My coworker Tim, who found me that Monday morning, red-eyed, sitting in an empty office at our financial firm, assumed I'd had a bad weekend. Maybe a fight with my boyfriend. In fact, moments before, I'd gotten the results from a biopsy of the lump in my left breast: cancer. When I told Tim, he barely said a word. The news, so raw, hung there between us until he broke the silence: "Do you want to get Slurpees?"
I did. Because going for Slurpees felt normal. It was our answer to botched assignments, long meetings and generally crummy days—all the things that, until now, had seemed as bad as it could get. I was 23 years old. I was used to worrying about which senior managers I should suck up to, which shoes I should buy, who my intramural rugby team was up against next. And on that cool day in April, as we sat on the curb outside 7-Eleven in Baltimore, I wanted to hold on to that life—a life suddenly made spectacular by just how unexciting it was.
When my boyfriend, Josh, had first felt the lump, I assumed it would go away on its own, like all the other lumps, bumps and bruises before it. I'd actually waited three months to tell my doctor—and I probably would have waited longer if I hadn't needed to see her for what I thought was a more pressing concern: seasonal allergies. My doctor seemed as unconcerned about the lump as I was, but she referred me to a radiologist anyway.
It turned out to be aggressive stage II cancer. The tumor (all 2.8 centimeters of it) was removed, and I gave myself over to the care of my parents and Josh. While my friends were out day-drinking their weekends away, planning trips to the beach and meeting at the mall, I stayed home. I was so wiped out by the chemo that I could barely fold a T-shirt.
And then, after a few rounds of radiation, the cancer was gone. I would live. I would get to keep my life, but what life? For the past year, I had been talking to my boss about transferring to our company's new office in Shanghai. That was out. The national tournament for my club basketball team was coming up in less than a month. I wouldn't play. I had gone from freaking out about missing a single birth control pill to asking my boyfriend of seven years if he wanted to fertilize my eggs. (The chemo, I'd learned, could send me into early menopause.) My fertility doctor gently urged me to save some unfertilized eggs in case things didn't work out with Josh; I didn't have to decide right then if he was the man I was going to have kids with. My panic was the cancer talking, as it bombarded me with life choices I wasn't really ready to make.
Cancer sucked. It was lonely. I was bruised and hairless and tired. But as banged up as my body was, it was still mine. And slowly I started to put it back in action. Five months after my final treatment, I played in my first postcancer rugby game. My teammates thought I was crazy, but I packed extra padding over my chest, ran onto the field and powered through every tackle and dive. I felt alive.
Last fall I pushed my body further still, biking 220 miles in the Young Survival Coalition's Tour de Pink from Philadelphia to Washington, D.C. On the day we neared the 70-mile mark, I was spent. There was a "poop out" bus that riders could take to the next pit stop, but I had committed to biking every inch of the course. As the sun began to set, a man whose wife had survived breast cancer slowed to go the last few miles of the day with me.
When I was a kid, I used to ride a purple bike with white handlebars and metallic streamers. In Baltimore I got around on a crappy ten-speed I found on Craigslist. Riding those bikes was easy. There was a simplicity to life back then. But there's always been something about tackling a hill—pressing down on the pedals with everything you've got, teeth gritted, legs aching—until you push past the hard part, regain your balance and fly.
Next: What you need to know about your risk
Could it happen to you?Setting the record straight about young women and breast cancer.
What are the odds?
Roughly 5 percent of new breast cancer cases occur in women under 40—about 13,000 diagnoses each year. "The younger you are, the lower the odds, but I have diagnosed breast cancer in women as young as 18," says Therese Bevers, MD, medical director of the Cancer Prevention Center at MD Anderson Cancer Center in Houston. The good news: The five-year survival rate for women under 40 is 84 percent.
Is breast cancer among young women on the rise?
According to a 2013 study in The Journal of the American Medical Association, the incidence of localized breast cancer among women under 40 showed no increase between 1976 and 2009. But the incidence of metastatic breast cancer (which is less common) nearly doubled over the same span.
Are self-exams still best?
Early detection is especially key for young women, as premenopausal breast cancer is often more aggressive and harder to treat than breast cancer in older women. "Nearly 80 percent of younger women find their own breast cancer lumps," says Jennifer Merschdorf, CEO of the Young Survival Coalition. "It's natural for young women to have lumpy breasts or cysts, and in most cases, nothing is wrong. But if a lump doesn't go away, you should absolutely get it checked out."
I found a lump. What tests should my doctor perform?
Mariana Chavez-Mac Gregor, MD, an assistant professor of breast medical oncology at MD Anderson Cancer Center, assesses the three most widely used options:
- Ultrasound. "In young women, most of the time we order an ultrasound first," Chavez-Mac Gregor says. They're quick, simple and good at evaluating cysts—small, usually benign fluid-filled sacs many women have in their breasts.
- Mammogram. "Young breasts tend to be very dense, so a mammogram will likely not show you much, but it can detect things like calcifications that an ultrasound can't," Chavez-Mac Gregor says.
- MRI. Because the highly detailed pictures they yield can sometimes trigger unnecessary biopsies of normal lumps, MRIs are often reserved for women who have tested positive for a breast cancer gene mutation (like BRCA1 or 2) or have a strong family history of the disease.
Some chemotherapy drugs have been found to genetically damage or destroy eggs or send patients into a type of medical menopause. Don't panic. The younger the patient, the more likely her ovaries and eggs will recover. And the options for patients whose infertility proves permanent are expanding: Now that the American Society of Reproductive Medicine has officially endorsed egg freezing for young women with cancer, it's expected that more insurance companies will cover parts of the costly procedure.
—Sunny Sea Gold
Next: Support for young women with breast cancer
Your Support TeamThese groups help young women navigate prevention, detection and recovery.
This nonprofit educates young women about prevention and early detection. You can get "Underwire Alerts," monthly text reminders to do breast checks, at BrightPink.org.
Young Survival Coalition (YSC)
"Before I was diagnosed, I didn't know young women could get breast cancer," says the group's CEO, Jennifer Merschdorf. "But I quickly found out about YSC and went to one of the support groups. The women I met helped me get through it." YSC runs in-person support meetings around the country, plus online forums at YoungSurvival.org.
Cancer and Careers
Maintaining a job while undergoing treatment can be tricky. "One of my friends works at a law firm surrounded by men who are after her job," Merschdorf says. "She doesn't want to be treated differently because she's been sick, but if she bursts into a sweat from hot flashes caused by her medication, that can be hard to conceal." At CancerandCareers.org, survivors can get career coaching and legal advice about workplace rights.
—Sunny Sea Gold
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