- Question from Chat: I'm 36. I feel too young to have breast cancer.
- Answers - Lillie Shockney Breast cancer doesn't discriminate by age. Though the mean age for diagnosis in the US during calendar year 2000 was age 54, there are many women diagnosed in their 30s and even their 20s with breast cancer. It is understandable that you would feel caught off guard, as often times we still look at breast cancer as a disease that strikes senior citizens, not premenopausal women. There are many of us who have been diagnosed in our 30s and have done well. Having an opportunity to be involved in support groups where there are other women close to your own age can be very helpful in letting you express the anxieties and concerns that you have as a young woman facing this disease.
- Gwen Darien Lillie, can you comment on some of the concerns that are specific to young women with breast cancer?
- Lillie Shockney Some of the concerns that women in their 30s have expressed focus on the desire to have a family, or continue expanding their family by having additional children. Anxiety about their sexuality — how their partner will look at them and think about them from a femininity perspective. Even a concern about job discrimination for women who are just establishing their careers, and worry that they may be passed over for promotions if individuals at work learn about their disease.
- New Breast Cancer Progression Model Developed Most of the women in my practice tend to be younger women with children, and their whole outlook on their future — the next day, month, or year — is sort of pulled out from under them. They are hesitant to plan or assume they will be around for an extended period of time. Some of the women are single and are worried about how to meet someone, tell them that, and how to establish an intimate relationship. All of the hormonal changes that can occur with aggressive chemotherapy with young women can be difficult.
- Lillie Shockney Communicating with children can also be difficult.
- Gwen Darien Can you also explain what some of the recent studies say about pregnancy after breast cancer?
New Breast Cancer Progression Model Developed
There are a lot of issues that surround getting pregnant after you have had breast cancer. One of the questions is whether you are with someone that you feel strongly enough about to have children. Another issue is your outlook, your prognosis. Was your breast cancer reasonably favorable so that you can think of being a parent, or were you diagnosed with life-threatening cancer that will limit your ability to be a parent for an extended period of time? Other issues include whether you can get pregnant on tamoxifen. For many women whose cancers are hormone receptor positive, tamoxifen is recommended after chemotherapy. The issue of taking tamoxifen competes with a women's ability to get pregnant when she might want to.
There is also a concern that pregnancy may make your hormones go high and wild. That may threaten your health because some people worry that it may increase the risk of having breast cancer recur. What we do know is that pregnancy does not seem to increase the risk of recurrence. If you have the risk, it would be with or without pregnancy. Most doctors do recommend that you postpone childbearing until about 2 years after your diagnosis or treatment, depending on how you are treated. The idea here is that they want to get you through the highest risk period for metastatic recurrence. If you come out okay on the other side of 2 years, then your chances of doing well beyond that are much greater.
The other issue is that many women who have been diagnosed with breast cancer and want a family may be close to, or over 40, and may be anxious because there aren't many years of fertility left. Some women that I take care of have already been dealing with infertility treatments prior to diagnosis and they are concerned about the safety of using infertility drugs to stimulate ovulation and with that the hope for getting pregnant. At this time, we don't know enough about infertility medications in women who have had breast cancer. In general, doctors are conservative and don't want to take a risk with your life. Most doctors would discourage your use of infertility medication if you are having trouble getting pregnant.
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