I'm too young to get breast cancer

But I’m too young to have breast cancer!
Early diagnosis offers the best chance for a cure.
So what is breast cancer?
Cancer stages
Breast cancer treatment depends on the cancer stage
Radiation after a lumpectomy reduces the rate of recurrence
What’s the difference between radiation and chemotherapy?
Things you can do to fight breast cancer at any age.
How common is breast cancer?
Signs of breast cancer?
Men get breast cancer too!
What about the breast cancer gene?
What is triple-negative breast cancer?
What’s Your Risk of Breast Cancer?
What are the risk factors for breast cancer?
 

 

But I’m too young to have breast cancer!

More than 11,000 women under the age of 40 will be told they have breast cancer this year. It is the leading cause of cancer death in women in this age group.

In the course of a lifetime, 1 in 8 women will fight breast cancer. Most breast cancer (60 to 70 percent) occurs in women over 50 years of age, but the incidence of breast cancer in young women is on the rise.

Rebecca Johnson, MD, of Seattle Children’s Hospital and University of Washington in Seattle, who is a pediatric oncologist and a young breast cancer survivor herself, studied the National Cancer Institute data from 1973 to 2009. In 1975, the study showed that there were 250 cases of metastatic breast cancer in women aged 25 to 34, in 2009 that number had grown to 800 cases per year.

The type of breast cancer affecting younger women is usually more aggressive. If a young woman receives the diagnosis of breast cancer, she will have a better chance of survival if she begins treatment within six weeks of the diagnosis.

Breast cancer in young women grows faster, spreads quickly, and usually requires aggressive treatment. The chemotherapy and radiation therapy can increase the risks of other cancers, heart disease and infertility.

There are other special challenges that face young breast cancer patients. Many young women feel isolated as they wage war on the disease while watching their friends and family building lives and having children. Since there is no cure for breast cancer, young women have to remain committed to having breast cancer screenings and performing self-breast exams.

Researchers are not sure why there has been an increase of breast cancer in young women. There are theories that the increase may be due to obesity, lack of exercise, overeating, exposure to chemicals, viruses and environmental toxins, or the increase may be due in part to the decision to delay child bearing until later in life.

Since yearly clinical breast cancer screenings are recommended to start at age 40, breast cancer in young women is usually found by self-breast exam. If a young woman finds a mass in her breast that does not go away, it is important that she seek medical attention immediately.

A young woman diagnosed with breast cancer should also seek support. Along with support from her healthcare provider, young women can find support and information through organizations such as Susan G. Komen and the Young Survival Coalition at www.youngsurvival.org.

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Early diagnosis offers the best chance for a cure.

According to the American Cancer Society, approximately 235,000 men and women will hear the diagnosis of breast cancer this year. Forty thousand of those diagnosed will succumb to the disease.

The average five-year survival rate for all women who have breast cancer is 90 percent. Early detection and early treatment can raise that rate to 99 percent. It’s important to be diagnosed early and start an effective treatment as early as possible.

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So what is breast cancer?

Breast tissue is made up of lobules (milk-producing glands shaped in broccoli-like bunches) and milk ducts (tube-like structures that carry milk to the nipple). Eighty percent of breast cancer starts in the milk ducts.

Normally milk ducts and lobules are lined with a single layer of cells. When these cells begin to grow abnormally and begin to create several layers, they are called atypical hyperplasia and need to be removed, examined and biopsied. If the layers grow across the duct or lobule, it is diagnosed as a carcinoma in situ. The cells become invasive when they break through the duct or lobule walls and invade surrounding tissue. These cells, now free of constraints, can enter the lymph system or bloodstream and invade other organs. When this happens, the cancer has metastasized.

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Cancer stages are determined by the size and location of the cancer cells.

Breast cancer is diagnosed in five stages ranging from 0 to 4. The definition of stages help surgeons and oncologists determine treatment based on the progression of the cancer.

STAGE 0: This earliest stage of cancer. The cancer cells are still within the ducts or lobules of the breast and has no ability to spread. It is the easiest to treat.

STAGE I: The cancer cells have invaded the walls of the duct or lobule, are less than 2.0 cm in size. The cancer cells are still in the breast and have not invaded the lymph nodes.

STAGE II: Cancer cells are less than 5 cm in size and have spread to one to three axillary (armpit) lymph nodes. Cancers that over 2 cm may also be diagnosed as stage II.

STAGE III: Cancer cells that invade four lymph nodes located in the armpit, collarbone and / or the nodes near the sternum or cancers that are over 5 cm that spread to any number of nodes; and tumors that have grown into the chest wall or skin are defined as Stage III.

STAGE IV: When cancer has spread beyond the breast and lymph nodes and has traveled or metastasized to distant nodes or the liver, lung, brain, bone or other organs, it is known as a Stage IV cancer.

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Breast cancer treatment depends on the cancer stage.

A lumpectomy is often followed by radiation treatment.

Mastectomy – Surgery to remove all the breast tissue. 

When you receive your diagnosis, you and your healthcare provider will discuss your treatment options. Your treatment choice is highly personal. Some women choose a lumpectomy with radiation treatments; others choose a double mastectomy. The outcomes of both are similar. Your healthcare provider can give you the information to make the right choice for you.

There may be other reasons that you want to consider a mastectomy rather a lumpectomy. If you have small breasts that would be disfigured by the removal of a large lump; cancers in different parts of the breast; would rather not have radiation treatments; already had radiation treatment in the same breast to treat cancer; have the BRCA genetic mutation or have a family history of breast cancer; you will need to factor those situations into your treatment choice.

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Radiation after a lumpectomy reduces the rate of recurrence of breast cancer from 40 percent to 4 to 8 percent.

Radiation is the process of sterilization and reduces the chance of cancer coming back in the breast, chest wall, or breast skin. Radiation causes skin redness and fatigue.

Ask your healthcare provider about the different types of radiation treatments. The traditional treatment is five days a week for about 6-and-a-half-weeks. If you meet certain qualifications, you may be a candidate for accelerated partial breast irradiation (APBI) which may take as little as five minutes, twice a day for five days.

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What’s the difference between radiation and chemotherapy?

While radiation sterilizes a localized area, chemotherapy is used to kill the rogue cancer cells that are in the bloodstream or cancer cells that have invaded another organ. Chemotherapy causes hair loss and nausea. With testing, your healthcare provider can help you assess your need for chemotherapy treatment.

If you are diagnosed with breast cancer, the best thing that you can do for yourself is to learn all you can about the disease, talk to your healthcare provider, and find support from other survivors. This information will help you make an informed decision about your treatment and your health. It will give you the knowledge that you need to make the best decision for you.

Though surgery and treatment are difficult, the 5-year survival rate for Stage 0 and Stage 1 breast cancer is 98 percent. Earlier detection and better treatment options give us hope of survival at every stage.

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Things you can do to fight breast cancer at any age.

In your 20s and 30s – get familiar with your breast and perform routine self-breast examinations, at least once a month. The best time is seven to 10 days after your menstrual period starts. If there is a change in your breast tissue or nipples – even a small one – don’t delay, see your healthcare provider right away.

Talk to your relatives and find out their health history. If someone in your immediate family had breast cancer before age 50; or if you have three or more first-degree or second-degree relatives with breast cancer or ovarian cancer, or if you have a male relative with breast cancer, talk to your healthcare provider and consider scheduling routine mammograms before age 40.

In your 40s – Get regular mammogram screenings. Watch the fat content in your diet. Reducing fat to 20 to 30 percent of your daily intake will help you maintain a healthy weight and reduce the amount of fat cells in your body. People with a high number of fat cells in their bodies produce more estrogen. After menopause, fat cells are the major estrogen producers, which may increase your risk.

Discuss hormone replacement therapy (HRT) with your healthcare provider. Make sure the benefits of HRT outweigh the risks. Studies have shown that women who have had five years or more of estrogen and progesterone therapy may have a higher incidence of breast cancer.

For all women – Reduce “bad” fats in your diet, especially polyunsaturated fats like those found in soybean, sunflower and corn oils. Use olive oil instead.

Eat more fatty fish, fruits, dark leafy green and cruciferous vegetables and whole grains.

Limit sweets. According to the journal Cancer Causes and Control women who ate added sugars found in desserts and beverages had a 27 percent greater risk of breast cancer.

Exercise 30 minutes a day; exercise boosts your immunity

Limit alcohol because it increases the estrogen in your system. Drink less than one drink a day.

Make sure you get enough folic acid.

Consider having children earlier rather than later and consider breastfeeding your children. These actions can help you cut your breast cancer risk in half.

Make sure that you are getting enough vitamin D from sun exposure or supplements and make sure that you are getting enough calcium.

Limit your consumption of grilled meats and avoid processed meats such as hot dogs, bacon and sausages; these meats may increase your breast cancer risk.

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How common is breast cancer?

  • 1 in 2,500 women under 30 will have breast cancer
  • 1 in 250 women under 40 will have breast cancer
  • One man will be diagnosed with breast cancer for every 100 women diagnosed
  • 410 men die from the disease each year
  • 1.3 men in 100,000 will get breast cancer

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Signs of breast cancer?

  • a lump, hard knot or thickening, which may be tender, in your breast or under your arm (in men lump are commonly found under the nipple and areola)
  • change in the size or shape of the breast
  • dimpling, puckering or redness of the skin of the breast
  • itchy, scaly sore or rash on the nipple
  • inversion (pulling in) of the nipple or areas of the breast
  • swelling, warmth or darkening of the breast
  • nipple discharge
  • pain that doesn’t go away

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Men get breast cancer too

There are 2,240 cases of invasive male breast cancer per year.

Men have breast tissue as well. Though during puberty, the high testosterone levels and low estrogen levels stop breast development in boys, men still may have some underdeveloped milk ducts and they are susceptible to breast cancer.

The prognosis for men and women experiencing breast cancer is the same at each stage. However, men are usually diagnosed at a later stage than women because they mistake the signs for other things or they are too embarrassed to visit the doctor and talk about the changes in their breasts.

Male breast cancer often occurs when men are older, but may develop at any age. Possible risk factors for breast cancer in men include:

  • heavy alcohol use
  • chronic obesity
  • hormone drugs used to treat prostate cancer
  • exposure to large amounts of radiation in childhood
  • Klinefelter’s syndrome
  • getting older
  • BRCA gene

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What about the breast cancer gene?

BRCA is the breast cancer susceptibility gene. The breast cancer BRCA1 and BRCA2 gene mutations increase the risk of breast cancer in both men and women by 30 to 85 percent. The gene mutation can be inherited from either parent and can be passed on to both sons and daughters.

Up to 40 percent of male breast cancers can be attributed to BRCA2 compared with just 5 to 10 percent of breast cancer in women.

The two major factors for developing breast cancer are:

  • being a woman
  • getting older

Other known factors include:

  • Family history of breast cancer, ovarian cancer or prostate cancer (10 percent of people diagnosed with breast cancer have other family members who have the disease)
  • Having the breast cancer mutation gene (BRCA1 or BRCA2) makes you five times more likely to develop breast cancer
  • Personal history of breast or ovarian cancer
  • Having high breast and bone density
  • Starting menstruation before age 13
  • Starting menopause after age 55
  • Having children after 35 or not having children
  • Being overweight after menopause or gaining weight as an adult (fat cells produce more estrogen)
  • Exposure to radiation or frequent X-rays as a child

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What is triple-negative breast cancer?

Breast cancer has three receptors – estrogen receptors, progestrone receptors, and human epidermal growth factor receptors (HER2). These receptor proteins live inside or on the surface of a cell and bind to something in the body to cause the cell reactions. These receptors can be positive or negative. Treatments such as tamoxifen and Herceptin target positive receptors and can slow or stop cancer growth. However, triple-negative breast cancers, which are responsible for 10 to 20 percent of breast cancer occurrences, do not respond to these medications. Chemotherapy is the most effective treatment for triple-negative breast cancer.

For more information on triple-negative breast cancer, visit TNBCFoundation.org.

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What’s your risk of breast cancer?

About a decade ago, a women’s health newsletter concluded that "unfortunately, there is little we can do to reduce our risk of breast cancer."

Fortunately, that has changed. Not only are there specific things women can do to lower their risk, but there are clear indications that significant numbers are doing them.

"Breast cancer is the most commonly diagnosed cancer in women and, after lung cancer, the one most likely to lead to death." according to Peter Gintner, PA-C, a physician assistant with Ministry Medical Group in Thorp. "The death rate from breast cancer has fallen since 1990, however, and more tumors are being found at an earlier stage."

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What are the risk factors for breast cancer?

According to Peter Gintner, there are several breast cancer risks. Some you can control and some you cannot control. So let’s take a look at the risks.

AGE, FAMILY HISTORY: The number one risk factor for breast cancer is age. If you’re 40 years old, your risk of developing breast cancer in the next 10 years is 1 in 48. If you’re 60 years old, that risk jumps to 1 in 26.

Family history is also important. If your mother, sister or daughter has breast cancer, your risk is double that of other women. In a few cases, family history is associated with a gene mutation such as BRCA1 or BRCA2 that substantially increases risk.

Gintner says, "While you can’t change your age, genetics or family history, you can use these risk factors to guide your decisions concerning screening. For women of average risk, the American Cancer Society recommends regular mammograms starting at age 40 and continuing as long as a woman is in good health. At any age, of course, a woman should learn about breast self-examination. Clinical examinations in your healthcare provider’s office are advised once every three years before age 40 and yearly after that time."

BREAST DENSITY: Two recent studies [September, 2006] indicated that breast density may be one of the most important risk factors for breast cancer. Dense breasts have less fat and more glandular material. Young women, who have a high risk, tend to have denser breasts, but so do some older women, particularly those who take hormone replacement therapy or have a genetic tendency.

Early tumors are also more difficult to detect in dense breast tissue. While you have no control over whether your breasts are dense, you can be more vigilant if they are and consider asking your healthcare provider about screening with digital mammography, MRI or ultrasound.

WEIGHT GAIN is a risk factor that you can control. A weight gain of 20 to 30 pounds after age 18 is associated with a 40 percent increased risk compared to a weight gain of five pounds or less. The theory is that fat cells stimulate production of estrogen, keeping the hormone in circulation even after menopause.

PHYSICAL ACTIVITY: Getting regular exercise is one of the best ways of avoiding weight gain. It also helps regulate hormones that have been linked to the growth of cancer cells. Studies have found that women who engage in moderately intense or vigorous exercise at least three or four hours a week are 20 to 30 percent less likely to develop breast cancer. The American Cancer Society recommends 45 to 60 minutes at least five days a week–a step up from what is generally recommended for good health.

FOLIC ACID, ALCOHOL: Women who have more than one drink of alcohol a dayhave an increased risk of breast cancer, but only if they fail to get adequate quantities (at least 500 micrograms a day) of folic acid, a B vitamin

VITAMIN D: Sun exposure triggers vitamin D production in the body, and there is considerable evidence that vitamin D offers protection against breast and a number of other cancers. Experts now realize that the recommended level of vitamin D (400 IU) is too low; 800 to 1,000 IU is best. Since dietary sources are limited, some of this must come from supplements or sun exposure.

"Taking a preventive approach to breast cancer has its frustrations," Gintner says. "About three quarters of breast cancers occur in people with no known risk factors. If you know your personal risks, there’s no reason for either anxiety or self assurance. With exercise, weight control, healthy habits and regular screening, you can improve your odds."

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