Why is breast cancer more common in African American women younger than age 45 compared to women of other races?

Researchers do not know why African American women are at higher risk for breast cancer at a young age (under age 45) compared to women of other races, but they have some ideas. We have recently learned that women whose people came from West Africa are more likely to get fast-growing breast cancer at young ages, whether they live in Nigeria, the Bahamas, or the United States. Some of these women may have inherited a gene in their family that increased their risk for breast cancer. Another idea is that pregnant African American women have higher growth-hormone levels during pregnancy that may increase the risk for breast cancer in their daughters. Lower rates of breast-feeding among African American women may be another possible factor increasing their risk for breast cancer. Although we do not fully understand the “why,” it is possible that African American women will benefit from starting yearly mammograms at a younger age, especially if one of the women in their family has had breast cancer.

How can I know if breast cancer runs in my family?

Only about 5–10 women out of 100 who get breast cancer inherited a damaged gene that increased their cancer risk. However, studies of African American women who got breast cancer before age 50 have found that more like 15–33 out of 100 have a damaged gene. Sometimes, women may have a very small family or know little about the health of their relatives. If you can find out about your relatives’ health, look separately at your mother’s and father’s sides of the family. The damaged gene can come from either parent. Was there at least one woman (other than you) who got breast cancer before age 50? The more women with breast cancer, and the younger they were when cancer was diagnosed, the more likely that a damaged gene runs in the family. It also is a sign if a woman got breast cancer on both the left and right sides at different times, or had both breast cancer and cancer of the ovary or fallopian tube. Breast cancer in a man is rare, but it can occur in a family with an inherited cancer risk. If you think cancer may run in your family, ask your oncologist or primary care doctor about seeing a genetic counselor. A genetic counselor can help you find out more details about your family history and help you to decide if you want genetic testing.

What kinds of emotions are normal in young women with breast cancer and what reactions are signs that I may need some extra support and help?

Many women go through a period of intense emotion following a breast cancer diagnosis. You might feel scared, sad, and alone one day and optimistic, peaceful, and ready to face the disease the next day. You may be upset and worried about what your diagnosis means for your sexuality, fertility, and relationships. You may worry about keeping your job and managing money during your illness. You may be scared that you will not live to see your children grow up. During the first year after news of breast cancer, or in the months after a recurrence, these feelings are very normal. Many women feel better if they can share their worries with other breast cancer survivors, close friends and family, or people in their church or community networks.

You may need some extra support and help, for example from a trained counselor or chaplain, if you have intense depression or anxiety that does not go away in the months after your cancer treatment. Even the strongest woman has trouble coping sometimes. Here are some signs to look for: frequent nightmares that make it hard to sleep, vivid memories of scary experiences from your cancer treatment that interrupt your daytime routine, sudden panic with your heart pounding and feelings of being out of control, noticing that you are feeling hopeless or worthless, or not finding pleasure in much of anything. Problems with worry and depression are more likely if a woman has other stresses in her life besides her cancer, or if she had times of feeling blue or anxious in her life before cancer. Section 3 has suggestions on finding support and help for emotional issues.

Why do some breast cancer treatments bring on menopause?

A woman is usually said to be in menopause if she has not had a menstrual period for a year. Surgery or radiation for breast cancer does not put a woman into menopause, but chemotherapy can damage the ovaries, shutting them down for a while or forever. Women in their 20s or early 30s often recover menstrual cycles after they stop chemotherapy, but they still may reach a final menopause earlier than the usual age of around 51 years. Women older than 35 are more likely to stop having periods permanently after chemotherapy. The risk of menopause also increases with a higher dose of chemotherapy. Some drugs or drug combinations damage the ovaries more than others. When a woman is in menopause, her ovaries stop making the female hormones, estrogen and progesterone. These hormones have several jobs in the body. They control the menstrual cycles (monthlies) and keep the uterus healthy during pregnancy. When a woman goes into menopause, she may notice hot flashes and vaginal dryness that makes sex uncomfortable. After menopause, the bones lose some strength (osteoporosis). Women who reach menopause at an early age have a higher-than-usual risk for osteoporosis as they get older.

Women in menopause usually cannot get pregnant, but young women sometimes are fertile in the months after chemotherapy even if they have no monthly bleeding. They should still use birth control to avoid an unintended pregnancy. Some women take the hormone tamoxifen as part of cancer treatment. Tamoxifen does not put women into menopause, but some women have less-regular menstrual cycles while taking it. It is possible to get pregnant while taking tamoxifen, but women are asked to use birth control to avoid pregnancy because tamoxifen can cause birth defects.

What can I do to prevent breast cancer treatment from damaging my fertility?

Chemotherapy for breast cancer can kill off some of the eggs in a woman’s ovaries. A woman’s fertility depends on how many eggs she has left. Many women younger than age 35 recover fertility after chemotherapy. Research also suggests that getting pregnant after breast cancer does not increase a woman’s risk for cancer returning, although more research on safety is always needed. Some women make a special effort to preserve their fertility (see Section 8). Before starting chemotherapy or tamoxifen, a woman will see an infertility specialist and take hormone shots for 2 to 3 weeks, causing more than one egg to ripen. When the eggs are ready, the woman has a minor, outpatient surgery. The doctors harvest her eggs and prepare them in a special laboratory. If the women is married or has a serious relationship, the eggs may be fertilized with her partner’s sperm. Embryos that develop are then frozen. They can be put back into the woman’s uterus at a future time, after she has had successful cancer treatment. Even if she ends up in menopause, she can carry a pregnancy with some hormone replacement in the early days. Some women also freeze unfertilized eggs to be thawed and fertilized later on when they are in a relationship. A few women freeze pieces of tissue removed from their ovary for future use, but that treatment is still considered experimental. These kinds of fertility-preservation treatments are quite expensive and often are not covered by insurance. Some cancer organizations offer financial help to women who cannot afford fertility preservation. If you are interested, ask your oncologist about fertility preservation as soon as possible before you start cancer treatment.

Although tamoxifen does not damage the ovaries by itself, women should not try to get pregnant while taking tamoxifen because it can cause birth defects. The chance of getting pregnant for any woman starts to decrease a lot in her late 30s. Some breast cancer survivors may no longer be able to get pregnant after the 5 years of taking tamoxifen.

What are the most common sexual problems in young women treated for breast cancer?

The most common sexual problems are loss of desire for sex or vaginal dryness. Both of these problems happen more often in women who have chemotherapy as part of their cancer treatment. If chemotherapy puts a woman into sudden menopause, she is likely to have vaginal dryness, even if she feels sexual desire and excitement. Vaginal dryness can make sexual touching and intercourse uncomfortable or even painful. If sex hurts, a woman may lose interest in trying it again. Women also may lose desire for sex because they are taking medicines for depression, pain, or anxiety that interfere. Chronic fatigue and depression, both very common in the months after breast cancer treatment, also make it hard to get in the mood for sex. Some women feel less sexually attractive because of scars on their breasts or changes in the way they look during and after chemotherapy. These sexual problems can be treated and overcome. See the suggestions in Section 7.

What can I do about vaginal dryness that makes sex uncomfortable or painful?

Vaginal dryness is a common problem when young women go into sudden menopause after breast cancer treatment. The hormone estrogen, made by the ovaries, helps a woman’s vagina get wet so that sexual touching and intercourse feel good. The vulva, the delicate tissues that make up the outside of a woman’s private parts, also gets dry and easily irritated. Taking estrogen in a pill, patch, or vaginal ring or tablet can quickly restore moisture, but many women who have had breast cancer do not want to take the risk that estrogen could feed any remaining breast cancer cells. If you do use replacement estrogen, a low dose directly in the vagina, in a cream, tablet, or ring, can help vaginal dryness without letting as much hormone affect the rest of your body. However, you can treat vaginal dryness without using hormones. You can use a vaginal moisturizer, in a gel or tablet form that helps keep the vagina moist inside. You can buy these products without a prescription and use them regularly, at least twice a week at bedtime. Then when you are having sexual touching or intercourse, add a water-based or silicone-based vaginal lubricant. You can find detailed information about vaginal moisturizers and lubricants in Section 7.

How can I feel more interest in sex again?

Women may lose desire for sex for many reasons after breast cancer. Women often hope for a simple answer, thinking a change in hormones is the likely cause. In fact, hormone treatments for low desire have not worked well in breast cancer survivors and could be risky. Women may lose desire if sex hurts; if they are tired or nauseated a lot of the time; if they feel unattractive; if they are not getting along well with a partner; or if they are taking medicines that have sexual side effects, for example pills to help with depression, anxiety, or pain. Enjoying sex again means figuring out what is getting in the way. Try vaginal lubricants and moisturizers if you have dryness and pain. Put a priority on time for sex when you are more rested. Find ways to enjoy good feelings in your body, even if you need to start by taking a bubble bath or getting a massage. Let your partner know what kinds of sexual touch would please you. Take time to lie back and enjoy your feelings during lovemaking. Watch a movie with a good love scene or read a sexy novel. Do something special to feel attractive. If you are taking prescription medicines, check with your doctor about their sexual side effects. If one of your medicines could be reducing your sexual desire or making it hard to reach orgasm, work with your doctor to see if you could reduce the dose or find an alternative medicine. It may take some effort, but sex can get better.

What can I do about hot flashes?

Hot flashes are a common problem in women going through menopause. They may be more severe in younger women whose cancer treatment brings on sudden menopause. Hot flashes happen most often at night. If they wake you from sleep several times a night, you may find that you are often tired. Taking estrogen to replace the missing hormone works best to prevent hot flashes, but it is not recommended for most breast cancer survivors. Some prescription medicines reduce the number and strength of hot flashes, although they also can have other side effects. One of the better ways to decrease hot flashes is by learning relaxation, yoga, or meditation techniques. Learn to recognize the warning signs that a flash is coming on. You may be able to head it off, or at least make it less intense, by using deep breathing or another type of relaxation. Many women find that hot flashes gradually become less frequent and severe after a couple of years. Try to sleep and work in cool places, and wear layered, cotton clothing.

What can I do to stay as healthy as possible in the future?

If you have had breast cancer at a young age, you may worry about your future health. Will breast cancer return? Will the cancer treatment itself cause long-term health problems? Rather than feeling helpless and fearful, you can learn from this experience to take the best possible care of yourself. Make sure you have a written summary of your cancer history and treatment, so that if you switch doctors, you will be able to give the facts to your new medical team. Ask what kinds of tests you should have— for example mammograms, MRI scans (magnetic resonance imaging scans), tests to measure bone density or heart health, and examinations by a gynecologist—and ask how often you should get each test. It is very important to stay at a healthy weight, using a combination of an exercise routine and a low-fat diet rich in whole grains, fresh vegetables, and fruits. If you use tobacco, now is the time to get help to quit. Women should also limit their alcoholic drinks. If you are in menopause and are younger than age 50, eat a diet rich in calcium and try to get weight-bearing exercise, like walking, dancing, or jogging, to help your bones stay strong. Ask your doctor if you should consider taking calcium supplements or prescription medicines to fight osteoporosis (weakening of the bones after menopause). If other women in your family have had breast cancer at a younger age, consider genetic counseling. If you have an inherited risk for breast cancer, you can find another cancer early or even reduce your chance of future breast or ovarian cancer by having special examinations on schedule, by taking preventive hormone therapy, or by having preventive surgery. You can also inform other young women in your family so that they are aware that they may also be at risk.