Some are young mothers in their 30s, others twentysomethings starting their first jobs, and on rare occasions they are even teenage girls just finishing high school.
At an age when most of their peers are establishing intimate relationships or starting families, these young women are facing a demon they hadn't expected to worry about for many, many years.
Breast cancer. Two words that would strike fear in a woman of any age, but for those 40 and under, the diagnosis can be especially devastating.
"The biology of their disease is different than that of older women," says Ellen Warner, a medical oncologist at Toronto's Sunnybrook Health Sciences Centre, who has begun a program called Pynk for young women with breast cancer.
"Their cancers tend to be bigger, more advanced, higher stage and ... are more likely to relapse, either in the breast if they've had breast conservation, or in distant organs," she says.
"And these women are more likely to die of their disease."
Dr. Warner says women 40 and under, who account for about 5 per cent of the roughly 22,000 cases diagnosed each year in Canada, also have to contend with a host of issues that may not apply to women of a more mature age.
"There are all the psychosocial issues these women have to deal with ... such as dating or early relationships or new marriages, little kids, being in school or just starting careers and trying to build them up."
There is also the social isolation from being the only one among their peers who isn't perfectly healthy, she says, and having "to deal with menopause symptoms (from chemotherapy) when you're 30, when no one else around you knows what menopause is, other than their grandma."
Pynk is named for the colour of breast-cancer advocacy, but with the Y referring to "young." Sunnybrook says it is the first program of its kind in Canada, designed to help young women navigate the medical system and to provide all manner of psychological and social support. It also has a strong research component, aimed at determining why their cancers tend to be deadlier, and developing treatments to alter that outcome.
Crystal Kramer, 34, is all too aware that when it comes to breast cancer, being young is no advantage.
The Toronto casting director was still breastfeeding her daughter, Lena, when she discovered a lump in one breast last spring. Though small, the tumour was "very aggressive," she says.
Ms. Kramer, who had tested positive for the BRCA1 gene that predisposes a woman to the disease, had both breasts removed, along with more than 30 lymph nodes under her arm and up the side of her neck, most of which showed signs of cancer.
She and her husband had planned to have more children, so she began setting up the process to have her eggs extracted and fertilized and the subsequent embryos frozen.
"But then I got my pathology back, and because my cancer was so aggressive we just decided to go straight into chemo, and gave up on the whole fertility aspect," Ms. Kramer says. "Because there's no point in trying to have another baby if I'm not even here."
Ms. Kramer knows that if her cancer recurs, it will probably be fatal. But she is refusing to give in to doom and gloom and is tenaciously positive.
"You have to be. Obviously you have moments when you don't, but I just told myself you have to be here. I have a child. I don't have a choice."
Dr. Warner says the biggest fear young mothers with breast cancer have is not being there to raise their children.
For a woman we'll call Carrie Jones, who asked that her real name not be published, finding out that she had breast cancer in her late 30s, not long after giving birth to her second child, was devastating.
