Many cancer doctors will tell you not to have coffee or sushi when you are pregnant, but what about cancer treatment? When Jamie Ledezma was wrapping up the first trimester of her first (and only) pregnancy, she was diagnosed with breast cancer.
“Twelve years later, our life is full of hope, but the fear and challenges that cancer has brought are also still present for me, my husband, and my son,” Jamie said in an interview with CONQUER magazine.
The Good and the Bad
Jamie felt a lump in her breast and mentioned it during an appointment with her OB/GYN doctor. After an ultrasound and a biopsy, she was diagnosed with stage II invasive ductal carcinoma, which was later classified as triple-negative breast cancer. Being diagnosed with triple-negative breast cancer while being pregnant was an “unplanned” coincidence.
The tumor was about 3 cm and was fully palpable. Jamie had to start treatment within a week.
“The day I received my diagnosis, I went back to work and told my supervisor, ‘I have good news and bad news. The good news is, I am pregnant; the bad news is, I have cancer,’” she said. And that’s how it continued. She had to share some of the best news of her life, along with some of the worst.
At the time she started treatment, Jamie had just entered the second trimester of the pregnancy, which she later learned was the marker of where she needed to be, to make sure that her baby had little or no consequences from being exposed to the cancer treatment along with her.
BRCA Mutation Can Be Inherited from Your Father
Jamie worked with her medical team to choose the best treatment plan, because she wanted to feel confident in making sure that they could go forward with aggressive treatment. This was necessary, because of her extensive family history of breast cancer on her father’s side.
They proceeded with genetic testing, which confirmed her suspicion that she had the BRCA mutation, which is an inherited genetic abnormality that increases the risk for certain cancers, including breast, ovarian, and uterine cancers. The BRCA mutation is a genetic abnormality that is inherited from the mother or the father.
Jamie’s paternal grandmother had breast cancer. Jamie remembers her grandmother being in and out of the hospital and seeing her after she had a bilateral mastectomy. Jamie naturally associated her grandmother with being old, but soon realized that she was so young—she died at age 54!
Jamie’s oldest cousin on her father’s side was diagnosed with breast cancer at age 34, and her aunt on her father’s side was diagnosed and died from ovarian cancer at age 44.
Her mom always had her bring up their family history to their primary care doctor, but the doctors would say she didn’t need any early screening, because at the time it was thought that breast cancer linked to the BRCA mutation was inherited from the mother’s side, not the father’s. Researchers have since learned that the BRCA gene can be inherited from either parent, regardless of sex.
When she was diagnosed, Jamie lived in a rural community. In consultation with her treating physician and her family, she decided that the best place to have surgeries was an academic hospital that was 4 hours away from her home. Luckily, her husband was able to take leave from work and drive her there nearly every week, which helped to overcome a significant barrier that many patients with cancer are facing.
Because the tumor was along her chest wall, the goal was to shrink it or to eliminate it.
Jamie was very concerned about her baby’s well-being. She was so early in the pregnancy, there was not sign that she was carrying a baby yet, and she was not feeling any kicking.
The doctors told her that her son would be okay, but she was not very trusting. The situation took a heavy psychological and emotional toll on Jamie.
Attending to the Spirit
Because of her anxiety, Jamie’s doctors decided that every week after treatment she would go to her OB/GYN doctor’s office and have an ultrasound, so she could see her baby doing somersaults and swimming around. This would help to reassure her that everything was okay. That image of him bouncing around was exactly what Jamie needed for her peace of mind.
“I have to hand it to my doctors,” Jamie said. “They were thinking outside the box and understood that they were tasked with not only treating my cancer, but also my mind and my spirit.” They understood that her well-being was very much at jeopardy because of her concern for her baby.
Life Born During Chemo
Jamie’s son had about 6 months of treatment with her while in utero, yet he was born healthy, with no side effects from it.
The chemotherapy did its job by attacking the cancer cells, and Jamie grew in absolute awe of the human body and of science.
Other parts of her body responded to treatment as well—she lost her hair and her fingernails, became incredibly pale, and the fatigue was significant, yet her stomach kept growing. Life was born through this process.
Jamie’s oncologist gave her a 2-week break from treatment after she gave birth, so that she could bond with her son.
Taking Preventive Measures
Jamie expected that her role as a new mom was going to look one way and it ended up being something very different. After her son was born, they had a new treatment plan in place. Their son wasn’t able to travel with them to the hospital every week.
Fortunately, they were wrapped in support from family, friends, and coworkers who all helped provide care for him during treatment. However, not every patient with young children has the benefit of family living nearby. The unanticipated burden of extended childcare and family separation during cancer treatment is a challenge that many people don’t always recognize.
Jamie had a few more months of therapy, and because of the residual tumor, she had to have surgery to remove it. And because she had the BRCA mutation, Jamie elected to have a bilateral mastectomy, with immediate breast reconstruction. Also because of her family history, she decided, in consultation with her care team, to take other preventive measures, including a hysterectomy.
They could have had more children, but they would have had to have them sooner rather than later, because of Jamie’s risk for ovarian or uterine cancer. Knowing that the risk increases for women with a BRCA mutation, Jamie asked her doctors what would be the plan if she had a daughter; how could they ensure that she would be in good health throughout her life?
They said that she would have to start screening 10 years before the age Jamie was when she was diagnosed with cancer, meaning that her cancer screening would begin before she was 17.
Jamie hopes that in 17 years we will be closer to a cure, but she didn’t think that she could endure that much more worry for her child; they therefore decided to call their family complete after their son was born.
“Today, I am the proud and fortunate mother of a healthy and happy 12-year-old teen. I have no evidence of cancer, which is more than I could have dreamt of at the time of my diagnosis,” Jamie said.
Adjusting to Life as a Survivor
In many respects, as an individual, and then as a family, Jamie and her husband have come leaps and bounds and are doing wonderfully well.
“I know things can change in an instant. That has been one of the silver linings of this experience,” Jamie said. “Nevertheless, cancer is still a part of our life that we carry with us in good days and in some not so good days.”
As someone who was diagnosed with cancer in her twenties, Jamie’s concerns were different. She had her entire career ahead of her, and so decisions of whether or not to take a new job or relocate had to be balanced against the decision and the concern and fear of cancer recurrence she lives with constantly.
Long-term survivorship is becoming the standard, not the exception, these days. Although we can have conversations about what long-term survivorship offers in terms of improved quality of life, we also need to be honest about the challenges associated with it.
We have wonderful care providers who are providing survivorship care for patients and their families, but there are still many people without access to those resources.
And many people don’t realize that Jamie is still living with cancer. The truth is that even if the cancer is in remission, those who had cancer are still living with the impact of the disease.
These challenges have different implications—mental, physical, emotional, financial, access to care issues, wellness, and sexual health—all sorts of issues that are not front and center when you get that initial diagnosis, when you’re just thinking about survival.
Jamie has had the opportunity to become involved with an initiative from Bristol Myers Squibb called “Survivorship Today” (www.bms.com/about-us/our-company/survivorship-today.html), which aims to advance the understanding of what it’s like to live with cancer today and to inspire better support for survivors. As more Americans survive cancer, we need to start a dialogue around the issues and challenges of living with the disease that are not always well-understood.
Everyone has their own paths and their own story to tell. Jamie has been on this road for a long time, which feels longer than she had prayed for; she’s grateful for that and is still in awe every time she meets other survivors or hears about their experience.
Making such connections, finding resources, knowing that you are not alone, but that there isn’t a finish line, is a bit daunting, but also exciting.