Lavender Week study day: highlighting the specific needs of young breast cancer patients
It is rare for younger women to develop breast cancer, but those who do face sensitive issues that can go unrecognized. This week is Lavender Week, when the Lavender Trust, a part of the UK charity Breast Cancer Care, raises awareness of the difficulties these women face and funds for their support services.
Coinciding with Lavender Week, the trust held a study day on Thursday 1st March 2007 for health professionals who work directly with these women. MedWire Reporter Cher Thornhill asks Breast Cancer Care’s Younger Women Clinical Nurse Specialist Kath McLachlan about the day’s highlights and what health professionals should keep in mind when treating these patients.
What proportion of breast cancer patients are young women?
Breast cancer is uncommon in younger women. Just over 44,000 are diagnosed in the UK each year. Eighty percent are actually over 50 years of age, that is postmenopausal women. There are 8000 diagnosed under 50 years, with around 2200 in their 20s and 30s.
What specific issues do younger patients face?
One of the main issues for younger women is isolation. Because there are few of them, it’s rare that they have contact with another younger woman with breast cancer, making them feel very isolated, and very alone in their situation, so they feel different from their friends and other women of their own age.
The treatments for breast cancer can induce a premature menopause for younger women. They need information about what to expect and support in dealing with and adjusting to the changes and menopausal side effects of treatment. And having these symptoms at a young age can make a younger woman feel old before her time. The menopause is often more intense when it’s treatment induced. It’s rather more gradual when we go through it naturally.
Due to the influence of an early menopause, infertility through treatment is a major issue that can create a great sense of loss for women. It’s important that younger women are given full information on the impact or potential impact of treatment on their future fertility. They face difficult and complex decisions.
The study day set out to raise awareness among health professionals of the specific issues faced by young women with breast cancer, and update them on clinical advancements, with expert sessions on:
• Imaging the younger breast
• Adjuvant hormone therapy: a different approach for younger women
• Preserving fertility: interventions and access to services
• Treating pregnancy-associated breast cancer
• “What are we going to tell the children?”
Who came to the study day?
Predominantly they were breast care nurses – clinical nurse specialists working with patients with breast cancer. There were other professionals – physiotherapists, lymphedema specialists, radiographers, ward sisters, nurse educators.
With regards to imaging, what new insights and advice were they given?
Imaging of the younger breast can be difficult due to the density of the breast tissue. Magnetic resonance imaging, MRI, has been shown to be helpful, but there are limitations, such as the specificity of MRI. It may be used as an additional tool. NICE (National Institute for Clinical Excellence) has published guidelines and recommends the use of MRI for surveillance in women aged 20–49 who are at increased risk of breast cancer.
How is hormone therapy different for a younger woman with breast cancer?
It can sometimes be confusing when we hear of new developments and advances in the effectiveness of treatments such as aromatase inhibitors, but younger women are generally not prescribed the aromatase inhibitors. Aromatase inhibitors suppress whole-body estrogen and so are only appropriate for postmenopausal women. Hormone therapy for younger women is often tamoxifen and zoladex.
Looking at fertility, what should health professionals consider?
It is important for younger women to have consultations with gynecologists and specialists in reproductive medicine prior to commencing treatment, to ensure they are given clear information so they have a full understanding of the risks to their fertility and an opportunity to discuss the possibility of preserving fertility. I think what the day highlighted was that the chances of, say, IVF and egg freezing can be quite low.
What issues were highlighted regarding breast cancer during pregnancy?
It can obviously alter feelings about pregnancy. The women fear that it could interfere with their abilities. At what should be a very happy time, they’re going to have very mixed feelings. Generally, breast cancer is treated in the same way as it would be for somebody who wasn’t pregnant. The first trimester of pregnancy is the time when treatment would be contraindicated. Women may then be faced with a very difficult decision if they are pregnant about what treatments they’re wanting to undertake or accept. It’s important again to have a multidisciplinary approach, including the oncologist who’s prescribing chemotherapy and the obstetrician caring for the pregnancy.
Why raise the issue of what to tell the children?
It provides an opportunity for women with children to express their concerns and their support needs and that family communication is paramount and has been shown to help adjustment and coping. There were recommendations for further reading, with suggestions on how to approach this difficult issue, such as to involve the children as best they can, and to acknowledge that a diagnosis of cancer affects the whole family.
The course also included some personal perspectives, where patients shared their experiences, including:
• Pregnancy during breast cancer: A personal perspective
• My chemotherapy ‘vs’ my fertility: A personal perspective on the pressure of choice
What impact did the personal perspectives have?
I think it was encouraging for the patients to hear that things have improved. The services that are available now are greater than they were, and there’s easier access to support to help reduce the sense of isolation. That, I feel, helped healthcare professionals to understand the distress and the impact a diagnosis of breast cancer can have and how younger women can be affected when making treatment decisions.
How have support services improved?
The Lavender Trust at Breast Cancer Care has been quite instrumental in that. We have publications for younger women so they have access to better written information, which will support the verbal information that they receive from their healthcare professionals. We have younger women’s forums – 2-day residential events where women can meet other women in a similar situation. And we also have telephone support groups, where they’re able to express inner feelings with each other, something that they may not feel able to share with anyone else.
Was the study day a success?
It went extremely well, I feel. I think we’ve actually reached the healthcare professionals who may not have had much contact with younger women due to the low levels of incidence, and therefore raised their awareness of all these issues and how they can actually support younger women, knowing what services are available to them. We’ve educated and trained the healthcare professionals, and they, in turn, can support the younger women with breast cancer.
To find out more about the Lavender Trust, Breast Cancer Care, and the services they provide, follow the links below:
Breast Cancer Care
Lavender Trust
Support services