Concerning Breast Cancer Trend: Young Women Like Actress Miranda McKeon, 22, Have Increased Risk of Cancer Recurrence, According To New Study

HR-positive (HR+) breast cancers have estrogen and progesterone receptors. Meanwhile, HER2-negative, otherwise known as ERBB2-negative, means that cancer cells have limited or zero levels of the human epidermal growth factor receptor 2 (HER2) protein.

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A post shared by Miranda McKeon (@miranda.mckeon)

As per the cohort study, led by Dr. Dong Seung Shin, of Samsung Medical Center in Seoul, South Korea, looked into whether age was an independent factor linked with late distant recurrence among breast cancer patients with estrogen receptor (ER)–positive and ERBB2-negative (HER2-) tumors.

The study looked into 2,772 patients under age 45 or younger with (HR+) and HER2-negative breast cancers, who had no distant cancer spread five years after surgery and found that “younger age was significantly associated with worse disease-free survival, locoregional recurrence-free survival, and late distant metastasis–free survival,” the study authors explained.

It was found that women between the ages of 21 and 35 were at the highest risk for recurrence when compared to those between the ages of 36 and 45.

The authors concluded that this study highlights “the importance of long-term monitoring and potential for personalized treatment approaches based on age, particularly for younger patients with ER-positive, ERBB2-negative breast cancer.”

Patients were grouped based on age, with 370 between the ages of 21 and 35, 885 patients between ages 36 and 40, and 1,517 between the ages of 41 and 45.

Additionally, recurrence risk was 47 percent less in those ages 36 to 40 years old and 70 percent less in those between the ages of 41 and 45 years.

For every one year older in age of a breast cancer diagnosis, the woman had a 9 percent lower risk for late distant recurrence.

It’s important to note the study did have some limitations. Authors explained, “First, this study was a retrospective study of a single country and a single race. The study has the limitations of a retrospective analysis of data collected from multicenter sources.

“There were patients with follow-up loss and unknown data, especially on receptor expression and adjuvant treatment, because we collected data from patients who had surgery over a period from 2000 to 2011 with long-term follow up. Additionally, we were unable to collect BRCA1/2 data for this cohort because genetic testing, including BRCA1/2, was not commonly performed in Korea at the time.”

Miranda McKeon’s Cancer Journey

Miranda McKeon shared parts of her cancer journey on Instagram, explaining how a small lump “the size of a jellybean” in her breast initially caught her attention.

“I stepped away into the bathroom. I peed, fixed my hair, and performed the classic boob scoop a typical mid party practice,” she wrote in an Instagram post. “I brushed across a lump that was definitely not there before. It was the size of a jellybean but powerful enough to sink my stomach and set off emergency sirens in my head.”

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After going to see her doctor about it, she underwent a mammogram, which screens for breast cancer. She also underwent a biopsy and an ultrasound. The tests confirmed her diagnosis of stage 3 hormone-positive breast cancer in June 2021. Interestingly, the young actress said she did not have a family history of the disease.

“I spent most of that time confused and scared, but mostly in shock,” she previously told Coping magazine. Most of us go through life believing that we are untouchable. It’s a crazy feeling when the spinner lands on you.”

As previously noted, before beginning chemotherapy, she preserved her eggs. She underwent several rounds of chemotherapy for treatment.

After chemotherapy, she underwent a double mastectomy [surgical removal of both breasts] and reconstruction, followed by 25 rounds of radiation.

“I never would have anticipated that going through cancer treatment would feel like working five full-time jobs at once!” she said.

Her treatment helped her reach remission, though she continues treatment to offset recurrence.

RELATED: Famous For Her Coming of Age Role, Actress Miranda McKeon, 22, Is Embracing Medically Induced Menopause To Keep Her Breast Cancer At Bay

The treatment McKeon is taking, Lupron (generic name leuprolide), is a hormone therapy shot that aims to reduce her estrogen levels so her cancer does not grow.

How To Reduce the Risk Of A Breast Cancer Recurrence

You beat breast cancer. You battled the beast and are healthy, strong and ready to tackle the rest of your life. But what about breast cancer recurrence?

As triumphant as breast cancer survivors can feel after learning they are cancer free, many worry about recurrence. What are their chances of the cancer returning and what, if anything, can they do to help prevent it from doing so?

While the chance of recurrence varies based on the biology of the tumor, the stage it was when diagnosed and the treatment received, according to the Susan G. Komen organization, “Most people diagnosed with breast cancer will never have a recurrence.” That’s the good news.

“Once a patient has finished his or her active therapy for breast cancer, we will often refer to that time as breast cancer survivorship,” says Dr. Erica Mayer, a breast cancer medical oncologist at Dana Farber Cancer Institute.

“This is a time when patients are still being actively monitored by their treatment team, not only to ensure that they remain healthy and cancer-free in the years ahead, but also making sure that they have recovered from any side effects of their initial treatment, and that they are pursuing healthy behaviors for example, getting regular exercise, eating a healthy diet, and keeping up with all their other routine medical care.”

But recurrence does happen, so it’s important to do everything you can to reduce your risk. Here are some tips:

1. Follow Treatment Guidelines

“The best way to reduce your risk of recurrence with breast cancer is to follow treatment guidelines and complete the course of treatment that’s given,” says Dr. Elisa Port, a surgical oncologist specializing in breast cancer at Mount Sinai, recently sat down with SurvivorNet and offered the following advice.

For example, she says many women have breast cancer that’s hormonally driven, and there are treatments that they give, such as pills like Tamoxifen or aromatase inhibitors, to reduce the risk of these hormonally-driven cancers coming back. The issue is that the course of treatment may call for patients to take the pills for 5-10 years. While some have no side effects, others may experience a host of unpleasant side effects, even to the point where they’re severely debilitated and have no quality of life on these medications.

“So the challenge is to work with every individual person to make sure we give her the best chance of getting through these treatments and enjoying the benefits of these treatments, which is the lowest rate of cancer coming back,” Port says.

2. Maintain a Healthy Weight

Maintaining a healthy weight may also reduce the risk.

“We know that obesity or being overweight can increase the risk of cancer recurrence in breast cancer,” Port says. “And so I say, maintaining a healthy body weight, whatever that is for the individual… You know, we talk a lot about healthy body weight, and there’s a very big range of this, but there are certain numbers beyond which, it does affect one’s health. So we try to keep people within a range of a healthy body weight.”

3. Limit Alcohol

Port says the other lifestyle factor that may increase one’s risk of breast cancer recurrence is heavy alcohol intake.

“We say alcohol in moderation is probably fine, which is defined as three to five drinks a week,” Port told SurvivorNet. “More than that can also potentially increase the risk of recurrence. So the big lifestyle factors are healthy body weight and moderate alcohol intake.”

4. Eat a Healthy Diet

She says there’s no one dietary element that you can eat or consume to give you an edge against breast cancer recurrence. It’s not eating more broccoli or eating more blueberries or becoming a vegetarian. She says the fact that sugar feeds cancer is a big myth too. However, everything you eat does contribute to your overall health.

“These things are all really helpful in maintaining an overall healthy well-balanced diet and also to maintain healthy body weight. We know that diets that are heavy in sugar content are also usually unhealthy and can lead to weight issues. So it all really funnels back to maintaining a healthy body weight when it comes to lifestyle factors.”

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5. Exercise

This goes hand-in-hand with maintaining a healthy weight. Dr. Erica Mayer, a breast cancer medical oncologist at Dana Farber Cancer Institute, previously told SurvivorNet, “Once a patient has finished his or her active therapy for breast cancer, we will often refer to that time as breast cancer survivorship.

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“This is a time when patients are still being actively monitored by their treatment team, not only to ensure that they remain healthy and cancer-free in the years ahead, but also making sure that they have recovered from any side effects of their initial treatment, and that they are pursuing healthy behaviors for example, getting regular exercise, eating a healthy diet, and keeping up with all their other routine medical care.”

CDK4/6 Inhibitors Can Help Reduce Chance of Breast Cancer Recurrence

In the breast cancer space, there are constant efforts from researchers and drug makers to develop therapies that can not only treat cancer better, but reduce the risk of it returning. And many promising advancements in breast cancer have arose in recent years.

For women with a common subtype of breast cancer — hormone-receptor-positive and HER2-negative (HR+ and HER2-) — a newer class of drugs called CDK4/6 inhibitors are showing promise.

CDK4/6 inhibitors work to interrupt the growth of cancer cells. SurvivorNet sat down with Dr. Eleonora Teplinsky, Head of Breast Medical Oncology at Valley Health System, to discuss how a CDK4/6 inhibitor, Ribociclib (sold under brand names Kisqali and Kryxana), is being studied for women with this specific type of breast cancer.

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Referencing data obtained from the NATALEE phase III clinical trial, Dr. Teplinsky explained how breast cancer patients who received Ribociclib along with endocrine therapy (the current recommended treatment) had a 25% lower risk in recurrence or death.

Prior to the study, “Ribociclib was already approved for metastatic hormone receptor-positive breast cancer, but this study was looking to see if it has benefits in reducing recurrence in earlier stage breast cancer,” she explained.

The study looked at something called disease-free survival, which means patients are alive without their cancer recurring.

“In the group that received Ribociclib and endocrine therapy … at three years their disease-free survival was 90.4% compared to 87.1% in the group that received endocrine therapy alone,” Dr. Teplinsky said. This translates to a 3.3% “absolute improvement.”

It’s important to note that this therapy option is not currently FDA-approved.

The Importance of Breast Cancer Screening

Screening for breast cancer is normally done through a mammogram, which looks for lumps in the breast tissue and signs of cancer.

While there is some disagreement about the exact age a woman should start getting mammograms, doctors generally agree it should happen in their 40s.

The American Cancer Society (ACS) suggests women should begin annual mammogram screenings for breast cancer at age 45 if they are at average risk for breast cancer.

However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) now says that women should start getting mammograms every other year at the age of 40, suggesting that this lowered the age for breast cancer screening could save 19% more lives

WATCH: Mammograms are still the best tool for detecting breast cancer.

The ACS also advises:

• Women aged 40-44 have the option to start screening with a mammogram every year
• Women aged 55 and older can switch to a mammogram every other year
• Women aged 55 and older could also choose to continue yearly mammograms

For screening purposes, a woman is considered to be at average risk if she doesn’t have a personal history of breast cancer, a strong family history of breast cancer, a genetic mutation known to increase risk of breast cancer such as a BRCA gene mutation or a medical history including chest radiation therapy before the age of 30.

Experiencing menstruation at an early age (before 12) or having dense breasts can also put you into a high-risk category. If you are at a higher risk for developing breast cancer, you should begin screening earlier.

Don’t delay speaking with your doctor to make sure you are staying on top of your breast health.

Understanding Provider Bias & Advocating for Your Health

While your doctor has undergone years of training and practice, she or he is ultimately still human and may come with their own set of biases that can impact how they treat patients.

To combat these biases and really the most out of your interactions with your doctor, you should provide her or him with plenty of information about your life and ask plenty of questions when things aren’t clear.

RELATED: Olivia Munn’s Doctor, Says She Was Called “Paranoid” & “Crazy” For Wanting a Double Mastectomy To Reduce Risk of Breast Cancer Recurrence

To better understand how you should approach conversations with your doctor, we spoke with Dr. Dana Chase, gynecologic oncologist at Arizona Oncology.

Avoiding Provider Bias – Is Your Doctor Understanding You?

According to Dr. Chase, physicians, like many of us, can be a bit biased when seeing patients. Dr. Chase makes clear that these biases are rarely sinister, but rather unconscious and more subtle. She says, “We have certain beliefs that we don’t know about. We might look, for example, at an older woman, and just by the way she looks we might make certain assumptions, and we might not even know that we’re making these assumptions.”

Sometimes, these assumptions can lead to differences in the care that doctors provide. That is the point at which you, the woman, should advocate for yourself and clear up any misconceptions the doctor may have, says Dr. Chase.

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“Say things to your doctor like, ‘I may not seem healthy because I’m 92, but I want you to know that I play tennis three times a day,’ ” she explains.

This type of discourse can be really helpful when building a relationship with your physicians and even more important when it comes to creating a treatment plan.

“In order to avoid situations where potentially the doctor is making assumptions about you that you don’t even really know about, reminding yourself to tell the doctor who you are, to explain your life situation, I think is really important.”

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It’s equally as important that you’re understanding your doctor as much as you want them to understand you.

“It’s never a bad thing to ask for something to be repeated, or to ask the doctors to explain it in different terms,” Dr. Chase adds.

So next time you go to your physician, we think you should feel empowered to speak up, both so she or he understands you and you understand them.

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Contributing: SurvivorNet Staff

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