At the age of 36 I was diagnosed with breast cancer. Here’s how I encountered it early on

By | April 2, 2024

Lauren Gray/Getty Images/STEVE GSCHMEISSNER

The story of my breast cancer diagnosis is full of improbabilities. First, there was my age, 36, which made me an unlikely candidate for a disease most common in people over 70. My generally good health, confirmed by annual blood tests at my GP, also suggested that there was a clear skies lay ahead. When I started experiencing my only symptom, a subtle but persistent pain in my right breast, my doctors thought it was extremely unlikely to be related to cancer. It was much more likely, they said, that it was related to hormonal changes in my menstrual cycle, or to an injury I couldn’t remember.

Eighteen months later, I know that improbability does not provide actual safety. People in their thirties get breast cancer. People who are otherwise in good health get breast cancer. People with rare or few symptoms may learn that these symptoms are actually the result of breast cancer.

I was very fortunate to see doctors who were willing to continue testing despite all these improbabilities. After a mammogram, an ultrasound, two MRIs, and a biopsy, they found my stage I invasive ductal carcinoma while it was still mercifully small, and before it could spread to nearby lymph nodes, which can circulate tumor cells.

Looking back, it’s easy to imagine how things could have gone differently. I requested the first mammogram and ultrasound because I was sure the pain – more of a concentrated burn than a cramp or ache – was unrelated to my menstrual cycle. When those tests came back clear, I took an even bigger leap and requested an MRI. I felt ashamed—even mortified—at the thought of wasting an oncologist’s time and resources. Wanting to be a “good patient,” both logical and respectful, I came glaringly close to abandoning my concerns. But in a crucial decision, my breast surgeon agreed to order additional imaging based on my family history, which showed I was at higher risk.

My first MRI revealed a “non-mass enhancement”: a lesion that does not meet the criteria of a defined mass and can be either malignant or benign. Cancer still seemed unlikely, but that ambiguous scan was enough to get everyone’s attention. My doctor ordered a follow-up MRI six months later, which located a small mass right at the site of the pain.

In the time since my treatment, there’s been no shortage of “what if” questions to keep me awake at night, but there’s one thought that feels especially poignant: what if I hadn’t trusted my gut that the pain was dangerous. used to be? What if there had been no pain at all?

Research has shown that younger people with breast cancer are more likely to experience diagnostic delays. This can have devastating consequences. According to the Cleveland Clinic, cases of breast cancer in young people are sometimes “more advanced when diagnosed” and “more difficult to treat” because they have had time to grow and spread.

This makes intuitive sense: If there were no symptoms, I would have waited until I turned 40 – possibly 45 – before ever considering a mammogram. What I didn’t know until after my diagnosis is that I would have been behind scheme. I have since learned that the mammogram recommendations are more detailed than I realized, and that I had missed a few potentially life-saving details.

Eric Winer, MD, director of the Yale Cancer Center and president and physician-in-chief of Smilow Cancer Hospital in New Haven, Connecticut, tells SELF that there is not entirely consensus about when cis women and people assigned female at birth, should start mammograms. Although the US Preventive Services Task Force lowered the recommended age to 40 in a new set of guidelines published last May, “there has been a back and forth between 40 and 50 years” between health authorities, explains Dr. Winer out.

“Several years ago, the American Cancer Society (ACS) took a very measured approach and set the age for women at average risk at 45,” says Dr. Winer. “It now says that women have the option to start at age 40, but should start getting annual mammograms no later than age 45 and continue this approach for at least the next ten years. At age 55, they have the option to switch to one every two years.” This continues as long as the patient is in good health and is expected to live for at least another ten years.

The key words here are ‘medium risk’. High-risk people have their own screening rules. “We recommend that a woman with a family history of breast cancer, which may include her mother, sister, aunt or grandmother, consider starting mammograms 10 years before the age at which that person was diagnosed, or starting at age 40 – depending on what comes next. first,” Michelle Specht, MD, co-director of the Avon Comprehensive Breast Evaluation Center at Massachusetts General Hospital and faculty member at Harvard Medical School, tells SELF. “If a woman’s relative is diagnosed with breast cancer at a very young age (under 40 years old), we use breast MRI to screen between 25 and 30 years old,” she explains. “I worry that women are not aware of current screening guidelines.”

It was not me. Applying this rule to my own family history, I should have had annual mammograms starting at about age 34. Applying this rule to my family’s future, I encourage my daughters to request MRIs starting at age 26 – 10 years before my age at diagnosis. unless the recommendations change.

Dr. Specht notes that the majority of breast cancers discovered in women under 40, which represents 7% of all new cases, are found in people with genetic abnormalities or a strong family history of the disease. However, there are other risk factors that should prompt early screening, as the ACS recommends. These include having had chest radiation before the age of 30, or living with health problems including Li-Fraumeni syndrome and Cowden syndrome.

If you have a lifetime risk of breast cancer of more than 20%, as calculated by a Breast Cancer Risk Assessment Tool (BRCAT), this also means you should start screening early. Before my diagnosis, I had never undergone this type of risk assessment, but I have since learned that my own lifetime risk was 33%, well above the national average of 13% and above the threshold for early screening. The National Cancer Institute offers an online version of this tool that you can try at home. By sharing your results with your doctor, you can start an important conversation about your risk level and find out if you are a candidate for early screening.

Dr. Winer adds that there’s another insidious way you can be vulnerable to breast cancer without even realizing it. He says factors like race, financial status, education level and even relationship status can all affect your prognosis, especially if you’re young. “If you are anything other than a middle- to upper-class white woman, you are at greater risk. If you are a 20-year-old black woman, you have twice the risk of dying from breast cancer compared to a 20-year-old white woman,” says Dr. Winer, noting that this gap is most likely explained by unequal access. on screening and treatment, not on biological differences. “That’s a shocking statistic, and one that shows how much work we have to do as a country,” he adds.

But Dr. Winer also offers reason for hope. “We’re really making a lot of progress in research and treatment today is very different than it was 10 years ago,” he explains. “Our treatments are better and the mortality rate has gone down. More than 40,000 women still die from breast cancer every year, but there are 300,000 cases every year. Most women with breast cancer survive in the long term.”

“It’s hard to predict where it will be in 10 years, but I think breast cancer will be one of the first cancers where we can say we’ve virtually eliminated mortality,” Dr. Winer says.

For now, early detection is still one of the best tools we have in the fight against breast cancer. Everyone – but especially people at high medical risk and high risk of healthcare disparity – should know the signs and symptoms, and be proactive and persistent in communicating any concerns to their doctors.

I was lucky. Because my cancer was discovered quickly, I was spared the most difficult forms of treatment. I was able to have a lumpectomy – a local operation to remove the tumor – instead of a mastectomy, which would have removed one or both breasts. I underwent radiation, but did not require chemotherapy as part of my treatment plan. I will continue to take endocrine therapy medications daily for the next five to ten years, but I have reason to believe that the worst of this experience is behind me. Fortunately, my prognosis is very good.

Although the majority of people under 40 do not need annual screenings, it is important to know if they do you Doing. I wish I had. Being aware of your risk level can increase your chances of a safer outcome in the unlikely event of an early diagnosis. Having experienced it myself, I know I would do just about anything to improve those odds.


Originally published on SELF

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