A breast cancer diagnosis, as scary and devastating as it is, can now be approached with more hopeful resolve because lives are being saved every day. Thanks to research, medical advances and the forward-thinking advocacy of organizations like the Greenwich-based Breast Cancer Alliance, more and more patients now end their breast cancer journey as survivors.
“The landscape of breast cancer treatment has changed dramatically over the past 20 years, and thanks to improvements in both screening and treatment, more women are alive after a diagnosis,” says Dr. Monica Morrow, chief of breast cancer Surgery at Memorial Sloan Kettering Cancer Center in New York City.
And while that’s cause for celebration, especially as Breast Cancer Awareness Month begins, there’s one small but alarming statistic that is particularly bothersome to experts surveying this otherwise encouraging landscape.
“For reasons we don’t completely understand, we are seeing more young women getting a breast cancer diagnosis,” says Yonni Wattenmaker, executive director of the Breast Cancer Alliance. “We have seen it right here in our community; and while that’s anecdotal, the numbers do seem to be increasing in a small but noteworthy way. Of course, that concerns us.”
Dr. Morrow notes the incidence of breast cancer in women younger than 40 is still relatively rare compared to their post-menopausal female counterparts in their 50s and beyond. Yet the subset of women being diagnosed who are 40 and younger has increased from less than one percent of all breast cancer cases to a number now approaching 4 percent, with the most noteworthy uptick being found in hormone receptor type breast cancers.
Wattenmaker says the sobering statistic—along with the devastation of confronting a life-threatening illness during a women’s prime reproductive years—is among the reasons the BCA wants to focus attention on younger breast cancer patients.
“We always talk about the importance of screenings, genetic testing, research, vigilance and self-advocacy,” she says. “With younger women, these things are even more important to emphasize. You hear so many young breast cancer patients and survivors say, “I didn’t know I could get breast cancer or I didn’t know I was at risk or that this could happen to me. Women will even say their doctors said, ‘You’re too young,’ when they had concerns. It’s why being an advocate for yourself is the best strategy you can take.”
As the BCA gets ready for its 28th Club Pink fundraising luncheon and fashion show on Wednesday, October 23, and its monthlong Go for Pink events, we spoke with experts and young survivors about the importance of the research, surgical fellowships and patient support that the nonprofit underwrites with the millions of dollars it raises through these annual efforts.
EARLY DIAGNOSIS
Dr. Kate Pawloski recently completed a breast cancer surgical fellowship supported by the BREAST CANCER ALLIANCE at New York City’s MEMORIAL SLOAN-KETTERING CANCER CENTER, where she now continues as a member of its surgical team. Her Veronica Beard Surgical Fellowship was one of many BCA has endowed as part of its ongoing efforts to increase the numbers of specially trained breast surgeons working across the country. As a young physician treating breast cancer, she gave us her perspective on the unique issues facing younger patients.
DR. KATE PAWLOSKI
GM: Are we really seeing more young women being diagnosed with breast cancer, and, if so, do we know why it’s happening?
Dr. Kate Pawloski: The incidence of breast cancer over the past several decades has been going up in general. When it comes to younger patients, it’s a small rate of increase, but one that’s been ticking up steadily over the last decade. The causes are still not delineated fully, but the majority of breast cancers, particularly in these younger women, are hormone positive. That makes us suspect the causes for the increase are somehow related to hormonal exposures. It’s a function of modern society that women are having children later, and so one question we ask is, “Is this somehow related to the hormonal environment in their bodies?” And then there is the question of other environmental factors. Nothing is proven yet, and there are still a lot of unknowns.
GM: There seems to be a real dilemma for younger women in that screening guidelines recommend anyone with average risk not begin yearly mammograms until age 45. What’s your advice for someone younger who wants—or needs—to be evaluated?
KP: In a younger woman—especially one with a lump or any other concerns—they should ask for a diagnostic study. For younger patients, the first course of action would be an ultrasound. If they are asymptomatic or just worried because they have a family history, they should work with their primary care provider or another physician to do a risk assessment. There are actually some very good tools online. One is the Breast Cancer Consortium’s Risk Model. You can plug in demographics and family history. This should be done with a qualified physician. Depending on the results, she may be eligible for screening at an earlier age or even high-risk screening or genetic testing.
GM: So, the message here is that younger women need to be vigilant and advocate for themselves?
KP: Absolutely. You are always going to be your own best advocate. The reality is that breast cancer is most common in post-menopausal in their 50s and 60s, but it can happen much younger. So, while it’s rare, if you find a lump or something suspicious, I always tell people, ‘Don’t panic. The odds are it’s nothing, but ask for an ultrasound. You have to prove it to yourself that it’s nothing.’
GM: Let’s talk about what happens when a young woman receives a breast cancer diagnosis. What kind of fears and concerns do you see in this demographic that may be different from older women who get the same news?
KP: There are lots of different immediate fears for both groups of women, but in younger patients the most worrisome thing seems to be how it will impact fertility. When a woman at a young age is diagnosed, there is a strong likelihood that chemotherapy or hormonal therapy will be part of the treatment which could decrease fertility. And if they want to pursue a pregnancy, the reality is that it may be recommended that they delay it a bit.
For that reason, consultations with fertility specialists are a part of the process. The good news is that fertility preservation is almost universally covered by health insurance. As doctors, we want to preserve our patients’ abilities to live their lives as normally as possible, and having a family is part of the that. So, fertility care is almost always bundled with breast cancer care when treating a younger woman.
The other fear I hear from younger patients is that there is always a concern it will come back. They will ask: ‘Will I have to deal with this again? Should I remove both breasts?’ And that is always such a personal decision, but we will discuss the risks of their particular type of cancer. And we have an excellent ability to screen for recurrences. So, unless she carries the mutation or the BRACA gene, she shouldn’t automatically assume she needs both breasts removed.
GM: What questions about breast cancer would you like to see answered through future research?
KP: I’m interested in risk factors and understanding more about personalized risk beyond what we already know. I would love to know more about how we can reduce risk—whether it’s through lifestyle factors or medications. There are some medications that can reduce the risk, but they also have side effects. One is tamoxifen. We know that it can reduce the risk by half, but historically there have been side effects that have prevented a lot of women from taking it. But there is now some evidence that even when taken in baby doses tamoxifen can still very much have an impact, and that’s interesting.
I would also love to know more about the interplay between these medications, breast density and risk reduction. The idea that we might be able to make inroads in prevention is exciting, and I would love to see more novel approaches to risk reduction.
GM: What impact did your fellowship experience have on you as a breast surgeon?
KP: I’m extra grateful for the support of the BCA and the opportunity to have this fellowship, where I’ve learned not only how to treat breast cancer surgically, but also that breast cancer treatment is really a team sport that requires the in-depth knowledge of medical oncology, radiation oncology, psychiatry and even, as we discussed, fertility specialists. I have gained this incredible knowledge about how these teams come together to treat women in a holistic way. I think it’s so important to give women the best outcomes possible, and to do that, we have to go beyond what we’re doing over the course of one surgery. It’s made me an expert in a much broader sense, and I’m excited to bring that to knowledge to my patients here at MSK.
CLEA SHEARER
WHEN THE HOME EDIT’S CLEA SHEARER WAS DIAGNOSED AT THE AGE OF 40, SHE TOOK ON HER MOST IMPORTANT PROJECT EVER—SURVIVING
Clea Shearer is part of the two-person team of Nashville-based home organizers/interior designers who use their abundant talents to declutter and reimagine living spaces on the Netflix Emmy-nominated series The Home Edit. Along with her business partner, Joanna Teplin, Shearer has organized and displayed Reese Witherspoon’s TV and film career memorabilia, cleaned up Khloe Kardashian’s cluttered garage and reimagined the Brooklyn basement playroom of actor Neil Patrick Harris’ twins.
Shearer’s talents for getting things done proved helpful when she was diagnosed with breast cancer in 2022 at age 40. Her treatment included a double mastectomy, chemotherapy and radiation.
We checked in with the married mother of two in anticipation of her October 23 keynote speech at Club Pink, the BCA’s luncheon and fashion show, for insights into her recovery and hopeful perspective.
GM: The Breast Cancer Alliance is devoted to supporting research, fellowships, community education and programs that directly support women going through treatment. What will your message be to the Club Pink audience?
Clea Shearer: Research is the key to new and innovative treatments, therapies and hopefully, someday, even a cure. So, everything we can do to fund those efforts is potentially lifesaving. But something we can do every single day is continue to educate ourselves and others on the importance of self-exams, self-advocacy and self-care. These things are particularly important for those of us undergoing cancer treatment. Whether active or adjunct, we need to remain vigilant about our health.
GM: There has been a small but concerning increase in the number of women, like you, who were young when they received their breast cancer diagnosis. How did you discover your cancer?
CS: I was 39 the first time I felt something abnormal in my right breast, but I didn’t look into it and just figured breasts have irregularities. It wasn’t until right after my 40th birthday that I felt that area with a different lens, since I knew I was due for my first mammogram. It was a moment of crystal clarity where I asked myself, ‘Why wouldn’t this be a tumor? What else would it be?’ And I knew, I absolutely knew, in my gut that I was about to be diagnosed with breast cancer.
GM: So, you weren’t surprised?
CS: I was shocked but not surprised. Like I said, I had a gut feeling that this was breast cancer from the moment I allowed the thought to enter my head. I still couldn’t quite believe the diagnosis and having to say the words out loud, ‘I have breast cancer, I am a cancer patient.’ That is a hard thing to mentally prepare for.
GM: What were your biggest concerns?
CS: I never for a second questioned whether I would live. I knew I would beat this. My first thoughts went to my quality of life. Would I be bedridden and sick the entire time? Would I have normal moments with my family where it didn’t revolve around me having cancer? Would I be able to work? Those were the thoughts occupying my mind.
GM: How did you cope? Did any of your superior organization skills help during your treatment and recovery?
CS: I coped by having goals and milestones. There’s nothing an organizer loves more than a checklist. Sometimes my goal would be to take a walk, and sometimes my goal would be to speak about the needs of mammograms—even if you’re under 40. No goal was too big or small.
Resilient Voices
We asked local women diagnosed with breast cancer at an early age, to share some of their experiences and advice for other patients. All active supporters of the BCA’s efforts, they offer poignant insights
GM: What was your greatest fear after diagnosis, and how did you cope?
SURVIVOR: DANA SHOCKER
Westchester County, N.Y.
diagnosed at age 30
Being diagnosed at 30 years old changed the course of my entire life. Having to make life-altering decisions so quickly was very difficult and terrifying. Most of my biggest fears after diagnosis were fear of recurrence, fear of not being able to have children, and of course, the fear of dying.
I am 33 now, and I still wake up every day terrified that it may come back. But I’ve definitely worked hard and continue to work hard to change my thought patterns and remind myself that we can only live for the now. The fears will always be there, but they are only fears. They may never happen! Cancer taught me to live life every day like it could be my last. It taught me that we only have the now. So, that has helped me. Right now, I’m OK, and I’m alive and healthy, and that is definitely something worth smiling about. Life is too short. Go live it!
SURVIVOR: KILEY DURHAM–CASTRICONE
Old Greenwich
diagnosed at 36
When I was originally diagnosed with breast cancer in 2017, I was 36 years old, and I had a five-and-a-half-year-old son and a three-month-old daughter. My initial fears mostly revolved around how I was going to keep my young family moving forward and how my illness would affect our routine and emotional health when treatment forced me to be less involved. I quickly learned to let go. Undergoing chemotherapy and recovering from a bilateral mastectomy with small children was not a time to expect perfection. It was a time to ask for help! I eventually realized that it was okay to let go of our family’s typical routine for a while and trust our friends and family to keep things moving forward.
In 2019 when my breast cancer metastasized to my spine and my prognosis became terminal, my biggest fear was not seeing my children grow into adults. I really didn’t cry much after my original diagnosis; I was laser-focused on powering through chemo, surgery and radiation so that I could get back to ‘normal life.’ But when I was confronted with the possibility that I might not live to see my children graduate or get married or have their own children, I lost it. I cried until I had no tears. I was completely devastated.
But then one morning I woke up, and the first thought that popped into my head was this: I was still alive and there was nothing stopping me from fighting for my life. Not one thing was stopping me from fighting for all of those future moments and more, so from that day forward I changed my mindset. With the help of my husband, friends, family and care team I refused to give up. I am currently cancer-free with a thirteen-year-old and a seven-and-a-half-year-old, and last year I was given the green light to go off treatment.
I adopted the most positive attitude I could possibly manage during my cancer journey, and I spent time every day in prayer and meditation to stay grounded and optimistic. I kept a very clean diet, cutting out all sugar, processed foods and alcohol, and I exercised for at least 20 minutes a day. Making an effort to take care of myself not only helped me manage the side effects of the numerous drugs I was taking, but it also felt like a small way to have a little bit of control over the chaos that my life had become.
Lastly, I made time to paint each day. Even if I only had 15 minutes (and I held my baby daughter while I did it). I made an effort to give myself a creative outlet daily. Art has always been a big part of my life, so having a moment to create was incredibly therapeutic. Plus, it was something fun to look forward to each day during an otherwise tough time.”
GM: WHAT DID YOU WISH YOU HAD KNOWN ABOUT BREAST CANCER BEFORE YOUR DIAGNOSIS?
SURVIVOR: AMANDA STERN
Old Greenwich
diagnosed at 29
I had not known that I was at elevated risk of breast cancer because I had an early period a age ten. The younger a girl is when she has her first period, the higher her breast cancer risk. No doctor had ever explained this to me despite knowing my medical history. I also incorrectly assumed that because I had no family history of cancer that my risk for breast cancer was low. However, I had no idea that 90 percent of breast cancers are not genetic. I am thankful that I did know how to give myself a breast exam, which in the end, saved my life.”
GM: WHAT ADVICE WOULD YOU GIVE TO OTHER YOUNG WOMEN FACING THIS DIAGNOSIS AND TREATMENT?
AMANDA STERN: I tell everyone that they must bring someone to each appointment who can take notes, because your head will be spinning. I also tell women to get multiple opinions—if they can stomach it—as treatment regimens and approaches can vary widely. I had three different chemo regimens recommended to me at three different New York City hospitals. That said, this is entirely personality-dependent. I thrive with more information, but some people get very overwhelmed with choice. In the end, there is no wrong way.
The most important part of my ability to navigate my diagnosis was having a strong support system. While my family and husband were rocks, it was the women who had been through breast cancer before who provided the best advice and most comfort. My best advice to those recently diagnosed is to find someone who has the same exact subtype/diagnosis as you to ask questions/get advice. Often, depending on your subtype of breast cancer, treatment regimens and challenges can be vastly different. You’ll glean the most important insights from those that have the same subtype as you. It was also important to me mentally to find someone who has gone through my subtype and survived and thrived after to serve as my hope and light at the end of the tunnel.
KILEY DURHAM-CASTRICONE: You are stronger than you think, so don’t give up. It’s cliché, but it’s true. It’s OK if it’s not pretty or if you need lots of help to get through the day. You will get there. Find inspiration and strength in your loved ones. My children have been my inspiration and reason to keep going every single day since that first phone call confirming that I had breast cancer. I not only want to live to see my son and daughter grow up, but I also want to be an example of perseverance for them. I hope that when they grow up, they know how hard I have fought to be here with them and it inspires them to stay positive and fight for what they want as well.
GOING PINK
HOW TO BECOME A PART OF THE CURE
Club Pink
BCA’S 28TH ANNUAL LUNCHEON AND FASHION SHOW
DATE: Wednesday, October 23
TIME: 11 a.m.
LOCATION: Westchester Country Club
Featuring a keynote speech by
CLEA SHEARER
Luncheon is held in collaboration with fashion partners
RICHARDS & AKRIS
PLUS!
Silent Auction
For tickets and more information visit breastcanceralliance.org/events
Since 2014, the BCA has partnered with restaurants, retailers and brands in the Greenwich area and across the United States to support its lifesaving work with its annual Go for Pink campaign. One hundred percent of Go for Pink’s proceeds are devoted to funding innovative and impactful breast cancer research. Last year, more than $1.6 million in grants came from this effort. To support the initiative and find participating businesses and brands visit breastcanceralliance.org/goforpink.