Siobhan Donovan of Worcester was feeling strong, vibrant and excited to welcome a new baby into the family — until one day two years ago when she felt a lump on her right breast.
The 33-year-old wife, mother and teacher — 36 weeks pregnant with her third child — called her obstetrician about what she thought might be a clogged milk duct.
She said she and her doctor weren’t worried at first. She had no family history of breast cancer and no symptoms. Her pregnancy was going well.
But test results and a biopsy showed the worst-case scenario. She was diagnosed with Stage 4 metastatic breast cancer that had spread to her bones.
“It’s not curable, it’s treatable,'' she said her doctor told her. ”There is no cure for this type of cancer.’'
She remembers asking, “Am I going to die?”
Donovan is one of a growing number of younger women who are being diagnosed with breast cancer, according to the American Cancer Society.
Breast cancer is the most common cancer diagnosed among women in the United States, and it is the second leading cause of death from cancer among women, only surpassed by lung cancer, the American Cancer Society says.
Advances in screening and treatment have helped. New findings show that breast cancer mortality rates overall have dropped by 44% since 1989. But many medical experts say what is concerning is the continued upward trend in breast cancer incidence, with the steepest increase in women under 50.
And younger women with breast cancer are more likely to have aggressive forms of the disease, according to a report by the Breast Cancer Research Foundation.
Sara Tolaney, a breast oncologist at the Dana-Farber Cancer, Institute, said Donovan’s profile matches the concerning trend.
“This is disturbing to all of us,'' she said. ”The challenge is we’re not exactly sure why it is rising so rapidly in younger people in particular.”
Tolaney said there are different hypotheses for what’s behind the increase, such as obesity, changes in the environment and diet. “But there’s nothing specific that we can really put our finger on for why it is rising so rapidly.”
She says one challenge is lack of early diagnosis. Often, when a woman in her 20s complains of a breast change, cancer is not the first thing that comes to mind, she said. But the rising rates of breast cancer in women under 50 has led to a re-thinking of everything. That includes new guidelines that women start getting regular mammograms when they turn 40, instead of the previously recommended age of 50.
Donovan said upon receiving her devastating news, she and her husband put their children — a newborn and two other children ages 1 and 3 — in their car seats, went to get Happy Meals, drove around and cried.
Her chemotherapy treatment began almost immediately.
Between June and December of that year, Donovan underwent 27 consecutive rounds of chemotherapy infusions at Dana-Farber Cancer Institute, sometimes with her infant in tow.
The treatment seemed to help. She was feeling ok. She was tired and overwhelmed but trying to adjust to the new normal. Her family decided to travel as much as they could to make every memory possible. They went to Disneyland, to Cape Cod and Maine.
She said doctors detected no further evidence of the disease and she felt hopeful. She went back to her teaching job at Fitchburg Memorial Middle School as an 8th grade English teacher.
But then she started getting skin rashes. She knew, “something was wrong.’' A biopsy showed she had skin cancer. Her disease had progressed. She’s learned she might have just five to ten years left.
Donovan says she thinks about the milestones she’ll miss as her children grow up without her — proms, graduations, and even her wedding anniversaries. But she digs deep and finds new gratitude for everyday she is with her family.
She also not ready to give up — motivated to show her children strength.
“It’s important for them to see me accomplishing this and working through struggle and coming out on the other side of something hard,'' she said, ”stronger than I ever imagined I could be.”
Donovan trained and finished the Boston Marathon with her sister last spring. Together they raised $20,000 for Dana-Farber. Running was the best, she said, a day of photographic proof for her children to hold onto when she’s gone.
Soon after the marathon, Donovan started a new cancer treatment. She receives an infusion of a new drug every three weeks. She admits it’s challenging. “Much harder somehow than chemo with an infant and two toddlers,” she said.
But Donovan says she’s not angry. She’s more sad and afraid. She cherishes every day. She says her strength is her “superpower.”
She said she wanted to tell her story to help others get through it. Many people don’t understand that Stage 4 metastatic breast cancer has a series of progressions. It’s best to face the darkness and her own mortality, she said, and make decisions on how to make use of the time she has left.
“I don’t want to say you’re gonna be okay. That’s not, that’s not it,'' she said. ”You’re gonna figure it out. You’re gonna be strong. And you’re gonna keep going.“
