Young Mothers and Breast Cancer: Why Does It Happen?
This past weekend I was among the 500 attendees at the Young Survivor Coalition (YSC) Summit in Houston, a three-day conference for young women diagnosed with breast cancer prior to their 41st birthday. Four break-out sessions were dedicated to people living with Stage IV (aka metastatic) breast cancer.
One of the most compelling speakers was Dr. Virginia Borges. According to her bio, “Since arriving at the University of Colorado in 2003, [Dr. Borges] has been exploring the prevention, causes and treatment of breast cancer in women under the age of 45. Dr. Borges also treats Pregnancy Associated Breast Cancer (PABC), a particularly aggressive type of cancer found in women who are diagnosed with breast cancer within five years of childbirth.”
When we think of people with breast cancer, we generally envision older women—after all, the median age for a woman with breast cancer in the U.S. is 61. But young people do get breast cancer—and some of them are mothers.
In October 2013, the Denver Post spoke to Dr. Borges about her work. Reporter Kyle Wagner cited American Cancer Society figures: 232,340 women are diagnosed with invasive breast cancer annually. Of those, about 27,000 are women 45 and under, or about 12 percent, and approximately half of those women are postpartum, defined as being within five years of having given birth.
I knew that NOT having children increased a woman’s risk, due to the unopposed flow of estrogen. But until a year ago, I didn’t know that recent childbirth can temporarily increase one’s breast cancer risk. As noted on www.cancer.gov:
Women who have recently given birth have a short-term increase in risk that declines after about 10 years. The reason for this temporary increase is not known, but some researchers believe that it may be due to the effect of high levels of hormones on microscopic cancers or to the rapid growth of breast cells during pregnancy (15). [Source: http://www.cancer.gov/cancertopics/factsheet/Risk/reproductive-history]
Young moms can pose a diagnostic challenge. Most would not have regular mammograms until their 40s or 50s. Some of their doctors may ascribe breast complaints to issues associated with breastfeeding. In 2002, Dana Robinson, then 31 years old, was diagnosed with Stage 2 breast cancer, more than a year after she first sought treatment.
“Because of my age, no family history and the fact that African-American women have high cases of fibroadenomas (a benign breast lump) — the lump went misdiagnosed,” Dana recounted. “I was told to come back and have it checked in six months. Six months later, I was told the same thing.”
In 2008, Dana was diagnosed with lung and bone mets. She died in 2012.
According to the Post, women diagnosed with breast cancer within five years of giving birth are three times more likely to experience a recurrence than those who are outside the postpartum window.
“Losing anyone to cancer is a terrible thing,” Borges told Wagner. “Losing a young mom to breast cancer has terrible ramifications on that family.”
Michele Conklin offers an overview of Borges’ efforts here. Here’s an excerpt:
Borges has partnered with Pepper Schedin, PhD, researcher and professor of medical oncology at the University of Colorado School of Medicine, to better understand pregnancy-associated breast cancer (PABC). Schedin was the first to identify that the process involved in returning breasts to their normal state after pregnancy or breastfeeding creates an environment ripe for cancer promotion.
During this process, called involution, the body uses wound healing mechanisms to kill milk-producing cells, similar to how the body removes damaged tissue after a cut.
“Wound healing is a good process, but tumor cells happen to love wound-like environments,” Schedin says. “This environment is not only more likely to grow tumors but also to cause metastases.”
Pregnancy-associated breast cancer can grow and spread more rapidly than breast cancer in women who have not had children. Some studies show that, on average, a woman diagnosed with breast cancer within two years of giving birth has a 40 percent 5-year survival rate, compared with a 70 percent rate in a woman who has not had a child prior to diagnosis.
“None of this is to say women shouldn’t get pregnant,” says Borges, an associate professor of medical oncology at the CU School of Medicine, and mother of two young sons. “Having children is a good thing. The point we would like to make is that care providers need to have this on their radar screens, and women need to be self advocates.” [ End of excerpt]
Among my legions of friends lost to metastatic breast cancer, there have been far too many young mothers. I often think of those families—the young fathers and the children left behind.
At this past weekend’s event there was a tribute board for young people who died from metastatic breast cancer. It was so sad to see the little scraps of paper pinned there. “I miss you, sis,” said one. One simply said “Mom.”
Lisa Bonchek Adams’ name was on that board. She died on March 6, 2015 at age 45 from metastatic breast cancer.
Lisa was diagnosed with Stage 2 breast cancer at 37 when her youngest child was 7 months old. In 2012, she learned the cancer had returned and was now metastatic, having spread to her bones. Over the next two years, she tried at least different six courses of treatment—when one failed, she moved on to the next, just as all of the 150,000 US people currently living with metastatic breast cancer routinely do. Eventually the scan, treat, repeat cycle ended—and Lisa became one of the 40,000 U.S. people to die from breast cancer this year.
“As a 43-year-old mother of three, my life was already full,” Lisa wrote shortly after her metastatic diagnosis. “I didn’t have time for cancer when I was first diagnosed in 2006. Now I only worry that my cancer means I don’t have time.”
Too many mothers didn’t have enough time.
Suzanne Hebert was 47 when she died in 2012; her children were 11 and 9 years old.
And far too many others.