Until recently, scientists believed that breast cancer was a thing for aging women. Several studies in the field have proved that women cannot get the cancer in before they hit midlife. In fact, breast cancer is widely included among the diseases associated with midlife crisis among women. But the case of Sylvia Mukazaire is just one among many recent developments in which young women are increasingly being diagnosed with breast cancer.
Mukazaire was diagnosed with breast cancer in June. According to Dr Leonard Kayonde, the director of cancer diseases at Rwanda Biomedical Centre, it is no longer a strange phenomenon for a young woman of 20 to be diagnosed with breast cancer. In an interview with Healthy Times, she pours her heart out. And it is a tale of suffering in the face of, first, the tragic moment in the country's history when her relatives were wiped out, and now the disease.
"Mukazaire's case started as a small swelling on her breast. It wasn't cancer, but it appears to have caused the cancer but it is only after subsequent tests that it was spotted. We planning to operate her and sure she will be okay," Dr Kayonde said.
Mukazaire's tale is that of a life's struggle. She can only trace the steps backwards to the 1994 Genocide against the Tutsi. She was 11 then.
"At 17 years, I got some pain in my right breast. The breast started swelling. I used painkillers and some pills and did not think it would come to this. To this day, I keep asking myself; 'why me?'
My mother was killed in the Genocide; I still remember that day when I was just 11 years old. But fate has failed to smile on me. With that tragedy, it [fate] just won't stop haunting me. Sometimes I wish she was here so I could talk to her because many times, I feel like no one really understands what I am passing through.
I'm on medication, which is ¬controlling it. The doctors are reassuring because they say many patients live longer with the disease while on drugs. But you know how it can be daunting. It's scary. The thought that you are living your life on borrowed time, that anytime you can actually die... it's that scary; I fear sleeping alone whenever the pain is intense.
However, I'm a happy-go-luck kind, feisty and carefree, which helps me a lot. I can wear a smile when with my friends or with people, joke around and have fun... I forget that I walk around with a shadow of death silhouetting my every step. I remember to thank God for what I'm, and for my auntie who has walked this journey with me. Although I miss my mother, I would never wish for another family because my aunt means the world to me.
My belief in God and the strength He grants me each day, keeps me going no matter what is thrown my way.
I think because I live with fear of death, living with this feeling that I'm not living long on this earth, makes me want to show those who cross my path how thankful I'm for each and every one of them. Some say I'm too friendly but I think it's a way of thanking God for the breath He gives me each day, seeing as I should never have celebrated 30 years.
I still remember that moment the medical team from Rwanda Biomedical Centre and the University Central Teaching Hospital Kigali told me about my status. It is fresh in my mind. One of my classmates said I would not make it past the age of 35 because of my condition. I responded that I would live many years because God would watch over me.
After that incident, there were many others at different stages of my life who said I would not get the same things as everyone else because I was not like everyone else.
But my guardians showed me otherwise. They never made me feel different while at home. I was not treated like everyone else and made to do as much house work as my siblings. Only that I was not allowed to dig at all.
I have to wear a sweater, big jackets so that I hide the big lump on my breast, even if it was searing hot.
Now that I think of it, this cancer has been eating into me for year. When I was at school, I used to have bouts of pain in my breast. Once in high school, I missed studies for a month as a result of having a terrible crisis, one of the worst I have had. I had wrenching pain in the chest. When I recovered, my legs were wobbly and I was not sure if I would walk properly again. I'm glad that I recovered and was able to sit my exams at Kigali Instituted of Education.
But I live in daily fear. Doctors said the medication can't cure me. I just live on hope."
What is breast cancer?
Breast cancer is cancer that starts in the tissues of the breast. There are two main types of breast cancer:
Ductal carcinoma starts in the ducts that move milk from the breast to the nipple. Most breast cancers are of this type.
Lobular carcinoma starts in the parts of the breast, called lobules, which produce milk.
In rare cases, breast cancer can start in other areas of the breast. Breast cancer can be invasive or noninvasive. Invasive means it has spread from the milk duct or lobule to other tissues in the breast. Noninvasive means it has not yet invaded other breast tissue. Noninvasive breast cancer is called 'in situ.'
Ductal carcinoma in situ or intraductal carcinoma, is breast cancer in the lining of the milk ducts that has not yet invaded nearby tissues. It may progress to invasive cancer if untreated.
Lobular carcinoma in situ is a marker for an increased risk of invasive cancer in the same or both breasts.
Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes the breast cancer tumor to grow. Such cancers have estrogen receptors on the surface of their cells. They are called estrogen receptor-positive cancer.
Some women have HER2-positive breast cancer. HER2 is a gene that helps cells grow and multiply. When cells have too many copies of this gene, they grow faster. In the past, women with HER2-positive breast cancer have a more aggressive disease. They have a higher risk that the disease will recur than in women without this type.
Breast cancer in young women:
Younger women generally do not consider themselves to be at risk for breast cancer. Only 5 per cent of all breast cancer cases occur in women under 40 years old. However, breast cancer can strike at any age, and all women should be aware of their personal risk factors for breast cancer.
What is different about breast cancer in younger women?
Diagnosing breast cancer in younger women (under 40 years old) is more difficult because their breast tissue is generally more dense than the breast tissue in older women. In addition, breast cancer in younger women may be aggressive and less likely to respond to treatment. Women who are diagnosed with breast cancer at a younger age are more likely to have altered BRCA1 or BRCA2 gene.
Delays in diagnosing breast cancer also are a problem. Many younger women who have breast cancer ignore the warning sign-such as a breast lump or unusual discharge -because they believe they are too young to get breast cancer. They assume that they are too young to get breast cancer and tend to assume that a lump is a harmless cyst or other growth. Some health care providers also dismiss breast lumps in young women as cysts and adopt a wait-and-see approach.
Breast cancer poses additional challenges for younger women as it can involve issues concerning sexuality, fertility, and pregnancy after breast cancer treatment.
Can breast cancer in younger women be prevented?
Although breast cancer might not be prevented, early detection and prompt treatment can significantly increase a woman's chances of surviving breast cancer. More than 90 per cent of women whose breast cancer is found in an early stage will survive.
When women learn at a young age about the risks and benefits of detecting breast cancer early, they are more likely to following the recommendations on clinical exams and mammograms (X-ray film of the soft tissue of the breast).
What's the best way for younger women to screen for breast cancer?
It is recommended that all women 20 years of age or older should perform monthly breast self-examinations (BSE). The best time to perform BSE is the day after your period ends. Becoming familiar with the look and feel of your breasts offers the best chance to notice any change. In addition to monthly BSE, annual clinical breast exams are also recommended.
Breast cancer fact file:
Over the course of a lifetime, 1 in 8 women will be diagnosed with breast cancer. Risk factors you cannot change include:
Age and gender
Your risk of developing breast cancer increases as you get older. Most advanced breast cancer cases are found in women over age 50. Men can also get breast cancer. But they are 100 times less likely than women to get breast cancer.
Family history of breast cancer
You may also have a higher risk of breast cancer if you have a close relative who has had breast, uterine, ovarian, or colon cancer. About 20 - 30% of women with breast cancer have a family history of the disease.
Some people have genetic mutations that make them more likely to develop breast cancer. The most common gene defects are found in the BRCA1 and BRCA2 genes. These genes normally produce proteins that protect you from cancer. If a parent passes you a defective gene, you have an increased risk of breast cancer. Women with one of these defects have up to an 80 per cent chance of getting breast cancer sometime during their life.
Women who got their periods early (before age 12) or went through menopause late (after age 55) have an increased risk of breast cancer.
Other risk factors include:
Drinking more than one to two glasses of alcohol a day may increase your risk of breast cancer.
Women who have never had children or who had them only after age 30 have an increased risk of breast cancer. Being pregnant more than once or becoming pregnant at an early age reduces your risk of breast cancer.
Women who took diethylstilbestrol (DES) to prevent miscarriage may have an increased risk of breast cancer after age 40. This drug was given to the women in the 1940s to 1960s.
Hormone replacement therapy (HRT)
You have a higher risk of breast cancer if you have received hormone replacement therapy with estrogen for several years or more.
Obesity has been linked to breast cancer, although this link is not completely understood. The theory is that obese women produce more estrogen. This can fuel the development of breast cancer.
If you received radiation therapy as a child or young adult to treat cancer of the chest area, you have a very high risk of developing breast cancer. The younger you started such radiation and the higher the dose, the higher your risk. This is especially true if the radiation was given during breast development.
Breast implants, using antiperspirants, and wearing underwire bras do not raise the risk of breast cancer. There is also no evidence of a direct link between breast cancer and pesticides.
Early breast cancer usually does not cause symptoms. This is why regular breast exams are important. As the cancer grows, symptoms may include:
Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt
Change in the size, shape, or feel of the breast or nipple, for example, you may have redness, dimpling, or puckering that looks like the skin of an orange.
Fluid coming from the nipple may be bloody, clear to yellow, green, and look like pus.
Men can get breast cancer, too. Symptoms include breast lump and breast pain and tenderness.
Symptoms of advanced breast cancer may include:
Breast pain or discomfort
Swelling of in the armpit (next to the breast with cancer)