In his 2012 photo book, “Breast Cancer, the Journey Through Eyes of a Surgeon,” Dr. Emran Imami chronicled the story of Heather Copley, 25 at the time, and the youngest breast cancer patient Imami had treated as medical director at TEPAS Breast Center in Melbourne.
“She underwent bilateral mastectomies with breast reconstruction, chemotherapy and radiation,” Imami said.
Mid-treatment Heather married, took the last name McCollough, and later had a child. Unfortunately, the story did not end happily.
“Sadly, as is often the case with young cancer victims, she had aggressive disease,” said Imami. “I grew close to her family and was honored to meet her husband, son and extended family when she passed (in March).”
Although breast cancer tends to affect women 50 or older, it is also found among young women and even teenagers. Eleven percent of all cases reported in the United States affect women under 45, according to the Centers for Disease Control and Prevention.
According to the National Cancer Institute, approximately 70,000 men and women age 15 to 39 are diagnosed annually with cancer in the United States. For women in this age group, breast cancer is the most common, for several reasons.
Because breast tissue is denser in younger women, mammograms are not as effective in detecting the disease in this population. Typically, women in this age bracket will detect breast abnormalities themselves, when it may already be at a later stage.
Research suggests that breast cancer in women under 40 tends to be more aggressive, because it may differ biologically from the cancer found in older women. The survival rate is lower, too.
Treatment for breast cancer is the same, irrespective of age.
“Assuming the person is in good health and does not have Stage IV (metastic) cancer, then removing the cancer itself is paramount,” Imami said. “Younger women warrant more aggressive therapies, though not necessarily more aggressive surgery.”
Partial removal of the breast, or lumpectomy, is followed by radiation therapy for women with small, single tumors. Mastectomy is indicated in other cases.
“There is a one to two percent chance of having two breast cancers simultaneously, which would justify a mastectomy,” Imami said. “We counsel women with genetic mutations such as BRACA (the Breast Cancer gene) of their double or triple future breast cancer risk and often recommend double mastectomies.”
Genetics often play a primary role in the breast cancer of younger victims, since they are not old enough for exposure to hormones or environmental factors to have triggered the disease.
“Young women with breast cancer often have one or more family members with the same condition,” Imami said.
Birth control pills during the teen years was once questioned as increasing the risk for breast cancer, but large studies have found very little, if any, increased risk, and simultaneously also discovered that the use of hormonal contraception actually reduces the chances a woman will develop cancer.
For women at risk for breast cancer, the National Comprehensive Cancer Network Guidelines recommend that young women undergo screening mammograms 10 years prior to the age that their youngest family member developed breast cancer, but not younger than 30. For screening MRIs, the recommendation is for women not younger than 25.
Adolescents and women who have symptoms such as breast mass, nipple discharge, skin changes or breast pain should consider a medical evaluation and possible breast imaging.
Fortunately, breast cancer remains rare in the teen years, although there are documented cases.
“Teenage girls tend to have a plethora of anxiety-provoking life changes to deal with and I would first recommend that parents reassure their teen that breast cancer is very unlikely to occur in this age group,” said Dr. Mary Ulrich, a pediatrician with Pediatrics in Brevard in Melbourne. In her more than 20 years in practice, Ulrich has not come upon a teen breast cancer case.
She cautions against breast self-exams in teens.
“They are far more likely to discover a lump that is normally growing breast tissue, a cyst or other benign lesion, which they are likely to then worry about to the point that they needlessly get a biopsy which leads to pain, risk of infection and unnecessary expense,” she said.
To minimize risk of breast cancer, as well as other types of cancers, Ulrich offers advice many a mother have recommended to their offspring.
“Teach the child to eat a wide variety of fruits and vegetables, to get an at least an hour of moderate exercise per day ad to avoid becoming overweight or obese,” Ulrich said. “Teaching children the importance of rest and of balance in life, which reduces stress, also will help reduce the risk of cancer as they grow older. A young person has the opportunity to make healthy choices that will reduce their risk of cancer, along with other health problems.”
She adds that the best way to make sure nothing serious is developing is to faithfully follow a regimen of yearly and thorough physical checkups that includes breast examinations.
For the younger cancer patients, the disease carries the possibility of early menopause, sexual dysfunction and loss of fertility due to treatment. Many of these women have to fight the disease while raising young families, and some may not have adequate health insurance to cover cancer care, adding to their stress and worry.
Breast cancer is life-changing at any age, but for the young survivors it is even more challenging.