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Young Breast Cancer Survivors Often Suffer Emotional Problems

Young women who are treated for breast cancer often suffer emotional disruption that persists for years after their treatment, according to researchers at the University of California, Los Angeles (UCLA).

Women younger than 50 may be especially hard-hit by feelings of vulnerability and a fear of cancer recurrence, the researchers reported in the Journal of Clinical Oncology (Vol. 21, No. 22: 4184-4193). About one-fourth of breast cancer cases in the United States occur in women in this age group.

"A lot of oncologists are not necessarily well-equipped to address these issues," said lead researcher Patricia Ganz, MD, of UCLA's Jonsson Comprehensive Cancer Center. "Whoever's taking care of these survivors needs to know about these problems."

Ganz and her colleagues examined 577 women who had been diagnosed with breast cancer an average of 6 years before the study. Their ages at diagnosis ranged from 25 to 51. About half the women had been treated by mastectomy, while the others had lumpectomy followed by radiation therapy. About three-fourths of the women had received some extra treatment after their breast cancer surgery, such as tamoxifen, chemotherapy, or both.

The women answered an extensive 45-page questionnaire about their physical and emotional functioning, as well as their health.

The women were generally in good health several years after their diagnosis, although almost all of them were unhappy with their body. Many had experienced weight gain and about half had problems with breast sensitivity. Many women also complained of general aching, joint pains, and muscle stiffness, as well as forgetfulness and trouble concentrating.

Most of the women were near or past menopause and were having hot flashes and night sweats. Because of their cancer diagnosis, these women were not candidates for hormonal replacement therapy to treat these symptoms.

The youngest women (those who had been between the ages of 25 and 34 at diagnosis) had fewer physical complaints, but more trouble with emotional function.

That finding isn't particularly surprising, Ganz said. Many of these young women may be focused on a first job or getting married and starting a family, and a serious illness can hamper those plans.

"They're at a time in their lives when cancer isn't on their list of expectations," Ganz noted. Young women who had become menopausal (and thus unable to have children) as a result of their treatment were the most likely to be depressed and have a negative attitude toward life.

Older women, who have had more life experiences, may be better equipped to cope with a cancer diagnosis and the effects of treatment, said Ganz.

Women who were in a relationship, those with higher educational levels, and African-Americans reported fewer problems than other women in the study. It may be that these women have stronger support networks or other life experiences that help them cope with the cancer diagnosis, Ganz said. In an earlier study, Ganz and her group found that African-American women find more meaning in life after having breast cancer than white women do.

Young women who are having troubles can take steps to help themselves, Ganz noted. There are medical remedies for many of the late effects of cancer treatment, so letting their doctor know about symptoms is important.

Even knowing they aren't alone in having physical or emotional side effects can be a help, Ganz said. Many survivors focus so intensely on just getting through their disease that they don't realize there could be side effects down the line. Research like this lets these women know they're not crazy, Ganz said. "What they're experiencing is what a lot of other women in their age group experience."

Although the findings may seem negative, Ganz said the overall message for young women is positive. Breast cancer survivors show a great deal of resiliency.

"Overall, women are doing very well, but we'd always like to do better," she said.