Hally Steiner's husband and parents travel from New York to accompany her on frequent visits to Dana-Farber.
Aggressive cancer, aggressive treatment
"We find all types of cancer in younger women, and all types in older women, but the mix in each group is different," Dr. Winer explains. "Breast cancer in younger patients is generally more aggressive, while in older patients it is somewhat more slow-growing, although there are always exceptions. Fortunately, some of the more aggressive cancers may actually respond better to certain treatments."
Some facts about age-related breast cancer are known, but there is more to learn. "Cancer in older women is more likely to be dependent on estrogen (or estrogen-receptor positive) making it easier to treat," says Ann Partridge, MD, MPH, a Dana-Farber medical oncologist specializing in breast cancer.
She points out that there may be delays in diagnosis for younger women because the disease is relatively uncommon in this age group. "Also, mammograms are less sensitive in younger women because their breasts are more dense, and because young women and their doctors often think they are too young for breast cancer. Therefore, this group appears to be at greater risk for cancer that has spread beyond the breast at diagnosis, and for cancer recurrence in the future."
A primary goal for Ashton-Panas during cancer treatment is to stay alive for her son, Nicholas.
Although most young women with breast cancer do not have an inherited genetic mutation, they are more likely to have one than older women. For Ashton-Panas, it was a complete surprise to learn that she has the mutant BRCA1 gene that greatly increases the risk for breast and ovarian cancer. There had been no breast cancer among close relatives, and she had undergone the test just to rule out the mutation. Steiner, however, was more than prepared to test positive for an altered BRCA1; her mother and sister both carry the gene.
Ashton-Panas received eight cycles of "dosedense" chemotherapy at Dana-Farber in which the drugs were given at two-week intervals instead of the usual three, aided by a shot that boosted her white blood cell count. In New York, Steiner initially had a lumpectomy, but cancer-free margins of tissue around the tumor were difficult to achieve, so she and her doctors opted for a double mastectomy and reconstruction. She, too, had dose-dense chemotherapy, but months later, the cancer reappeared in the internal mammary nodes in the center of her chest, and she came to Dana-Farber to enroll in a clinical trial under the care of Dr. Winer. Steiner is receiving low-dose chemotherapy in pill form and biweekly infusions of a drug designed to "starve" a tumor by blocking its blood supply.
Just as breast cancer is often more aggressive in young women, so is their approach to care, says Jay Harris, MD, chair, Radiation Oncology, Dana-Farber/Brigham and Women's Cancer Center. "Generally speaking, younger women ask a lot of questions, do their own Internet research, and may even request copies of scientific studies, while older women tend to rely more on their clinician's judgment and their own intuition," he says. "Of course, there are always exceptions."
Ask Ashton-Panas or Steiner about their cancer and its treatment, and they sound as knowledgeable as their clinicians. Steiner advises, "Do research. Be smart. Be your own best advocate." Ashton-Panas emphasizes: "Dr. Partridge treats me like a partner in my own care. I approach my clients in my law practice this way, and I appreciate the same kind of partnership with my healthcare provider."
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