During a routine 38-week ultrasound for her second pregnancy, Parul felt a lump in her left breast. For most women, a clogged milk duct or pregnancy-related hormones would be suspected. But for Parul, who had a known genetic risk for breast cancer, the lump set off alarm bells. Before she could schedule a breast workup, her water broke. She delivered a healthy baby girl two weeks early. When her milk came in, she could no longer feel the lump. But her instincts drove her to push for an evaluation.
“My husband wheeled me in my C-section gown to the neighboring breast clinic for an ultrasound and a biopsy,” said Parul. Just days after leaving the hospital, she received the news. At 32 years of age, she had cancer.
“We had two glorious days at home with our happy family when I got the call that the biopsy results were in and it was malignant,” she said. She was seen at Stanford within a week of her diagnosis. Less than a month later, her treatment began.
“When Dr. Telli told me I would need to stop breastfeeding my newborn, it was only then that I started crying,” she recalled. Because she had a high-grade, aggressive type of cancer, she needed to try to rapidly wean the baby, said her medical oncologist Melinda Telli, MD, assistant professor of oncology at Stanford Medicine. “These kinds of cancers tend to grow very quickly, and they can be very life threatening.”
Treatment would consist of 12 to 20 weeks of combination chemotherapy, followed by surgery, neither of which was compatible with breastfeeding.
“Because we knew her BRCA status, we could more optimally select therapies,” said Telli. She further explained that for Parul’s type of breast cancer, how a patient responds to chemotherapy is directly related to their long-term survival. By administering chemotherapy first, her medical team could assess Parul’s response and adjust the therapy if needed. After 12 weeks, Parul had no sign of cancer in the breast or lymph node, a complete response to treatment.
Understanding her genetic risk and treatment options helped guide Parul’s medical decision-making. She selected to have bilateral mastectomies, according to her surgeon Amanda Wheeler, MD, both to help preventa recurrence and to avoid further treatment with radiation. That was in 2014. Four years later, she remains cancer free, well past the peak risk for recurrence.
“It’s important to take the time to do the research, be comfortable with your care team and plan out the best course of action,” said Parul. “That was one of the things I loved about Stanford. Dr. Telli and Dr. Wheeler just sitting down with me, and very clearly walking me through this. This is what we see. This is what it means. These are the trade offs. They’ve been so amazing at a time when I needed it most.”
Parul credits her health today to the care she received at Stanford, and to the knowledge she gained from genetic testing. A doctor recommended Parul receive genetic testing when she was just 29 years old because of her family history. Her mother had been diagnosed with breast cancer in her early 30s. A simple saliva swab showed that Parul was positive for a mutation in the BRCA 1 gene, putting her at a much higher lifetime risk of developing breast and ovarian cancer. “If I hadn’t gotten the genetic testing, it would have probably been a year later, once I stopped breastfeeding, that I would feel my lump again,” she said. “And by then, the end of this story would be very different than what it is today.”
“I’m a very big proponent of genetic testing,” said Parul. “It’s what probably saved my life.”