Diagnóstico de cáncer de mama (seno) durante el embarazo

This podcast is made possible by Lilly [and Novartis]. 

Welcome to The Breastcancer.org Podcast, the podcast that brings you the latest information on breast cancer research, treatments, side effects, and survivorship issues through expert interviews, as well as personal stories from people affected by breast cancer. Here’s your host, Breastcancer.org Senior Editor, Jamie DePolo .

Jamie DePolo: Hello, thanks for listening. According to statistics from 2022, about one in 3,000 pregnant women will be diagnosed with breast cancer, most in the first trimester. Many women going through this feel alone and anxious, worrying about their health and what breast cancer treatment means for the health of their babies. Rafaela Dreisin was diagnosed while pregnant. She joins us today to share her story and offer insights and resources for others in the same situation. Rafaela, welcome to the podcast. Thank you so much for talking to us about this.

Rafaela Dreisin: Thank you so much for having me as a guest today.

Jamie DePolo: So, just to start, could you tell us when and how you were diagnosed? Were you considered at high risk for breast cancer? Was there a family history? Or was it just not even on your radar?

Rafaela Dreisin: It was not on my radar. I do have a family history. My mother had breast cancer. She’s in remission now. She was post-menopausal when she was diagnosed. So, it was never like something that came up. Any time I went to my yearly OB-GYN appointments, they didn’t seem concerned that I was at particularly high risk for getting diagnosed at a young age with breast cancer. So, it really wasn’t on my radar.

I found out that I had breast cancer, my official diagnosis, was just before I was 12 weeks pregnant. So, just about the start of my second trimester, which I can get into later. It was strange because oftentimes people wait until three months of their pregnancy to let people know about the pregnancy. 

Jamie DePolo: Sure.

Rafaela Dreisin: So, I was like giving people both pieces of news at the same time, which had its own complications. So, I was about three months pregnant. Initially I felt a lump on my own, which I think is common for women who get diagnosed at an early age because we have less screening. I thought maybe it has something to do with the pregnancy, like maybe something is swollen. 

I asked my primary care physician because I just so happened to have an appointment with her coming up. I went to that appointment, asked her to check out the lump. I almost didn’t. I almost thought, I'm being paranoid. She felt it. She said, you know what, there’s something weird there, let’s get some imaging done. I went to have imaging done. They did an ultrasound because when you are pregnant, they avoid certain scans. 

Jamie DePolo: Right.

Rafaela Dreisin: The ultrasound…initially the radiologist said, I'm almost positive this is a fibroadenoma. She was right. The thing I went in for that I felt was not cancerous. 

Jamie DePolo: Oh wow.

Rafaela Dreisin: They did a more in-depth scan. They found, actually, like behind that, was cancer. So, it was sort of like this freak thing. Yeah. The initial ultrasound, they just looked at this one area. It was a fibroadenoma, but my radiologist, thankfully, was like, let’s just be extra cautious and have you come in for a biopsy. When I went in for the biopsy, they did a larger ultrasound and more in-depth, and then they noticed more lumps so they biopsied several sites, and then it turned out that I did have invasive ductal carcinoma. 

Jamie DePolo: Okay. And how old were you?

Rafaela Dreisin: 36 at the time. 

Jamie DePolo: Okay. 

Rafaela Dreisin: Yeah.

Jamie DePolo: Okay. And what were your thoughts? I can't even imagine what you were thinking. It must have been like up and down, up and down, up and down. 

Rafaela Dreisin: Yeah. It’s a strange thing to deal with, because you're dealing with such different extreme emotions. I was so, so, so, so excited about the pregnancy and then you receive this sort of crushing news and you're trying to balance all of these things at once. I think my very first thought was like, has this ever happened to anybody before in the world? 

Jamie DePolo: Right.

Rafaela Dreisin: Which looking back on it, you're like, yes, this does happen, unfortunately. It’s not super common, but it’s not completely unheard of either. And so, I think at first, there’s just the crushing news of finding out you have breast cancer and what does this mean? It’s scary. And also, what does this mean? Am I going to be able to keep, you know, continue with this pregnancy and keep this baby? And just all of that. There were just so many questions all at once.

Jamie DePolo: Yeah. And I guess I'm wondering, how did you get those answered? Did your doctors or your care team kind of give you a clear path? Because I'm sure, like your OB-GYN probably could answer some of them, the oncologist could answer some, but did you have to go back and forth or was there one place where you could go?

Rafaela Dreisin: I'm very fortunate to be able to have received such good care. I live in Baltimore and so I am being treated at Johns Hopkins. And so, because they have so many specialists, they have seen this case before. So, I was set up with a specialist for like an OB-GYN, who has treated other cancer patients before. And then, on the other side, my oncologists, and surgeons, and radiologists have all worked with pregnant women before. That’s obviously not the case for everybody across the country, but I felt like they were able to give me a very holistic treatment in view of everything. 

My radiologist was the one who delivered the cancer diagnosis to me, and she was so, like, this has happened before, you're going to be okay, the baby’s going to be okay. She got me set up with the oncologists and they were all…my oncologist told me, "If I had a daycare for all of the babies running around from people I've treated who were pregnant while they had cancer, I'd have like a full daycare." So, that was really reassuring to hear that I wasn’t alone and that they knew how to treat my specific case. 

Jamie DePolo: Right. Right. Oh yeah. That’s wonderful. I'm so glad you had that situation. Did your doctors talk to you at all about any connections between being pregnant and developing breast cancer? You know, I've read some studies that talk about how…no, this would be after. I want to remember. I want to say it exactly right. Like there are some studies showing that the risk of breast cancer just goes up a tiny bit after a woman gives birth and for those five or 10 years after. But did anybody talk to you about that at all or no?

Rafaela Dreisin: No. And you know, they’re really not sure because I hadn’t had like any imaging done beforehand. 

Jamie DePolo: Right.

Rafaela Dreisin: They didn’t discover this until like a year later, but they suspect that I had probably already had the cancer before I was pregnant, or there was a chance. And maybe the increase in hormones…my particular type of cancer is hormone reactive. 

Jamie DePolo: Hormone receptor-positive?

Rafaela Dreisin: Yes. Yeah. So, the jump in estrogen maybe didn’t help that or made it more noticeable.

Jamie DePolo: Okay.

Rafaela Dreisin: I knew so little about breast cancer. Even though my mom had breast cancer…and when she had breast cancer, they didn’t do things like BRCA testing, especially…you know, it was 16 years ago. So, it just wasn’t really on my radar. My doctors let me know that although my cancer was hormone-positive…I wouldn’t have any expected different outcomes, you know, being a pregnant person. Like basically, being pregnant or not pregnant doesn’t necessarily affect the outcome. 

Jamie DePolo: Okay.

Rafaela Dreisin: Your survival outcomes, I guess.

Jamie DePolo: Sure.

Rafaela Dreisin: Yeah. I'm not sure if I said that well, but…

Jamie DePolo: No. No. That would make sense. And I guess that’s kind of a lead into what I was wondering. How did you and your doctors decide on treatment? I mean, I believe if I'm understanding correctly, there are certain treatments that if you're pregnant you should not get at certain times, like first trimester, second trimester, whatever. So, did they go through all of that with you?

Rafaela Dreisin: Yes, they did. You know, certainly my treatment path was different than if I wasn’t pregnant. 

Jamie DePolo: Sure.

Rafaela Dreisin: I'd say one of the big differences also is just that you can't have an MRI or a PET scan while you're pregnant. And when you're younger…they could do a mammogram. They put like a lead covering over my belly to do the mammogram, but younger women tend to have more dense breast tissue, which makes mammograms less effective. So, they were sort of doing the best they could to make decisions on the information that they had. 

So, I actually first had a lumpectomy. When they did the lumpectomy, they realized the mammogram didn’t pick everything up and it was actually a little bit more widespread than they originally were able to see. So, I didn’t get clean margins. So, then I had to go back and have another surgery, but they were able to do these surgeries while I was pregnant. The thing with my second surgery happened right around the beginning of my third trimester. You're not able to take normal pain medication. 

Jamie DePolo: Oh, right. 

Rafaela Dreisin: So, I think after my mastectomy it was just like regular Tylenol I was taking, which made the recovery process interesting. So, I think that was interesting.

You can do certain types of chemotherapy. You can't do them when you're in your first trimester, but there’s specific kinds you can do in your second and third trimester. So, they gave me the treatment options.

I originally was going to have a lumpectomy and then start chemotherapy while I was pregnant. They realized they couldn’t get clean margins, so then I ended up having the unilateral mastectomy and then because of where I was in my pregnancy, they weren’t really going to be able to start chemo because they need to stop to give your body a break to heal to give birth. I had my surgery. They induced me a month early. So, I was induced at 36 weeks. They gave my body a few weeks to heal and then I started chemotherapy when I was three weeks post-partum. 

Jamie DePolo: Wow.

Rafaela Dreisin: Yes. But there were some options along the way, and they did talk me through everything, and yeah. 

Jamie DePolo: I'm assuming radiation was off the table because you were pregnant. Is that correct?

Rafaela Dreisin: Yes. You can't do radiation while you're pregnant and I think maybe even just the order of doing the surgery first and then the chemo second is sort of maybe more unusual, but again that was all because of the fact that I was pregnant. And yes. Radiation I wasn’t going to need because I got clean margins from my mastectomy.

Jamie DePolo: Okay. So, that wasn’t really recommended anyway. 

Rafaela Dreisin: Yeah. I didn’t have to do radiation, regardless. 

Jamie DePolo: Okay. And then, what about if the cancer is hormone receptor-positive, usually there’s, given your age, I'm assuming it would be tamoxifen rather than an aromatase inhibitor would be recommended after surgery for five to 10 years. I don’t know how that works if you're breast feeding or if you have a small child, or whatever. 

Rafaela Dreisin: Yes. So, I tried breast feeding. I knew I wasn’t going to be able to do it for long because once you start chemotherapy you can absolutely not breastfeed. But there was like a two- or three-week period of time that I thought I would try to. I was having difficulty and I only had one breast and I just decided in the end not to go that route since I wouldn’t be able to do it for long anyways. I would say there’s this amazing resource. I was able to get donor breast milk. 

Jamie DePolo: Okay.

Rafaela Dreisin: For like the first two months that my daughter was a baby she had donor breast milk. So, that was an amazing resource. Yeah, once you start chemotherapy you cannot breastfeed and if you start chemotherapy when you're pregnant I think they don’t recommend, you know, you would need to wait quite a while before you would be able to breastfeed again. So, there was that. I'm not on tamoxifen. I'm on something called anastrozole.

Jamie DePolo: Oh, okay. So, an aromatase inhibitor. Got you.

Rafaela Dreisin: Yes. And that’s something that they started while I was on chemotherapy still. Long story short, I’ll jump ahead a little bit. It was originally early-stage breast cancer, they thought. Again, my lymph nodes were clear and based on all of this imaging that they were able to do at the time, which was mostly mammogram and ultrasound, that was the understanding.

I found out this past spring, about a year ago from today, that I, in fact, had metastatic breast cancer, which was something I didn’t find out until I was able to have an MRI after all of my treatments were over. And I was going to have reconstructive surgery. 

They did a pre-scan and found two spots. So, I had metastatic cancer on two spots on my bones, but that’s why they think the cancer had maybe been there since before I was pregnant. It’s an unusual case because typically when your lymph nodes are clear they're not worried about it spreading. So, this is not like your standard case and my doctors were quite surprised. I don’t want to scare anybody else who’s going through this. There are amazing treatments that they have. So, now I'm on all kinds of hormonal…I take the anastrozole. I have a monthly ovarian suppression shot and I'm on some immunotherapy called Verzenio. 

Jamie DePolo: Oh, right. Okay. Sure. 

Rafaela Dreisin: And I get my scans. But yes, it certainly probably will affect your ability to breastfeed if you are diagnosed just because of your treatment plans. 

Jamie DePolo: Sure. 

Rafaela Dreisin: And you know, of course, your decision to maybe have another child. Because for me at the time I was a little bit later in life. I had my first child when I was 36 and if you have hormone-positive cancer then you are supposed to be on tamoxifen or one of these hormonal medications for at least a couple of years. And I think, depending on the case, they will let you take a break after two years if things are looking good to get pregnant. Or in some cases, they gave me the option that if I wanted to, I could try and do some egg freezing before starting my chemotherapy and all these other things because chemotherapy also affects your fertility. 

So, you know, my doctors were really great. My oncologists and my OB-GYNs had me meet with a fertility specialist during the early stages of my diagnosis to figure out what all of my options are. You know, you obviously can't freeze your eggs while you're pregnant. So, there was just the conversation of if you want to try and do that after you give birth before you start whatever your next treatment steps are. For me personally, I decided I had enough going on and we were just happy with our one baby and to not go that path. But I know there are options for people who are interested in continuing to have more children in the future.

Jamie DePolo: Yeah. Yeah. I would imagine that’s a very complicated decision that you have to take all those various things into account.

Rafaela Dreisin: Yes.

Jamie DePolo: Especially if, as you say, the treatment is long-term or ongoing.

Rafaela Dreisin: Yes. Once you have metastatic cancer it’s probably not a real option to have kids because of the hormonal related stuff.

Jamie DePolo: The ongoing treatment. And I realize for our listeners and actually for myself, too, I should’ve asked you this question right up front. How is your daughter now? Happy, healthy, and thriving, I'm hoping?

Rafaela Dreisin: Yes. My daughter is doing so great. She will be two this coming July. 

Jamie DePolo: Excellent.

Rafaela Dreisin: She is doing so great. Thankfully I didn’t have any other complications to my pregnancy. The only sort of complication, which was related to the treatment, was just that I had to be induced a month early. So they made sure to have the NICU team right there when I gave birth to make sure her lungs were fully developed and all of that. They did also give me some steroid shots the weeks before I gave birth since they knew she was being born prematurely to help, I don’t know, like reduce the likeliness that she would have problems with her lungs when she was born. So, that was something helpful and again this was a specialist. 

I was seeing a high-risk OB-GYN who had dealt with patients like me before and so I think that was a good recommendation. And so, my daughter didn’t need any special treatment when she was born. She was great. We were able to take her home after a couple of days in the hospital, and she’s doing great. All of my doctors reassured me, too, that, like…you know, we introduced formula pretty early on just due to everything and the doctors weren’t worried about that at all. I know that’s like something you can really get in your head about amongst all the other things you get worried about as a new mom. But she’s doing absolutely wonderful and she’s the thing that keeps us going.

Jamie DePolo: Oh, that’s great. I'm thrilled to hear that. That’s so wonderful. So wonderful for you.

I guess I'm wondering, how did you cope with some of these emotions? It just seems like there was so much going on. You know, were you offered any special counseling? Did you seek that out on your own? Did you turn to friends? I know some people turn to their clergy? Did you have that kind of help?

Rafaela Dreisin: Thankfully I have a really great support system in my life. My husband is wonderful. We have really supportive families. His family lives nearby, which also had its own special benefits. My folks came and stayed with us for the surgeries and chemo and all of that to help with the new baby. So, having that support system was huge.

Thankfully I already had been seeing a therapist just in my life, so she was really there for me throughout it all and I can't recommend that enough. There were also support groups at my treatment center at Hopkins that are specifically for women that get diagnosed with cancer, I think it’s like for under 40. So, it’s young women with early-stage cancer support group that I would attend. It was virtual. I would check into that quite often and that was a really great resource. I was the only one who was in this specific situation of being pregnant when diagnosed, but it was still just helpful to know the kinds of things that people were dealing with and how they dealt with their diagnosis and treatment options. 

And I also had a friend who was a breast cancer survivor, and she reached out to me and was super helpful. So, I think all those various ways of reaching out to people and connecting with people was really helpful.

I did feel very alone with the pregnancy component and it felt like everything I read about dealing with breast cancer treatment was not necessarily specific to me. And so, trying to connect with other people who had gone through this, you know, is something that I think could be helpful. There is a group called Hope for Two, and it’s specifically an organization for people who are diagnosed while they are pregnant, and that was really helpful and made me feel less alone. And that was a resource that my treatment center provided me with.

Jamie DePolo: Oh nice. Okay. 

Rafaela Dreisin: So, yeah. I was, you know, fortunate to be in a place at a treatment center with a lot of resources and having a good support group.

I think one of the big things for me was going through different waves of, how do I balance feeling really excited about my baby and dealing with the stress of breast cancer? I think you are almost grieving two different things. You're grieving the fact that you have breast cancer and then you're grieving, like the loss of this pregnancy experience that you feel like you're kind of robbed of.

You know, I was hoping this was going to be a really happy time in my life where you do all kinds of planning and have, you know, you go to your pregnancy yoga classes and your, I don’t know, just like all of these things that you imagined for yourself and you feel like you're kind of robbed of that. 

And the amount of doctor’s appointments that you have, I mean, you already go to a lot of doctor’s appointments when you have cancer or you're pregnant and then you combine them, and it was just like four doctor’s appointments a week. It was crazy.

I think there was a time when I thought maybe I should really compartmentalize these two things, but that didn’t work because they’re not separate ultimately, and they do impact each other. 

So, I think for me, it was not forcing myself to try and ignore the breast cancer, but also to create moments of just celebration. And so, doing a maternity shoot. I did that. That’s something that I don’t think I would’ve done maybe otherwise, but one of the things I thought was, let me plan something happy to celebrate this pregnancy. We did like a little maternity shoot and that was really fun. My friends threw me a baby shower. And so, planning things for your pregnancy and really trying to not let the breast cancer experience rob those things from you. I don’t think you have to put the pressure on yourself, of like, I'm not going to think about breast cancer, because it’s sort of hard not to do that…

Jamie DePolo: I was going to say…

Rafaela Dreisin: …because that kind of pressure you put on yourself. It’s like when you're meditating and you're like, don’t think about anything else. You know, it’s kind of hard to force yourself to do that. I think letting the thoughts enter and leave and just saying, this is your own pregnancy journey. Everybody’s pregnancy journey is different and some people have really hard pregnancy journeys, even without breast cancer. People have things like miscarriages. People have concerns over all of the tests and ultrasounds they have along the way. Some people have gestational diabetes and other family issues. And so, I think not having this ideal image of a pregnancy experience that you're comparing yourself to and just saying like, this is my unique pregnancy experience and still trying to find ways to really still celebrate that while you're going through all of this and giving yourself a lot of grace.

Jamie DePolo: Absolutely. I mean, that makes sense. I do think a lot of things related to, I guess I would call them milestones in women’s lives, marriage, pregnancy, they get idealized and nothing bad ever happens during those times and those are these perfect things but that’s not reality. 

Rafaela Dreisin: Yeah. I remember thinking to myself like, I'm going to go to a pregnancy yoga class because I want to be able to do something that feels like…and I went and there’s like this really beautiful space and this group of women. And at the beginning, they had people go around and say, what’s something that’s difficult that you're trying to deal with that you want to let go of. It got to me, and I just sort of started hysterically crying and I think I traumatized everybody in the room. I was like crying the entire class, like silently, and I was like, oh my gosh, this is so embarrassing. But you know, you deserve to take up space and you know. 

Jamie DePolo: Yeah. There’s room for everybody. 

Rafaela Dreisin: Yeah. Go through your own experience and I think having a little bit of a sense of humor about it doesn’t hurt also.

Jamie DePolo: Absolutely. If I can ask, this is kind of a nosy question, have you thought about how you're going to talk to your daughter about breast cancer?

Rafaela Dreisin: Yeah. That’s a great question. I’ve certainly thought a lot about it, but I haven’t really come to a good conclusion yet. Because when I look up things about talking to your children about breast cancer it’s usually like, tell them right away and talk to them, blah, blah, blah. It doesn’t often come from the perspective of getting diagnosed before your child is even born or getting this metastatic diagnosis when my child was like eight months old. So, you know about it already for a long time, how do you talk to them about it? When is the right time to bring it up in that context when you already know about it before they can have the ability to process that? 

So, I haven’t really found what I'm going to do yet and it’s something that now that she’s approaching the age of two and can understand a lot more, I really have to think about a lot more seriously. So, I don’t know yet.

From most of the things that I've read in general about talking to your kids about cancer, it’s like tell them right away and be as open as you can about the realities of the situation. So, I’ll probably do a lot of research. You know, trying to do that, it’s hard because I'm like, well, I don’t want my child to take on this sense of anxiety that their day-to-day life is going to be ripped away from them. 

But starting when they’re like two years old and just live with this fear and anxiety their entire childhood. So, I kind of go back and forth in my head. With the advancements they’ve made, you know, obviously there’s no cure for the type of cancer that I currently have, but there is treatment. My doctors, where I'm at with it, have told me to think of it almost like a chronic illness instead of like an immediate, life-threatening illness. And so, in my mind I've gotten to a place mentally where I plan on being here for at least the foreseeable future and nobody knows, you know, what will happen to them. And so, trying to balance that, like, yeah, what information do I want to give her without traumatizing her or giving her lifelong anxiety issues.

Jamie DePolo: Yeah. I do have…I’ll recommend one person to look up. 

Rafaela Dreisin: Yes.

Jamie DePolo: Her name is Kelly Grosklags . 

Rafaela Dreisin: Okay.

Jamie DePolo: And she’s in Minnesota. She was a therapist for a number of years and now she’s a grief counselor. She’s worked with a lot of people with metastatic breast cancer. And she has some really good tips on how to talk to kids. In fact, I did a podcast with her on that specific topic .

Rafaela Dreisin: I'm definitely going to check that out. 

Jamie DePolo: Yeah. Because she kind of addresses some of the things that you're talking about and I'm not going to pretend to know what Kelly knows, but I would just offer her up as a resource because she’s so good. She also does a podcast, and she has a Facebook group, too, if you want to check her out there. 

Rafaela Dreisin: I definitely will. That’s very good to know.

Jamie DePolo: Yeah. Finally, I guess I know you’ve kind of said this throughout the podcast, but if somebody else came to you who was recently diagnosed while pregnant, what are the top three things you would tell them, that you would want them to know?

Rafaela Dreisin: I’d say that, I'd reassure them that being pregnant won't negatively impact your treatment options and your outcomes, and that like if you're being treated by someone who hasn’t treated someone who is pregnant before, make that second appointment and get that second opinion with someone who has, whether that’s a larger hospital that you can travel to one weekend. You can get second opinion appointments that are specifically just for that. I don’t think your doctor will be offended. It’s really worthwhile doing. 

Again, I'm fortunate to be treated at a place that has amazing resources and does have a lot of specialties, but even when I got my metastatic treatment, I got a second opinion at Sloan Kettering in New York because it’s peace of mind and that’s in itself really important. So, I would just recommend that. I know there’s a lot to manage already, but I really suggest trying to do that if you're being treated at a place where they don’t have as much expertise in that particular area. 

You know, make your own pregnancy journey your own and don’t focus so much on the things that are being taken away and just focus on this is my individual journey. Find ways to celebrate and don’t put too much pressure on yourself either to like make everything feel perfect. And remember that your child will know how strong you are by going through this.

You know, while there are obviously challenges, I also in a way wouldn’t have changed anything because I have this beautiful gift of my daughter and if I had found out that I had breast cancer before I was pregnant, I might not have been able to have had a child at all or at least this particular child. So, that’s like the silver lining in a way. Finding out you have breast cancer while you're pregnant sucks, but if I had found out before I was pregnant then I wouldn’t have this beautiful child that I'm giving birth to. And so, looking at it from kind of like, the glass is half-full perspective when you can. And yeah, just knowing that you're not alone. This happens, unfortunately, to other people and that there is a good amount of research about treatment options. So, not feeling totally alone or panicking. 

Jamie DePolo: What was the name of that support group that you said you your doctors connected you with?

Rafaela Dreisin: Hope for Two.

Jamie DePolo: Okay. Okay.

Rafaela Dreisin: Yeah. Make sure, you know, I think therapy is an amazing thing, so I always recommend that.

There’s the physical component of all of it. You know, you already deal with a lot of image changes and difficulties when you're pregnant and post-partum. Your body changes so much and then on top of that, if you go through chemotherapy, you're like, oh, and now I don’t have any hair. And all of the toll that the chemotherapy takes on you. And so, then you're like double body image issues. That’s something that I found hard and still find hard. I mean, as you can see, I am two years post-chemo, basically, and this is like the length that my hair is. I used to have very long hair. And so, there’s a lot of changes where you just don’t feel like yourself. 

Jamie DePolo: Right.

Rafaela Dreisin: But yeah, try to be kind, give yourself grace, take care of yourself, and you will feel more like yourself one day. And here I am, I feel so much more like me, back to normal. You know, yes, going through chemotherapy and having a newborn is like so crazy. But at least your kid doesn’t know what’s going on, you know. So, at least there’s that. You're not like traumatizing them because they don’t really know what’s happening when you're going through that hard period of time. 

And don’t be afraid to take pictures with your child even if you're going through chemotherapy and you feel ugly. I know it sounds superficial, but you know don’t let that stop you from capturing special moments.

Jamie DePolo: Right. Keep those memories because they're your memories. They're your life. They're your experience. 

Rafaela Dreisin: Yeah. It also impacts, like, your reconstruction timeline because for me they want to keep the surgery as short as possible when they put you under when you're pregnant. So, they don’t want to do expanders or any kind of reconstructive or any…

Jamie DePolo: You probably can't have like flap reconstruction because you can't move the tissue around like that.

Rafaela Dreisin: Yeah. So, I actually still don’t have reconstructive surgery just because then I had this other diagnosis, but the plan for me at least originally was that I would basically go for a year with just one boob and then would do reconstruction a year later after I finished chemo and my body had recovered and I was in a place to do it. So, just kind of, you know, keeping that in mind. 

I think, advocate for yourself. If you think you have a lump and you're pregnant…something I heard from other women who had gone through this, thankfully this was not the case for me, my doctor is excellent, it can be written off sometimes as, oh, you're too young, you're not high-risk, and they’d say not to worry about it. I'd say advocate for yourself and push to get something checked out through an ultrasound scan if you suspect that something is going on while you're pregnant. 

And then my general thing that I've been telling everybody in my life, not necessarily people who are already diagnosed, but try to get more information about your risks because I didn’t think I realized how high a risk I was until after I was diagnosed.

My mother had breast cancer. Women are getting diagnosed at a younger age. Get a BRCA test if you have any family history. Also, there are certain ethnicities that are more at risk. I am on both my father’s and mother’s side an Ashkenazi Jewish from an ethnic standpoint and I did not realize that that means, I think, it’s four more times likely to develop breast cancer in your life. I don’t even think a doctor had asked me that, you know. That wasn’t on my forms of what my ethnic background was in that particular way and what that meant for my risk. 

So, I just tell women out there to know more information about your risks so that you can advocate for more scans. Like I said, mammograms are less effective on younger women, and I think that it’s more common for younger women to find their breast cancer on their own because there’s less screening. So, advocate for getting screened more at an earlier age if you think that you have higher risk.

At the same, there’s really not a single thing that I would change because I have this beautiful daughter of mine and if I had caught the cancer earlier then I might not be able to have this beautiful child in my life. So, there’s really nothing I personally would change. Humans are incredibly resilient and find things to make you laugh and give you joy along the way.

Jamie DePolo: That’s all excellent advice, Rafaela. Thank you so much. I so appreciate you sharing your story. I know it will be helpful to other women out there. Thank you.

Rafaela Dreisin: Absolutely. I'm so happy to have had the opportunity and hope this can help someone else who’s feeling alone in their pregnancy with cancer journey because it is wild to say the least. But yeah, you're not alone if you're out there.

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