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From early menopause to fertility uncertainty, young women with cancer lack support

Hilary Boswell was diagnosed with breast cancer just days ahead of her 40th birthday.

“I was in some of the best shape of my life. My body had never been more fit or looked better.”

Her cancer diagnosis would quickly change that. A unilateral mastectomy — a surgery she didn’t necessarily want but felt pressured into by her surgeon — would leave the Calgary woman with one breast. Add that to the hair loss from chemotherapy and other side effects from cancer treatment and Boswell says it felt like she was staring back at a stranger in the mirror.

“I definitely was in love with myself before,” she told Global News. “I don’t think I will ever look at myself the same or ever love what I see, like I did before.”

It’s a familiar story for the thousands of young Canadian women diagnosed with cancer each year. Treatments vary depending on the type of cancer, and each person has a different journey, but every diagnosis shares common themes for young women — lives and careers put on hold, disfiguring and long-lasting side effects from treatment, and snap decisions that need to be made around family planning and fertility.

Global News spoke with several young female cancer survivors and women working in Canada’s cancer community to find out more about the unique challenges that these young women face, and how the medical industry and cancer community are slowly adapting to accommodate a younger cohort of cancer patients as cancer diagnoses continue to rise in that age group.

The pressure of family planning

One of the biggest issues young women face upon receiving a cancer diagnosis is uncertainty about their fertility, says Katie Jacobs, director of clinical programming at Gilda’s Club Toronto, a cancer organization that provides support and workshops for cancer patients and their families.

“Young women, especially in their teens and 20s, might not actually be thinking about family planning yet, and then, all of a sudden, they’re being asked to make decisions about their fertility quite quickly, when they receive a cancer diagnosis,” she told Global News.

Many cancers are treated with chemotherapy, which can shut down the ovaries on a short-term or long-term basis, sending otherwise fertile young women into peri- or full-blown menopause. Doctors often can’t predict if or when a woman’s period will return or if she’ll one day be able to conceive, meaning many are tasked with making decisions around family planning and fertility preservation in as little as 24 hours.

Time is of the essence for many young women, who are asked whether they want to undergo egg retrieval before they start chemotherapy, or undergo surgery or radiation that could affect their reproductive organs.

“When people are diagnosed with cancer, they’re immediately put into a system where everything moves really fast. So, once you get a diagnosis, you’re having to make decisions about your care in a really fast way and you’ve got to wrap your head around the treatment plan,” said Thomas. “But then you’re also tasked with wrapping your head around decisions about fertility and it can be really intense and stressful, especially when you’ve never considered it much before.”

Dr. Kimberley Cullen, a Toronto-based clinical and health psychologist who works with young women affected by cancer, agrees, noting the amount of information thrust on cancer patients when they first enter the medical system can be overwhelming and they’re often not in a headspace to make so many decisions so quickly.

“A lot of patients, as well as medical providers, will share reports — particularly when the diagnosis is first given the focus — on treatment and preserving (the patient’s) life. But what can happen is that there is so much information coming at women that the issues (of fertility and menopause) are not necessarily top of mind, not because they’re not important, but because there are other, more pressing issues.”

The issue of early menopause

When the initial diagnosis dust settles, Cullen says that fallout from treatment-induced menopause is another one of the most-cited stressors she hears about from her clients.

“The problem with menopause among female cancer patients, which is induced primarily through chemotherapy, is that it’s pretty instant and it’s pretty quick and it’s…at a time where it is normally not expected to happen,” she said.

Despite being put into forced menopause — a phenomenon that oncologists are well-aware can happen — Cullen says many of her patients report not being properly educated on the short- and long-term side effects.

“(There can be) a change of sexual libido and interest, and pain and vaginal dryness,” she said, as well as symptoms “like fatigue and hair-loss and changes to their skin, difficulties concentrating. And this is a very drastic change for women to cope with after already having gone through cancer treatment.”

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