Young women's experience of breast cancer: defining young and identifying concerns

The diagnosis and treatment of breast cancer is a major life stress that is followed by significant psychological morbidity. For younger women, the physical and psychosocial morbidity associated with treatments may affect their ability to successfully function in social roles that typify this age group. Previous studies have shown that young women with breast cancer experience greater unmet needs, more unhappiness and more financial distress than older women (Mor et al., 1994; Schover, 1994; Stanton et al., 1998; Wang et al., 1999). However, the issue of how to best define ‘young’ as it refers to the experience of breast cancer, and the specific nature of young women’s needs and concerns require further investigation. A qualitative study of 23 women with breast cancer, with an age range of 31–47 years (Mean=37 years), including nine who had breast conservation, 13 a mastectomy, and one a bilateral mastectomy, was undertaken. Women were between 1 month and 7 years post-treatment. A multi-angulated method, including a literature review, two focus groups, four in-depth interviews and a three round iterative survey of the total group of women was employed. Outcomes of the study include a functional definition of ‘young’ as it relates to a breast cancer diagnosis. Importantly, this definition does not rely on chronological distinction. Key concerns experienced by young women with breast cancer are described, along with preferred interventions. Also, the potential negative impact on young women from health promotion messages targeting breast screening for women over 50 years is discussed. Finally, the unintended consequences of media portrayals relating to women with breast cancer, the Camellia effect, is described. Each year in Queensland, over 1617 women are diagnosed with breast cancer (Queensland Cancer Registry, 1998). For these women, the diagnosis and treatment of their breast cancer will be a major life stress, followed by a range of emotional, cognitive, social, physical and spiritual difficulties (Ferrell et al., 1997; Bloom et al., 1998; Dunn et al., 1998; Steginga et al., 1998). Of all women diagnosed with breast cancer, women who are younger may experience greater difficulties at this time (Schover, 1994; Stanton et al., 1998; Wang et al., 1999). In a comparison of women under the age of 55 with women over the age of 55 years, younger women were found to experience lower levels of emotional well-being, greater financial difficulties, more disruption to daily life from chemotherapy and more unmet needs in administration and child care compared with older women (Mor et al., 1994). Similarly, Bloom and Kessler (1994) found that being younger and having more children under the age of 21 years was predictive of women experiencing greater psychological morbidity after breast cancer treatment. In the present context, 29% of women diagnosed with breast cancer will be under 50 years (Queensland Cancer Registry, 1998). The greater difficulties experienced by this group of women suggest that supportive interventions will need to be tailored to their specific needs. There are a number of reasons why young women with breast cancer may experience increased psychosocial morbidity compared with * Correspondence to: Community Services, Queensland Cancer Fund, PO Box 201, Spring Hill 4004, Australia. Tel. : +617 3258 2261; fax: +617 3257 1306; e-mail: jdunn@qldcancer.com. au