Six weeks after my second child was born, my daughter Francesca, I went to see my obstetrician Dr. Shieva Ghofrany for my postpartum checkup. Dr. Ghofrany is not your typical OB-GYN, and though we covered the basics, we also had a conversation focused entirely on maternal physical health that would change my life forever. We spoke about the importance of shifting my mindset to be more attentive to changes in my body, in a way that I had never considered before. In the past, I took solace in the fact that I was young, active, and thankfully drama-free when it came to my health. Two months later when I performed a breast self-exam and found that my left breast felt different, my mind jumped right back to that appointment with Dr. Ghofrany. It’s safe to say that conversation, coupled with a breast self-check, saved my life. 

As a 35-year-old mother of two with no family history of breast cancer, my risk of developing breast cancer in the next five years was low, approximately 0.2% in fact, though new research shows that the global incidence of breast cancer in early onset (under 50) is rising. I had always known that pregnancy was a risk factor for disease development, so I did breast self-exams on a regular basis. It is easy to overlook or disregard a lump or a change in breast tissue postpartum because your breasts are constantly fluctuating in size and texture. However, I knew my breasts well enough to know that something was subtly, but clearly, different. 

Getting familiar with your breasts

You see with breast checks, it’s not so much about perfectly executing the steps, or doing them the way a doctor would or even doing them the same way every time. It’s actually about knowing what your “normal” feels like, and really familiarizing yourself with the unique characteristics of your own breasts—a baseline. Though clinical or self breast exams are no longer recommended as part of breast cancer screening by the American Cancer Society, what doctors do recommend are self examinations where you are regularly feeling your breasts and looking for any changes. The more familiar you are with your breasts, the more something will stand out to you should a change occur. 

On Aug. 16th, 2022, I decided to feel them in the passenger seat of the car while my husband and I drove to a hotel on our first couple’s getaway since our son was born three years earlier. As I felt the top of my breast, just below my collarbone, something felt different. It was not a typical lump, but the tissue that sits over the breast bone felt harder than usual. I would know—because I had done a check just a few weeks before. 

I immediately contacted Dr. Ghofrany, hoping to hear that it wasn’t anything to be concerned about. Instead, I received an actionable response, telling me to go get imaging just to be safe. I picked up the phone and called my local hospital, and a mammogram was immediately scheduled to take place a few days later. At this point I was no longer breastfeeding, but I suspected that this change in my breast was most likely related to normal postpartum changes. 

What follows is a bit of a blur. I checked in and was seen for an ultrasound, which triggered a mammogram. The radiologist informed me that she didn’t like what she saw and wanted me to come in the next morning for a biopsy. Despite her evident concern, I couldn’t metabolize the fear. I felt genuinely curious and in many ways, invincible. I am healthy, cautious and have no history of breast cancer in my family. There’s no way this could happen to me, I thought. 

By that Thursday afternoon, four days after I woke up a seemingly healthy woman, mom, wife, friend, sister, daughter, I received a MyChart update which prompted me to “check in” for my oncology appointment the next morning. A few minutes later I received a call that confirmed I had triple negative breast cancer, but from what the radiologist could see in the imaging, it was under 2 centimeters. The radiologist suggested that this meant I most likely caught it early, but we couldn’t be sure until I did more imaging. 

What to know about triple negative breast cancer

Triple negative breast cancer (TNBC) is an aggressive form of breast cancer which is typically associated with a poorer prognosis, and makes up only 15% of invasive breast cancers. Unlike other subtypes of breast cancer which contain hormone or HER2 receptors, TNBC has fewer targeted treatments. It most commonly affects women under 40. Because it so often occurs in younger populations, it is often self-detected. I was lucky that I checked, because TNBC is aggressive and can spread quickly in a short period of time if it goes undetected. 

Being aware of pregnancy-associated breast cancer

Though breast cancer during pregnancy is not common, it is, along with cervical cancer, the most commonly diagnosed cancer during pregnancy and in the first year postpartum. In my case, because I had so recently delivered my daughter, my cancer was considered “pregnancy-associated breast cancer” (PABC), which researchers posit is growing due to both decreasing age at onset of breast cancer and to increasing maternal age. PABC is often considered aggressive.

What followed was one year of intense chemotherapy, immunotherapy, radiation and a partial mastectomy (also known as lumpectomy). Looking down at my infant and not knowing whether I was going to watch her grow up was devastating. Telling my 3-year-old son that I was sick with cancer was the hardest conversation of my life, and yet I felt lucky that I could confidently tell him that I was in the best hands with my medical team. Having detected my tumor meant that we addressed the disease before it spread to my lymph nodes, improving my five-year prognosis to 91%. 

On April 3rd, 2022—after completing 16 rounds of chemotherapy and 12 rounds of immunotherapy, my surgery revealed that I had no evidence of cancer left in the tumor. I am grateful every single day for those results, as they suggest I responded well to treatment and give me hope that my body will make a full recovery, though my recurrence risk will be higher than average for the next five years. Though TNBC does have a higher recurrence rate than other subtypes, I choose to focus on what I can control: my physical, mental and emotional fitness. I consistently exercise and see a psychotherapist to help me address my treatment-related trauma and ongoing anxiety.

Check your breasts—and advocate for yourself

Though mammograms are now officially recommended for women beginning at age 40, breast self-exams remain the most common method of detection for cancers in early stages. Again, it is not that you have to perform an official breast exam, it is simply critical that you are familiar with your breasts so that you can notice any changes, especially if you’re not yet eligible for regular mammograms—and as breast cancer is starting to affect women at younger ages.

It’s also vital that you have a care provider whom you trust. Most of us do not have the type of obstetrician that I am so lucky to have—one who listens, takes you seriously and encourages you to advocate for your own health, so if you feel something, do something, especially as medical gaslighting is so common in women’s health

Get to know your breasts and know your normal by observing and checking them routinely. If something feels or looks different, continue to advocate until you are given a proper assessment, ideally via imaging.