The group of women who met to drink beer and cackle over the dirty pictures in their adult coloring books in Vancouver, Wash., certainly didn’t act like cancer patients — whatever that would even mean.

At the inaugural meetup of a new support group — one specifically designed for young women affected by breast cancer — there was nary a pink ribbon or inspirational T-shirt in sight. But a few attendees sported pins specially selected on Etsy for the fledgling Pink Lemonade Project group: little enamel lemons, with “slightly bitter” engraved in cutesy script.

One of the organizers was Jana Cox, who spent the meetup diligently working on a page in an adult-themed coloring book titled “Fresh out of (expletive).”

Cox addressed Meaghann Ande, the new-ish executive director of local nonprofit Pink Lemonade Project.

“I’m making something for your office,” said Cox, 36, in a voice likely shooting for innocent but fooling no one.

Support group

Look, we can’t tell you what the page said or print it in a newspaper. But suffice to say the caption started with “I’m not a gynecologist, but …” and ended with being able to recognize a certain explicit, four-letter part of the female anatomy, when one sees one.

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Cox was pleased with herself. She paused, deliberating over her next color choice.

“I just don’t know if I’m doing the message justice.”

The raunchy coloring books were a silly ice-breaker, but they also helped set the tone for a new group looking to offer an alternative to the “rah-rah pink” atmosphere often associated with breast cancer organizations — a constant cheeriness that some said can feel off-putting toward grown women battling a serious disease.

That’s not to say there’s anything wrong with pink. There’s nothing wrong with bake sales or tea parties or racing for the cure. But this group, specifically, was not going to be one of those groups.

So on that sunny Sept. 3 evening at Latte Da Coffee House and Wine Bar, seven women gathered around the table to brainstorm about what this new group should be.

They’re looking at ways to be inclusive, but also alternative — how can they help younger women find a tribe? Where are existing resources falling short?

“There’s a difference in the discourse for younger women versus older women,” said Ande, 32, who in January kicked off her tenure at the helm of Pink Lemonade by repainting the walls of the nonprofit’s office from pink to a muted, sophisticated gray.

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Younger breast cancer survivors are grappling with distinct considerations. For some, their diagnosis forced them to halt work in the middle of a period that should have been peak career-building years. Many of them have young children. Others don’t have kids, but still want them, and are hoping to treat their cancer in a way that preserves their fertility.

And they talk about things differently. They’re open about topics such as sex. Adrienne San Nicholas, a fellow organizer of the group, suggested that they host a sex-positive toy party at a future meetup. Not only would it be fun, but it would help combat one of the side-effects of treatment.

“It absolutely changes everything about your sex drive,” San Nicholas said. “It’s difficult, I think, to talk about with your husbands, even.”

Another challenge is making this new group as accessible as possible. These women tend to face different hurdles to getting out the door — coordinating schedules around young kids, for instance.

“I don’t go to a lot of things because I don’t have child care,” Erin Maher, a 35-year-old mom of two preschool-age kids, pointed out.

So that was settled: For future meetings, there would be child care. Who knows a good baby-sitter?

Creating a culture

Resources for people with breast cancer often revolve around older women, and for good reason. The Centers for Disease Control reports that around 89 percent of breast cancer cases occur in women older than 45.

But among young women with a diagnosis, standard events for breast cancer survivors can feel a bit alienating.

Cox first spoke with The Columbian in 2018, just before starting radiation to battle a particularly fast-spreading form of breast cancer — triple-negative, which means aggressive chemotherapy.

At the time, she said she wasn’t into pink, and regarded many of the mainstream breast cancer causes and events as a marketing ploy. She struggled to find a community of similar survivors, she said, and preferred to connect with peers online.

All that changed, she said, when her nurse navigator talked her into attending a Pink Lemonade retreat. By the luck of the draw, the group happened to be made up of younger women.

“It took everything for me to show up and not cancel — it was a life-changing experience,” Cox said. “We bonded in ways I can’t even describe.”

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The experience inspired her to get formally involved with the organization. The former pink-skeptic became a mentor with Pink Lemonade, hoping to help other women with the same attitude connect with one another.

She’s still not into pink. Luckily, that won’t be a problem here.

“I haven’t been PG a day in my life,” Cox laughed, sitting at the coffeehouse with her new allies. “I just feel great, sitting here at this table.”