Laurie Foster of Toledo, Ohio, had never given a moment's thought to breast cancer. She was a healthy, active 29-year-old wife and mother, and there was no history of breast cancer in her family. She had never even performed a breast self-exam. But then her gynecologist found three small lumps clustered together in Foster's right breast during a routine visit in November 1998. Subsequent tests (an ultrasound, a mammogram and a biopsy) revealed the worst: The lumps were cancerous and -- as is typical in young women -- growing fast.
"My first reaction was, 'Please don't let me die,' " Foster, now 32, recalls. Her surgeon presented two treatment options: breast conservation, which would remove almost all of the tissue from the breast but preserve the nipple -- leaving a breast with a deflated appearance; or a mastectomy, which would remove the entire breast. Foster didn't hesitate: She chose mastectomy. "My daughter, Natalie, was only 15 months old. I knew that I had to get better for her," she explains. "I said, 'Just get the cancer out.' "
Like Foster, Joy Simha, a 34-year-old free-lance corporate video producer and avid kayaker living in Glen Rock, N.J., was only in her 20s when she found a malignant pea-sized lump under her right nipple in 1994. "I felt that my body had betrayed me," recalls Simha, now cancer-free for seven years, married and the mother of a baby boy, Anand. "I had an amazing career and future before me. I had recently started to kayak, and I loved the sport so much. I was stronger, thinner and healthier than I had ever been before, and I was single at the time. I felt cheated. But after a month of spending every waking hour thinking about the cancer and being devastated, I realized I wanted to live and ride the river."
At first, she couldn't fathom losing her breast. "I saw three surgeons and went with the one who said I could have a lumpectomy, followed by radiation therapy," Simha says. But when the lumpectomy didn't remove all of the cancer, her surgeon recommended mastectomy.
"Mastectomy is often a good option for young women because it may not be possible to conserve the breasts, which may be smaller [and less fatty] than those of older women," says Jeanne Petrek, M.D., surgical director of the Lauder Breast Cancer Program at Memorial Sloan-Kettering Cancer Center in New York City and an expert in treating young women with breast cancer. "In addition, the radiation after breast-conserving surgery can actually cause cancer later in life."
Losing a breast at such a young age, however, comes with unique consequences. Foster, whose attitude when weighing her treatment options was an unequivocal "take the breast off," recalls that the reality of what mastectomy had done to her body didn't hit her until she returned from the hospital and her bandages came off. "Every time I took a bath and saw my chest, I cried," she says. "It was covered with scars and [surgical] staples. I felt so wounded and violated." Foster's husband of eight years, Jason, helped her through the ordeal. "He bathed me and told me I was beautiful," she says. "Without him, I never would have gotten through this -- and because of him, I was able to accept my body."
Jason calls her scarred chest her "war wound -- because it shows I've won my battle with cancer," Foster says. And indeed she has. Just as she was preparing to have reconstructive surgery on her breast, Foster discovered she was pregnant again. In April, she gave birth to a boy. Now, with the pregnancy behind her, she is eager for a new breast. "I'm so young, and I hate wearing a prosthesis -- it's heavy and hot in the summer," she says. "And it's so hard to find clothing I can wear. I walk into Victoria's Secret and see all of these beautiful spaghetti-strap and V-neck nightgowns and fancy bras that I can't buy because my scars will show. There aren't many places that cater to young women who've had a mastectomy. Most of the clothing is dowdy, like bathing suits with skirts."
Simha also had planned to undergo reconstruction, but has since decided against it. "I looked into my options, and it was all very complicated and too much for me to digest right after surgery and chemotherapy," she says. "I worried that reconstruction would inhibit my ability to kayak and to work, and as time went on, it became less important to me."
Simha reconciled with her new body by performing an exercise she learned in a breast-cancer support group: "Every day, I stood naked in front of a mirror and told myself that I was beautiful," she says. "And I really tried to believe the words. Somehow, after doing this a few times and dancing in front of the mirror, I began to look beyond my image and to see inside to my soul. I realized that my entire being is beautiful -- and who am I to question the individual parts of it?" Simha also found that being active helped her to embrace her body as it now was. "I may not have a breast, but I can paddle my boat, surf a wave, use a StairMaster for half an hour -- even have a baby. And my husband, Vasu, doesn't care if I have two breasts or not. He accepts me as I am."
Having a baby after breast cancer
Although fertility can be compromised by chemotherapy (which may induce premature menopause), Foster and Simha, who both had chemo, had no trouble conceiving. While Foster got pregnant unexpectedly early, most doctors advise waiting two to five years after completion of therapy before conceiving. The reason: Most recurrences happen in this window, and treating a woman who is pregnant poses the concern of potential harm to the fetus. Nor is there any evidence that breast-feeding a child after having had breast cancer puts a baby at risk by passing on "bad immunities." Simha has been breast-feeding with the help of a lactation specialist. "It's totally possible to nourish a child on one breast, just as mothers of twins nurse one child per breast," she says.
Take the time -- examine your breasts
Because mammograms aren't standard screening tests for young women, monthly breast self-exams are the best means of early detection. The sooner the disease is caught, the better the odds for survival: Government data indicate that the five-year survival rate for young women with early breast cancer is 81 percent and the 20-year survival rate is 52 percent. However, many young women's cancers are caught later and are very aggressive compared with older women's tumors, which reduces the chance of long-term survival, according to Debbie Saslow, Ph.D., director of the breast- and cervical-cancer program with the American Cancer Society in Atlanta.
"Most young survivors find their own breast cancers, just as I did. Self-exam is all we have," Simha says, adding that it's crucial to be proactive if a lump is found. "I've met many young women who showed breast lumps to their primary-care doctors as soon as they discovered them, and were told to wait and watch the lump because 'young women don't get breast cancer.'" Yet Foster and Simha are among 250,000 women under 40 in the United States who have had breast cancer.
Adds Foster: "Breast cancer is such a random disease. I was young, healthy and active. And I still got breast cancer."