Young Women With Breast Cancer Grapple With Extra Dose of Denial

For five years, the pair had been inseparable, a dazzling combination of contrasting good looks: Gina Shafonsky, the sporty blond; Lynne Stan, an elegant, leggy brunette.

Called the “Salt and Pepper Package” by other models, they booked jobs in Hawaii, San Francisco and Las Vegas, and, in the process, became fast friends.

“It felt like we were sisters,” remembers Shafonsky of Newport Beach. “We tried to sell ourselves together as a package, rather than individually. It was a great friendship.”

When Stan was diagnosed with breast cancer at age 28, Shafonsky was heartbroken. As Stan withered from the effects of the disease, Shafonsky stayed close.

Stan died Nov. 14, 1992, just one month past her 30th birthday. She was survived by her mother and father, two brothers and a sister. And a dear friend.

Shafonsky, now a volunteer for the American Cancer Society in Orange County, golfed Monday in Stan’s memory at a breast cancer benefit in Huntington Beach.

“I thought breast cancer was for older women,” she says. “I never knew it could touch someone so young.”

Breast cancer, traumatic for women of any age, can be devastating for women in their 20s who may lack the life experiences and sturdy support systems to help them cope with the disease, experts say.

Some young women are learning of the dangers of breast cancer and the importance of self-examination, regular doctor visits and--for those with a family history of the disease--early mammography.

Experts in Orange County are trying to help by offering awareness programs and a new support group targeting young women.

“Even though they are very small in number, (young women with breast cancer) are very important,” says Hoda Anton-Culver, director of cancer surveillance at UC Irvine. “. . . The number of years lost, the severity of the disease, the fact that it’s . . . more (often) hereditary, make them more important to be looked at for prevention and control.”

The American Cancer Society says one in nine women will develop breast cancer in their lifetime and 46,000 women will die of the disease this year. The chances of contracting it depend on a variety of factors, including age and family history. One percent of all breast cancer victims are men.

The risk of breast cancer increases with age. Young women, feeling less threatened by the disease, may slough off regular self-examinations and recommended checkups by their doctors, experts say.

In addition, mammography--the most powerful tool for early detection of breast cancer--is less effective in spotting potential cancers in young women, because their breast tissue is so dense.

Experts disagree about what risk factors should prompt young women to have early mammographies.

Dava F. Gerard, medical director of the Breast Health Center in Santa Ana, says young women should consider themselves in a higher risk category if they have a sister or mother with the disease. Young African American women also have a higher incidence of breast cancer, she says.

Anton-Culver, who is also chief of epidemiology at UC Irvine’s Department of Medicine, says women should also take into consideration an incidence of breast cancer in aunts and grandmothers, on either side of the family.

These young women, she says, should pinpoint the age that their relative was diagnosed and schedule their first mammography 10 years before that age.

Although it is an imperfect tool for cancer detection in young women, that X-ray technique, combined with a careful breast examination, offers the best chance at early detection, she says, adding:

“If a young woman has a positive familial history of breast cancer, she should not dismiss that fact. She cannot say, ‘I’m too young for breast cancer,’ because that is not true.”

American Cancer Society statistics say one woman in 2,426 will develop breast cancer by age 30; by age 50, that risk rises to one in 52.

Although the incidence of breast cancer is lower for young women, the stakes may in some ways be higher. Since young women often do not consider themselves breast cancer candidates, they may be diagnosed at a later stage when the disease is more aggressive and the mortality rate is higher, Anton-Culver says.

“It’s so shocking when it happens in women that young,” says oncology nurse Nancy Raymon. “It doesn’t fit the norm.” Raymon launched a breast cancer support group at Western Medical Center in Santa Ana this month. Although the group includes women in their early 40s, it will focus particularly on issues affecting women in their 20s and 30s, she says.

Experts say the disease poses keen emotional trials for young women, who are just beginning to establish their families, careers and romantic relationships. And although husbands are likely to stick with their mates, young boyfriends very often do not.

“It’s very difficult on a relationship to go through aggressive treatment for cancer,” says Donna Farris, who with Raymon is planning a breast cancer survivor retreat called Healing Odyssey in Santa Barbara next month. “That’s kind of a repeated theme we’ve heard among the younger women.”

Those who have not married yet may be especially horrified at the prospect of losing a breast.

“Lynne (Stan) couldn’t even comprehend that,” says her friend Shafonsky. “In your 20s, you’re still young and dating and your appearance is a little more important--or you think it is--than when you’re in your 30s and you start to realize the physical appearance is not everything.”

Young mothers have the added burden of juggling children and chemotherapy treatments--and with wondering what will become of their offspring if they die.

Denial is not uncommon.

La Trice Mack, then 27, learned she had cancer in the milk ducts of her breasts on March 25, 1993. She had been bleeding from her right nipple for about three weeks but could not see it as something serious.

“I thought it was nothing, there was no lump,” she says. Then, “one day, it bled through my shirt at work and the ladies I work with demanded I call my doctor.”

Even then, cancer did not occur to her.

“Cancer, right, yeah,” she now says, in a tone sarcastic and disbelieving. “That was the last thing on my mind.”

Mack’s mastectomy and breast reconstruction was scheduled for May 10, two days before her 28th birthday. Next, she underwent seven months of aggressive chemotherapy.

“I got really sick,” she says. She spent a long time in the hospital. “I’m a single parent. I was really having a hard time.”

Friends who “just couldn’t handle it” began staying away, she says. Mack’s young daughter moved in with her parents.

Because she has been taking tamoxifen--a hormone blocker commonly given to women with breast cancer--the Van Nuys resident now experiences hot flashes, night sweats and other symptoms of menopause.

Being fast-forwarded into midlife is a jagged experience for one not yet through her 20s. And Mack, whose father had four sisters with breast cancer, admits she has not made peace with this new reality.

“It’s like someone’s pushing the remote control, and it’s not me,” she says. “Women our age are supposed to be so together in these times. We’re supposed to be in control and very independent.”

Mack, who once bowled and taught aerobics, works as a hospital clerk and has enrolled in college and is hurriedly reading the classics, currently, John Steinbeck’s “Of Mice and Men.”

“These are things I didn’t do and I want to do it,” she says. “I might not live to see 30. I want to sky dive and bungee jump. I want to go to Paris.”

In what could be another turn of bad news, Mack says recent tests indicate the cancer may have resurfaced in her body. On Friday, she plans to consult with a new doctor.

“There are other options,” she says. “I know there have to be other options.”

The American Cancer Society says that women 20 and older should do monthly breast self-examinations and that women 20 to 40 should be examined by their physicians every three years. Mammographies are recommended every one or two years for women from 40 through 49 and annually for women 50 and over. A base-line mammography should be done by age 40.

Bruce Vancil, director of cancer control for the American Cancer Society in Orange County, says these guidelines are intended for women who have no symptoms and no known risk of breast cancer. All other women should consult with their doctors to determine the appropriate screening schedule.

Experts say that caught early, breast cancer is more than 95% curable, using techniques such as lumpectomy, radiation, mastectomy and chemotherapy.

Stan, whose maternal aunt is a breast cancer survivor, had fought the disease with chemotherapy, but it was a battle that did not begin until the disease had already progressed, her father, Lou Stan, says.

“The thought was there that we were going to lose her, but we didn’t want to face the reality it could happen,” he says, squinting in the bright sunshine at the breast cancer benefit Monday. “She kept telling me she was going to pull out of it: ‘Don’t worry Dad.’ She was so strong, I couldn’t believe it.”

Shortly before she died, Shafonsky and another friend took Stan to a waterfront restaurant for her 30th birthday dinner. She ordered prime rib, her favorite. She was thin and weak but ate most of her meal.

“We had a great day on the water, the sun was out, she was able to walk to and from the car,” says Shafonsky. “The will to live was amazing.”

Losing Stan has made Shafonsky--and Stan’s other young friends--both sadder and wiser. They no longer feel immune to breast cancer, a disease that had once seemed remote.

“I’ve told all my girlfriends,” says Shafonsky. “We’ve taught each other and told each other how to do the self-examination. It’s unfortunate we lost Lynn, but we’ve all learned a great deal about breast cancer.”