When a young woman is diagnosed with breast cancer, she will face a whole range of unique and often confronting challenges that differ considerably to women who are diagnosed when they are older.
Premature menopause, fertility and parenting issues, sexuality and body image difficulties, career disruption, and high levels of psychosocial stress are some of the factors that affect women under the age of 40 in an age specific way.
Additionally, pre-menopausal women are more likely than older women to be diagnosed with triple negative breast cancer, which tends to grow faster, with fewer effective treatment options. It’s also more likely to recur in subsequent years.
“Cancer tends to be a disease of old age, so when you’re young and it’s not on your agenda, you go into a forced holding pattern,” clinical psychologist Dr Lesley Stafford told Women’s Agenda recently.
“Everybody else is building a career, or having a family, or getting married, or doing a whole range of other things, and you’re just sick.”
Dr Lesley Stafford is clinical psychologist who delivers specialist psychological care for women with breast cancer in a private practice setting. She says when a young woman is diagnosed with breast cancer, there’s often a greater burden of disease, and a greater psychological burden.
“I think anyone diagnosed with cancer immediately thinks, “Am I going to die? What about my kids? What about my family?” That’s much harder when you have young children who are very dependent on you, who you haven’t finished raising yet,” Dr Stafford explains.
“For women who are younger than 40, you can imagine many of them have got babies or primary school-aged children. Younger women also have a lot longer to worry about the cancer coming back, which is the number one reason people seek me out – for fears of recurrence.”
Fertility
Recently, Women’s Agenda spoke to Laura McCambridge, a young woman in Melbourne who was diagnosed with breast cancer at age 31. One of the most confronting conversations she was faced with after being diagnosed was the one about her fertility, and the idea that she suddenly had to think about storing eggs. Up until that point, McCambridge hadn’t made any decisions about whether she wanted to have children or not.
According to Dr Stafford, one of the most challenging issues affecting young women with a breast cancer diagnosis is what to do about their fertility if they have not yet had children or intend to have more children.
“Some cancer treatments do affect fertility. Sometimes there isn’t an opportunity to freeze eggs or do something like that before treatment starts,” she explains. “That may mean that these women can’t complete their family, or the chances of them having any children at all are affected.”
“Some treatments can also give you menopause-like symptoms and drive you into an earlier menopause.”
Sexuality, sexual functioning and body image
For younger women, going through treatment for breast cancer can have a massive impact on their sexuality, sexual functioning, and body image. And while it’s true these issues are common for people of any age, when you are younger, the experience can be more distressing.
“Those menopausal symptoms can have a big impact on sexuality and sexual functioning,” Dr Stafford says. “There are just certain things that are different when you are young. For a young person who is still dating, the changes in physical appearance can take a big toll.”
“I think it can be particularly difficult for young women in terms of their confidence and worries about attracting a partner because of feeling different, or perhaps one breast just looks a bit different now, or because there have been changes in sensation in breasts if you’ve had reconstruction scars.”
Hair loss
One of the more difficult parts of the process to come to terms with for many young women diagnosed with breast cancer is losing their hair in treatment.
“We think about hair, many of us, as a symbol of beauty, a symbol of femininity, and a symbol of womanhood,” Dr Stafford explains.
“When you lose your hair with chemotherapy, you also lose your eyebrows and your eyelashes. You don’t look at all like yourself. What it means is that you are wearing your diagnosis on the outside. It’s just a real loss of privacy. It’s a real loss of identity.”
Psychological distress
Young women tend to have less life experience than older people, so receiving a breast cancer diagnosis and going through treatment can be difficult to come to terms with. With so much of life still ahead, it can be shocking to comprehend what being unwell might mean for the future.
“You don’t have the life experience that an older person has, and you’re less likely to be living among peers who are sick,” Dr Stafford said. “Chances are, you don’t know many people with cancer. It’s true that as you get older, you have more of a sense of your own mortality, and of your contemporaries being sick.”
Younger women tend to experience higher levels of psychosocial distress following a diagnosis, and Dr Stafford says feeling listened to can go a long way.
“Many people just need to be listened to. They need to be understood. They need to be validated. They need someone to not say to them, “Don’t worry, it’ll be fine.” Because no one knows it’s going to be fine, right?”
Associate Professor Lesley Stafford will be a panel member at an upcoming Q&A with Breast Cancer Trials on 27 July from 5:30-7pm (AEST), on the topic of Breast Cancer in Young Women. Moderated by Author and Journalist Annabel Crabb, you can find out more about the Q&A or register to watch the online Q&A here.