Melissa Rojas was a week away from her first wedding anniversary when she learned she had breast cancer. The 28-year-old nurse had no family history of the disease.
Jasmine Harris was 26 working as a health coordinator at a hospital when she felt a lump in her breast while taking a shower.
Joan Bauman was a 45-year-old mother of four running ultramarathons when a lump in her breast grew more painful.
All three were considered “too young” for breast cancer. Indeed, fewer than 5 percent of women under 40 are diagnosed yearly with breast cancer, according to the National Cancer Institute.
However, there will be more than 12,000 diagnoses of breast cancer in women under 40 this year, and more than 26,000 in women under 45, according to NCI.
The median age of a breast cancer diagnosis in U.S. women is 62, according to the Susan G. Komen Foundation, the organizer behind a recent Komen Miami/Fort Lauderdale More Than Pink Walk at Bayfront Park in downtown Miami.
Breast cancer in younger women tends to be a more aggressive cancer, researchers say, because it’s often diagnosed later, is farther along when found and insurance companies set minimum ages on mammograms, which can deter detection.
In addition, because the numbers are relatively small, some doctors don’t always jump to cancer as a conclusion in younger women. In fact, nearly 80 percent of young women diagnosed with breast cancer found their breast abnormality themselves, according to a 2009 Journal of Oncology study about breast cancer in younger women. As such, they may have to push their doctor to get a mammogram, ultrasound or biopsy.
Harris, the 26-year-old, initially brought her concerns to her gynecologist, who thought she had a cyst related to her menstrual cycle. He told her to come back after the cycle was over. She did and asked for an ultrasound, as the lump had not gone away.
The ultrasound showed a mass, which required a biopsy. The biopsy, performed in August 2015, came back positive.
“The doctor sat me down and just kept apologizing,” Harris said, referring to her radiologist’s reaction.
Harris went to Broward Health North in Deerfield Beach, Florida, for treatment of triple negative breast cancer. After four rounds of chemotherapy, her tumor was gone. She then had a double mastectomy followed by a month of radiation.
Three months later, she learned she was pregnant, a big surprise since she hadn’t frozen her eggs. (Chemo and radiation can render women infertile.) She gave birth to a healthy baby boy nine months later.
“Get tested no matter how old you are,” she says. “Just get tested.”
Rojas, the 28-year-old nurse, had a similar experience with her doctors.
She felt a lump during a self-examination in December 2012, and went to a breast cancer clinic to get it checked out. There, she was told she was too young for cancer. Rojas underwent a mammogram, which came back negative.
Six months later, after the lump grew larger and got more painful, she had a biopsy.
She was diagnosed with stage 3 invasive ductal carcinoma breast cancer, which had spread to her lymph nodes. She went to the Miami Cancer Institute at Baptist Health South Florida for treatment.
After a year of chemo, her tumor shrunk, she had surgery to remove some of her lymph nodes and began a month of radiation.
In September 2014 — six months after finishing her radiation treatments — she became pregnant. Although Rojas froze her eggs, a process that cost her $20,000 in out-of-pocket insurance costs, she had a natural pregnancy.
After her son was born, Rojas felt hardening along the scar tissue on her breast. Her doctor said it was normal for scar tissue to harden over time. She insisted on an ultrasound, which revealed a tumor attached to the scar tissue.
She underwent a double mastectomy in August 2016 and then went through eight rounds of chemotherapy. In May of 2018, a biopsy of a swollen lymph node revealed the cancer was back. She had 36 lymph nodes removed two months later.
“Why would I be checking my breast in my 20s?” said Rojas, who advocates for younger women to do self-exams and get tested.
“You either go into flight or fight mode,” she said. “I was going to fight.”
Rachel Greengrass, associate rabbi at Temple Beth Am in Pinecrest, learned that lesson early on.
She found a lump while breastfeeding her 2-year-old son. She was 32.
She saw her doctor, who suggested it was a cyst caused by hormonal changes after her pregnancy. She insisted on getting a mammogram, which led to a biopsy. In March 2013, she was diagnosed with triple positive breast cancer.
“As a rabbi, I had known so many women who had gone through cancer treatment,” she said. After six rounds of chemotherapy and a bilateral mastectomy, she has been cancer-free for five years.
Bauman, the marathon runner, also found skeptical doctors on her breast cancer journey.
She found a lump in her breast in 2015. After getting a mammogram, her doctors said it was nothing. A year later, another mammogram came back benign.
Two years later, in February 2018, a biopsy revealed she had stage 2 breast cancer.
Her doctor was in disbelief, saying he couldn’t believe that someone who ran marathons and was relatively young — she was diagnosed when she was 45 — could have breast cancer.
“People say you are a survivor and I don’t agree with that because I never felt like I was in jeopardy,” said Bauman, who went through four rounds of chemo and underwent a double mastectomy in April.
She ran throughout her chemotherapy. After her last round, she ran a 50K — a 32-mile run — the next day.
“I did it for myself,” said the elementary school teacher from Palm City, near Stuart. “To show that chemo and cancer can’t keep me down.”
The perception that younger women don’t get cancer has seeped into insurance policies. Insurance companies generally don’t cover the cost of mammograms of women under 40, unless they are deemed high risk, which includes a personal history of breast cancer, a strong family history of breast cancer or a genetic mutation.
But genetic mutations are rare.
“Only 5 to 10 percent of breast cancer diagnoses are genetic,” said Dr. Joyce Slingerland, director of the Braman Family Breast Cancer Institute at Sylvester Comprehensive Cancer Center at the University of Miami, where Bauman was treated.
None of the women had hereditary cancer or had mutations of the BRCA1 and BRCA2 genes, which can increase the risk of contracting breast cancer.
Slingerland said although younger women are not diagnosed as often, the concern is they’re often diagnosed later, leading to more aggressive cancer.
Tamara Rodriguez, CFO of Fatima Group, a conglomerate that focuses on rebuilding Haiti, was diagnosed at 35. She said that she didn’t have a history of cancer in her Haitian family, didn’t smoke cigarettes, ate healthy and had none of the typical risk factors associated with breast cancer.
Her oncologist, Dr. Lauren Carcus at the Miami Cancer Institute at Baptist, said she typically sees patients who are under 40 because she herself is a younger oncologist.
Rodriguez, who later wrote a book, “Hair to the Queen,” to explain breast cancer to her two daughters, was told that she was too young to have breast cancer.
“I wish I would’ve known that younger women were able to get cancer,” said Rodriguez. “I wish I knew that even though I lived a healthy lifestyle I could get it. I wish I knew what caused it, and I wish there were more tools for families to understand breast cancer.”