For younger women diagnosed with breast cancer, there's a different set of issues

It all happened fast — a lump, a visit to a family doctor, a mammogram and needle biopsy. A breast cancer diagnosis on April 28, 2020, and a bilateral mastectomy three days later. 

"Everything happened very quickly after that. I went in for eight rounds of chemotherapy, 16 rounds of radiation and 18 rounds of hormone therapy," said Sarah O'Flanagan, 41, and a mother of two. 

Then 37-years-old, O'Flanagan had to go through surgery and other cancer treatments alone, because the region was in the grips of COVID-19 lockdowns. Now, she's sharing her experience so that other young women don't feel so alone, and to raise awareness this October, which is Breast Cancer Awareness Month. 

"It was very difficult. I'm lucky enough that my children's father has been extremely supportive and I also have a partner who's extremely supportive. But it's very difficult trying to parent young children — my kids were five and seven when I was diagnosed — because life is extremely busy and treatments just wreck you." 

The mental health impact of a cancer diagnosis is something that many people don't consider, O'Flanagan said. 

"Anxiety is intense because you don't know what's going to happen, and also depression because something awful and life-changing has happened to you, and it's very difficult to wrap your head around that," she said. 

Those diagnosed under the age of 50 are in the midst of financial responsibilities such as leases, mortgages, car loans, student loans and daycare costs, she added.

"We often have young children or other dependents and sometimes we're caring for elderly parents while we're trying to work and build a career. It is extremely expensive to be sick, even in Canada where we have universal health care. Most of us have to stop working during treatment.".

Financial and family stresses aren't unique to younger people with cancer, but need to be thought of differently, said Dr. Sarah Knowles, the medical director of the breast care program at St. Joseph's Health Care London. 

"It's a unique population in the sense of what is going on in their life at that time," Knowles said. "They have families or elderly parents, they're early in their career, potentially, so there are financial stresses. In addition to that, they have a lot of additional emotional stresses, especially if they do have young children." 

Knowles' youngest patients are in their 20s, which is rare. "We're seeing patients in their 30s and 40s as well." 

Conversations about mastectomies can be difficult, especially with younger patients, Knowles said. 

"There are different things to think about, including cosmetic outcomes, because that's really important, and I think we still need to value that despite everything the patient is going through," she said. "They want to have a good outcome, they want to feel good about their body, and to have a positive self-image." 

Family planning, and whether a woman may want to breast feed, can also be part of the discussion with surgeons, Knowles said.