5 cancers that strike young: nobody expects to get a life-threatening disease in her 20s or 30s, but it happens. Do you know the signs?

By Rachel Grumman, April, 2004

"You've got cancer." Most women in their 20s and 30s can't even imagine hearing those chilling words. But the truth is that youth doesn't always shield you from disease. Here, how to recognize some of the most prevalent types of cancer found in women under age 40 and the steps to take to reduce your risk.

Melanoma

What it is A deadly form of skin cancer. While melanoma accounts for only about 4 percent of all skin-cancer cases, it causes almost 80 percent of the deaths. "The belief is that if you're tan, you're healthy, but that tan could prove deadly," says Casey Culbertson, M.D., chairman of the Melanoma Research Foundation in Princeton, N.J. How common According to the Skin Cancer Foundation Journal, the melanoma rate is increasing particularly rapidly in younger women: It's the most common cancer to hit women ages 25-29 and the second most common cancer (after breast cancer) in women 30-34, according to the Skin Cancer Foundation. In general, the people most at risk are Caucasians (especially those with fair skin and light eyes/hair) who've had a blistering sunburn before age 18.

Red flags Moles (most people have 10-40 of them, though people with dark skin may have fewer) that change in size, shape or color, as well as ones that flake or itch; a dermatologist should check these right away, as even one such change could indicate melanoma.

Risk reduction Avoid the sun at peak hours--between 10 a.m. and 4 p.m.--and do not use tanning booths. When you head outside, slather on sunblock with SPF 30 or higher about 20 minutes before going out and wear sunglasses and protective clothing, such as a hat. Also, see a dermatologist twice a year; he or she will monitor suspicious-looking moles by measuring and photographing them. (Ask the doctor to do this, if she doesn't offer.) Perform your own head-to-toe skin check regularly (including ears, genital area and between the toes), and enlist your partner to inspect hard-to-see spots such as your rear, back and scalp.

Treatment options A superficial skin lesion often can be excised, with no other treatment required. If a growth is deeper than that, the dermatologist will remove as much of it as possible and may do a lymph-node biopsy to see whether or not the cancer has spread. In addition to surgery, chemotherapy and/or radiation may be required. In the future, a melanoma vaccine may be available; several pharmaceutical companies are currently testing vaccines.

Survival rate If the melanoma is on or just below the skin's surface, the five- and 10-year survival rates are 90-100 percent, according to Culbertson. However, once melanoma invades the deep tissues of the skin, prognosis worsens. If the cancer has reached the lymph nodes, for example, the five-year survival rate is 30 percent.

Cervical cancer

What it is There are more than 100 types of the human papillomavirus (HPV). About 30 types can be transmitted sexually, and about half of these may be connected to cervical cancer. "The vast majority of HPV infections simply go away on their own," notes Diane Solomon, M.D., a senior investigator in the Division of Cancer Prevention at the National Cancer Institute (NCI). But sometimes an infection persists, and that can lead to cervical cancer.

How common There were approximately 12,000 cases of cervical cancer diagnosed in the United States in 2003, and about 4,100 women died of it.

Red flags Precancerous lesions generally don't have any symptoms, Solomon says. But once cancer has developed, there may be irregular bleeding between periods and bloody post-coital discharge. (Keep in mind, however, that these also can be caused by factors other than cancer.)

Risk reduction Pap tests, which detect abnormal cervical-cell changes, should be done every year with a standard Pap smear, or every two years using a liquidbased test (such as ThinPrep), according to new guidelines put out by the American Cancer Society (ACS). If you're 30 or older and have had three normal test results in a row, you may get screened every two to three years with your doctor's approval; recently, the U.S. Food & Drug Administration approved combining a Pap smear and an HPV test for women in this age group. That's because if you're diagnosed with HPV when you're older, you're more likely to have a strain of the virus that won't go away on its own and may lead to cancer, so you'll need to be monitored more regularly. If you're under 30, however, HPV tests are not useful, because HPV is so common in young women.

Treatment options "The good news is that most significant abnormalities are detected by screening and treated before cancer develops," Solomon says. If your test result shows a low-grade change, your doctor may perform a colposcopy to get a closer look at the cervix. For high-grade changes, you'll have a colposcopy and the doctor may biopsy a small amount of tissue. If the lesions are more extensive, you'll need a cone biopsy, which involves taking a large tissue sample from the cervix. A combination of therapies may be used for invasive cervical cancer, such as surgery (hysterectomy), chemotherapy and/or radiation.

Survival rate When cervical lesions are still precancerous, they are virtually 100 percent treatable. The five-year relative survival rate for the earliest stage of invasive cervical cancer is 92 percent. For advanced invasive cervical cancer, the five-year survival rate drops to about 16 percent. The overall (all stages combined) five-year survival rate for the disease is about 71 percent, according to the ACS.

Thyroid cancer

What it is A disease that affects the thyroid--a small, butterfly-shaped gland located beneath the Adam's apple, which produces thyroid hormone. The hormone helps regulate your metabolism and keeps the cardiovascular and central nervous systems functioning normally, says Paul W. Ladenson, M.D., director of the Johns Hopkins Thyroid Tumor Center in Baltimore.

How common According to the NCI, the rate of incidence is about 11 new cases of thyroid cancer per year for every 100,000 women ages 20-39. The cancer is three times more common in women than in men, and "it is the most rapidly growing form of cancer in women," Ladenson says. About 1,400 Americans die of the disease each year.

Red flags Patients themselves occasionally detect a lump in their neck--what's described as a "second Adam's apple," a lump that moves up and down when you swallow and is usually painless. In rare cases there are other symptoms, such as difficulty swallowing solid foods, hoarseness, pain below the Adam's apple or pain that radiates to the jaw and ear, and/or a persistent cough--particularly coughing up blood.

Risk reduction The American Association of Clinical Endocrinologists recommends doing a "neck check": Use a hand-held mirror to examine the area below your Adam's apple and above your collarbone. Take a sip of water, tip your head back, and swallow, watching for any bulges. To make sure you're not confusing the thyroid gland with your Adam's apple, repeat the test. If you spot anything abnormal, visit your physician.

Treatment options About 95 percent of thyroid nodules are benign, but if a biopsy turns out positive, a surgeon may remove half or all of the gland. One or two months post-surgery, you'll typically take a one-time pill containing radioactive iodine, which kills any remaining thyroid tissue. Then, you will need to begin a lifelong course of thyroid-hormone therapy to replace the hormone your missing gland can no longer provide. In advanced cases when the cancer has spread, radiation therapy is sometimes required to relieve pain and to help stop or slow the growth of tumor tissue.

Survival rate If detected early in young women, the relative survival rate of papillary thyroid cancer--the most common type, which comprises about 90 percent of thyroid cancers for women 20-39 and is most likely to affect those under 40--is extremely high, Ladenson says. The NCI reports that the five-year survival rate is more than 95 percent for women ages 20-39 who've been diagnosed with advanced papillary thyroid cancer.

Leukemia

What it is A disease characterized by abnormal white-blood-cell production in blood-forming tissues

How common Nearly 30,000 Americans are diagnosed with leukemia each year, according to the NCI. Acute lymphocytic leukemia (ALL), which accounts for nearly 4,000 cases a year, is the most common type found in young adults and children.

Red flags Symptoms--which can include fever, fatigue, drenching night sweats, bleeding, numerous bruises and weight loss--can mimic a number of ailments. "It's when some of the symptoms persist for weeks to months and don't go away that they may be worrisome," says Wyndham Wilson, M.D., chief of the lymphoma section at the NCI.

Risk reduction There's no way to reduce your risk, but seeking prompt treatment increases your chances of survival.

Treatment options Wilson strongly suggests going to a nationally recognized center and seeing a specialist for treatment if a blood test and bone or bone-marrow biopsy has confirmed you have leukemia. (To find either, go to the ACS Web site at cancer.org, or log on to the American Medical Association's Physician Select site at ama-assn.org/aps/amahg.htm.) Traditionally, intense chemotherapy is given for several months to treat ALL, followed by lower dosages for one to two years.

Survival rate The overall five-year survival rate has more than tripled in the past 40 years, from 14 percent to 46 percent, according to the Leukemia & Lymphoma Society, thanks to improvements in treatment modalities. For ALL, the five-year survival rate is more than 60 percent.

Hodgkin's lymphoma

What it is A rare type of lymphoma, a cancer characterized by abnormal cells in the lymphatic system

How common Hodgkin's comprises less than 1 percent of all new U.S. cancer cases, according to the NCI, but most people who develop it are ages 15-34 or over the age of 55.

Red flags The disease can show the same symptoms as leukemia does, as well as itchy skin and painless swelling of the lymph nodes in the neck, armpit or groin.

Risk reduction Again, prompt medical attention can improve survival odds.

Treatment options An X-ray, CAT scan and/or MRI as well as a lymph-node biopsy may be required for a diagnosis. Hodgkin's is often treated with chemotherapy for four to six months, and sometimes is followed with radiation as well.

Survival rate The 10-year survival rate is more than 70 percent, Wilson says.

Rachel Grumman is a freelance health writer in New York City.

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