What are the stages of lung cancer?
We often hear a “stage” number referred to in connection with lung cancer. What does that number mean and why is it important?
Dr. Noran Barry is a board-certified, fellowship-trained breast surgical oncology doctor affiliated with Sharp Rees-Stealy Medical Group, Sharp Memorial Hospital and Sharp Mary Birch Hospital for Women & Newborns.
The essay was published first in the San Diego Union-Tribune on Oct. 18, 2023.
Surrounded by her care team, Carly Ferry struck the gong in the Laurel Amtower Cancer Institute at Sharp Memorial Hospital, signaling the end of her breast cancer treatment. Carly had two types of breast cancer: invasive ductal carcinoma — the most common type of breast cancer, which affects the milk ducts and breast tissue — and invasive lobular carcinoma, which begins in the breasts’ milk-producing glands.
What makes Carly unique is that she was diagnosed with breast cancer at age 37. Most breast cancers are diagnosed after age 50. Carly decided to undergo a double mastectomy to help save her life. She’s not the first young patient I treated this year, and she won’t be the last. One in eight women of all ages will develop breast cancer.
Breast cancer is often associated with middle-aged and older women, as the median age at the time of diagnosis is 62. Indeed, cases of young women (under age 40) developing breast cancer are still low overall — 1 in 196 — but this number is growing.
Early detection and treatment are key to help prevent deaths from breast cancer. The American Society of Breast Surgeons recommends women with average risk of breast cancer receive an annual screening mammogram beginning at age 40.
A recent study published in JAMA revealed that from 2010 to 2019, breast cancer was the most common cancer among women in the United States under age 50 — with an 8% increase in incidence over the last decade. Young women are more susceptible to a diagnosis of advanced or aggressive breast cancer and have a higher chance of recurrence.
No clear single risk factor explains why there are more young women developing breast cancer, but several variables can increase risk.
Dense breasts — those containing higher amounts of glandular and fibrous connective tissue and lower amounts of fatty tissue — have a higher risk of developing cancer. Approximately 50% of women over age 40 have dense breasts and may require additional imaging, such as 3D mammography and ultrasound, to help see through breast tissue to determine if cancer is present.
Fluctuating hormone levels during menstrual cycles and throughout a women’s lifespan may increase the chance of cell mutations and tumor development. This frequent cell turnover makes breasts more susceptible to DNA errors. Also, delaying pregnancy until after age 35 can allow the breasts to accumulate abnormal cells.
In my practice, I’ve noticed that many young women diagnosed with breast cancer experienced chronic stress in the years prior. When someone undergoes profound life stressors, such as overwhelming grief or financial struggles, levels of the stress hormone cortisol remain high, which negatively causes DNA changes in the body’s cells. Researchers have suggested these changes may increase the risk of developing cancer.
Societal expectations and heightened exposure to toxic stress constantly pressure young women. A comprehensive approach to caring for the whole individual, such as carefully considering their mental health as well as stress factors that can impact their well-being, is crucial. As medical professionals, we are dedicated to treating all our patients as best as we can. Part of our efforts must include helping young women implement changes that support stress reduction and foster resilience.
I encourage women of all ages to practice breast self-awareness. That means more than just feeling for a lump. It includes noting any breast changes, such as swelling, warmth, redness or darkening of the breast; a change in the size or shape of the breast; dimpling or puckering of the skin on the breast; and sudden nipple discharge. If you see or feel changes in your body, talk to your doctor and ask for a screening. I cannot emphasize this enough — you know your body best. It’s not impolite to advocate for your health or seek a second opinion.
As a doctor and mother managing multiple responsibilities, I’m all too familiar with the pressure women face. However, to care for others, we ourselves must be healthy. I encourage my patients to say “no” when they need to prioritize balance in their lives and give themselves permission to express and release their emotions. While some risk factors for developing breast cancer may be out of our control, leaning into resilience and balance while reducing toxic stress can help support a long and healthy life.
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