Diagnosed Under 40 For younger women, breast cancer comes with a different set of challenges.

By Jennifer Walker



Marsha Hammond
In remission: Marsha Lynn Hammond, 40, with her son, Owen.

Two years ago, breast cancer wasn’t on Marsha Lynn Hammond’s radar. At 38, she hadn’t reached the age when women can start getting an annual mammogram, and she didn’t have a family history of the disease. But when she brushed up against a lump in her breast while putting her then-3-year-old son, Owen, to bed, she had a gut feeling that something was amiss.

Shortly thereafter, Hammond, who lives in Baltimore, was diagnosed with stage 2 breast cancer. She had a lumpectomy and then did chemo, getting infusions once every three weeks for about three months, after which she had radiation every weekday for six weeks. But Hammond, now 40 and in remission, thinks that one of her biggest challenges at the time was explaining cancer to her son. “We tried to joke about it a little bit, like, ‘Isn’t it weird that the doctors gave Mommy medicine that makes her hair fall out?’” Hammond says. “I still don’t know how much he understands of what cancer is. We tried to say, ‘Mommy’s sick, Mommy’s tired, but Mommy will get better.’ But that was tough, trying to be there for him in the way he needed me.”

Fewer than 5 percent of new breast cancer diagnoses occur in women under the age of 40. Still, in 2015, an estimated 10,500 women were diagnosed with invasive breast cancer—which tends to be more aggressive in young women—before they reached 40, the minimum age for an insurance-covered annual mammogram. Despite common belief, family history doesn’t play a large role: At any age, less than 15 percent of women with breast cancer have a family member with the disease. (The average woman has a 12 percent chance of developing breast cancer over her lifetime; if a woman has inherited a harmful BRCA1 or BRCA2 gene mutation, the risk goes up.) And although survival rates are high, an estimated 1,000 women younger than 40 likely died of breast cancer in 2015.

Once diagnosed, young women may face issues that are not as pronounced in women over 40. Young people tend to feel more isolated. For those who plan to have children, chemo can cause menopause and permanent ovarian suppression, which would prevent them from getting pregnant, or partial ovarian suppression, which would make it more difficult to get pregnant, says Dr. Dawn Leonard, medical director of the Herman & Walter Samuelson Breast Care Center at Northwest Hospital in Randallstown. Women who already have young children could struggle with balancing their roles as parent, professional and patient. “These women often have work, they have their family and now they have their cancer treatment. It’s really overwhelming,” Leonard says. “There’s a lot of increased anxiety and fear that exists in a younger patient.”

Last year, then-high school senior Tamara Jones, of Joint Base Andrews in Prince George’s County, was diagnosed with stage 1B breast cancer. Jones chose to have a mastectomy on her left breast, thinking she’d then be done with treatment. But her doctors wanted her to have chemo, too. “They said, ‘If you would have had the same diagnosis at 40 or 50, we wouldn’t even bother you with other treatments,’” remembers Jones, whose cancer diagnosis ruined her plan to enlist in the U.S. Air Force. (Jones’ stepfather is retired from the Air Force, and her sister serves in the U.S. Navy Reserve.) “‘But cancer in any young person is always more aggressive, and we don’t want this to ever come back. So we have to treat this as aggressively as possible.’”

Jones did four months of chemo, going to the hospital once a month while working full time and taking online classes in communications. She felt isolated. She didn’t know other cancer patients her age, and most of her friends, many of whom had gone off to college, weren’t a strong source of support. “My friends are pretty much nonexistent to me,” Jones says.

It helped that Jones connected with Meghan Fitzgibbons, a young-patient navigator (under 40) with the Ulman Cancer Fund for Young Adults, a Baltimore-based nonprofit that provides services and support for young adults who have cancer.  Fitzgibbons, who works out of Walter Reed National Military Medical Center in Bethesda (where Jones was treated), accompanied Jones to some of her medical appointments there. “In all these rooms with all these doctors and older people, she looked like someone who could have been my peer,” Jones says. “That comforted me.”

Because chemo can affect fertility, Jones made the decision, prior to beginning treatment, to go to an egg-harvesting facility. She wanted to start the process, but she would have needed hormone injections to stimulate her ovaries to produce multiple eggs. Because Jones’ breast cancer was hormone-receptor positive, meaning the cancer feeds off of hormones, her doctors didn’t want her to take the risk. If she does get pregnant in the future, she will require frequent breast exams to ensure the cancer isn’t coming back. “I could see myself being a mom,” says Jones, “but I don’t really know if that’s possible.”

Today, Jones, now 19, who will be taking a hormone-blocking pill for the next 10 years, is anxious about the cancer returning. She examines her right breast several times a day. For peace of mind, she is considering having a second mastectomy. After her experience, she wants other young women who feel they have symptoms of breast cancer to know their feelings are valid. Before she was diagnosed, Jones was having pain in her chest, and she felt a lump in her breast. The first doctor she saw said not to worry, that women get lumps in their breasts all the time; a second doctor was apprehensive about performing a mammogram. Jones insisted the pain was strong and the lump was large. “They shook it off,” says Jones, adding that it was the third doctor she saw who performed a mammogram, ultrasound and biopsy. “They’re already not going to take you as seriously because of your age, but don’t let that deter you, because it’s your body at the end of the day.”

Hammond and Jones have “survivor” stories, but Melissa Baum, 36, of Pikesville, hates that word. “I don’t identify with it,” she says. “Because to me, ‘survivor’ is some- one who is done with treatment.”

Two years ago, Baum was diagnosed with metastatic breast cancer (stage 4), meaning the cancer had spread from her breast to another area of her body, in this case her lungs. The median survival rate for women with metastatic breast cancer is three years. Baum—who found out she has a BRCA2 mutation and that 45 percent of women with this gene mutation will develop breast cancer by age 70—retired from her job as a lawyer, joined a clinical trial and did chemo for a year and a half. “The chemo worked from my neck down and killed everything,” says Baum, who has a 10-year-old daughter named Hannah. “I was doing very well.”

But Baum also had cancer cells in her brain from the time she was diagnosed. At first, the small cells weren’t problematic. But because the chemo didn’t reach her brain, the cancer cells there grew, causing Baum to become severely impaired. She couldn’t drive, cook or clean; she struggled with recollecting words, walking and balancing. This past January, she stopped chemo; two months later, she began a two-week course of radiation to shrink the tumors in her brain. Uncertain if she would make it to Hannah’s birthday in July, she threw an early party.

Then the radiation started to work, and Baum has returned to doing everyday activities. She’s also resumed chemo because the tumors in her breast and lungs have returned, and new tumors have developed on her lower back, but she’s most worried about the brain tumors. “We’re just hoping the brain symptoms stay quiet,” she says. Still, as of August, Baum was in hospice with a prognosis of less than six months.

Since diagnosis, Baum has struggled the most with the loss of her identity. “I had plans and goals that, long-term, just aren’t possible anymore,” she explains.

With Hannah, Baum is honest about cancer, but also lighthearted when possible. When Baum was in the hospital for a week, Hannah was scared to visit. So Baum talked about the great room service. Other times, Baum is forthright with her daughter. “Initially, she thought I would just suddenly die,” she says. “So I explained to her how a person dies from cancer. It’s not something that happens overnight … [But] sometimes I think she doesn’t realize how short my time is.”

When asked if she thinks that metastatic breast cancer receives enough public attention, Baum says that it can sometimes be ignored in favor of early-stage breast cancer stories with happier endings. “It’s not exciting and happy to hear that a 36-year-old with a 10-year-old daughter is dying,” she says. “Everyone wants to hear the pretty pink success story of early-stage cancer. [But] we’re throwing money at awareness campaigns that are long dead. Everyone is aware. [We] need to fund research.”

 

Support and Detection

In 2015, an estimated 10,500 women under the age of 40 were diagnosed with invasive breast cancer. Here are some resources to help.

The Ulman Cancer Fund for Young Adults.  Based in Baltimore, this nonprofit provides direct services and a community of support for young cancer fighters and survivors.  ulmanfund.org

Mammovan.  The Mammovan offers free mammograms at corporate and community sites in Maryland, Virginia and Washington, D.C. The staff performs more than 2,000 mammograms annually. gwdocs.com/mammovan

The Courage Club. Katie Campbell, of Frederick, who blogs about her metastatic breast cancer journey at Katie Crushes Cancer, has written the book The Courage Club for young adults with cancer who are “living in the midst of crisis.” Available on Amazon.

First Descents. This Colorado-based nonprofit offers free surfing, rock climbing and kayaking trips for cancer fighters or survivors ages 18 to 39. firstdescents.org

Dhremo Therapy IV Decals. Wanting to change the feel of her hospital room with its reminders of disease all around her, Marsha Lynn Hammond, who had stage 2 breast cancer, created apothecary-style decals with uplifting messages such as “Vitality” and “Hope” to affix to her chemo bags. The decals include brightly colored options—inspired by vintage circus posters—for kids who are undergoing chemo. Available at dhremo.com.

 

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