| Darline Turner-Lee Physician Assistant | ACSM Exercise Specialist Advocating for Choices in Women's Healthcare |
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Pink Ribbon Cowgirls: Breast Cancer Survivors Encourage Other Young Women Battling Breast Cancerby Darline Turner Lee, Physician Assistant, ACSM Exercise SpecialistArticle Last Reviewed: June 19, 2007Women in the 20’s and 30’s are on the fast track to full lives. They’ve completed college and many have earned advanced degrees. They have careers and are pursuing their intellectual dreams. Many women meet their life mates and plan long-term relationships for the first time. Thoughts turn towards starting families and children. How to balance all the facets of their busy and exciting lives? Endless possibilities exist and young women stand poised to move forward - strong and confident. But for many young women this forward progression comes to a screeching halt when they are diagnosed with breast cancer. According to Surveillance Epidemiology and End Results (SEER) of the National Cancer Institute and data tabulated by the American Cancer Society, approximately 212,920 women will be diagnosed with breast cancer in 2006. 13 percent of the women diagnosed, approximately 27, 680, will be women under age 44. “A young woman with breast cancer is pulled out of her peer group,” says Michele Burton, a young breast cancer survivor. “Her entire focus shifts from career and family to survival. Although friends and family members try to be supportive, they really can’t understand the impact that a cancer diagnosis has on a young woman. The body image issues alone are overwhelming.” According to SEER, the median age at diagnosis for breast cancer is 61. Breast cancer support materials and groups target their information to women in or near this age group. Young women attending these support groups seldom find answers to questions such as dating with breast cancer, fertility preservation and raising children while on chemotherapy. Burton, a volunteer at the Breast Cancer Resource Center of Austin (BCRC), along with Shauna Martin and Audra Outlaw, also young breast cancer survivors, organized The Pink Ribbon Cowgirls-A Social Network of Younger Breast Cancer Survivors. The group provides support and information to young women with breast cancer and operates under the direction and support of the BCRC. The three women met in late 2005 and attended the Young Survival Coalition (YSC) conference together in early 2006. They agreed that younger women with breast cancer do need more and different support and wanted some form of support in Austin. Outlaw wanted to start an Austin Chapter of YSC, but as they continued their discussions and reviewed the criteria for starting a local YSC chapter, they found that their vision for the group diverged from the criteria of YSC. At the urging of the BCRC they organized a group to specifically address the needs and issues of young breast cancer patients and survivors. The board members and staff of the BCRC agreed to help develop the group and the three young women now sit on the board of directors of the BCRC representing this important project. The Pink Ribbon Cowgirls held their first meeting in April 2006 at Central Market Café on North Lamar Boulevard. The group meets there on the third Friday each month for lunch. “With each luncheon attendance continues to grow,” says Burton. “At the first few luncheons, we only had about five attendees. Then we had 30 and attendance continues to grow.” The group organizes girls’ night out evenings, speaker meetings, workshops, seminars and family friendly activities. They discusses topics like nutrition, fitness, fertility and family planning, caring for young children during treatment, career and dating issues. Burton, Martin and Outlaw are no strangers to these issues as they have all battled and continue to battle breast cancer themselves. Michele Burton found a lump in her breast on self-exam in 2001. Her gynecologist also felt the lump and referred Burton for a mammogram. She explained that Burton’s risk of having breast cancer was low because she was just 32 years old. Burton’s mammogram and additional ultrasound images showed “micro calcifications in her breast.” She did not receive treatment at that time and had a repeat examination in six months. At the re-examination a radiologist who specializes in breast disease was more suspicious of the spots on the mammograms and asked Burton to have a biopsy right then and there. The biopsy results showed that Burton had invasive stage one ductal carcinoma. Two weeks later she found out that she was pregnant. “It was all so overwhelming,” says Burton. “Everyone I talked to said to terminate the pregnancy, but I didn’t want to do that. Finally I went to MD Anderson Cancer Center in Houston. Those doctors were the first and only ones to tell me that I could actually continue the pregnancy.” Burton had a lumpectomy with sentinel node biopsy in her first trimester and started chemotherapy in her second trimester. Three weeks after she completed chemotherapy, Burton gave birth to her daughter. One month after delivery, she had radiation therapy and is now on Tamoxifen for tumor suppression. She will complete Tamoxifen therapy in 2008. Burton’s daughter, now 3 years old, has no known developmental problems. Time will tell if she has any fertility issues as a result of her mother’s chemotherapy. “A woman does not have to terminate her pregnancy because she’s diagnosed with breast cancer,” says Karin Hahn, MD, assistant professor at MD Anderson’s Breast Department of Medical Oncology. “It really depends on the tumor and the type of cancer she has. In general, pregnant women with breast cancer do as well as non-pregnant women with breast cancer. Prognosis really depends on the stage of the cancer at diagnosis.” Hahn says, “Women can have surgery any time during pregnancy. If the cancer isn’t aggressively spreading, chemotherapy starts in the second trimester, the safest trimester for treatment. Young women diagnosed with breast cancer who want to become pregnant in the future must be proactive in their care. Chemotherapy typically causes infertility, so if a woman wants to have children, fertility treatments must be performed prior to chemotherapy. “ Shauna Martin knew she wanted to have more children when she was diagnosed with stage II breast cancer in her left breast in August 2005. She was 33 years old and her son was 19 months. Martin relentlessly researched how to preserve her fertility. She contacted Fertile Hope, a non-profit organization that provides information and support to cancer patients who risk losing their fertility to cancer treatment. Martin, who had an aggressive breast cancer that required aggressive treatment, had planned to freeze her eggs. She learned, “Eggs don’t freeze as well as embryos, so I had fertility treatments, removed my eggs and froze 12 embryos prior to my lumpectomy and chemotherapy.” Following all of her cancer treatments and five years of Tamoxifen suppression, she can try to conceive using the frozen embryos. She will be 40 years old. Martin and her husband met with Thomas Vaughn, MD at Texas Fertility Center. Like many breast cancers, Martin’s tumor was estrogen sensitive. To avoid raising her estrogen levels, they first tried an in vitro fertilization cycle without estrogen stimulation. Three embryos were harvested and preserved as a result. But Martin wanted more chances at conception following her cancer treatments. She continued searching and found a physician, Kutluk Oktay, MD at the Center for Reproductive Medicine and Infertility in New York City. Oktay pioneered and is perfecting in vitro fertilization cycles that stimulate ovarian egg production while suppressing estrogen stimulation. Working with Dr. Vaughn, Oktay supervised the in vitro protocol for Martin from New York City. “We use Letrozole, an estrogen suppressant, in combination with
fertility drugs for in vitro fertilization cycles,” says Oktay.
“Letrozole was originally used to treat breast cancer, but further
research revealed that it suppress estrogen levels while allowing other
fertility drugs to stimulate the ovaries to produce more eggs. Many women
with breast cancer have estrogen sensitive tumors and they can’t
risk increasing their estrogen levels. This regimen is ideal for them
and is so successful in producing lots of viable eggs for in vitro fertilization,
it may become the standard procedure for everyone.” Cancer survivors are keenly aware that their cancers can recur. Survivor Audra Outlaw discovered, “You can’t predict what’s going to happen. Live your life and take a chance.” For Outlaw, the risks have paid off. In May 2002 Audra Outlaw was 31 years old and had been married for eight months. While doing a breast self-exam, she noted a lump protruding from her left breast. Mammography could not detect any tumor, but ultrasound revealed two tumors. Outlaw’s biopsy results indicated that she had very aggressive locally advanced invasive ductal carcinoma, between stage II and stage III. It had entered the lymph nodes and her doctors predicted that it would spread. “It was a very emotional time,” says Outlaw who understood that her cancer treatments would likely leave her infertile. “I felt so badly that my husband would never have the family that we had hoped for. I wasn’t even sure how long we’d have together. It was also very difficult to imagine having both breasts removed. But I knew that it was the right thing for me to do. I couldn’t wait around monitoring the tumors and waiting to see if the cancer spread. I didn’t want the worry.” Outlaw had her surgeries performed at MD Anderson Cancer Center and her chemotherapy here in Austin. Once again there was trouble. “I developed painful ovarian cysts while on the Tamoxifen. While it was blocking my menstrual cycles, it didn’t completely suppress them. That meant I had a chance at being fertile enough to have a baby.” It was a very narrow window, but according to Outlaw’s obstetrician, Mark Akin, MD, it was enough to try one cycle of Clomid. Outlaw took the medication and conceived. She delivered her son in June 2005, two years and two weeks after her breast cancer diagnosis. Outlaw is currently pregnant with her second child, conceived naturally, and due to deliver in February 2007. There is no sign of her breast cancer recurring. Young women with breast cancer face difficult treatment decisions that are further complicated by such issues as blossoming careers, preservation of fertility and caring for young children while in treatment. The Pink Ribbon Cowgirls offer social outlets where young breast cancer survivors can meet and share support, ask questions and get answers. For the young women of Austin, they’re nothing short of the cavalry. Resources and Recommendations
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