Valerie Bunt doesn’t look like your typical breast cancer survivor. A mother to a thriving eight-year-old, Valerie usually spends her days working in her family’s legal headhunting firm and caring for her daughter.
She has long brown hair, with no evidence of the toll of chemotherapy. And strangers don’t know about the surgery scars that stretch over her chest and behind her right shoulder.
But what throws people off most is her age. At 33, Valerie flies under the survivor radar at breast cancer events and hospital appointments. One woman even praised her for wearing a breast-cancer shirt and “being a great supporter”.
“It happens,” she said later that day, recounting the long journey from before her diagnosis in 2011 to her status now as a survivor. “They don’t think it’s me. And then they ask, ‘How old are you?’ They don’t know anyone who’s been in that scenario.”
Breast cancer is an increasingly visible cause – especially in October, when “the whole world turns pink” for breast cancer awareness month, said Valerie’s stepmother, Abbe Bunt. But survivors under 40, a small but increasing fraction of those diagnosed with the disease, say they are combating the perception that breast cancer is an older woman’s disease.
Many of them didn’t expect a diagnosis in their first decade or two of adulthood, before mammograms are recommended for screening. Nor did some of their early doctors, who initially discounted the possibility their lumps might be cancerous. “I was one of those people who believed young kids got cancer or older people got cancer. I thought the middle age was OK,” said Valerie.
About 7% of women who are diagnosed with breast cancer are younger than 40, though the number of new cases has slowly been increasing since the mid-1990s, according to the American Cancer Society.
Part of the reason, said Dr Carmen Calfa, Valerie’s oncologist at the Plantation campus of the Sylvester Cancer Center at the University of Miami in the United States, is that certain protective factors like having children earlier and breastfeeding are declining.
Other factors involving hormonal changes can also play a role, she said. When cancer does surface in younger patients, it tends to be more aggressive and more advanced, she said. “It’s a different biology when cancer happens at a younger age.”
Those earlier and more aggressive onsets mean younger patients also face different challenges. They have to determine how to balance budding careers and fertility issues, and given their life expectancies, how to manage longer-term care after they are diagnosed.
Being diagnosed when younger can also leave more of an impression on friends and family, if only because it is rare, said Dr Gladys Giron, a surgical oncologist at the Miami Cancer Institute. “Who expects a 35-year-old to have a breast cancer diagnosis, or someone in their 20s? Because they’re younger, they don’t expect that.”
Valerie was 25 when she first felt the pea-sized lump in her right breast and went to a surgical oncologist. Her mother had had cystic breasts, and as a result, “there was always this fear of breast cancer”, she said. But that doctor told her “you’re too young to have breast cancer”, she remembered.
She had been trying to breastfeed her infant daughter, Alyssa, at the time. Alyssa had been born premature, and the doctor suggested that the lump was just a clogged milk duct.
Valerie couldn’t shake her worry. She had started losing weight – so much so that soon she weighed less than she had before she had gotten pregnant. A few months later, the lump had spread into what felt like a gravel road, with “small pebbles” extending from under her breast and toward the centre of her chest.
Valerie said she remembered walking into her stepmother’s office, stripping off her shirt and lying down on the carpet to show the bumps she felt under her skin. “Find me someone who will take me seriously,” Valerie remembered demanding. “Something’s wrong.”
Valerie went back to the hospital to another doctor, who ordered a sonogram, then a mammogram, then a biopsy. She was diagnosed with breast cancer in January 2011, about five months after she had first found her lump. It was Stage 2.
Valerie quickly began an aggressive treatment plan, starting with a bilateral mastectomy, chemotherapy and radiation. “It was a bombardment,” Abbe said. Valerie also realised she had to grapple with issues that older patients usually escape, including medically-induced menopause and the possibility that chemotherapy might make her infertile.
Valerie, an only child, didn’t want her own daughter to grow up without a sibling and opted to have her eggs frozen, with some financial help from the Livestrong Foundation and a fertility doctor who agreed to do the procedure for just the cost of the anaesthesia.
Worse Than The Diagnosis
Dafne Morales Pogoda, 35, found herself in a similar situation last year when she was diagnosed with Stage 2 breast cancer. She didn’t have children, but didn’t want to rule out the possibility either.
She was already grappling with her diagnosis “and now you’re going to tell me that I might not even have babies”, she recalled thinking. “That was even worse than the diagnosis itself.”
Freezing her eggs, she said, was like taking insurance on that possibility: “It’s like 28 babies waiting for you in the freezer, waiting for you to go back to being healthy,” she said.
Pogoda, of Miramar, had also just started a job as an assistant manager at a pharmaceutical company, and found herself balancing her job – literally, with a laptop while in the chemotherapy chair – and hospital appointments, she said.
“I’ve always been the person who is working,” she said. She didn’t miss any work while she was undergoing treatment, she said.
The range of ages among younger patients with breast cancer coincides almost perfectly with the shifting period in which women tend to be caretakers for multiple generations, said Eileen Tome of Miami Lakes, who was diagnosed with breast cancer not long after her youngest son turned three. “That’s when everything is happening in our lives: careers, relationships, long-term relationships, children.”
Tome, who has five children, was diagnosed last summer when she was 46, just a year after doctors recommended women get mammograms to screen for breast cancer. But, she said, she hadn’t had a mammogram in four years. “It kept getting bumped down to the end of the list” amid other responsibilities, said Tome, who was treated at Baptist Health South Florida.
Valerie, already juggling an infant daughter, discovered the same. At points in her treatment, she said, she was scheduling two to three doctor appointments a day. After her surgery, she went through nearly a year of chemotherapy and radiation, before going on hormone therapy, on and off, to mitigate her risk.
Now, a little over five years after her last radiation treatment, Valerie is still mindful that her cancer could come back. Testing indicates that she is at high risk for a recurrence of her cancer between the five- to 10-year mark.
But, she said, she has become more aware of her body – and the signals that something might be wrong. “I’m doing all these things to make sure I can see my daughter get married, walk across the stage to get her degree,” she said. “I’ve done literally everything I could do.”
She said she plans to make sure her daughter also learns to be self-aware and advocate for her own treatment, in case this ever happens to her. “She’s going to be monitored a little closer than she would be otherwise.” – Miami Herald/Tribune News Service