She was 25 years old and pregnant with her first child—the picture of health, happiness, and the potential of life. But Nicole Davis had no idea that she’d developed a relentless form of cancer that was, in a cruel twist, aggravated by her pregnancy.
On a bright day in February 2009, about two weeks after the lumpectomy, Nicole and her Aunt Marilyn arrived at the Kaiser Franklin Medical Center for her first oncology appointment. Uncle Ted would soon join them, but Tyler had to work. He’d taken off nearly a week during the lumpectomy, and they desperately needed the income from his job as a financial planner at Citigroup, as well as his health insurance. He hated not going—he had gone to every appointment so far—but he reminded himself that this was a routine initial exam to discuss the treatment options for after the baby was born.
In a white-walled exam room, Dr. Catherine Azar introduced herself. A no-nonsense woman, Azar glanced over the pathology report on the tumor removed from Nicole’s breast. When she looked up, her face had changed. “Nicole,” Dr. Azar said slowly, “I need you to trust me right now, with your life and your baby’s life. We need to start chemotherapy today—right now.”
Nicole and her aunt looked at each another. Nicole clutched her belly, feeling as if her airways were closing. She heard whimpering, and it took her a moment to realize she was making the sounds. “If we don’t start today,” the doctor said, “I can’t guarantee you’ll make it through this pregnancy.”
Azar explained that the cancer threatening Nicole and her baby was Stage 2B out of 4, which in Nicole’s case meant it had spread to a lymph node. It was both estrogen and progesterone positive, which meant that as the hormones surging through her body primed her uterus for childbirth and helped her baby grow, they were likely also feeding the destructive cells that, if unchecked, would multiply until they halted her body’s basic functions.
And, as if all that weren’t scary enough, there was this: Nicole’s cancer was a particularly aggressive type called HER2-positive. This meant it tested positive for a protein called human epidermal growth factor receptor 2, which roughly one in five breast cancers produce in abnormally high amounts as a result of a gene mutation, and which causes cancer cells to replicate at an especially high rate. HER2-positive cancers aren’t limited to breast cancer, and they’re especially difficult to deal with because they require very specific types of treatment.
Yet there was one encouraging possibility: a revolutionary drug called Herceptin. Developed specifically to slow, or stop, the growth of HER2-positive cancer cells, Herceptin has enabled 85 percent of patients diagnosed in the first two stages to live to at least five years, compared to roughly 70 percent before its release in 2006.
Aborting the pregnancy is typically not an option for pregnant women with breast cancer, because, according to the NCI, it’s not likely to increase chances of survival. However, it is possible to treat the mother with chemotherapy in the final trimester—Nicole was in her third trimester—without hurting the fetus, which by then is nearly fully formed.
Pregnancy complicates a woman’s treatment, but age is actually the most critical factor when it comes to survival. Scientists don’t know precisely why, but the cancers found in young women tend to be especially aggressive. Women diagnosed under 40—pregnant or not—have increased risk of recurrence, and by extension, death. The tumors in these women are often fast-growing and therefore harder to detect early, which makes them potentially more lethal. Because mammograms are less effective in young women and younger breasts are more sensitive to radiation, the best way for young women to find cancer is to practice “breast awareness”—to know what their breasts normally feel like and to get anything abnormal checked out.
Azar said they would begin with a standard chemotherapy regimen called AC, follow that with additional chemo drugs and radiation, and fight the cancer with Herceptin. Nicole would be in treatment for more than a year. She was just two months from her due date, but the doctor said this first round of chemotherapy was unlikely to harm her baby because she was close to fully formed. Nicole kept turning that word over in her mind. Unlikely?