Alexis Klimpl felt an itch. So, like anyone else, she went to scratch it. But her fingers curled around something else. A massive lump on her right breast.
About a year ago, the now 25-year-old was laying in bed with her boyfriend and immediately shot up. Her face dropped. “What?” he asked, naively. “There’s literally a lump on my boob,” she said. They felt it – maybe it’s a bone? It was hard. But if it were a bone, could you move it around in a circle? Was it a cyst? A benign lump? Or …
Breast cancer. Maybe it’s breast cancer. At 24 years old. The diagnosis that affects more than 300,000 women each year in the U.S. More than 40,000 women die of it every year.
Klimpl is one of the 300,000 – and one of a growing number of women under 40 diagnosed with breast cancer in recent years. But she’s now also one of the 4 million survivors living in the U.S., too.
Breast cancer treatment and side effects, including menopause
Klimpl lives in San Diego but is a Hawaii native. She’s at peace in the water and loves to surf. A beach trip to Indonesia she’d been planning was scheduled for a few days after first feeling that lump. With the travel planned, the money spent, she pressed on. The lump grew and grew.
Once she returned, diagnostics confirmed it. Her doctor had a difficult time telling her, trying to reassure her and explaining it was very rare. “She kept looking at my mom more so than me, as if she was the patient,” Klimpl says.
“It’s still relatively uncommon,” says Dr. Eric Winer, director of the Yale Cancer Center, of breast cancer in young people, “but it is a concern that it’s going up at all, and that, of course, is not because of screening, because we don’t screen young patients like this, and we don’t really understand the cause.” Mammography alone for younger women under 40 may not be as effective due to denser breast tissue.
But why are multiple cancers increasing in young people? No one knows for sure. “The increased incidence of breast cancer and the early onset is a serious concern and is likely multi-factorial,” says Dr. Carmen Calfa, breast oncologist and medical co-director of the Survivorship Cancer Program at Sylvester Comprehensive Cancer Center, part of the University of Miami Health System. “We need to make every effort to understand all risks factors (including genetics) and modify those that are modifiable.”
Klimpl collapsed in that patient room after receiving her diagnosis; she had already gone through enough grief after losing her father to bile duct cancer in 2017. “All I could think about was how he was feeling, and how people similar to that feel, and what goes through their mind,” she says, recalling his terminal illness.
But Klimpl wasn’t terminal. She had triple positive breast cancer, meaning her tumor cells included estrogen, progesterone and a higher number of HER2 receptors. This kind of cancer would be receptive to hormone therapy, and it was only stage 2. Not the earliest stage, but not the worst.
Consultations with a plastic surgeon, radiologist and oncologist followed. Freezing her eggs was a priority because chemotherapy could ruin her chances of fertility and natural birth. She laments the process – injections aimed at growing your ovaries to produce more eggs. You look like you’re pregnant, mood swings rattle your brain, the emotional toll. Poking, prodding, blood draw after blood draw.
Cheotherapy (Taxotere and Carboplatin) and hormone drugs (Herceptin and Perjeta) came next, as well as cold capping to try to preserve her hair. Nausea consumed her during treatment.
“I’m already a nauseous person, but this nausea was like the type that runs through your bones and your veins, like you just feel it everywhere, and no matter how many meds they give you. Nothing really helps,” she says.
A bad rash also dotted her face which depleted her self-esteem. She isolated herself to protect her immune system and grew stir-crazy. Plus, “I was losing my mind a little bit, not being able to be in the water.”
The medicines are indeed toxic, but incredible considering where scientists were decades ago. “We now think of breast cancer as being really a family of diseases, and we’re able to name different types of breast cancer, all of which receive very different treatment,” Winer says. “So our treatment is much more targeted, it’s much more sophisticated.”
It’s better to have more choices than fewer. “It’s good for the patient, because the knowledge that we gained over three decades is really significant,” says Dr. Naoto T. Ueno, director of the University of Hawaiʻi Cancer Center.
Surgery followed to removed her tumor and lymph nodes followed by a double mastectomy; even though she didn’t have the BRCA or other breast cancer genes, she craved certainty. Now, she’s on a hormone blocker likely for the next decade and going through menopause. For a 25-year-old going through it, resources are scarce.
“With the menopause, the side effects are bone pain, hair loss, mood swings,” she says. “So they’re all pretty manageable, but that’s just what it comes with.” Anyone concerned about menopause symptoms after breast cancer can check out American Cancer Society tips.
Klimpl’s body will return to normal once she stops the hormone blocker and she can get pregnant if she so chooses. “I won’t know if I’m able to carry my own baby until I try,” she says, “There’s nothing I want more than that, so I’m crossing my fingers for when the day comes.”
She’s found connection on social media with others in similar situations, and that’s encouraged her to speak out. But more than anything right now, she’s been excited to surf.
Breast cancer tips: ‘If you feel a lump, don’t ignore it’
Anyone concerned about breast cancer should talk to health care providers and/or look for reputable information from sources like the American Cancer Society, and consider taking the Breast Cancer Risk Assessment Tool.
Calfa is glad Klimpl sought care. “If you feel a lump, don’t ignore it,” she says. “If someone says ‘you are too young to have breast cancer,’ please don’t stop until your concerns (and) symptoms are fully and thoroughly evaluated.”
And remember, too, that “for patients who have stage 1 or stage 2 or 3 breast cancer, the goal of treatment is to get them to a state where they’re cancer-free and hopefully they’re never going to hear from that cancer again,” Winer says. “Depending on a variety of prognostic features, we know that some people are at lower or greater risk of having a recurrence of breast cancer.”
And, “because of ongoing research and developments, even women with advanced cancer can live many many years with an excellent quality of life,” adds Dr. Dawn Hershman, deputy director of the Herbert Irving Comprehensive Cancer Center at Columbia University.
Klimpl recently went to visit Hawaii and swam for the first time in the ocean since right before starting chemotherapy. A full-circle moment for her. The warm water on her skin, in her hair, letting go of worries. Grief overwhelmed her.
“One of the things that made me feel closer to my dad was surfing and being in the water,” she says, “because he’s the one that taught me how to do all of that. And so I’ve had a really big disconnect, um, this past year from him, without being able to do that.”
When she finally surfed again in San Diego, a week or so later, goosebumps overwhelmed her body. The sun came out after clouds had covered the sky for weeks. “Interesting timing,” she says. “Maybe it was my dad shining down?”
This article originally appeared on USA TODAY: Breast cancer treatment, symptoms, menopause: A young woman’s story
