When Julie McAllister found the lump while breastfeeding her son, she suspected it was just a blocked milk duct. After learning it was a rare type of triple negative breast cancer and that she was BRCA positive, the then 36-year-old was stunned. Having a mastectomy and a hysterectomy would reduce her chances of a recurrence of breast cancer and ovarian cancer. But she wasn’t sure what this meant for her as a mom.
“My husband, Brendan, and I were not sure if we were done completing our family,” McAllister, now 41, of Westport, Connecticut, told TODAY. “(My oncologist) thought that it was imperative that if I wanted to have the option of having more kids trying to do a round of egg retrieval and embryo creation (before cancer treatment).”
After being cancer-free for five years, McAllister is pregnant again. She’s sharing her story to offer hope.
“You can be diagnosed at a young age and it doesn’t necessarily mean that your life is over or that you can’t have kids,” she said. “There’s a light at the end of the tunnel and I’m proof of that.”
Breastfeeding symptom leads to an unexpected diagnosis
When McAllister was weaning her second son from breastfeeding, she found a lump in her right breast.
“I thought initially it was mastitis or something like that. I wasn’t too concerned,” she said.
Still, she visited the doctor, who performed an exam and thought the lump “felt a little suspicious” and recommended McAllister have a sonogram. McAllister had little experience with the breast cancer tests at her age.
“I’d never had a mammogram. I’d never had a breast sonogram,” she said. “They told me it looks suspicious and asked if I could stay to get a biopsy and a mammogram on the spot.”
She was worried and later her doctor called and said that McAllister had a rare type of triple negative breast cancer called metaplastic carcinoma.
“They asked me to get genetic testing because I was 36 years old and it’s not typical for a young, healthy woman to have breast cancer,” she said. “I was BRCA positive.”
People who are BRCA positive are at increased risk of developing ovarian cancer so they often undergo a prophylactic hysterectomy. But a hysterectomy that removes the uterus and ovaries would mean that McAllister couldn’t carry any more children. On top of it, her cancer was rare and didn’t respond to targeted treatment. McAllister was overwhelmed.
“I had a baby. I had a 3-year-old,” she said. “I was debilitatingly depressed. I didn’t know how to process it.”
McAllister had a mastectomy, chemotherapy, radiation and finally had her ovaries removed but kept her uterus.
Her husband created a calendar with a quote on each day and she crossed off important milestones, such as surgery days or the last treatments. His support helped her grapple with the difficulties of life with cancer.
“He resigned from (his) job and he was there for me and my family the whole time,” she said.
Breast cancer in young women
Breastfeeding lowers a person’s risk of developing breast cancer, which is why some are stunned to learn they have cancer while breastfeeding.
“It’s a big mistake to say it protects you in that moment. Breastfeeding, and again just because it reduces your risk of getting breast cancer, it doesn’t prevent it,” Dr. Elisa Port, chief of breast surgery and director of Dubin Breast Center of The Tisch Cancer Institute at Mount Sinai, told TODAY. “Breast cancer in younger women is rare, and currently in breastfeeding women it’s rare. (But) it’s absolutely possible.”
While the Centers for Disease Control and Prevention says women over 50 make up the largest group of people with breast cancer, about 9% of new breast cancer diagnoses are in people younger than 45. Younger people are at increased risk if they:
- Have close relatives diagnosed with breast cancer before 45.
- Have close relatives with ovarian cancer.
- Carry BRCA1 or BRCA2 gene mutations.
- Are of Ashkenazi Jewish heritage.
- Have undergone radiation to breast or chest.
- Have dense breasts.
“Women of all ages need to be familiar with what is normal for them,” Port said. “Anything that is new or changed — whether it is a lump, whether it’s a skin change, whether it’s a rash, whether it’s nipple discharge — they need to call attention of their doctors to it.”
Younger patients face different considerations when it comes to treatment, such as the impact on their fertility. Some women, like McAllister, may opt to undergo fertility treatment like egg freezing or embryo creation before they begin cancer treatment.
“It’s obviously still a very small group of women in terms of the percentage of women who are as young as Julie who are considering having more children,” Dr. Hanna Irie, professor of medicine, hematology and medical oncology at Ichan School of Medicine at Mount Sinai. “The data so far suggests that getting pregnant after diagnosis and treatment for breast cancer is not dangerous in terms of breast cancer recurrence.”
Timing becomes more important in family planning.
“Some treatments involve medicines that can be harmful to a baby,” Irie explained. “The timing of any planned pregnancy, whether natural or assisted, is something that is meant to be a discussion between the patient, her family and the oncologist.”
While McAllister still has her uterus, her doctors believe it won’t contribute to her developing uterine cancer and her risk of having cancer again has lessened since she’s been cancer-free for five years.
“If triple negative breast cancers recur they tend to recur within the first three to five years,” Irie said. “She made it to that milestone.”
Life after breast cancer
When McAllister was first diagnosed, she longed to meet another person who had the same type of cancer as her and survived for five years. She hoped to understand what life was like after cancer.
“I don’t want somebody to think that being diagnosed with cancer is something that’s just going to define you. Because it’s really not. It’s a big hurtle that you have to get over and it’s going to be in the forefront when you’re going through it,” she said. “But give it some time and it won’t be the first thing you think about when you wake in the morning, which is really great.”
She’s expecting her third child due in February 2022.
“How my family is now, we’re actually closer than we’ve ever been,” she said. “There’s hope out there.”