Just a few months before learning that she had breast cancer, Christina Applegate got a shocking insight into the struggles faced by other young women also at high risk for the disease -- and who don’t have the resources of a Hollywood celebrity.
Because her mother had battled breast cancer and ovarian cancer, Applegate had been going for regular mammograms since age 30. “But when I turned 36, my doctor said that my breasts were just too dense for mammography alone, and he referred me for screening MRIs at Cedars-Sinai Medical Center,” she recalls. “After my second MRI, the patient relations woman who’d been taking care of me for years told me that a lot of high-risk young women were opting not to have screening MRIs because they couldn’t afford it -- they cost about $3,000 each -- and insurance wouldn’t cover it. It really angered me!”
Triple-negative breast cancer (TNBC) is defined as the absence of staining for estrogen receptor, progesterone receptor, and HER2/neu. TNBC is insensitive to some of the most effective therapies available for breast cancer treatment including HER2-directed therapy such as trastuzumab and endocrine therapies such as tamoxifen or the aromatase inhibitors. Combination cytotoxic chemotherapy administered in a dose-dense or metronomic schedule remains the standard therapy for early-stage TNBC. A prospective...
Less than a year later, in 2008, Applegate -- who had landed the starring role in ABC’s comedy series Samantha Who? -- was diagnosed with breast cancer -- an early-stage cancer caught with the help of those MRIs. She was barely out of treatment when she began putting together a new foundation, Right Action for Women (RAW). RAW, an Entertainment Industry Foundation initiative, has raised money and awareness for support programs that provide free or low-cost screening MRIs to younger women who, like Applegate, have a high risk of developing breast cancer because of significant family histories and cancer-causing genetic mutations.
This year, approximately 10,000 women younger than 40 will be diagnosed with breast cancer. What do they need to know about breast cancer right now? Here’s some advice and info straight from Christina Applegate and her doctor, Philomena McAndrew, MD, a medical oncologist with the Tower Hematology/Oncology Group in Los Angeles:
Know Your Breasts. Breast cancer is the leading cause of cancer death in young women aged 15 to 34. Talk to your doctor about the pros and cons of breast self-exams. If you choose to do breast self exams, your doctor can review how to do them with you. (WebMD.com has an online guide; search “breast self exam.”) If you know how your breasts “should” feel, you’ll know when there’s a significant change that means you should call your doctor.
Be Persistent. If you think you feel “something,” and family or doctors dismiss your concerns because you’re “too young for breast cancer,” it might be tempting to believe them and not seek further answers. But you have to be your own advocate, says McAndrew. “The youngest patient I’ve seen was 18 when she felt the mass, and 22 when she was found to have stage IV breast cancer. She kept telling doctors that she felt something and was worried about it, but they dismissed it because she was ‘too young.’”
Doctor Shop. Don’t automatically go with the first doctor you see. And yes, you have time. “Most breast cancers are not like other cancers where you have to start treatment immediately,” says McAndrew. “You want a treatment team you’re comfortable with and that is aware of all the newer approaches, such as genetics, neoadjuvant therapy (chemotherapy before surgery), and looking at molecular markers of your tumor to figure out your individual risk.”
Research Your Options. “Learn about things like stage and grade, and what they mean to your treatment options,” Applegate says. “No question is stupid. Every question is important.” Good online sources for information, recommended by Applegate and McAndrew, include breastcancer.org, the Young Survival Coalition (www.youngsurvival.org), and Facing Our Risk of Cancer Empowered (FORCE, www.facingourrisk.org), for women at genetically higher risk of developing cancer.
Network with Other Young Women. “Breast cancer when you’re in your 20s, 30s, and even 40s can be so isolating,” McAndrew says. “Look online and ask your doctor for connections with other women your age. Women with breast cancer are amazing -- women who’ve never met are connected by a doctor or a friend, and they’ll visit each other at home or pick someone up and take them to chemo. It isn’t a group you’d ever sign up for, but it’s a group that can make dealing with cancer as a young woman so much less lonely and difficult.”