Katherine Warrick was 31 when she was blindsided by an aggressive form of breast cancer. Like many young adults, she simply had no time for it: She was a newlywed, finishing her first year of graduate school and working full time as a social worker.
Cancer treatment forced Warrick to take two semesters off from her graduate program. Though newly promoted at work, she worried she wasn't pulling her weight. Now she wonders whether she'll be able to have children. And if she does, will she live long enough to see them grow up?
Breast cancer steals something from everyone, regardless of age. But when you're younger than 40, the disease threatens key milestones and independence during the prime of life, adding to the burden of the illness.
“I thought treatment would be a phase; once it was done I could go back to the way it was,” said Warrick, who went through 18 rounds of chemo, four surgeries and will now take a daily maintenance drug for the next five years. “But cancer takes your old ‘normal' and gives you this new one. Thanks, but no thanks. I liked my old ‘normal' just fine.”
Breast cancer is relatively rare in young women: In the U.S., about 7 percent of women with breast cancer are diagnosed before they've hit their 40th birthday.
But when it does strike, young women often grapple with distinct concerns and have lower survival rates than their older counterparts, due to differences in the tumors, biology and stage of life.
Below, we look at why the incidence of advanced late-stage breast cancer may be on the rise among younger women and at the unique challenges these women face — everything from treatments that can compromise fertility to an increased risk of secondary cancers.
Looking at age
Although breast cancer risk increases with age, the prognosis tends to be worse for younger patients, says pediatric oncologist Rebecca Johnson, medical director of the Adolescent and Young Adult oncology program at Seattle Children's Hospital.
During her 40th year of life, a woman has a 1 in 173 chance of being diagnosed with breast cancer, Johnson said, though the incidence varies with race and ethnicity. Black women younger than 35 have more than twice the incidence of invasive breast cancer and three times the breast cancer mortality of young white women, several studies show.
Johnson's latest research, meanwhile, shows another disturbing trend: a small but statistically significant increase in the incidence of advanced breast cancer for women 25 to 38 without a corresponding increase in older women. (The researchers did not find a rise in earlier-stage breast cancer in young adults.)
The study, published in the February issue of The Journal of the American Medical Association, showed the number of young adult women getting metastatic breast cancer has nearly doubled since the 1970's.
“It used to be 4 percent, now it's 7 percent,” she said. “It's still thankfully a small increase but we didn't find a single risk factor to explain it.”
Estrogen-sensitive cancers appear to make up the bulk of the increase, which is “comparatively fortunate,” the Journal authors note, because those cancers are somewhat more responsive to treatment and have longer average survival rates.
But still, less than one-third of women with advanced or metastatic disease survive at least five years after diagnosis. Women with early stage disease — where the cancer hasn't spread — have a more than 80 percent chance of survival if they are older. If they are younger than 40 however, they have a 60 percent chance, Johnson said.
These odds hit close to home for Johnson, who was 27 and beginning the second year of her medical residency when she was diagnosed with breast cancer. Treatment included chemotherapy and a mastectomy. This August, at age 44, doctors detected a slightly different type of cancer in her other breast. In September she underwent a second mastectomy.
“(The first time,) my doctor said ‘We don't know why, but young women with breast cancer don't do as well,'” said Johnson. “Seventeen years later, we still don't really know why young women have a greater chance of dying of early stage breast cancer than older women.”
Still, while Johnson's study is “provocative” and warrants further work, one expert said it could also be more of a reflection of how doctors are looking at advanced disease and less that things are getting worse for young women.
“What's not completely clear is whether it's a true new problem or whether it's a result of better imaging or screening for metastasis and newer technologies,” said Dr. Ann Partridge, founder and director of the Program for Young Women with Breast Cancer and director of the Adult Survivorship Program at the Dana-Farber Cancer Institute. “Are we're looking harder in young women or is there some biological phenomenon going on?
“Young women still have lower survival rates than older women — those in their 40s have the best survival — so something is going on with the very young that we're trying to sort out.”