Cancer didn't catch Christina Applegate unprepared. Because her mother had battled both breast cancer and ovarian cancer, Applegate had been going for regular mammograms since the age of 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.
Just a few months before she learned she herself had breast cancer, the actor got a shocking insight into the struggles faced by other young women who are also at high risk for the disease -- and who don't have the resources of a Hollywood celebrity.
"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!"
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. "I was so lucky. I was really diligent about my testing, I never missed a time I was supposed to go," she says. "There was no cancer detected at one three-month visit, and when I went back for another MRI three months later, there it was. The cancer actually became detectable in me within three months. Had I waited six months or a year, who knows how far it would have spread?"
Right Action for Women
Determined not to let other young women find out the potentially deadly answer to that question, Applegate -- who is now pregnant, with her fiance, Martyn Lenoble, a Dutch bass player -- was barely out of treatment when she began putting together a new foundation, Right Action for Women (RAW, rightactionforwomen.org). 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.
"When I was able to find my cancer in the stage I did, my passion for wanting to do something for these women was beyond what I could express," she says. The past two years have been a big fundraising push for RAW -- and now, at last, the foundation has reached the point where it can start to offer fully funded MRIs for high-risk young women on a small scale at a handful of hospitals in Los Angeles and Washington, D.C.
"We're starting small, but we want to go national," Applegate says. "We'd also like to start working with places that will offer these women a certain number of MRIs for free." This service is especially welcome, says Applegate, "because screening MRIs are about $3,000 each!"
Breast Cancer Early Detection
Another goal for RAW is support for genetic testing and counseling for women who may have genetic mutations that raise their risk for breast cancer, such as the BRCA1 mutation Applegate has. "Genetic testing and counseling can be very expensive and are often not covered by insurance, but having that information can radically change how you're treated. Finding out I was BRCA-positive made my choice about treatment very different," says Applegate, who had a bilateral mastectomy (both breasts removed).
After the cancer was initially diagnosed, Applegate first had two lumpectomies. Only after those surgeries did she receive the results of her genetic testing. "I went in and talked to my doctor, and at first I was very against the idea of mastectomy. I cried and said there's no way in hell I'm doing this. Then it just hit me: I had a chance of recurrence that was way above 50%. I didn't want to live with that fear for the rest of my life, so I came to terms with it, and we went ahead and decided to take both off."
Applegate's decision was an understandable one, says Eric Winer, MD, director of the Breast Oncology Center and chief of the division of women's cancers at the Dana-Farber Cancer Institute in Boston. "We know that women who have a mutation and have a first breast cancer are at substantially increased risk of cancer in the other breast. She could have chosen other options, but I think for a woman in her situation, this is the approach that would give her the least likelihood of a subsequent problem." On the other hand, women who have "sporadic" cancers -- those that are not linked to a known cancer-causing mutation -- do not appear to reap any long-term survival benefit from "prophylactic" double mastectomies, Winer says.
Risk Factors for Early Breast Cancer
The doctor who helped Applegate decide on her mastectomy was Philomena McAndrew, MD, a medical oncologist with the Tower Hematology/Oncology Group in Los Angeles and associate medical director for breast oncology at the Saul and Joyce Brandman Breast Center at Cedars-Sinai. She says all young women --not just those at high risk, like Applegate -- need to be vigilant about breast cancer.
"Young women have to know they're not somehow protected from getting breast cancer until they're older," McAndrew says. "Christina, of course, faced a higher risk because of her family history [and genetic mutation], but even among women with no family history, we're seeing increasing risk of breast cancer in younger populations.
"There are a variety of reasons for this, including later first pregnancies, an increase in obesity, environmental exposures to things like hormones, and other factors -- things that have stimulated the proliferation of breast tissue more today than 100 years ago."
Scientists are still debating about some of these factors, such as whether exposure to chemicals in the environment that contain or mimic estrogen can lead to breast cancer. But there's little debate that a woman who has her first child in her 20s is more protected against breast cancer than one who doesn't get pregnant until her 30s.
"I know a girl whose cancer was found at stage III," says Applegate. "She'd gone in a year earlier feeling a lump, and the doctor told her it was probably just a calcium deposit and did no tests. If she'd had it taken out then, maybe it would have been a stage I cancer. Now it's in her lymph nodes, and she's dealing with a much worse situation."
Many young women involved in the Young Survival Coalition, an organization for young women with breast cancer, report similar experiences -- finding a lump or another suspicious change in their breast and being told by doctors that they're "too young for breast cancer."
Cancer has changed Applegate's life in many ways. She's become much more vigilant about her health in general. She has adopted a macrobiotic diet that she says offers her the reassurance that everything she's putting in her body is as healthy as possible.
She's also done her best to wipe stress from her life. "The second I was diagnosed, this house became a stress-free zone. There's no bull**** in my house -- I don't allow it here," she says. "I changed my bedroom over and cleaned out a lot of unnecessary things to make the environment clean, calm, and clutter-free so I could wake up in a sanctuary. It's been good for my mind and my spirit."
Perhaps not surprisingly for the star of Fox's long-running Married ... With Children and films like Anchorman: The Legend of Ron Burgundy, as well as in the new Farrelly brothers comedy, Hall Pass, with Owen Wilson, opening in February 2011, Applegate's best weapon in battling cancer has been humor.
"I laughed more during my surgery and during the time afterward than I ever had in my life," Applegate says. "There are so many funny things in a hospital, really, you just have to laugh. You know, I had a catheter when I was in the hospital after my mastectomy, and I always thought it was funny that the people who came to visit me were sitting right next to my bathroom. I'd look at them and say, ‘I'm going. Right now. How's that make you feel?'"
But comedian though Applegate is, the journey hasn't all been laughter. "Having a mastectomy is an amputation," she says. "A lot of doctors will tell you that you'll look so much better -- your breasts will be higher up or prettier or perkier, and maybe that's true. But they're not going to be the same as what you had. Your body and your emotions and your soul and your spirit are all going through an amputation. I wasn't as prepared as I thought I was for that aspect."
Breast Cancer: The Importance of Social Support
That's one reason Applegate urges all young women facing a breast cancer diagnosis to try to connect with other young women in the same boat. "You need people you can talk to, even if it's not in person, even if just on the phone, who've been there, too." When she was diagnosed, Applegate's doctors put her in touch with just such a group. Today, she calls them her "comrades in boobs."
"From day one, until now, we've been talking," she says. "They helped me through the hardest times, the nights when I'd wake up with odd pains and think it was the cancer coming back. They've been uplifting through the whole process."
She also counts herself fortunate to have the support of fiance Lenoble, a founding member of the band Porno for Pyros. "I am so lucky that he was in my life at that time," she says. "There was no way he was going to walk away from me as I went through this. For other women who might be just starting to date someone when they're diagnosed, I think you should tell them as soon as you can. It shows you the character of the man: Will he walk with you through this journey, or is it too much for him to handle? Better to weed out someone who can't be there right away."
In July, Applegate announced that she and Lenoble are expecting their first child together. (Because Applegate's cancer was caught at an early stage, she did not have to undergo chemotherapy, which can be damaging to a woman's fertility.) She hasn't revealed the due date, but "bump watchers" think it should be sometime after the New Year.
Since many breast cancers -- including Applegate's -- are the kind fed by hormones like estrogen, and pregnancy is basically one long hormone-fest, is it really safe for a woman who's recently had breast cancer to get pregnant? Surprisingly, the answer is yes. Studies show that having a baby after being successfully treated for breast cancer doesn't appear to raise your risk of the cancer's returning, and some research even indicates that pregnancy after breast cancer could have a protective effect.
"The hardest thing about pregnancy so far is the unexpected fatigue," says Applegate. But she's reveling in the anticipation of being a new mom, something she's long looked forward to. "I'm really enjoying feeling the baby kick and move!"
Applegate has one other piece of advice for young women dealing with breast cancer: Don't let cancer define you. "We all want to be activists and do all we can, but after all my interviews last year, I was like, please, can I not be Cancer Girl for a couple of months? The last thing you want to do is stew in this thing. Get out there and do other things that have nothing to do with cancer! Cancer is not who you are -- it's something you go through. My mom has always said, ‘Cancer is a word, not a sentence.'
3 Things Women Need to Know About Breast Cancer
This year, about 10,000 women younger than 40 will be diagnosed with breast cancer. Because of a lack of awareness about the disease in young women, many will be diagnosed in later stages than women who get breast cancer in their 50s and 60s. If you're under 40, what do you need to know about breast cancer right now? Here's some advice straight from Christina Applegate and her doctor, Philomena McAndrew, MD:
Know your breasts. Breast cancer is the leading cause of cancer death in young women ages 15 to 54. Talk to your doctor about the pros and cons of breast self-exams. If you choose to do them, your doctor can review the techniques with you. (For WebMD.com's online guide, search "breast self-exam.") If you know how your breasts "should" look and 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 she felt something and was worried about it, but they dismissed it because she was 'too young.'"
Doc shop. Don't automatically go with the first doctor you consult. 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." Good online sources for information, recommended by Applegate and McAndrew, include breastcancer.org, the Young Survival Coalition (youngsurvival.org), and FORCE: Facing Our Risk of Cancer Empowered (www.facingourrisk.org).