10-Year-Old Girl Battles Rare Breast Cancer
Hannah Powell-Auslam faced an exceedingly rare diagnosis for her age.
By DAN CHILDS<br>ABC News Medical Unit
May 19, 2009— -- For many of the estimated 180,000 women whose doctors will tell them they have breast cancer this year, the diagnosis will no doubt come as a shock.
But for the parents of 10-year-old Hannah Powell-Auslam of Fullerton, Calif., who learned in early April that their daughter had breast cancer, the news was particularly hard to swallow.
"It should be the furthest thing from your mind," Hannah's mother Carrie Auslam told reporters from KCAL-TV in Los Angeles. "Ten-year-olds don't get breast cancer."
For Hannah, the realization that she would have to deal with a disease normally associated with women many times her age was a difficult one to take.
"I told my mom, I just wanna be a normal kid," she told reporters. "I want to go back to school, play sports, hang out with my friends. So I started crying."
According to the family Web site documenting Hannah's fight against her cancer, Hannah underwent surgery to remove her breast on May 7, and she will likely progress to chemotherapy to minimize the chances that the cancer will spread or recur.
But Hannah's family said that the girl has endured the diagnosis with remarkable strength. Today, after an operation to remove the tumor and the surrounding breast tissue, her parents say on a family blog that she is back home and now has become a young symbol of the fight against cancer.
Breast Cancer Exceedingly Rare in Kids
As of Monday evening, requests by ABC News to contact both the family and Hannah's doctors were unsuccessful. Media reports have identified her cancer as an invasive ductal carcinoma at Stage IIA -- a type of cancer that oncologists say has rarely, if ever, been found in a girl of Hannah's age.
However, Hannah's father Jeremy Auslam said on the Web site that while his daughter had originally been diagnosed with invasive ductal carcinoma, it was later changed to invasive secretory carcinoma. This type of cancer is also rare in girls of Hannah's age and younger; it has only ever been documented in perhaps a few hundred girls in this age group.
But Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, said that the change in diagnosis is good news, if true.
"This type of cancer is also extremely rare, but in children is more common than ductal carcinoma," he said. "The rarity of this disease makes information about it scarce; nonetheless it is thought to be a slow growing tumor with an excellent prognosis."
Hannah's Cancer a Scary Diagnosis
Regardless of what type of tumor it was, any kind of cancer is a heavy diagnosis to handle for a child Hannah's age, noted Lillie Shockney, administrative director of the Johns Hopkins Avon Foundation Breast Center in Baltimore, Md.
"This is the youngest case I've ever heard of," Shockney said. "I find for youngsters at this age its best to not be focusing on the kind of cancer it is, but that it is cancer and that surgery and other treatment are needed.
"It's hard enough for adults to get their heads around breast cancer, much less a child."
While Hannah's story is ultimately a hopeful one, Shockney said that it is also highly unusual, and she added that she does not feel that it would be appropriate for parents to believe breast cancer is a major risk for their young daughters.
"I don't want the outcome to be that mothers are panicked across the country wanting to have their daughters in elementary and middle and high school to get mammograms or even clinical breast exams," Shockney said. "This is a highly unusual situation."
Shockney was not the only one to express reservations about how the situation should be broached to the public. While the Auslam family has been very open about Hannah's fight, the media coverage of her experience has sparked debate among breast cancer experts as to whether or not such a rare case of cancer should be given widespread coverage.
The risk of calling attention to such a story, said Fran Visco, president of the National Breast Cancer Coalition, could give parents and their daughters the impression that this form of cancer is far more common in young girls than it actually is -- a misconception that she said could lead to unnecessary fear and unneeded medical procedures.
"Breast cancer in this population is exceedingly rare, less than one in a million," Visco said. "We don't want these girls doing self exams and getting mammograms. We don't want to spread that message; it will only result in harm and no benefit. It's important to understand: this could be harmful to these young women."
Cancer in Young Girls 'Not a Public Health Issue'
Dr. Daniel Hayes, clinical director of the Breast Oncology Program at the University of Michigan Comprehensive Cancer Center in Ann Arbor, agreed that there was no need for young girls to begin unnecessary cancer screening.
"This is not a major public health issue, and there is no 'take home' message," he said. "What we don't want is a bunch of young girls having unnecessary biopsies or, worse, mammograms."
On the other side of the debate is Dr. Marisa Weiss, the president and founder of Breastcancer.org and author of the book "Taking Care of Your 'Girls': A Breast Health Guide for Girls, Teens, and In-Betweens."
Weiss heads up the Prevention Initiative for girls, a national outreach program designed to educate girls ages 8 to 18 on breast health and breast cancer prevention. She firmly supports the idea of educating girls about breast cancer and how to prevent it, even at a young age range. At the same time, she noted, "the fact is that breast cancer in girls is extraordinarily rare, though it does happen."
So why tell these girls about breast cancer at all? Weiss said that educating girls when they are young lays the foundation for a lifetime of breast health.
"What we do is explain to them what to expect in terms of breast development -- what are healthy changes, and what are unhealthy changes."
Weiss added that establishing positive breast health habits when girls are young -- habits such as healthy eating, exercise and smoking avoidance -- has the potential to lower future breast cancer rates.
"There is an opportunity, while they are that age, to build the healthiest foundation possible… this is just about the time when they begin to take up those unhealthy behaviors."
Parents Must Communicate Concerns to Doctors
Regardless of how rare Hannah's cancer is, some doctors said the case illustrates the need for parents to communicate their concerns to doctors -- and for doctors to take into account any potential health threats, however unusual.
"What bears emphasizing is that: a) this is incredibly rare, and teenagers need not worry about this happening to them; and b) physicians need to be aware that, while rare, this can happen, so that new lumps should be taken seriously," said Dr. George Sledge, professor of Medicine and Pathology at the Indiana University School of Medicine in Indianapolis and editor-in-chief of the journal Clinical Breast Cancer.
Lichtenfeld agreed. "Hannah's case, which thankfully appears to be having an excellent outcome, is extremely unusual and should not be cause for undue alarm," he said. "As with any health issue, parents who are concerned about any seemingly unusual physical change should talk to their family's health care professional."
Likewise, Hannah told KCAL that she hopes her experience will help other children like her keep open lines of communication with their parents when it comes to health issues.
"I want to set an example for all the kids in the world, that if there's something wrong with your body, you tell your parents," she said.
Michelle Schlief and the ABC News Medical Unit contributed to this report.