Young women don’t get breast cancer often — only about 10 percent of the more than 250,000 cases diagnosed each year hit women under 45, and only 5 percent are under 40.
Since it's not sensible to screen all young women routinely when their risk is so low, identifying which of them to focus on is critical.
A little-noticed part of the health care overhaul may help.
New provisions boost research by the National Institutes of Health on breast cancer in young women as well encourage awareness about breast health through educational campaigns. The law provides $9 million a year for fiscal years 2010 through 2014.
Heidi Hannan of Gross Pointe Park, Mich., might have slipped through the diagnostic cracks if it weren’t for an extra cautious ob/gyn. After easily becoming pregnant with her first child, Hannan, then 35, had three miscarriages, and she and her doctor were trying to figure out why.
Because Hannan’s paternal grandmother had breast cancer, her ob/gyn suggested she get a baseline mammogram. The results showed suspicious calcifications, a possible sign of cancer.
A biopsy confirmed she had ductal carcinoma in situ, a cancer that is confined to the milk ducts and hasn’t invaded the breast. In Hannan’s case, however, the cancer had permeated the ducts throughout her right breast, so she needed a mastectomy instead of the usual lumpectomy.
"It blew me away," says Hannan, now 40. "I thought breast cancer was for older women."
Since she didn’t have multiple close relatives with breast cancer and/or ovarian cancer and wasn’t of Ashkenazi Jewish background – two of the biggest risk factors - there was no real reason to suspect a genetic mutation was responsible for Hannan’s breast cancer.
But Hannan decided to get tested anyway, and discovered that she carries the BRCA2 genetic mutation, which increased her odds of getting breast cancer to about 60 percent over her lifetime, compared with about 12 percent for the average woman. To reduce her risk of further cancer, Hannan had a bilateral mastectomy and last year, after giving birth to her daughter, now 3, a hysterectomy.
Under current screening guidelines, women don’t begin routine screening for breast cancer until at least age 40. In Hannan’s case, her lone relative with breast cancer wouldn’t prompt a referral for a mammogram at age 35, says Dr. Therese Bevers, medical director of the cancer prevention center at the MD Anderson Cancer Center at the University of Texas in Houston.
Nor should it, experts agree. "For women under 40 this is a rare disease," she says. "The benefit wouldn’t outweigh the risk because the vast majority won’t get breast cancer." Unfortunately, what that means is "there are going to be young women in the middle, with no risk factors but who have the genetic mutation."
That’s why the research section of the law is the most important of the provisions dealing with young women and breast cancer, in Bever’s opinion. "We’ve got to have ways of identifying women at increased risk."