Younger women with breast cancer can have more aggressive disease
Jessica Duemig’s first reaction to being diagnosed with breast cancer was she was too busy.
So, the then 32-year-old went into overdrive.
Within three weeks, she underwent a double mastectomy. Soon after, she embarked on fertility treatment to preserve her eggs and began chemotherapy.
Within seven months, she’d completed her chemo and breast reconstruction surgeries.
“At that point, it was rapid fire,” said Duemig. “After the last chemo session I was like, ‘Oh my God, it’s over,’ and it all comes pouring out because you have to be strong to get through it. Then you’re like, ‘What did I just deal with?’”
The 35-year-old from Coconut Creek is now cancer-free and has written a book about her experience, “Warrior.”
“I wrote the guidebook I wish I had,” she said. “For me, I really believe your attitude is everything so I wanted people to know you’re about to go into war. And you know what? You have all the tools to come out on top.”
DISEASE OFTEN MORE AGGRESSIVE IN YOUNGER WOMEN
The American Cancer Society estimates 279,100 people will be diagnosed with breast cancer this year, and fewer than 10 percent of those will be below 40.
But when younger women develop the disease, it tends to be more aggressive and in an advanced stage, partly due to guidelines that recommend most women get their first mammogram at 40.
“So, there may have been something that they had going on for quite a while that had a chance to grow and spread before we are aware of it,” said Dr. Erica Bloomquist, a breast surgical oncologist at Memorial Breast Cancer Center in Broward.
Family history, too, could play a part; women in the Bahamas have greater risks due to genetic predispositions, according to researchers at Sylvester Comprehensive Cancer Center at the University of Miami.
DISMISSING EARLY SIGNS OF BREAST CANCER
Duemig does not have a family history of breast cancer, so when she woke up with a sharp pain in her left breast and noticed a small lump, she initially dismissed it as an ingrown hair or a pimple. But when the pain came back about two months later, the lump had grown.
The lump turned out to be stage 2a triple-negative metaplastic breast cancer. The American Cancer Society says triple-negative cancers are most common in women under 40, and the kind Duemig had accounts for fewer than 1 percent of annual breast cancer cases.
“It’s a very rare tumor; I only see one or two a year,” said Dr. Starr Mautner, a breast surgeon with Miami Cancer Institute, part of Baptist Health South Florida. “It can be extremely aggressive, and it’s usually diagnosed at a higher stage.”
QUESTION OVER WHETHER TO FREEZE ONE’S EGGS
Mautner helped Duemig beat the disease, but she still had to face the challenges pre-menopausal breast cancer patients face — including fertility issues. Since breast cancer treatments can affect a woman’s ability to become pregnant, many younger women are thrust into making family-planning decisions.
“I never wanted kids,” said Duemig, who froze her eggs before starting chemotherapy. “But then you take away that safety net of being able to change your mind, and it’s like maybe I do want kids.”
For younger cancer patients, balancing treatment with a career and a social life can be daunting. Add in dating, and things can be complicated quickly. But Duemig, who worked in advertising, was determined to maintain her routine.
“Most days through my treatment I was operating as normal,” Duemig said. “I talked openly about it. I was bald. I didn’t wear a wig. It wasn’t like a secret.”
While a majority of her friends and family were supportive, Duemig says a few friends would send her articles with unfounded claims that certain foods or bras cause breast cancer.
“I lost a few friends when I got diagnosed,” Duemig said. “Don’t sit here and tell me that you read in Cosmopolitan magazine that women who eat healthy don’t get cancer.
No, women who eat healthy get cancer, too.”
Mautner, her doctor, is quick to debunk Internet rumors about the causes of breast cancer.
“There is no magic food they should be eating or shouldn’t be eating,” Mautner said. “The rule of thumb is everything is in moderation. You should have a varied diet that is healthy.”
Regular screenings can also be a powerful prevention tool, and women are encouraged to get familiar with their own bodies so they can notice any changes.
“Basically, when you’re showering and you’re washing you’re sort of aware of the general architecture of your breast and that really is enough for women to identify, ‘Hey, something feels a little off,’” Bloomquist said. “It may not be a distinct lump, but it could be just the feel of the breast issue is firmer, more dense, and just different from the other side.”
GENETIC MUTATIONS AFFECT BAHAMIAN WOMEN
Family history, race and genetics can play a role in determining a woman’s risk of developing breast cancer. The Centers for Disease Control and Prevention says Black women die at a higher rate from breast cancer compared to white women, despite women of both races being diagnosed at similar rates.
But even those statistics don’t tell the entire story.
“The Black community in the United States is not monolithic,” said Dr. Judith Hurley, an oncologist with Sylvester Comprehensive Cancer Center of the University of Miami Miller School of Medicine. “The Black population isn’t the same; you have to sub-categorize.”
Through her research of studying hundreds of Bahamian women, Hurley has found that they, on average, develop breast cancer at 42 — about two decades before
American women. (The median age of diagnosis in U.S. women is 62, according to the CDC.)
Women in the Bahamas have the youngest age of breast cancer diagnosis in the Caribbean, according to Hurley’s research.
While 3 to 5 percent of breast cancers in the United States are caused by mutations in breast cancer genes, in the Bahamas 25 percent of cases can be attributed to these mutations. The most common mutations are in the genes BRCA1 and BRCA2.
After studying a group of 250 women in the Bahamas over four years and publishing their findings in 2013, Hurley and her team expanded their research to six other Caribbean islands. Those islands are Dominica, Jamaica, Haiti, Trinidad and Tobago, the Cayman Islands, Barbados, in addition to the Bahamas.
Although she encourages Bahamian women to undergo genetic testing, Hurley notes the risk of developing breast cancer isn’t isolated to a particular location. When people immigrant to the United States they “bring their risk with them.”
“One of the things we noticed in women from
Haiti is that the type of breast cancer they develop in the United States is different than the one they’d develop in Haiti,” Hurley said. “So we’ve been interested in the effect of immigration on the development of breast cancer.
“In addition, we’ve noticed Afro-Caribbean in Miami have a better prognosis for their breast cancer as compared to Black women in Miami.”
DIAGNOSED AT AGE 37
Opre Golding is of Jamaican descent, doesn’t have a family history for the disease, and has tested negative for genetic markers. Despite this, the 37-year-old third-grade teacher was diagnosed with breast cancer on May 28.
“I was shocked,” Golding said. “I never thought I’d hear those words.”
In 2003, the Miramar resident had a lump checked out in her breast, which turned out to be benign. She had it looked at again in 2017, and once again it was nothing.
But in April, in the midst of the coronavirus pandemic, she noticed the lump was getting bigger and called her doctor.
A biopsy confirmed that it was stage 2 invasive ductal carcinoma, considered the most common type of breast cancer.
The mother of two is now undergoing treatment at Memorial Breast Cancer Center.
“I don’t want people to feel too confident, counting on their age to protect them from breast cancer. I got diagnosed at 37 and I’ve seen women who get it even younger,” Golding said. “Breast cancer doesn’t discriminate.”
Hurley’s colleague at Sylvester, Sophia George, Ph.D., says understanding racial disparities can improve a patient’s care.
“We have to advocate for ourselves and our community,” George said. “Even to provide the references and say, ‘Yes, this data is out there. Women of certain backgrounds have an increased risk for developing breast cancer and ovarian cancer — they are linked.’”
George says it’s critical for women of color to participate in biomedical research so there can be more diversity in the data pool.
“We have to participate in order for us to be able to understand studies,” George said. “We can’t be bystanders.”