According to Cancer Research UK, approximately one in five of all new female breast cancer cases are under the age 50 and around half are between 35 – 64 (https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/breast-cancer/incidence-invasive). These women are of working age and they are often at a stage of their lives when their career dominates. Many have caring commitments, either their own children under the age of 18, elderly parents or perhaps grandchildren. Often a breast cancer diagnosis will be their first experience of a severe disease.
For the patients who are under 50 and pre-menopausal, many of the standard risk factors for breast cancer do not fully apply. Obesity is not a strong risk factor for breast cancer at a younger age, some studies show low BMI may be a risk factor, others do not. For all patients, more people from high-income groups get diagnosed with breast cancer, but patients from low-income groups have worse outcomes. Many of the risk factors are non-modifiable, such as tall height, starting your periods before the age of 12 and family history. Oncologists take a full history to see if patients are eligible for genetic screening. Exercise reduces the risk of getting cancer and of progression, and of all modifiable risk factors this has the strongest evidence. But even exercise does not prevent breast cancer.
Essentially, breast cancer strikes at random, and no-one really knows why. Breast cancer cannot be prevented, all anyone can do is reduce their risk factors.
According to the Office for National Statistics, metastatic breast cancer is now the leading cause of death in women between the ages of 35-64. (https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsregistrationsummarytables/2022) It is rare for women in these age groups to die, but if they do die, then metastatic breast cancer is likely to be the cause. This is why a breast cancer diagnosis is such a shock. One moment you are a successful woman with a career, a busy diary and a reasonably healthy lifestyle. The next, all your plans are cancelled, and you are completely dependent on institutions to keep you alive. And it sucks. Because you are an adult and used to making the decisions and have a life you want to live.
Breast cancer treatment is brutal. Treatment for early-stage breast cancer is often high dose chemotherapy for a defined number of cycles, which hammers your bloods. For metastatic breast cancer, treatments are often gentler because the intent is to manage disease. But there’s a sting to this, because treatment carries on until the cancer progresses or your body can take no more. Being on cancer treatment for years is tiring. No, it’s exhausting. Often patients put on their game face at appointments, but their bloods do not lie. After years of treatments, it can take longer for bloods to ping back.
One of the worst things about long-term treatment for metastatic breast cancer is that it changes you permanently. Chemo brain is real, and the treatment I am on massively affects my powers of reasoning. For about a week after every treatment, I am not myself. I cannot think clearly and in some ways I feel detached and not entirely human. Although the worst of this abates after a week, I feel like every treatment takes a little bit of myself away. I recently found out there is a reason for this which can be seen on my brain MRI. I have an accumulation of metals in the brain caused by liver toxicity from chemo.
This loss of personality and erosion of the sense of self is one of the hardest things about metastatic breast cancer. I have been on treatments for six years, not as a super responder but as someone who is on a third-line chemo. Don’t get me wrong: I’m grateful for these treatments, without them I would be long dead. But I used to be fairly smart and could hold my own in an argument. Now, I’m the slowest in my family. Get me on a good week and hopefully you won’t notice.
Who Really Cares? I do.
Madeleine Meynell
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