Thinking Young About Breast Cancer
New technologies are making it easier to diagnose the disease in women under 40.
Survivor Shauna Martin co-founded Pink Robbon Cowgirls, a support group for younger women with breast cancer.photography by Scott Womack
Shauna Martin was breast-feeding her 9-month-old son in 2005 when she discovered a lump in her breast. Her physician suspected it was a clogged milk duct. He doubted it was cancer, because Martin was just 33 years old. There was no sense of urgency.
But by the time she returned to her doctor three months later, the lump had grown. After a sonogram, Martin could tell by the technician’s reaction that it was serious. A subsequent biopsy revealed that she had stage II breast cancer. Two years of surgeries and chemotherapy followed, but Martin has since been cancer free.
“If you feel you may have a problem, act immediately,” Martin says. “My friends with the highest survival rate are the ones who take control of their treatment and health. I am the keeper of my health, not my doctor. You have to bring that to the table to survive. You have to steer your own ship.”
Breast cancer can be especially cruel to young women. Their tumors tend to grow faster, can be less responsive to treatment, and are often more likely to reoccur. Once detected, the cancer is often advanced.
Breast cancer represents the most frequent cancer in young women, accounting for about one-third of cancer cases. But because 93 percent of breast cancers occur in women who are 40 or older, screening is not common among younger women. What’s more, tumors in younger women are harder to detect with standard mammography because their breast tissue is dense.
Collin County women are fortunate to have an excellent resource for early detection. Baylor Diagnostic Imaging Center at Craig Ranch, part of Baylor Regional Medical Center at Plano, is one of only six facilities worldwide to offer dual-head molecular breast imaging (MBI). The technology has the ability to find breast tumors usually missed by standard mammography. MBI can find lesions as small as 3 millimeters, and can accurately detect abnormalities of less than 10 millimeters in nearly 90 percent of screenings. Tumor size is a critical marker of cancer aggressiveness. If tumors are 15 millimeters or smaller, there’s only about a 25 percent chance that the cancer has spread to other parts of the body.
Once detected and treated, relapse among younger with with cancer is relatively common. A study of women under 35 at The University of Texas MD Anderson Cancer Center in Houston found that breast cancer reoccurred in about 15 percent of women who had mastectomy plus radiation therapy, about 20 percent in those who had breast-conserving therapy, and about 24 percent for those who had only a mastectomy.
A lonely battle
Breast cancer can be especially devastating for younger women. Chemotherapy can affect fertility and body image. Younger women are more prone to depression, and tend to lack peer support of fellow victims.
“It’s scary,” says Martin, general counsel and executive vice president of Plano-based Genband. “You lose breasts and your hair. You may have small children, or you want them and your fertility is affected. Doctors put most [younger breast cancer victims] on antidepressants. Survival rates are much worse.”
After Martin was diagnosed in 2005, she immediately insisted that her 31-year-old sister, Tamara Martin, have an MRI; this uncovered a stage I tumor. The sisters found no support group for younger women, so they created one. Pink Ribbon Cowgirls, which is based in Austin, has about 250 members. The organization connects young breast-cancer victims through monthly luncheons, a members-only web-based forum, and special fundraising events. Martin’s goal is to take Pink Ribbon Cowgirls statewide.
Detection and prompt treatment can significantly improve the odds of survival. More than 90 percent of women survive breast cancer if found in an early stage. However, younger women often ignore symptoms because they believe they are too young to develop the disease. Some health-care providers erroneously dismiss younger women’s lumps as cysts.
“There is a huge need [for MBI],” Martin says. “It’s tragic how many friends I’ve had who were diagnosed at a late stage.”
“False positives” and other risks
Due to dense breast tissue and low cancer rates, women under 40 using standard screening mammography have high rates of callbacks for additional testing. According to a study in the Journal of the National Cancer Institute, in a theoretical population of 10,000 women age 35-39, about 1,265 would need additional testing, and just 16 cancer cases would be found. That means one in eight breast-cancer screenings would result in false positives.
Most experts believe the breast-cancer risk among younger women is too low to justify the expense, radiation exposure, and anxiety from frequent false positives. It is also a concern for insurance companies and government insurance programs because of the expense and repeated callbacks for additional testing.
Dr. Lynn Canavan, a breast surgeon at Texas Breast Surgeons/Texas Oncology in McKinney and Plano, has used MBI for more than two years and is a proponent of the technology. She said MBI should be viewed as complementary to, rather than as a replacement for, standard mammography. She said there have been cases where MBI picked up tumors missed by mammography. “Without [MBI], they would have gone another year with that tumor going undetected,” Canavan noted.
MRIs vs. MBIs
Magnetic resonance imaging has comparable accuracy to MBI. MRI screening has been endorsed by the American Cancer Society for women with a lifetime breast cancer risk exceeding 20 percent. But MRIs can cost $1,000 to $4,000 per treatment, compared to $500 for MBI. What’s more, MRIs can generate 1,000 images per breast, which can be overwhelming to read and analyze.
The benefit of MBI extends to older women as well. About 25 percent of women over 40 have dense breast tissue that affects mammography accuracy. In a study of 940 dense-breasted women, MBI found three times as many cancers as mammography.
About two-thirds of breast cancer occurs in women over 50 years old, compared to 7 percent of those under 40.
Canavan recommends that women have their first mammogram between the ages of 35 and 40 and annually after 40. If a woman’s mother or sister has been diagnosed with breast cancer, she encourages screening a decade earlier. For example, if her mother was diagnosed at age 35, Canavan encourages screening to begin at age 25.
“We have ways of finding breast cancer early that we did not have 10 years ago,” she says. “We can do genetic testing and calculate a woman’s risk [mathematically]. We now have medications that can cut the risk in half. Rather than being on the defensive, we can be on the offensive.”