. The blockage is usually due to scar tissue from surgery or the less effective drainage in the absence of the lymph nodes you had removed. It can also be caused by radiation to the area where your lymph nodes were removed. In addition to swelling, lymph system damage can result in limited mobility and vulnerability to infection or cellulitis. Pay attention to early warning signs. Call your doctor at the first signs of pain, discomfort or swelling. Don't leave these symptoms untreated - especially if you suspect an infection, which could quickly become serious.
If you are undergoing a lumpectomy, you'll be sent home from the hospital within 24 hours. Once you are taken into surgery, the actual procedure takes 2-3 hours, including the lymph node dissection. After a few hours in the recovery room, upon your awakening and stabilization of vital signs, you'll be moved to your room. The next day you will be walking around and will most likely be sent home.
The surgery associated with a mastectomy requires a longer hospital stay, generally 3-4 days. The surgery itself may last up to 6-7 hours if your plastic surgeon teams with your general surgeon to begin the reconstruction process.
Chemotherapy is the therapeutic use of a variety of chemicals - given intravenously or orally - to systemically destroy any carcinogenic cells that might be lingering anywhere in your body. The administered chemical agents travel through the bloodstream and reach most cells in the body. The chemical agents can target carcinogenic cells and interfere with their replication and growth thus preventing the spread of cancer. The administered chemical dose has been exacted from years of research studies to determine the maximum tolerable amount of chemicals (which do not cause permanent damage to healthy tissues) resulting in the greatest probability of killing any remaining cancer cells. Administering a series of treatments of the same or different drugs over time ensures that chemotherapy will remove all carcinogenic cells as they undergo different phases of their growth cycle.
Chemotherapy may be given in the following settings:
Depending on what combination of drugs your oncologist recommends, the kind of cancer you have and how you respond your treatment sessions will be given on and off daily, weekly or even monthly. The time periods between these treatments allow your body to recover from any damage to healthy cells, such as white blood cells in the bone marrow. The drugs will be administered to you either by intravenous drip, which can take anywhere from thirty minutes to a few hours, or orally in pill form. Chemotherapy can be administered on an outpatient basis at a hospital, in a special treatment clinic or even in your doctor's offices.
Everyone experiences chemotherapy differently. Some people find they have days when they feel fine, and days that they're not so fine, days when they are more energetic or much weaker than usual, days with a hearty appetite and days they don't even want to smell food. There are days when white blood cell counts are low, which makes one more susceptible to infections. There are treatments available to help prevent and/or reduce the nausea and vomiting brought on by chemotherapy as well as treatments to strengthen the immune system. You should speak with your doctor about the best ways to manage the side effects of your treatment.
The most common side effects of the most common chemotherapy drugs are as follows:
Other more general side effects of chemotherapy may include temporary memory loss (often called "chemo brain"), fatigue and depression, all induced by a complex interaction of chemical, physical and emotional factors.
Hormone therapy is beneficial only to breast cancer patients who have hormone (ER+ or PR+) receptor positive cancer. This will be indicated on a pathology report. Receiving hormone therapy is not dependent upon age or stage of cancer although the type of hormonal agent may be.
Tamoxifen is the most commonly prescribed hormonal treatment. It is prescribed for newly diagnosed women, patients with metastatic disease and sometimes, for women at high risk for contracting breast cancer. The usual dosage is 20 mg per day for five years taken in pill form once or twice daily. Tamoxifen blocks the effects of estrogen on breast tissue without changing your body's production of estrogen.
Ovarian suppression and ablation refer to the cessation (stopping) of the production of natural hormones by the ovaries to block those hormones (estrogen and progesterone) from reaching cancer cells and causing them to grow.
First, you will need to decide when or if you want to have breast reconstruction. You may want an immediate reconstruction, or you may want to wait to decide which type of reconstruction is right for you, or you may not want to have reconstruction at all.
There are no right answers - only what's right for you. If you will be considering breast reconstruction at any point, you should see a plastic surgeon before your initial surgery. You should also bear in mind that breast reconstruction almost always involves more than one surgery, including nipple reconstruction if you choose it, and possibly surgery on the other breast to make the body symmetrical. Talk to your doctors about the best and worst possible outcomes for your reconstruction. You can have immediate reconstruction in which you wake up from your breast surgery with a newly constructed breast, or you can decide to wait months or even years.
After surgery you will be given a temporary prosthesis that you can wear during your recovery. When you are ready, you can be fitted by a professional for a prosthesis that will fit into pockets sewn into your bra (and swimsuits) to hold it in place. Breast prostheses come in a wide range of shapes, sizes and skin tones. The costs are generally covered by insurance. They are made of silicone to reproduce the natural curves, weight and feel of your breast, including nipple outline.
Get a feel for the different types of reconstructive surgery by asking questions and doing research. There are more surgical options than ever before. It may help to speak with women who have made different choices, including those who have opted to have no reconstruction.
Immediate Reconstruction – This is done immediately following your breast surgery so that you wake up with a new breast. The reconstruction is done by a plastic surgeon during the mastectomy operation itself. The surgeon and the plastic surgeon work together as a team rather than sequentially. Talk to your surgeon before surgery to see if you are a candidate for the procedure.
Implants – Breast implants are silicone sacs filled with either saline or silicone that are placed behind your chest muscle. Sterile saline (salt water) filled implants are used by physicians much more often than silicone-gel filled implants because of concern that silicone leakage could debilitate the immune system. Usually, the plastic surgeon will implant a tissue expander first. This is like an implant, but it is not fully inflated, and so at first, is smaller than your implant will be. In the weeks following surgery, your plastic surgeon will inject saline into the tissue expander until it is fully expanded. Then you will undergo surgery to remove the tissue expander and replace it with your permanent implant.
Flap Reconstruction – Flap reconstruction depends upon your body type and anatomy. Here, tissue and muscle from another part of your body (tummy, back, thigh, buttocks) is used to make a new breast. There are a number of different techniques available:
Soreness and tenderness are to be expected within the first two weeks of recovery. There may also be swelling or bruising which could last for many weeks. Most women will require the insertion of a drain, in order to prevent the build up of excess fluid. The entire recovery period could last anywhere from four to six weeks. Flap surgeries generally require longer recovery periods.
A recurrence is when breast cancer returns after you have completed treatment for your initial diagnosis of breast cancer. This can happen within a relatively short period of time after treatment, many years later or never. There are three types of breast cancer recurrence:
Metastatic breast cancer, often referred to as advanced breast cancer, is when breast cancer spreads beyond its original site to a different site in the body. Metastatic breast cancer, or metastasis, most often occurs in the bones, lungs, liver and brain, but can show up in other areas of the body. A breast cancer metastasis is still considered breast cancer, regardless of where it may spread. For example, breast cancer metastasis that spreads to the liver is not liver cancer.
Anything unusual that lasts more than two weeks or is severe should be checked out. Keep in mind that cancer patients still get arthritis and the flu, so don't panic. Most women whose breast cancer has metastasized do not show symptoms until the disease is extensive. Symptoms of metastatic breast cancer may include:
While these symptoms may be possible signs of metastasis to the bone, lung, liver or other parts of the body, this does not mean that every woman who experiences them has metastatic breast cancer. There can be a variety of other reasons why you might experience the above symptoms, and they may have nothing to do with cancer of any kind. The important thing is that you listen and pay attention to what your body is trying to tell you and that you seek medical help to determine what may be causing your particular symptom or condition.
There are several tests used to detect metastatic disease:
Since every woman is an individual and each situation is unique to her, the treatment options available may vary. However, treatment of metastatic breast cancer generally involves systemic (whole body) treatment such as chemotherapy and/or hormonal therapy. An overview of the various treatments:
Although the above symptoms may indicate a benign breast disorder, any change to your breast(s) should be reported to your healthcare professional immediately. In addition, these symptoms may appear quickly and suddenly.
Clinical trials are often available for patients with IBC. You can find information on these on the Inflammatory Breast Cancer Research Foundation website – www.ibcresearch.org. In addition, you can visit the BCYW_Research&Trials Research and Clinical Trials section of our website to get information on how to find breast cancer clinical trials.
Clinical trials are research studies in which patients help doctors find ways to improve health and cancer care. Each study tries to answer scientific questions and to find better ways to prevent, diagnose or treat cancer.
Ask your doctor about clinical trials for which you might qualify. You can find a listing of current trials from the BCYW_Research&Trials Research and Clinical Trials section of our website. You can also contact the NCI Cancer Information Service at 1-800-4-CANCER, or visit the NCI website for listings or visit www.breastcancertrials.org.
Once you are finished with your treatment (surgery, chemotherapy and radiation), you will continue to have regular check ups with your doctors. You will see one of your doctors -- surgeon, oncologist and radiation oncologist -- every 8-10 weeks to receive a physical exam as well as a blood test. These exams will become less frequent as time goes on. You will have an annual mammogram (and possibly sonogram), and you may have annual bone scans and/or chest x-rays. It is important that even beyond five years after diagnosis you continue your relationship with your healthcare team and continue follow-up visits although perhaps less frequently.Your gynecological exams will be more comprehensive, as anyone who has survived breast cancer is now at slightly higher risk for other female gynecological cancers. Discuss with your gynecologist options for more comprehensive monitoring. This might mean more frequent visits or even vaginal sonograms on an annual basis.
Part of the aftermath of the breast cancer experience is very similar to the post-traumatic stress disorder syndrome often experienced by war survivors. You may become paranoid about the cancer returning, and you may feel a little like a hypochondriac. These are part of the survival instincts. Every time you have a pain in your joints or bones, you may be frightened that it's a recurrence, rather than just simply an inflammation or strain. You can manage anxiety by realizing that what you are feeling is normal. Don't ever think an ache or pain is too small to mention to one of your doctors, especially if it lasts more than a few weeks. Many women agree that this fear, although present, will subside with the passage of time.
While you might not want to hear about anything to do with cancer, it is important to help yourself by staying informed. Even after treatment, new research and technologies can affect your long-term health.
Many women find that turning their efforts toward action and advocacy at the end of treatment can be both rewarding and empowering. Some take part in marathons or volunteer at local organizations. Young Survival Coalition is the product of women who were determined to turn their experiences into something positive to help empower other young women. Action as seemingly simple as sharing your story can make a huge impact in other young women's lives as well as in the fight for a cure. You can learn more about opportunities in the Advocacy section of our website or read about Upcoming Events. You might also wish to volunteer for our SurvivorLink program for other young women affected by breast cancer.
Some women can and do become pregnant after breast cancer, but because not enough studies have been done on this subject women should talk to their doctors if they are considering becoming pregnant. It is important to realize that certain cancer treatments can affect one's ability to bear children, and careful thought and planning is necessary to preserve fertility before and during treatment.
There are some clinical issues to consider when thinking about pregnancy after breast cancer:
More and more research is being done every year on the subject of breast cancer and pregnancy with the hope that soon women will have more options open to them. You can find some of the more recent studies in the Published Research section of our website, and we encourage women to keep up to date with all new studies and innovations occurring in this field.
You may also want to visit the following websites for more information:
Hereditary Breast Cancer and Genetic Testing (FAQs on this topic created together with FORCE)
The benefits of genetic testing can vary depending on individual circumstances. Knowing your BRCA genetic status can be very empowering. Should you test positive for a known mutation, genetic testing can allow you to choose medical options to lower your risk for cancer or detect the disease at an early stage. It may also qualify you to participate in research studies that are looking for better ways to detect cancer early or to prevent cancer. However, not everyone views the knowledge of cancer risk as a benefit. The limitations of the test are complex. Genetic testing impacts both the individual undergoing testing and other members of the family. Some people may find the information and uncertainty associated with risk overwhelming, especially at first. And since the test itself can only identify the two most common genes involved in hereditary breast cancer, under certain circumstances, a negative test may not rule out hereditary breast cancer in your family. Because not every person who carries a mutation will get cancer, it is very important to remember that genetic testing cannot detect breast cancer nor can it tell you with certainty if you will get breast cancer at some point in your life.
The BRCA1 and BRCA2 gene mutations are linked primarily to breast and ovarian cancer, but BRCA2 mutations also carry a somewhat higher risk for other cancers, including melanoma and prostate cancer in men.