Navigating the difficult choices that come with an early-onset cancer diagnosis
Being told you have cancer at any age is tragic. But at a time when you're contemplating having a family or starting a career, patients have to make difficult decisions about how or when they're treated.
The goal is survival, but what happens on the other side?
Will your physical relations be the same? Can you have kids? Every choice must be taken with balanced measure.
Throughout Orange County, the latest research shows cancer among 18- to 49-year-olds is occurring in unprecedented numbers.
"Particularly breast cancer is one of the things we're seeing a lot of," said Dr. Amanda Schwer, a radiation oncologist with City of Hope.
The same sobering observation has also been seen in particular communities throughout the San Gabriel Valley.
"Alarming. Huge. It's the largest increased jump in new breast cancer patients is in this Asian American population," said Dr. Niki Tank, a medical oncologist at the Huntington Cancer Center in Pasadena.
Tank is also seeing an increase among young African American women. It's a nationwide trend, acutely felt in California because of its diverse population. While it's too new to understand the causes, some of the data is clear.
"The older you are when you have your first child, the higher your risk is of developing breast cancer. So if you have your first child before 30, or if you have your first child before 25, you're at the lowest risk. If you have your first child above 40, you're at the highest risk," she said.
Never having kids also raises your risk.
Being a mom has always been the plan for Juliette Landgrave. But before her 38th birthday, she was diagnosed with triple negative breast cancer, a highly aggressive disease that requires chemo, radiation and often a mastectomy.
"I said I wanted to have a lumpectomy because I wanted to keep my breast," Landgrave said.
Her doctor strongly advised against it, so she got a second opinion at City of Hope, where doctors believed they could treat her cancer and save her breast.
Juliette also wanted to save something else. Her ability to have kids.
Those choices require a careful balancing act. But Tank said patients need to be part of the decision-making.
"Making sure that patients understand what the options are, what the risks are, but making sure that they still have a voice in this," she said.
Every early-onset cancer patient may have a different take.
"My thought was, well, there is no quality without life," said Tom Brown of Redlands.
At age 49, Brown felt sick after an international trip, so he went to his doctor and did routine blood work that included his first PSA screening. The results stunned him.
"It was discovered that my PSA was at 12.8, a very high number," Brown said.
He'd eventually learn it was stage 2 prostate cancer.
"And my doctor indicated that it was likely growing for nearly two years in my prostate," he said.
PSA testing is recommended for average risk men starting at age 50. So what should younger men do? Talk to your doctor about your family history and risk and get regular digital rectal exams at every physical.
"It's a check that all men should have and it's painless, so why not check?" Brown said.
For women, mammograms should start at age 40, but before this age, and even after, be aware of the most common risk factor young women face: dense breast tissue.
"Forty percent of women have it and dense breast tissue is associated with a breast cancer risk of one and a half to two fold," said Dr. Arif Kamal, Chief Patient Officer of the American Cancer Society.
It also makes self breast exams a challenge.
"It sort of feels like hard dough rather than soft dough. And so because of that, it's harder to find and feel lumps," said Tank.
She said don't be afraid to bring up any changes with your doctor and if you do get a mammogram, ask if you should be getting an ultrasound screening as well.
"There's nothing wrong with the nudge. And I think again, there are many scenarios where even pushing a little bit, you know, is not the wrong thing," said Tank.
Also, ask about your lifetime breast cancer risk score. Actress Olivia Munn credits her doctor for asking that question. The two then took an online test to get her score. A result over 20% is considered high risk.
Munn's score was 37.3. She ended up getting an MRI, which detected 2 tumors.
Early-onset cancers are usually aggressive, but patients Tom's age often choose more conservative treatments such as radiation. Surgical prostate removal carries a chance of incontinence and impotence.
As a software developer, it's no surprise Brown studied all the data. In the end, he chose to have a prostatectomy at Loma Linda University Medical Center.
"I wanted it out of my body as quickly as possible," he said.
Finding an experienced surgeon at a major cancer center is how Brown mitigated his risk for side effects.
Now, five years later: "I have no incontinence. (Erectile dysfunction) quickly went away after a few weeks. And I credit a lot of that to my doctor and his nerve-sparing techniques," Brown said.
In 2025, Landgrave's dream of starting a family remains intact. Although her tumor grew rapidly during her egg retrieval procedure, her breast cancer treatments were successful.
"I am hoping that the five-year mark comes in soon with no recurrences and yeah, I hope that soon I could have a family and I could live a long, long life," she said.
Landgrave hopes this year will be a reset, but it's not always easy for cancer survivors to pick up where they left off.
A cancer diagnosis can affect many aspects of a patient's entire life. Research shows cancer patients are significantly more likely to experience bankruptcy compared to the general population.
Next on our series, The Changing Face of Cancer, Circle of Health reporter Denise Dador will take a deeper look into this problem.
