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Breast CancerSurvivorship

Breast Cancer Under 40: The Impact on Young Patients

An encouraging story of survival from a breast cancer nurse navigator who is also a breast cancer survivor.
July 2020 Part 3 of 4 - Breast Cancer Special Issue Series
Dana Stevens, RN, BSN, MSHA, CBCN, CN-BN, ONN-CG
Breast Nurse Navigator, Sarah Cannon Cancer Institute at Good Samaritan Hospital

A breast cancer diagnosis is overwhelming for anyone, and it can be especially shocking for younger women. It is difficult to comprehend how your life can change in a moment after hearing the words “you have breast cancer.” You now have to focus on treatment, side effects, recovery, and survivorship. Hearing those same words at 39 years of age, I had to change my focus from being a wife, trying to have children, and advancing my healthcare administration career to a life that was now completely turned upside down.

Breast Cancer Statistics

In 2020, the American Cancer Society estimates that 276,480 new cases of invasive breast cancer will be diagnosed among women, and approximately 2,620 cases will be diagnosed in men. In 2020, it is estimated that 15,700 cases of breast cancer will be diagnosed in women and men under the age of 40 years.

Breast cancer can be harder to diagnose at a younger age due to many factors. When breast cancer is diagnosed at a young age, it’s more likely to be aggressive and to spread quickly. Young women may not get a diagnosis right away because regular mammogram screenings are recommended at age 45 or 50 years for women with an average risk of breast cancer. It can also be more difficult for doctors to find breast cancer in young women than in older women because younger women tend to have denser breast tissue.

Unique Challenges

Breast cancer in young adults has unique challenges. The young adults diagnosed with breast cancer are often in a different phase of their life and encounter unique challenges compared with average breast cancer patients (age 62). Diagnosis arrives when life revolves around growing families, careers and advancement, keeping the household running, as well as friends and social commitments. Who has time for breast cancer when life is already so busy? The onset of breast cancer demands that all aspects of life be put on the back burner so that you may focus on breast cancer treatment. Some of the unique challenges and issues that young adults may face include but are not limited to the following issues.

Fertility Issues

Breast cancer treatment can affect a woman’s ability and plans to have children. The American Society of Clinical Oncology Clinical Practice Guidelines recommend that fertility preservation be discussed with all new patients at the time of diagnosis because efforts such as sperm banking and embryo/oocyte cryopreservation (the freezing of fertilized or unfertilized eggs) should be started in advance of treatment. Many women do not make fertility preservation arrangements because they are unaware of the options. Reasons for not making arrangements for fertility preservation may include being worried about the delay of cancer treatment, financial cost of treatment, timing of pregnancy following treatment, and the inability to have children.

Pregnancy and Breast Cancer

Although breast cancer during pregnancy is very rare, it is the most common cancer in pregnant and postpartum women, occurring most often between the ages of 32 and 38 years. Receiving the news of breast cancer during pregnancy or postpartum can be distressing. The most common concerns and questions for women include personal health (Can the cancer be treated?); baby’s health (Can the cancer hurt the baby?); parenting (Will I be able to care for my baby?); passing on the risk of breast cancer to the child (Can I pass breast cancer/genetic mutation to my baby?); and breastfeeding (Will I be able to breastfeed my baby?).

Fears of Death

Many women’s first thought after being diagnosed with breast cancer at a younger age is whether they will die of it. That fear is fed largely by daunting statistics showing that women younger than 40 tend to have more aggressive forms of breast cancer and face the higher likelihood that they will experience a recurrence later in life.

Telling Young Children and Raising Small Children While Undergoing Treatment

Many newly diagnosed mothers have a difficult time telling their children about the cancer diagnosis and worry about how the children will process and react to the news. How does a child react to their mom going bald, being too tired to play, or being unable to hug them while recovering from a mastectomy? Some women have a difficult time deciding if they should tell their children about their cancer diagnosis, and if so, how to do it. How to tell children often hinges on the age of the children, making sure the information is consistent and age appropriate. Fortunately, there are many resources to help.

Body Image

Many young women have a heightened concern about body image, especially after breast cancer– related surgery and treatment. Scars, the loss of breasts, changes to erogenous zones, weight changes, and hair loss can contribute to feeling unattractive or less sexy. Whether married or single, intimacy issues may arise for women diagnosed with breast cancer.

Dating with Breast Cancer

Body image and sexual issues can make dating much more challenging. It can be difficult to tell a new person in their life about a cancer diagnosis, potential loss of fertility, possible side effects from treatments, and body changes. Have you ever had to try to explain your early menopause over dinner? How awkward is that?

Sexual Dysfunction

Breast cancer impacts the most intimate part of women’s lives. Diagnosis and treatment reduce natural libido and causes emotional and physical changes that can deeply affect young women’s sex lives.

Early Menopause

Some women may experience early treatmentinduced menopause, which some women call “chemopause,” due to the side effects of treatment, including chemotherapy. Menopause symptoms may include hot flashes, irregular periods, vaginal dryness or discomfort, lack of interest in sex, fatigue, sleep and memory problems, as well as other issues such as mood problems.

Bone Health

Because a majority of young women diagnosed with early-stage breast cancer will survive many years following diagnosis and treatment, bone loss associated with both hormone-blocking medication and harmful chemotherapy agents must be taken into consideration to prevent long-term complications, including osteopenia, osteoporosis, and potentially disabling fractures.

Workplace

Careers are often interrupted right in the middle of a woman’s professional prime due to treatments and side effects. Many women face challenges to financial stability due to workplace issues, lack of sufficient health insurance, and the cost of cancer care. Some of the issues that women may face in the workplace include whether to work during treatment, and side effects such as pain, fatigue, nausea and vomiting, changes in appearance, hair loss, mouth problems, chemo brain, constipation or diarrhea, and stress. They may also have difficulty sharing their diagnosis at work and asking for reasonable accommodations while in active treatment or after returning to work.

Isolation

Younger breast cancer patients often feel more lonely and isolated because fewer women younger than 40 years are diagnosed with breast cancer. Early menopause can often contribute to the feelings of isolation for women among their peers, and it can also be a daily reminder of a past cancer diagnosis.

Co-Survivors

Breast cancer doesn’t just affect the young diagnosed women, it also affects their loved ones and can place a great emotional toll on a family. Often, roles may change when someone is diagnosed with breast cancer. The co-survivor may struggle with how to help; saying the right thing; and providing emotional, physical, financial, or spiritual support that a young woman with breast cancer may need. Co-survivors also put a lot of energy into supporting their loved one and can face new challenges and opportunities. Co-survivors often experience strong emotions, at times feeling sad, alone, and overwhelmed, but they can also experience a sense of purpose during this difficult time.

Psychosocial Issues

Young breast cancer survivors have a higher prevalence of psychosocial issues such as anxiety and depression. Although a diagnosis of breast cancer is distressing at any age, this occurrence in young women is filled with several unique challenges. These challenges, and the impact of having breast cancer before age 40, can be a difficult road with many speed bumps; however, that road can take them to a different, unintended destination.

Throughout my breast cancer treatment and survivorship, I have experienced—and continue to experience— many of the challenges that women younger than 40 with breast cancer may face. My fertility and hopes of having a biological child are gone, and chemotherapy side effects caused septic shock that required an ICU stay and major surgeries. My husband (co-survivor) took charge and cared for our household functions, finances, and pets in addition to taking care of me. Friends and family offered to help; however, it was difficult to ask not knowing what we needed. My career goals were impacted, and life was put on hold.

Now, as I have entered into survivorship, my perspective on life has changed. Cancer did change my career goals—I am now a breast cancer nurse navigator, helping other breast cancer patients navigate their own cancer journeys. Instead of raising children, we are dog parents who travel to places around the world to have amazing experiences, creating beautiful memories. Cancer has taken me down a different path and created a wonderful new normal for me and my family.

Sources

  • American Cancer Society. Cancer Facts & Figures 2020. www.cancer.org/ research/cancer-facts-statistics/all-cancer-facts-figures/cancer-factsfigures- 2020.html. 2020.
  • American Cancer Society. Cancer Facts & Figures 2020. Special Section: Cancer in Adolescents and Young Adults. www.cancer.org/research/ cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2020. html. 2020.
  • Anders CK, Johnson R, Litton J, et al. Breast cancer before age 40 years. Semin Oncol. 2009;36:237-249.
  • Leeder J. What life is like when you have breast cancer—and kids. Today’s Parent. www.todaysparent.com/family/family-health/what-life-is-like-whenyou- have-breast-cancer-and-kids. September 30, 2019.
  • Susan G. Komen: Facts for Life. Breast Cancer During Pregnancy. ww5. komen.org/uploadedFiles/_Komen/Content/About_Breast_Cancer/Tools_ and_Resources/Fact_Sheets_and_Breast_Self_Awareness_Cards/ BreastCancerinPregnancy.pdf.
  • Watson S. Breast Cancer in Young Women. Healthline. www.healthline. com/health/breast-cancer/breast-cancer-in-young-women. 2016. Young Survival Coalition. www.youngsurvival.org.
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