Not too young to get breast cancer
Commonly associated with older age, the reality is that breast cancer can turn up even in the prime of adulthood, bringing along unique challenges for young women.
Things have been going swimmingly well. You may have just embarked on married life. Or a promotion may be on its way. Or perhaps your child had the loveliest first day at preschool, bringing home their first scrappy drawing. You feel like you’re finally hitting your stride in your 30s.
At this stage of life, you could never anticipate sitting in the doctor’s clinic, facing a diagnosis of breast cancer.
Breast cancer is the most common cancer among women in Singapore and the sobering reality is that more young women are getting diagnosed with it every year. An early onset of breast cancer is defined as patients who are diagnosed under 45 years of age. Locally, one in six women diagnosed with breast cancer is less than 45 years of age, while one in 10 is under 40 years old.
“The challenges to diagnosing young women are multifold,” says Dr Faith Leong, Associate Consultant, Breast Service, Sengkang General Hospital.
Young patients often face delayed recognition and diagnosis of breast cancer, which means the cancer is typically caught at a later stage.
Unlike older women who benefit from mammograms, the denser breast tissue of younger women can limit the accuracy of this screening method in picking up new growths. Dr Leong also notes that compared to older women, young patients are likely to have more aggressive cancer subtypes, such as triple-negative breast cancer.
The journey of these younger patients after their diagnosis can thus be markedly different. “In my practice, the first thing I see young patients struggle with is the acceptance of the diagnosis,” says Dr Leong. “They often grieve the potential loss in life expectancy and the loss of ‘normal’ experiences that many people take for granted, such as watching their children grow up.”
Younger patients may also struggle to cope with self-image issues. As these patients are more likely to undergo chemotherapy and other targeted therapies due to their aggressive cancer types, they may struggle to cope with certain side-effects of these treatments, such as hair loss.
With these specific worries, treatment focuses not only on preserving years to their lives, but also a quality of life to those years, says Dr Leong. This means that breast conserving surgery is often preferred. The breast service at SKH offers a variety of surgical and reconstructive options, including minimally invasive techniques that are individualised to each patient. In cases that require a mastectomy or total breast removal surgery, many opt for breast reconstruction. For those planning to start a family, fertility preservation procedures, such as egg freezing, may also be considered.
“At SKH, we have a partnership with the obstetrics and gynaecology department at Singapore General Hospital and KK Women’s and Children’s Hospital, where patients can see a fertility specialist and undergo fertility preservation procedures quickly. This avoids any significant delay to their cancer treatment,” says Dr Leong.
“For young patients who have many years ahead of them, every small improvement in their quality of life can mean a big difference.”
<Check out conditions we treat>
As women below 40 are not in the recommended age group for mammogram screening, they are encouraged to perform monthly breast self-examinations. This includes looking for lumps, skin or nipple changes, and nipple discharge. Early detection significantly improves survival chances.
“It is more common for younger women to present with symptoms, like a lump that can be felt,” says Dr Leong. She recommends that self-examinations be done one week after the first day of the menstrual cycle for consistency, and to seek medical attention immediately if something feels amiss.
“While we should not alarm all young women into thinking they are at a high risk for breast cancer, it is still important to evaluate all new breast lesions to exclude a high-risk or malignant diagnosis,” says Dr Leong.
It is also worthwhile undergoing genetic counselling and testing if one has certain risk factors. These include:
Having a mother, sister, or a relative diagnosed with early onset breast cancer
Having a family history of breast and ovarian cancer
Having family members with known changes in certain breast cancer genes, such as BRCA1 and BRCA2
However, Dr Leong also points out that genetic conditions account for only five to 10 percent of all breast cancers. “Apart from this group of patients who have an inherited predisposition to breast cancer, there is no single causative factor for most young women diagnosed with breast cancer,” says Dr Leong.
Lifestyle factors can also play a paramount role in breast cancer risk. Take charge of your health in these ways:
Avoid or quit smoking as early as possible
Avoid or drink alcohol in moderation
Have an active lifestyle, ideally 150 minutes of moderate intensity exercise each week
Maintain a healthy weight
Despite the increased numbers of early onset breast cancer today, there is also a silver lining on the horizon: the steady decrease in deaths from breast cancer.
“One misconception that we often see is that breast cancer in young women is a death sentence,” expresses Dr Leong. “But most breast cancers are diagnosed at an early stage, where cure rates and long-term survival rates are very good. Breast cancer treatment is also rapidly evolving, with new drugs and better surgical techniques over the last decade.”
Additionally, Dr Leong points out that younger patients undergoing surgical treatment are less likely to develop complications associated with age and other health conditions, such as diabetes.
Nevertheless, a diagnosis of breast cancer at a young age could feel a lot more disruptive at the prime of their lives when careers and planning for a family are at the forefront. This is where the support of family and friends is vital.
“Treatment is not a sprint, but a marathon,” reminds Dr Leong. “Even for patients who have completed their cancer treatment, the anxiety associated with multiple tests and fear of recurrence may affect their daily lives. While it may be difficult to talk about cancer, it is important to let these women know that they are emotionally supported and not alone in their journey.”
Offering practical assistance such as preparing meals, providing transport as the side-effects from treatment might make it more difficult for patients to carry out tasks
Respecting the patient’s desire to maintain a sense of normalcy and agency over their routines and medical decisions
Allowing patients to express their feelings and providing a listening ear
Checking in with their direct caregivers who may also experience burnout
Looking out for signs of distress, such as self-isolation, anxiety, poor concentration, anger
Encouraging patients and their caregivers to seek professional help if needed. Joining a breast cancer support group can help them process their diagnosis and treatment journey and find comfort in community. SKH has an active breast cancer support group called the ‘Pink Peonies’, led by our breast specialist nurses. For more information on membership, please email [email protected].
Subscribe to our mailing list to get the updates to your email inbox...
