The Pink Ribbon Report
What younger women need to know to be proactive about breast cancer
Once a woman reaches the age of 40, breast cancer screening becomes an official part of her annual medical regimen. But what of younger women, whose risk of developing the disease is statistically lower yet still present? (The latest figures from the Centers for Disease Control and Prevention put the incidence of invasive breast cancer in this age range at 20.4 per 100,000 women.)
“Women under 40 should understand that their doctors aren’t even going to talk about mammography screening unless they are at high risk,” says Emily F. Conant, MD, chief of breast imaging at Penn Medicine in Philadelphia. “So you are your own best advocate.”
Delaware mom Sharon Hart kept her kids in the loop when she battled breast cancer several years ago. She and son William share their story here.
“Breast cancer is a highly curable disease, so the message for young women who get this diagnosis is that they have the potential to live long, productive lives,” says Generosa Grana, MD, director of South Jersey’s Cooper Cancer Institute. Below, we discuss important ways for all women to be proactive about their breast health.
“Breast self-exams have been pooh-poohed as not being particularly helpful, but I think it’s important that a woman knows her breasts, particularly women under 40 for whom mammograms are not recommended,” says Grana. “That way any change can lead to attention.”
The newest advancement in mammography, tomosynthesis reconstructs images in 3D, especially helpful for younger women who often have denser breasts. “Not only has density recently been shown to be related to an increased risk of getting breast cancer — as if in having more gland tissue, there’s more area for cancer to develop — but also an inability to find some cancers that may be obscured, for example, behind a gland,” says Conant. “Having a 3D ability where you can peel visually to look through each slice of the breast, there is a higher likelihood that you’re going to find the cancer.”
Though insurance doesn’t currently pay for tomosynthesis, which ranges in cost from $50 to $100, certain radiology centers, including Penn Medicine, offer this screening free of charge.
Knowing your risks, including family history and prior radiation or biopsies, can help catch breast cancer at its earliest stages. The GAIL Model evaluates awoman’s risk based on five simple questions.
Genetic testing may be appropriate for women with a strong family history of breast or ovarian cancer. Regular exercise, a low-fat diet and avoiding smoking and alcohol may also help prevent cancer.
The Angelina effect
Earlier this year, Angelina Jolie opted to have an elective double mastectomy to reduce her genetically high risk of the disease that killed her mother and aunt. Jolie’s highly publicized decision at age 37 spurred conversation and action.
“Her decision is not a new one — the fact that she’s a known actress brought it to the forefront,” explains Cathy Holloway, program director for education and survivorship at the Wilmington-based Delaware Breast Cancer Coalition. “Many young women who have a mother, aunt or sister who have had cancer have had genetic testing. If they find they have the genetic predisposition that increases their chances of developing breast and/or ovarian cancer, they have that decision to make.”
For women diagnosed with breast cancer before or during their child-bearing years, many therapies can disrupt or end fertility.
“It’s an issue that every young woman with a cancer diagnosis who is facing chemotherapy or hormonal therapy needs to address,” points out Grana. Options include harvesting eggs or embryos for future use, using a surrogate or choosing to take your chances once treatment is complete.
Breast cancer treatment
Though treatments generally include some combination of surgery, radiation, hormone therapy and/or chemotherapy, there is no longer a one-size-fits-all breast cancer prescription.
“Research has proved that breast cancer is not one disease, so treatments are becoming more personalized based on the pathology and specific biology of a particular woman’s cancer,” explains Holloway.
“There have been significant improvements on how, when and what types of treatments women receive,” Conant says. “So if a woman is diagnosed with cancer, she wants to be with a team that specializes in the treatment of breast cancer and can explain all the options.”
Terri Akman is a contributing writer to MetroKids.