6%的乳腺癌患者被诊断为40岁以下

2020-10-14 07:35

You're Not Too Young to Think About Breast Cancer — 6% of Diagnoses Are Under 40 9XC世界播

你不会太年轻而不能考虑乳腺癌-6%的诊断年龄在40岁以下。9XC世界播


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With every October comes the predictable onslaught of pink everything: bracelets, perfume, athleisure, tacky T-shirts, and even $1,750 pumps, all in the name of breast cancer awareness and fundraising. And while broadcasting our support of the one in eight women who will face breast cancer in their lifetimes and the 2,620 new cases of invasive breast cancer that are projected to be diagnosed in men this year is important, we've become inured to the narrative that breast cancer is a disease that only affects women in middle age and beyond. The reality is that six percent of breast cancer patients who were diagnosed in 2019 were under 40, and nearly 12,000 women younger than 40 were diagnosed with invasive breast cancer in 2019, according to the latest data from the American Cancer Society. 9XC世界播

每年10月,粉色的一切都会如期来袭:手镯、香水、运动休闲、俗气的T恤,甚至1750美元的高跟鞋,所有这些都是以关注乳腺癌和筹款的名义进行的。虽然广播我们对八分之一的女性一生中将面临乳腺癌的支持,以及今年预计将在男性中被诊断出的2620例新的浸润性乳腺癌病例是重要的,但我们已经习惯了乳腺癌是一种只影响中年以上女性的疾病的说法。现实情况是,根据美国癌症协会(American Cancer Society)的最新数据,2019年确诊的乳腺癌患者中,6%的人年龄在40岁以下,2019年,近1.2万名40岁以下的女性被诊断为浸润性乳腺癌。9XC世界播


That reality is at odds with what we've been taught about breast cancer and what the CDC recommends: while most women are told to conduct breast self-exams from puberty, people don't need to even start talking with their doctor about getting mammograms until they are 40, and it's not until age 50 that you need to get them every two years. It's believed that you're more likely to have breast cancer if you have a close family history — in fact, breast cancer screening should begin at 25 only if you have the genetic mutation of the BRCA1 or BRCA2 genes, according to the Cleveland Clinic, or 10 years earlier than when the first affected relative in your family was diagnosed. 9XC世界播

这一现实与我们被告知的乳腺癌知识和疾控中心的建议不符:虽然大多数女性从青春期就被告知要进行乳房自我检查,但人们在40岁之前甚至不需要开始与医生谈论乳房X光检查,而且直到50岁,你才需要每两年做一次乳房X光检查。人们认为,如果你有密切的家族史,你更有可能患乳腺癌-事实上,根据克利夫兰诊所的说法,只有当你有BRCA1或BRCA2基因的基因突变时,或者比你家族中第一个受影响的亲戚被诊断出来的时候早10年,你才应该在25岁开始乳腺癌筛查。9XC世界播


While all this may be true, it ignores the painful reality that more than 250,000 people living with breast cancer in the US today were diagnosed before age 40, according to Young Survival Coalition. A 2016 article in the Journal of Clinical Oncology found that women age 40 or younger were 30 percent more likely to die from breast cancer compared to women who were diagnosed between the ages of 51 to 60, and breast cancer is the leading cause of cancer-related deaths in women under 40. The incidence of metastatic breast cancer — cancer that has spread to other areas of the body (brain, liver, or bones, for example), resulting in a lower survival rate — is rising in that population. About 800 women younger than 40 are diagnosed with metastatic breast cancer each year compared to about 250 per year in 1976. 9XC世界播

尽管这一切可能是真的,但它忽略了一个痛苦的现实,即根据青年生存联盟的数据,今天美国有超过25万乳腺癌患者在40岁之前被诊断出患有乳腺癌。2016年发表在临床肿瘤学杂志上的一篇文章发现,与51岁至60岁之间被诊断为乳腺癌的女性相比,40岁或40岁以下的女性死于乳腺癌的可能性高出30%,乳腺癌是40岁以下女性癌症相关死亡的首要原因。转移性乳腺癌的发病率在该人群中正在上升。转移性乳腺癌已经扩散到身体的其他部位(例如,大脑、肝脏或骨骼),导致存活率较低。与1976年每年约250名40岁以下的女性被诊断为转移性乳腺癌相比,每年约有800名女性被诊断出患有转移性乳腺癌。9XC世界播


"We do know that women under the age of 40 who are diagnosed with breast cancer are more likely to have a genetic predisposition," Elizabeth Comen, MD, a medical oncologist at Memorial Sloan Kettering Cancer Center who specializes in breast cancer, told POPSUGAR. "But that being said, the vast majority of women that are diagnosed with breast cancer have no family history. And that includes women under the age of 40." In fact, only about five to 10 percent of breast cancer cases are thought to be hereditary, meaning they result directly from gene mutations passed on from a parent, according to the American Cancer Society, and about 15 percent of women with breast cancer have a family member with the disease. 9XC世界播

“我们确实知道,40岁以下被诊断患有乳腺癌的女性更有可能有遗传倾向,”纪念斯隆·凯特琳癌症中心专门研究乳腺癌的内科肿瘤学家伊丽莎白·科门(Elizabeth Comen)医学博士告诉POPSUGAR。“但话虽如此,绝大多数被诊断患有乳腺癌的女性都没有家族史。这其中也包括40岁以下的女性。”事实上,根据美国癌症协会(American Cancer Society)的数据,只有大约5%到10%的乳腺癌病例被认为是遗传性的,这意味着它们直接是由父母遗传来的基因突变造成的,而大约15%的乳腺癌女性患者的家人患有这种疾病。9XC世界播


While there are certain risk factors that increase your likelihood of developing breast cancer, according to the CDC — getting your period before age 12; having dense breasts; a genetic mutation, such as the BRCA1 and BRCA2 genes; or a family history of breast or ovarian cancer — the sad reality is that for many women diagnosed with breast cancer under 40, they didn't have a family history at all. 9XC世界播

根据疾控中心的说法,虽然有某些风险因素会增加你患乳腺癌的可能性-在12岁之前来月经;乳房致密;基因突变,如BRCA1和BRCA2基因;或者乳腺癌或卵巢癌的家族史-但令人悲哀的现实是,对于许多40岁以下被诊断患有乳腺癌的女性来说,她们根本没有家族史。9XC世界播


"[Breast cancer] didn't run in my genes at all. No one in my family had breast cancer," Tyra Francis, 27, told POPSUGAR. Francis, who works as a substitute public school teacher and lives in New York City, was diagnosed when she was 23 despite not having a family history of the disease. She knew something was wrong when she noticed a bloody discharge from her nipple, which looked bruised. After a few days, she went to the emergency room, where she was told it didn't look serious, sent home with bacitracin ointment, and instructed to follow up with her primary-care physician. 9XC世界播

27岁的泰拉·弗朗西斯(Tyra Francis)告诉POPSUGAR:“(乳腺癌)完全没有遗传在我的基因中。我们家没有人患有乳腺癌。”弗朗西斯是一名公立学校的代课教师,住在纽约市,尽管没有家族病史,但她在23岁时被诊断出患有这种疾病。当她注意到从她的乳头上流出带血的分泌物时,她知道有些不对劲,看起来有瘀伤。几天后,她去了急诊室,在那里她被告知情况看起来并不严重,她被送回家,带着杆菌肽软膏,并指示她的初级保健医生跟进。9XC世界播


When Francis went to her primary-care doctor, the doctor mentioned that it could be cancer and decided to run some tests. "It was a shock to me because it made no sense," Francis said. "[Cancer] didn't run in my family, it wasn't in my genes, and she asked me a couple of follow-up questions and everything was no." Francis's doctor referred her to a breast specialist who thought her swollen breast, which had started to change colors, could be infected. "The last thing she thought was cancer," in part because Francis was so young. As her symptoms got worse, her breast specialist decided to do a biopsy and diagnosed her with stage 1 ductal carcinoma; stage 1 means the tumor is smaller than two centimeters in diameter and the cancer has not spread beyond the breast. 9XC世界播

当弗朗西斯去看她的初级保健医生时,医生提到可能是癌症,并决定做一些检查。“这让我很震惊,因为这毫无意义,”弗朗西斯说。“(癌症)在我的家族中没有遗传,也不在我的基因中,她问了我几个后续问题,一切都是否定的。”弗朗西斯的医生让她去看乳房专家,后者认为她肿胀的乳房已经开始变色,可能是感染了。“她想到的最后一件事是癌症,”部分原因是弗朗西斯太年轻了。随着她的症状恶化,她的乳房专家决定做活检,并诊断出她患有1期导管癌;1期意味着肿瘤直径小于2厘米,癌症没有扩散到乳房以外。9XC世界播


Francis decided to get a second opinion. Her new oncologist ran some more tests and revealed the cancer was actually stage 3 inflammatory breast cancer, about a month after she first noticed the bloody discharge. Stage 3 means the cancer has spread beyond the immediate area of the tumor — all inflammatory breast cancers start as stage 3 since they involve the skin — but if the cancer spreads outside the breast to distant organs, it's considered stage 4. Even though her mammogram results came back negative, the only way to diagnose inflammatory breast cancer is through a biopsy. 9XC世界播

弗朗西斯决定听取另一种意见。她的新肿瘤学家又做了一些测试,发现癌症实际上是3期炎症性乳腺癌,大约在她第一次注意到血性分泌物一个月后。3期意味着癌症已经扩散到肿瘤附近以外--所有炎症性乳腺癌都始于3期,因为它们涉及皮肤--但如果癌症扩散到乳房外的远处器官,就被认为是4期。尽管她的乳房X光检查结果为阴性,诊断炎症性乳腺癌的唯一方法是通过活检。9XC世界播


"When I found out, my heart literally dropped," she said. "I didn't know what to do; I didn't know how to wrap my head around it. I just felt like my world was crashing down." She had recently started a new job that she ended up having to quit because she was missing days of work. Her doctors urged her to act fast, so she ended up undergoing chemotherapy, during which she had a horrible allergic reaction; her veins turned black, she broke out in hives, and she couldn't breathe. Francis was ready to give up treatment, but with the encouragement of her friends and family, she decided to keep going. She had a double mastectomy — although the cancer was only in one breast, there was a five percent chance it could return in the other breast — immediate reconstructive surgery, and radiation. 9XC世界播

“当我发现的时候,我的心真的掉了下来,”她说。“我不知道该怎么办;我不知道该怎么想。我只是觉得我的世界正在崩溃。”她最近开始了一份新工作,最后不得不辞职,因为她错过了几天的工作。她的医生敦促她迅速采取行动,所以她最终接受了化疗,在此期间她出现了可怕的过敏反应;她的静脉变黑了,她爆发了麻疹,她无法呼吸。弗朗西斯准备放弃治疗,但在朋友和家人的鼓励下,她决定继续下去。她接受了双侧乳房切除术-虽然癌症只在一个乳房发生,但在另一个乳房有5%的可能性复发-立即进行重建手术,并进行放射治疗。9XC世界播


Three years after her diagnosis, Francis is cancer-free. She's the youngest of three siblings, so her immediate family, including her mom, need to get screened for cancer now, too. Francis still has to see her radiation oncologist and breast specialist and get regular screenings, and her goal is to finish her master's degree and pursue a career in mental health counseling. "I know that I'm going to come across people who have been diagnosed with breast cancer, or who are going through any type of diagnosis in life, and I want to be able to motivate them and give them words of encouragement to keep them pushing and allowing them to know that everything is going to be OK," she said. "Don't let anything break you; it can either make you or break you." 9XC世界播

在她被诊断出癌症三年后,弗朗西斯已经没有癌症了。她是三个兄弟姐妹中最小的,所以她的直系亲属,包括她的母亲,现在也需要接受癌症筛查。弗朗西斯仍然要去看她的放射肿瘤学家和乳房专家,并定期接受筛查,她的目标是完成硕士学位,从事心理健康咨询工作。她说:“我知道我会遇到那些被诊断出患有乳腺癌或正在经历生活中任何类型的诊断的人,我希望能够激励他们,给他们鼓励的话,让他们继续努力,让他们知道一切都会好起来的。”她说:“我知道我会遇到那些被诊断出患有乳腺癌或正在经历任何类型的诊断的人,我希望能够激励他们,给他们鼓励的话,让他们知道一切都会好起来的。”“不要让任何事情毁了你,它可以成就你,也可以毁了你。”9XC世界播


Francis's resilience is inspiring, and it's a common thread I noticed in the women I talked to for this article. Although Francis was diagnosed at stage 3, it's not uncommon for women under 40 to be diagnosed with metastatic breast cancer — or stage 4 — where the cancer has spread to other parts of your body: lymph nodes, liver, brain, or bones, for example. Doctors may not immediately think a patient has breast cancer if they are younger than 40 since it's so rare, like in Francis's case, and the cancer may go undiagnosed and progress to later stages. 9XC世界播

弗朗西斯的韧性令人振奋,这也是我在本文采访过的女性身上的一条共同主线。虽然弗朗西斯是在第3期被诊断出来的,但对于40岁以下的女性来说,被诊断出患有转移性乳腺癌-或第4期-癌症已经扩散到你身体的其他部位:例如淋巴结、肝脏、大脑或骨骼,这并不少见。如果患者年龄在40岁以下,医生可能不会立即认为他们患有乳腺癌,因为这种情况非常罕见,就像弗朗西斯的情况一样,而且癌症可能会被漏诊并进展到后期。9XC世界播


Morgan Mitchell, now 31, who is a senior account executive at an advertising technology firm, was diagnosed with breast cancer in 2017 when she was 28. She had dense breast tissue, so she had always known that a self-exam wasn't sufficient. "Ever since I was maybe 10 or 12 when I would go to the doctor, she would tell me, 'You have really dense breast tissue. If you dig around, you're going to think that you're sick and you're not,'" Mitchell told POPSUGAR. She instead relied on the breast exams her doctor would conduct every year during an annual visit. However, during a trip to Yosemite with her now-husband, Bob O'Dell, Mitchell noticed a walnut-size lump in her left breast one morning. It alarmed her, but she decided to enjoy the day hiking and scenery; in fact, O'Dell proposed to her that day. They were excited and celebrated their engagement, but Mitchell, still concerned about the lump, scheduled an appointment with a specialist she could see as soon as she returned to New York City. 9XC世界播

现年31岁的摩根·米切尔(Morgan Mitchell)是一家广告技术公司的高级客户主管,她在2017年28岁时被诊断出患有乳腺癌。她有致密的乳房组织,所以她一直知道自我检查是不够的。米切尔在接受POPSUGAR采访时表示:“自从我10或12岁去看医生时,她就会告诉我,‘你的乳房组织真的很致密。如果你四处挖掘,你会认为自己生病了,但实际上并没有病。’”取而代之的是,她依赖于她的医生每年在年度访问期间进行的乳房检查。然而,一天早上,米切尔和她现在的丈夫鲍勃·奥戴尔去约塞米蒂旅行时,注意到她的左乳房有一个核桃大小的肿块。这让她感到震惊,但她决定享受这一天的徒步旅行和风景;事实上,奥戴尔那天就向她求婚了。他们很兴奋,庆祝订婚,但米切尔仍然担心肿块,她一回到纽约市就安排了一个她可以去看的专家的预约。9XC世界播


After an initial exam, doctors told Mitchell the lump could be cancer, so they conducted more rigorous testing: a mammogram, sonogram, and more in-depth core biopsies. They found that not only did she have cancer, but it had also spread to her lymph nodes. It's protocol that once cancer is found in lymph nodes, the patient is ordered to get a PET scan. After this scan, Mitchell was diagnosed with stage 4 — the breast cancer had metastasized to her liver. "That week felt like a year in itself," she said, noting that the speed with which she was tested and diagnosed is rare for breast cancer patients since she had a close friend who worked in healthcare. For some, it can take weeks or longer. 9XC世界播

在初步检查后,医生告诉米切尔肿块可能是癌症,所以他们进行了更严格的测试:乳房X光检查、超声波检查和更深入的核心活组织检查。他们发现她不仅得了癌症,而且还扩散到了淋巴结。按照规定,一旦在淋巴结中发现癌症,就会命令患者接受PET扫描。在这次扫描后,米切尔被诊断为4期-乳腺癌已经转移到她的肝脏。“那一周感觉就像是一年,”她说,并指出,她被检测和诊断的速度对于乳腺癌患者来说是罕见的,因为她有一个在医疗保健领域工作的密友。对于一些人来说,这可能需要几周或更长时间。9XC世界播


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Like Francis, Mitchell didn't know of a family history of breast cancer. However, after she was diagnosed, her immediate family did genetic testing, and they found out her dad has the BRCA gene. In fact, she learned of a great aunt on her dad's side who died from breast cancer before menopause. As far as other risk factors, Mitchell was active and ate a healthy diet; she ran the New York City Marathon three weeks before she got her diagnosis. 9XC世界播

和弗朗西斯一样,米切尔也不知道乳腺癌的家族史。然而,在她被确诊后,她的直系亲属做了基因测试,他们发现她的父亲有BRCA基因。事实上,她了解到她父亲身边的一位姑姑在绝经前死于乳腺癌。至于其他危险因素,米切尔很活跃,饮食健康;她在得到诊断前三周跑了纽约市马拉松。9XC世界播


Lauren Hufnal, who is an agency development director at Microsoft, had a similar experience. She was diagnosed in 2013 at age 38. She noticed a lump in her breast when she was breastfeeding her son (he is her first and only child), and doctors initially dismissed it as a clogged milk duct — not uncommon with breastfeeding. After six months with no improvement in symptoms, Hufnal saw a breast specialist and got a number of tests done, including a mammogram, sonogram, and biopsy. She was initially diagnosed at stage 2, which means the cancer is growing but still contained in the breast or only extended to nearby lymph nodes. But after a second opinion at another hospital, she got a proper diagnosis: stage 4. The cancer had spread to her bones. 9XC世界播

微软代理开发总监劳伦·赫夫纳尔(Lauren Hufonal)也有类似的经历。她在2013年38岁时被确诊。她在母乳喂养儿子(他是她的第一个也是唯一的孩子)时注意到她的乳房里有一个肿块,医生最初认为这是乳管堵塞-这在母乳喂养中并不少见。在症状没有改善的六个月后,赫夫纳尔去看了一位乳房专家,并做了一系列检查,包括乳房X光检查、超声波检查和活检。她最初被诊断为2期,这意味着癌症正在生长,但仍在乳房内,或者只扩散到附近的淋巴结。但在另一家医院接受第二次诊断后,她得到了正确的诊断:4期。癌症已经扩散到她的骨骼。9XC世界播


After going through chemotherapy, Hufnal had a relapse in 2019 and had a partial mastectomy. And like Mitchell and Francis, she had no family history of breast cancer. "No cancer in my family whatsoever," she told POPSUGAR. "I did all the genetic testing postdiagnosis; no BRCA2, no nothing." Hufnal also lived an active, healthy lifestyle. "[Cancer] wasn't even on my radar," she said. "I was like, 'I'm totally healthy. I eat kale salads every day.'" 9XC世界播

经过化疗后,赫夫纳尔在2019年复发,做了乳房部分切除术。和米切尔和弗朗西斯一样,她没有乳腺癌家族史。“我们家没有癌症,”她告诉POPSUGAR。“诊断后的所有基因检测都是我做的;没有BRCA2,什么都没有。”赫夫纳也过着积极健康的生活方式。“(癌症)甚至没有在我的雷达上,”她说。“我当时的感觉是,‘我非常健康。我每天都吃甘蓝沙拉。’”9XC世界播


Since she has estrogen-positive, HER2-positive metastatic breast cancer, Mitchell's treatments are different from someone who is diagnosed at an earlier stage. Unlike stages 1-3, there is no cure for stage 4 breast cancer; Mitchell and Hufnal will be getting treatments for the rest of their lives. Mitchell is treated with KADCYLA every three weeks, which is a targeted chemo infusion to treat the HER2 mutation in her liver. She also gets a monthly hormonal injection and has doctor appointments every three weeks. Hufnal, who has estrogen- and progesterone-positive breast cancer, is on a maintenance mode of treatment that consists of multiple daily oral medication, monthly bone cancer injection, monthly hormonal injection, and ongoing blood work and scans. She said she will be on this course of treatment for as long as it keeps working. According to the American Cancer Society, the five-year survival rate after diagnosis for people who have breast cancer that spreads to other parts of the body is 27 percent. 9XC世界播

由于她患有雌激素阳性,HER2阳性的转移性乳腺癌,米切尔的治疗与早期诊断的人不同。与1-3期不同,4期乳腺癌无法治愈;米切尔和赫夫纳将在他们的余生中接受治疗。米切尔每三周接受一次Kadcyla治疗,这是一种有针对性的化疗输液,用于治疗她肝脏中的HER2突变。她还每月注射一次荷尔蒙,每三周预约一次医生。赫夫纳尔患有雌激素和孕激素阳性的乳腺癌,他正在接受维持治疗模式,包括每天多次口服药物,每月注射骨癌,每月注射激素,以及持续的血液检查和扫描。她说,只要这个疗程继续起作用,她就会一直接受这个疗程。根据美国癌症协会(American Cancer Society)的数据,患有扩散到身体其他部位的乳腺癌的人在确诊后的五年存活率为27%。9XC世界播


"With metastatic breast cancer, my oncology team urged me to think of my treatment in this analogy: you want each chapter, or treatment type, to be very long," Mitchell said. "Breast cancer is no longer the death sentence it used to be. I am very fortunate to have some receptors in my cancer be positive so we can target them." 9XC世界播

米切尔说:“对于转移性乳腺癌,我的肿瘤学团队敦促我用这个类比来考虑我的治疗:你希望每个章节或治疗类型都非常长。”“乳腺癌不再是过去的死刑判决了。我非常幸运,我的癌症中有一些受体呈阳性,这样我们就可以针对它们了。”9XC世界播


"The goals of stage 4 are to extend survival, if possible, and palliate symptoms that might arise from the cancer growing, and provide the best quality of life," explained Paula Klein, MD, medical breast oncologist at Mount Sinai Health System, who is Mitchell's oncologist. For Mitchell and Hufnal, that means having a team of doctors who will support them and make them feel cared for for the long haul. "You're going to be with these people for forever," Hufnal said. "So you've got to like them. You've got to have a good team in place." 9XC世界播

“第四阶段的目标是如果可能的话,延长生存期,缓解癌症增长可能出现的症状,并提供最好的生活质量,”西奈山健康系统的医学乳腺肿瘤学家、米切尔的肿瘤学家Paula Klein解释说。对于米切尔和赫夫纳来说,这意味着有一支医生团队将支持他们,让他们感到长期受到照顾。“你将永远和这些人在一起,”赫夫纳尔说。“所以你必须喜欢他们。你必须有一支优秀的团队。”9XC世界播


One important decision young people who are diagnosed with breast cancer have to make is how they want to proceed with possible fertility treatments in the hopes of having kids down the road, whether that's because their estrogen production needs to be shut down or their ovaries removed to treat estrogen-positive cancer, or how their treatments will affect their fertility and delay their ability to conceive. "Premenopausal women diagnosed with breast cancer should have a discussion about fertility . . . and be offered a referral to a fertility specialist," Dr. Klein explained. This could mean freezing your eggs, if you're single, or freezing an embryo with your partner. 9XC世界播

被诊断患有乳腺癌的年轻人必须做出的一个重要决定是,他们希望如何继续进行可能的生育治疗,以期将来有孩子,无论是因为他们的雌激素分泌需要停止,还是因为他们的卵巢被切除以治疗雌激素阳性的癌症,或者他们的治疗将如何影响他们的生育能力和推迟他们的受孕能力。克莱因博士解释说:“被诊断患有乳腺癌的绝经前妇女应该就生育问题进行讨论……并被推荐到生育专家那里。”如果你是单身,这可能意味着冷冻你的卵子,或者和你的伴侣冷冻一个胚胎。9XC世界播


Dr. Comen added that there are lots of tools and techniques to help patients who want to explore fertility — "I've had lots of babies in my practice," she said — but the key is not to delay. When Mitchell was diagnosed, she was told she had about a two-week window to go through with fertility before she began her cancer treatment plan. This entailed getting a dose of Letrozole to keep her estrogen production at bay since she had estrogen-positive cancer, but to maintain a level where she could go through with an egg retrieval. After two weeks of fertility treatments, Mitchell got her eggs retrieved — not many since her estrogen levels were so low, but a few — and started her cancer treatments that same day with a hormone therapy to rid her body of estrogen. Although Mitchell won't be able to carry an embryo, the hope is to have a gestational carrier carry a baby for her and her husband. 9XC世界播

科门博士补充说,有很多工具和技术可以帮助那些想要探索生育能力的患者--“我在实践中生过很多孩子,”她说--但关键是不要拖延。当米切尔被诊断出来时,她被告知在开始癌症治疗计划之前,她有大约两周的时间进行生育。这需要服用一剂来曲唑,以控制她的雌激素产生,因为她患有雌激素阳性癌症,但要保持一个水平,使她可以完成取卵。经过两周的生育治疗,米切尔取回了她的卵子-不是很多,因为她的雌激素水平很低,但很少-并在同一天开始了她的癌症治疗,使用了一种激素疗法,以清除体内的雌激素。虽然米切尔不能携带胚胎,但希望有一个怀孕的携带者为她和她的丈夫怀上孩子。9XC世界播


What people might misunderstand about metastatic patients, Mitchell and Hufnal both emphasized, is that you can't necessarily physically see that someone is going through cancer treatment. For earlier stages, when chemotherapy and radiation are administered, people may lose their hair or eyelashes. They may have a course of treatment for a few years and eventually be cancer-free. 9XC世界播

米切尔和赫夫纳尔都强调,人们对转移性患者可能会误解的是,你不一定能从身体上看到某人正在接受癌症治疗。在早期阶段,当进行化疗和放射治疗时,人们可能会掉头发或睫毛。他们可能会有几年的疗程,最终不会患癌症。9XC世界播


"When you're walking around [with] stage four, you just look totally normal," Hufnal said. "It's not that I want people to handle me with kid gloves, but I think that people just don't realize that we're still going through it and we'll never be like, 'OK, totally fine. On to the next phase of my life.'" She added that even the distinction with the language around those living with metastatic is different from other cancer patients who may have been diagnosed at earlier stages and be cancer-free. "We're technically not survivors; we're thrivers," Hufnal explained, adding that she's not offended if someone messes up the terminology ("it's just semantics," she said). 9XC世界播

“当你带着第四阶段走来走去时,你看起来完全正常,”赫夫纳尔说。“这并不是说我希望人们小心谨慎地对待我,但我认为,人们只是没有意识到我们仍在经历,我们永远不会说,‘好的,完全好。进入我人生的下一个阶段。’”她补充说,即使与转移性癌症患者周围的语言不同,也不同于其他癌症患者,这些患者可能在早期被诊断出来,并且没有癌症。“从技术上讲,我们不是幸存者;我们是欣欣向荣的人,”赫夫纳解释说,并补充说,如果有人弄乱了术语,她并不生气(“这只是语义,”她说)。9XC世界播


Especially if you don't "look" sick, Mitchell said part of helping people understand what it's like to live with breast cancer is to be honest. "Your bosses, your coworkers, everybody in your life does not know what you're going through, and so helping them help you is probably one of the biggest things I'd recommend," she said. "I need to do a better job, for example, of being like, 'I need to slow down.'" 9XC世界播

特别是如果你不“看起来”生病,米切尔说,帮助人们理解与乳腺癌生活在一起是什么感觉的一部分就是诚实。“你的老板,你的同事,你生活中的每个人都不知道你正在经历什么,所以帮助他们帮助你可能是我推荐的最重要的事情之一,”她说。“我需要做得更好,比如,‘我需要放慢脚步。’”9XC世界播


"That's the hard part," she continued. "You want the opportunity to excel at work, because to be quite candid, you have better perspective. You probably will fight harder than anybody else because you're currently battling something else, which I think is why [Hufnal] and I do excel at work." 9XC世界播

“这是最难的部分,”她继续说。“你想要在工作中出类拔萃的机会,因为坦率地说,你有更好的视角。你可能会比其他任何人更努力地奋斗,因为你目前在与其他事情斗争,我认为这就是(赫夫纳)和我在工作中表现出色的原因。”9XC世界播


Hufnal and Mitchell both said that while living with metastatic breast cancer is indeed stressful, they want to be treated like normal people. Sometimes that means being honest with your friends and letting them know you just want an opportunity to hang out and not think about cancer. "Can we go to brunch and can I hear about your sh*tty date you went on last night?" Mitchell said. "Because I don't want to talk about me." 9XC世界播

赫夫纳尔和米切尔都表示,虽然与转移性乳腺癌生活在一起确实有压力,但他们希望得到正常人的待遇。有时,这意味着要对你的朋友诚实,让他们知道你只是想有机会出去玩,而不是去想癌症。“我们能去吃早午餐吗?我能听听你昨晚约会的情况吗?”米切尔说。“因为我不想谈论我自己。”9XC世界播


I told Mitchell that as someone who has been friends with her for more than eight years — she was one of the first friends I made when I moved to New York City — I want her to know that I am always thinking about her, care about her, and want to check in and see how she's doing. But I also don't want every time we talk or hang out to be talking about cancer; I want to be a distraction and treat her like any other of my friends. "We're human, too," Mitchell said. "We want to b*tch about normal things, too, and not just talk about cancer." She added that she doesn't want to "feel like an old sick person," so having that sense of normalcy is key. 9XC世界播

我告诉米切尔,作为一个和她交了八年多朋友的人-她是我搬到纽约市时结识的第一批朋友之一-我想让她知道,我一直在想她,关心她,想看看她过得怎么样。但我也不希望我们每次谈话或闲逛时都在谈论癌症;我想分散注意力,像对待我的其他朋友一样对待她。“我们也是人,”米切尔说。“我们也想谈论正常的事情,而不仅仅是癌症。”她补充说,她不想“感觉像一个年迈的病人”,所以拥有那种正常感是关键。9XC世界播


Hufnal said she had friends who would be hesitant to bring up what was going on in their lives. "Eventually, something would come up, and I was like, 'Oh my god, why didn't you tell me?' They said, 'Well, I didn't want to worry you,' or 'What you're going through is so much more serious,' and I was like, 'Oh my gosh, I'm still here for you.'" 9XC世界播

赫夫纳说,她的朋友们会犹豫是否要提起他们生活中发生的事情。“最终,事情会发生,我会说,‘天哪,你为什么不告诉我?’他们说,‘嗯,我不想让你担心,’或者‘你正在经历的事情要严重得多’,我说,‘哦,天哪,我还在这里等你。’”9XC世界播


Because Mitchell, Hufnal, and Francis fall into the rare category of cancer patients diagnosed younger than 40, Hufnal said it was hard after she was first diagnosed when she'd attend meetups of cancer patients and was often not only the youngest but also one of the only people with stage 4. One of the biggest things that helped them was finding other people they could relate to who were battling cancer in similar stages of their lives. All three are members of 5 Under 40, a nonprofit organization that provides funded medical, wellness, beauty, and educational services to women who have been diagnosed with breast cancer under the age of 40 or who have the BRCA gene mutation. 9XC世界播

由于米切尔、赫夫纳和弗朗西斯属于罕见的40岁以下确诊的癌症患者,赫夫纳说,她在参加癌症患者聚会时第一次被诊断出来很困难,而且通常不仅是最年轻的,也是唯一的4期患者之一。帮助他们找到其他可以与癌症作斗争的人是他们生命中最大的一件事。这三人都是5 Under 40的成员,这是一个非营利性组织,为40岁以下被诊断患有乳腺癌或携带BRCA基因突变的女性提供资助的医疗、健康、美容和教育服务。9XC世界播


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Breast cancer survivor Jennifer Finkelstein founded 5 Under 40 in 2011. She was diagnosed with stage 2 breast cancer in 2005 at age 32, just weeks before her wedding. The organization was born out of a need to connect with other young breast cancer patients and get accurate, targeted information and resources for those who are diagnosed so young. Luckily, she was marrying a doctor and is the daughter of a world-renowned gastroenterologist, so she was able to get connected with oncologists and specialists, but she still felt alone since most breast cancer patients are older. 9XC世界播

乳腺癌幸存者詹妮弗·芬克尔斯坦(Jennifer Finkelstein)于2011年创立了5 Under 40。2005年,32岁的她在婚礼前几周被诊断出患有第二期乳腺癌。该组织诞生于与其他年轻乳腺癌患者联系的需要,并为那些被诊断为如此年轻的人获得准确、有针对性的信息和资源。幸运的是,她嫁给了一位医生,是一位世界知名的胃肠病专家的女儿,所以她能够与肿瘤学家和专家取得联系,但由于大多数乳腺癌患者年龄较大,她仍然感到孤独。9XC世界播


She was eventually introduced to another young woman who had also been diagnosed at age 32. "She literally held me by the hand and told me everything to expect," Finkelstein said. "We both were stage 2. We had the same doctors. In the weeks leading up to meeting her, I had never known anyone who had been on the other side, let alone anyone young." After her diagnosis, Finkelstein realized there was a need for other young women who are diagnosed with breast cancer to connect with each other and get information, tools, and services to manage their diagnosis. 9XC世界播

她最终被介绍给另一名年轻女子,这名女子也是在32岁时被诊断出来的。芬克尔斯坦说:“她真的牵着我的手,告诉了我一切可以期待的事情。”“我们都是第二阶段。我们有相同的医生。在见到她之前的几周里,我从来没有认识过任何在另一边的人,更不用说任何年轻的人了。”在确诊后,芬克尔斯坦意识到,其他被诊断患有乳腺癌的年轻女性需要相互联系,获得信息、工具和服务来管理她们的诊断。9XC世界播


In 2012, 5 Under 40 received 501(c)(3) status, and in 2013, it began extending funded medical, beauty, and wellness services to women in the New York and New Jersey areas. Finkelstein knew the alarming statistic that one in eight women will face breast cancer in their lifetime, and the name came after Finkelstein saw a Chinese acupuncturist after her diagnosis who taught her that five elements — wood, fire, Earth, metal, and water — show how our internal organs, systems, and structures are categorized and connected. Eight times five is 40; "it was a 'boom' moment," she said of naming the organization. Five is also a common theme in 5 Under 40's services. 9XC世界播

2012年,40岁以下的5人获得了501(C)(3)身份,2013年,它开始向纽约和新泽西地区的女性提供资助的医疗、美容和健康服务。芬克尔斯坦知道一个令人震惊的统计数据,即每八名女性中就有一人会在一生中面临乳腺癌,这个名字是在芬克尔斯坦确诊后看过一位中国针灸师后得出的,这位针灸师告诉她,五种元素-木、火、土、金属和水-表明了我们的内脏、系统和结构是如何分类和联系的。8乘以5等于40;“这是一个‘繁荣’的时刻,”她在提到该组织的名字时说。在40岁以下的5岁以下服务中,5岁也是一个共同的主题。9XC世界播


"The organization has identified five issues that make breast cancer under 40 a significant emotional and physical challenge," she explained. "Looking at managing career growth, dating, fertility, financial hardships, and this harrowing sense of isolation, which is really what I suffered from." They help young women navigate the nuances of what it means to live with such a life-altering diagnosis, such as how to navigate their career and what to tell their employers and how to fill out health insurance claims and paperwork. 9XC世界播

“该组织已经确定了五个问题,使40岁以下的乳腺癌成为一个重大的情感和身体挑战,”她解释说。“看着如何管理职业发展、约会、生育、经济困难,以及这种令人痛苦的孤立感,这真的是我所遭受的痛苦。”它们帮助年轻女性驾驭与这样一种改变人生的诊断一起生活意味着什么的细微差别,比如如何驾驭自己的职业生涯,告诉雇主什么,以及如何填写医疗保险索赔和文书工作。9XC世界播


5 Under 40 funds each patient for one year — for metastatic patients like Mitchell, it's for a lifetime — and Finkelstein said each patient individually receives "thousands of dollars" in funding. And while the organization doesn't offer its members medical advice, it has a medical advisory board consisting of top experts specializing in reproduction, endocrinology, genetics, oncology, and breast surgery. They help patients get mental health counseling, get fitted for and purchase human-hair wigs if they've lost their hair, get set up with a medical tattoo artist, and utilize wellness services including personal training sessions and nutritional counseling — and those are just a few of the dozens of services 5 Under 40 provides. While many other breast cancer charities are focused on research, which Finkelstein notes is important, "we serve real women in real time," she said. "I will never knock research . . . this is different. Research is later; 5 Under 40 is now." In addition to all the funded services, 5 Under 40 hosts meetups so young women can connect with each other and have a sense of community. 9XC世界播

40岁以下的5名患者资助每位患者一年-对于像米切尔这样的转移性患者来说,这是终生的-芬克尔斯坦说,每个患者个人都会得到“数千美元”的资助。虽然该组织不向其成员提供医疗建议,但它有一个医疗顾问委员会,由生殖、内分泌学、遗传学、肿瘤学和乳房外科方面的顶级专家组成。他们帮助患者接受心理健康咨询,如果他们脱发了,他们可以试戴和购买人发假发,与医学纹身师建立联系,并利用包括个人培训课程和营养咨询在内的健康服务-这些只是40岁以下的5岁以下患者提供的数十项服务中的一小部分。她说,虽然许多其他乳腺癌慈善机构都专注于研究,芬克尔斯坦指出这一点很重要,但“我们实时为真实的女性提供服务。”“我永远不会抨击研究……这是不同的。研究是后来的;现在是40岁以下的5岁以下。”除了所有资助的服务外,5 Under 40举办聚会,让年轻女性能够相互联系,并有社区意识。9XC世界播


As of publication of this article, 5 Under 40 now serves 605 funded recipients. As soon as 5 Under 40 gets a referral, whether that's from a teaching institute, word of mouth, or the contact form on its website, the operations manager refers the person to the peer match team for a vetting appointment. They ask patients to fill out a short application and get a sign-off from their doctor. 9XC世界播

截至本文发表时,“40岁以下的5人”现已为605名受资助的受助人提供服务。一旦40岁以下的5岁以下的人得到推荐,无论是来自教学机构、口碑还是其网站上的联系人表格,运营经理就会将此人推荐给同行比赛团队进行审查。他们要求患者填写一份简短的申请表,并得到医生的签字。9XC世界播


Since we are in the midst of the COVID-19 pandemic, large gatherings aren't a possibility. However, 5 Under 40 is still extending virtual services to members, such as mental health sessions, nutritional counseling, breathwork, yoga classes, and makeup tutorials. It is also hosting virtual meetups, which Finkelstein said women from all over the US age 18-39 are welcome to join. If you're not a member, DM 5 Under 40 on Instagram (@5Under40) for more information. On Oct. 28, it is hosting a virtual metastatic meetup with one of its mental health experts, and on Oct. 29, it's hosting a virtual panel titled "Dealing With Uncertainty, Breast Cancer Thrivers Advice," moderated by Mitchell and featuring a panel of prominent survivors and thrivers, including Hufnal. 9XC世界播

由于我们正处于新冠肺炎大流行之中,不可能举行大型聚会。然而,40岁以下的5人仍在向会员提供虚拟服务,如心理健康会议、营养咨询、呼吸、瑜伽课和化妆教程。它还举办虚拟聚会,芬克尔斯坦表示,欢迎来自美国各地18-39岁的女性参加。如果您不是会员,请访问Instagram上的DM 5 Under40(@5Under40)了解更多信息。10月28日,它将与其一名精神健康专家举办一场虚拟的转移性会议,10月29日,它将主持一个名为“应对不确定性,乳腺癌特里弗斯建议”的虚拟小组讨论,由米切尔主持,包括赫夫纳尔在内的知名幸存者和成功者组成的小组讨论。9XC世界播


Finkelstein said the organization is aiming to resume in-person meetups in Q3 of 2021. In the meantime, while adhering to COVID-19 safety protocols such as wearing a mask and social distancing, 5 Under 40 has been able to facilitate in-person services to a few women over the last few months including getting fitted for wigs and accompanying them to get 3D nipple tattoos. 9XC世界播

芬克尔斯坦说,该组织的目标是在2021年第三季度恢复面对面的会面。与此同时,在遵守新冠肺炎的安全协议(如戴口罩和社交距离)的同时,在过去的几个月里,40岁以下的5岁以下女性已经能够为一些女性提供面对面的服务,包括为她们试戴假发,并陪同她们进行3D乳头纹身。9XC世界播


For more information, follow 5 Under 40 on Instagram (@5Under40), and if you are interested in donating, please visit 5under40.org/pay-it-forward. 9XC世界播

欲了解更多信息,请在Instagram上关注5 Under40(@5Under40),如果您有兴趣捐款,请访问5Under40.org/payit-forward。9XC世界播


Although getting diagnosed with breast cancer under the age of 40 is relatively rare, it is still a possibility. And while there are certain risk factors for breast cancer, sometimes a diagnosis is inevitable, even if you live a healthy lifestyle and don't have a family history of cancer. 9XC世界播

虽然40岁以下被诊断出患有乳腺癌的情况相对较少,但仍有可能。虽然乳腺癌有一定的风险因素,但有时诊断是不可避免的,即使你过着健康的生活方式,没有癌症家族史。9XC世界播


If fertility is something you're concerned about, Dr. Comen advises patients to have that conversation with their doctor as soon as possible, especially since some doctors might rush patients to treatment without first discussing fertility. And while 5 Under 40 is a unique organization providing fully funded medical, wellness, beauty, and educational services for breast cancer patients, there are other organizations that host meetups and retreats, like Breasties and other local services you can find through cancer.org. If you don't live near a big city, there are online resources available. 9XC世界播

如果你担心的是生育问题,科门医生建议患者尽快与医生进行对话,特别是考虑到一些医生可能会在没有事先讨论生育问题的情况下催促患者接受治疗。虽然5 Under 40是一个为乳腺癌患者提供全额资助的医疗、健康、美容和教育服务的独特组织,但也有其他组织举办聚会和务虚会,比如胸罩和其他你可以通过ancer.org找到的当地服务。如果你不住在大城市附近,有在线资源可用。9XC世界播


All the patients I spoke to said it's important to advocate for your own health and stay in tune with your body, especially if you feel like something is wrong — sometimes a second or third opinion is necessary. To mitigate your risk, it's important to know your family history on both sides and request a mammogram if you fall into the at-risk category. Dr. Comen also emphasized that breast self-exams are important, and starting at age 20, you should do them once a month around your period. It will help you get familiar with what your breasts look and feel like so you can notice any changes; she suggests showing your ob-gyn how you do your self-exam to make sure you're doing it properly, which entails feeling under your armpit and all the way up to your clavicle. 9XC世界播

我采访的所有患者都说,倡导自己的健康并与自己的身体保持协调是很重要的,特别是当你感觉有什么不对劲的时候-有时第二或第三种意见是必要的。为了降低你的风险,重要的是了解你双方的家族史,如果你属于高危类别,要求做乳房X光检查。科门博士还强调,乳房自我检查很重要,从20岁开始,你应该在月经前后每月做一次乳房自我检查。这将帮助你熟悉乳房的外观和手感,这样你就可以注意到任何变化;她建议向你的妇产科医生展示你是如何做自我检查的,以确保你做得正确,这需要感觉你的腋下,一直到你的锁骨。9XC世界播


Dr. Comen also wants patients to understand if they are diagnosed with breast cancer at a young age, they are not alone and have allies in the medical community. "We see you, we hear you, we feel for you, we bleed for you, and we want desperately to improve the treatment options and the screening techniques for you," she said, adding that there's a lot more research being done in younger people for finding new treatments and better detection techniques. "We're sensitive to the lifestyle issues and quality of life issues that may arise over time, whether it be fertility, sex life, body image, relationships, all of that goes into how we care for breast cancer patients." 9XC世界播

科门博士还希望患者明白,如果他们在很小的时候就被诊断出患有乳腺癌,他们并不孤单,而且在医学界有盟友。“我们看到你,我们听到你,我们同情你,我们为你流血,我们迫切希望为你改进治疗选择和筛查技术,”她说。她补充说,为了找到新的治疗方法和更好的检测技术,正在对年轻人进行更多的研究。“随着时间的推移,我们对可能出现的生活方式问题和生活质量问题很敏感,无论是生育、性生活、身体形象、人际关系,所有这些都与我们如何照顾乳腺癌患者有关。”9XC世界播


If you do get diagnosed with breast cancer, even stage 4, Hufnal wants people to know that even though "it sucks," you can still live a normal life. "I don't feel like I'm the same person I was before; I definitely am more tired, I'm definitely more worried," she said. "I was always an anxious person, so [I'm] a touch more worried. But I can still do everything that I want to do. I can still go play tennis. I still can have full-time job, which I'm successful in. I can still travel. This is not the path you want, but I think there are still things you can do and accomplish and live." 9XC世界播

如果你真的被诊断出患有乳腺癌,即使是第4期,赫夫纳也想让人们知道,即使“这很糟糕”,你仍然可以过上正常的生活。她说:“我感觉我已经不是以前的我了,我肯定更累了,我肯定更担心了。”“我一直是一个焦虑的人,所以(我)有点担心。但我仍然可以做我想做的一切。我仍然可以去打网球。我仍然可以有一份全职工作,这是我成功的。我仍然可以旅行。这不是你想要的道路,但我认为你仍然可以做一些事情,完成一些事情,生活下去。”9XC世界播


Francis also wants breast cancer patients to know that a diagnosis does not have to derail the rest of your life. "For the ones who do get diagnosed, I want them to know that cancer does not define who you are," she said. "Don't ever think that it's a stop sign in your life and it's going to hinder you forever." 9XC世界播

弗朗西斯还希望乳腺癌患者知道,诊断不一定会破坏你的余生。“对于那些确实被诊断出来的人,我想让他们知道,癌症并不能定义你是谁,”她说。“永远不要认为这是你生活中的一个停止标志,它会永远阻碍你。”9XC世界播

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