Around 150 women under the age of 40 will be diagnosed with breast cancer in New Zealand each year and these women face many concerns that their older counterparts do not have to confront.

BCAC committee member Greer Davis understands these issues all too well.  She is one of the 150 - she was diagnosed with breast cancer last year at the age of only 25.

She recently attended the annual conference for young women affected by breast cancer C4YW to hear a range of presenters discuss the issues and concerns that are specific to young women with breast cancer.  This year’s conference was held in Seattle, in the USA and was co-hosted by Living Beyond Breast Cancer (www.lbbc.com) and Young Survival Coalition (www.youngsurvival.org).

More than 500 young women with breast cancer attended the conference, which is co-hosted by Living Beyond Breast Cancer and Young Survival Coalition.

Greer says the conference is is hugely beneficial for premenopausal women diagnosed with breast cancer.  She says it aims to provide content that reflects the current interests of young women diagnosed with all stages of breast cancer, whether they be newly diagnosed, a long term survivor, in treatment, living with metastatic breast cancer, or you are a loved one of someone who has breast cancer.

Says Greer, “A huge benefit of this event was the ability to widen my support group. For three days I was surrounded by women my age who “get it”. We have shared in the experience of cancer at a young age and the camaraderie that comes from this is significant. It was so refreshing to be in workshops with 50 other women at a time and to feel normal. Their concerns are my concerns. Their hopes and fears are mine. I made some fantastic friends, all at varying stages of distance from their diagnosis, who I will remain in contact with.”

Greer attended three workshops at C4YW:

  • Healthy eating after breast cancer
  • Fertility and pregnancy – post-treatment options
  • Breast reconstruction options

Find out more about what she heard below.

Healthy Eating After Breast Cancer
Presented by Jennifer Adler - PassionateNutrition.com

Greer says this talk was a great reinforcement of the powerful impact what you eat can have on your system and your health. A few key points I took away from the session include the following:

  • Fruit and vegetables can provide concentrated amounts of antioxidants, carotenes, folates, selenium, indl-3 carbinol and other anti-cancer phytochemicals and nutrientsthat are very difficult to attain in supplement form.
  • Poor diets mean the body lacks the nutrients it needs to maintain healthy cells and tissues, and the immune system doesn’t have what it needs to defend itself against invaders that may trigger cancer. Cells of the immune system circulate around the body, alert for the presence of anything abnormal.  Critical nutrients for the immune system include selenium (1 brazil nut/day is sufficient), germanium (broccoli, celery, garlic, shitake, milk, onions etc), green tea, dark leafy greens and vitamins A, C & E.
  • Jennifer emphasized the importance of protein in our diet and said that you should be dividing your weight in lbs in half and this is the amount in grams of protein that you need on a daily basis – the need for protein also increases significantly during cancer treatment as it is essential for recovery. Animal protein is the most biologically available but the quality is very important (grass fed red meat has higher omega 3 levels than grain-fed meat). Dairy, nuts, fish, eggs, legumes are all good protein sources.
  • Eating organic fruit and vegetables can help to cut your exposure to pesticides.
  • The bacteria in our gut are very important. Fermented/cultured foods e.g. kimchi, miso, yoghurt are all great – make sure it comes from the refrigerated section of the supermarket and do not cook before you eat as excessive heating will destroy the bacteria.
  • Studies have found that people who had high fibre diets were less likely to get cancer than those with poor fibre diets.
  • Tips – pre-make vegetables to have readily on hand i.e. sauté onion, mushrooms etc and keep in the fridge so you can add to lots of things when you are time-pressured during the week. Also keep frozen fruit and vegetables cut up in the freezer/fridge so you don’t have to remember to go to the supermarket.
  • Make sure you get five servings/day of fruit and vegetables
  • Alcohol – not good, so minimize consumption, but if you do drink then the higher the quality of alcohol, the better!


Fertility and pregnancy: post treatment options
Presented by Irene Su (University of Colorado Cancer Centre).

  • Breast cancer is the leading cancer of women under 40
  • Chemotherapy can damage your eggs, ovarian follicles (sacs in the ovaries that contain the eggs), and sex hormones. Radiation can do the same damage when treatment is to your whole body or near certain organs.  These include your reproductive organs and the pituitary gland (a hormone-producing gland at the base of the brain).
  • Often, chemotherapy or radiation therapy can stop your periods for a while or make them irregular. Your periods may continue or return after treatment, but you should know that having periods does not always mean that you are fertile. In some cases periods may never return. There is still a small chance of pregnancy even if you are not having periods. Despite this, few young women in the USA go through specialized fertility preservation counseling or treatment.
  • Cancer treatment raises the chance that you will go into permanent menopause early (natural menopause is usually around age 50.) If your menstrual periods stop before you are 40, this is “premature” menopause.
  • Parenthood by age 35 is less likely in cancer survivors than age matched controls but precise estimates of risk of infertility aren’t known for treatments.
  •  Following groups of young women, pregnancy doesn’t appear to increase recurrence/death. In E+ women, no difference between pregnancy/not pregnancy and recurrence. The safety of pregnancy <2 years isn’t clear, but one study has shown no difference between the length of time waited (although only 140 participants / early trial stage but not definitive).
  • Pregnancy outcomes after BC treatment are reassuring – no higher risk of congenital malformations, genetic disorders, skewed gender ratios, no higher risks of stillbirth, decrease fetal weight, preterm delivery etc. chemotherapy exposure doesn’t lead to higher risk of pregnancy complications.
  • Fertility-saving options vary by person, type and stage of cancer, and how quickly you must start cancer treatment.
  • Embryo banking. Freezing of embryos (fertilized eggs) may be an option. You may need fertility drugs (usually daily injections) to boost egg production. Your eggs are “harvested” (removed surgically) and combined with your partner’s (or donor’s) sperm in a laboratory dish. This is called in vitro fertilization, or IVF. The embryos stay frozen, or “banked,” until you need them.
  • Ovarian reserve markers; FSH (follicle stimulating hormone), AMH (anti-mullerian hormone), AFC (antral follicle count) – markets can change over time. Good indicator of fertility = high AMH&AFC and low FSH (less than 10). Bad indicator = high FSH and low AMH&AFC (if levels lower than 4-6 then all meds available won’t be likely to increase fertility). AMH hormone levels – if these are high then fertility will be high. But ovaries need time to recover so one shouldn’t rely on measurement early after treatment. Tamoxifen doesn’t affect AMH but does slightly impact FSH.
  • If you banked your eggs before treatment then your ovarian function doesn’t matter – levels are only important when trying to get pregnant unassisted.

Basically, if you have Breast Cancer treatment… your window of fertility is shorter, periods do not = fertility, think about getting pregnant earlier or undergoing IVF.

This wasn’t the most encouraging session as most of the attendees had finished treatment or were on hormonal therapy and thus early pregnancy / IVF was longer applicable. This workshop should be improved next year and focused more on what fertility information is needed by women after a Breast Cancer diagnosis/treatment after feedback from members of the Young Survival Coalition (YSC).

Breast Reconstruction options

Presented by Plastic Surgeon Dr Karen Horton.

 

Many patients in the US have immediate nipple sparing mastectomies or prophylactic mastectomies so these techniques were explained.

  •  Immediate single stage implant reconstruction: permanent, postoperatively adjustable implants used to reconstruct. Often placed above the pectoral muscle for a natural look/feel. These can be changed for silicone after 3 months (initially are saline which can ripple more). Adjustable permanent implants give women control over final results. The incision is typically in the inframamory fold.
  • Some of the options for fix-ups and adjustments include: lipofilling (free fat grafting); scar revisions, and; flap donor site contouring using liposuction.
  •  Microsurgery is a specialized technique used to surgically transplant skin and fat to reconstruct the breast. Free flaps provide warm, living tissue – feels natural, lasts forever and helps to counteract past injury i.e. radiation, infection, scar tissue.
  •  If you experience significant problems with capsular contraction (grade 3 or 4) then surgery will likely be necessary to remove implant and do a flap procedure, change the implant and cut away the scar tissue, or capsularectomy.

 


You can download podcasts of these workshops and plenary sessions here.

 

The next C4YW will be held in Orlando, Florida on February 21st-23rd 2014. Travel grant assistance can be applied for through C4YW.org. Greer says she will definitely be returning!