How one woman fought for her family, and her health, after being diagnosed with triple-negative breast cancer while pregnant.
She didn’t know it yet, but finding a lump in her breast was just the first in a series of life-altering events.
It was September 2007 when 37-year-old Stephanie Hosford discovered that chickpea-sized lump.
At the time, she and her husband, Grant, were raising a young son and trying to expand their family. In fact, they were two years into the process of adopting a baby.
A mammogram followed by an ultrasound and core needle biopsy brought disturbing news.
It was triple-negative breast cancer (TNBC), a particularly aggressive form of the disease.
While awaiting a surgical consultation, Stephanie realized her breasts were sore and her period was late.
After five years of trying to conceive, pregnancy at this moment seemed like a long shot. But tests confirmed this latest piece of news.
There was a baby on the way.
“I was completely terrified, confused, totally not knowing what to do,” Hosford told Healthline. “My husband and I had conflicting emotions. We were happy about the pregnancy, but somewhat devastated.”
The news from the surgical consultation was dire. They were told they would have to terminate the pregnancy. So, they arranged several other consultations, all resulting in the same heartbreaking advice.
Then her husband told her he’d heard about a place called City of Hope and he wanted to get one more expert opinion.
Hosford wasn’t eager to make another appointment, or to hear the same news again.
However, they ended up in consultation with Dr. Benjamin Paz, a surgical oncologist at City of Hope in California, and Hosford said she immediately had a different feeling.
“Dr. Paz is one of the warmest, most sincere people I’ve ever met. When we asked about terminating the pregnancy, he said we didn’t need to. I could get treatment while pregnant,” Hosford said.
That changed everything.
“When you have a person in front of you, you’re not treating a cancer,” Paz told Healthline. “We tend to focus on the disease and not the person. The first thing you must do is take the time to understand how important all this is to them. What Stephanie and Grant wanted was to live and have a family, not just to be a cancer survivor.”
While Paz noted that a pregnancy during cancer can’t always be saved, he said he felt there was only a small amount of risk in Hosford’s case.
“We know that after the first trimester, many chemotherapy agents are safe and don’t affect the fetus,” he said.
Because her cancer was not driven by hormones, it wasn’t affected by the pregnancy itself.
“As a physician, you must try to help families to accomplish what they want. There’s no question it’s scientifically safe to do. We can treat women during pregnancy,” said Paz.
Hosford’s diagnosis was stage 1 and the tumor was small. She was able to have a lumpectomy during her first trimester.
Once she entered her second trimester, chemotherapy could begin.
During four rounds of chemo, Hosford continued to feel well.
“The craziest part was that I didn’t get sick. I tolerated it quite well. I was scared I wouldn’t hold it down and the baby might not get nutrients. But I was monitored like crazy and so was the baby. I was told to eat whatever I was able to tolerate. I wondered if it was even working until my hair fell out,” Hosford said.
Meanwhile, that adoption kept moving along.
The long-awaited call came in March and Hosford’s husband flew to China to bring their second child, a daughter, home.
May rolled around and, right on schedule, Hosford went into labor, giving birth to a healthy baby girl.
But Hosford wasn’t finished with treatment yet. She needed four more rounds of chemotherapy. This time, the effects were “horrible.”
Following chemotherapy, she chose a double mastectomy with reconstruction over radiation treatment.
She had followed Dr. Paz’s advice to think about how she wanted to live.
“It’s an individual choice. You know yourself how you can live your life best. It was great to know that City of Hope was behind me either way,” Hosford said.
However, Paz points out that Hosford’s decision to have a double mastectomy didn’t fight the cancer for which she was already being treated. It was done to lower her risk in the future.
He clarified that many people tend to confuse cancer treatment with cancer prevention.
“A bilateral mastectomy does not reduce your risk or impact survival of the cancer you were treated for. It only decreases the risk of developing a new cancer. That’s why I almost never offer bilateral mastectomy to women undergoing treatment,” Paz explained. “Stephanie made it through treatment alive and with her daughter. She was still young and had a long time to develop a second occurrence. She doesn’t carry the BRCA gene, but her chances were one in four of a second occurrence over her lifetime. And she didn’t want to think about it at all.”
Paz credits the couple’s courage for successful treatment.
“She had the most aggressive form of breast cancer. It took tremendous courage to confront cancer and get treatment and understand the potential she might die and not be there for her children. She and Grant had to be able to say, OK, this could happen, but we still want this child,” said Paz.
He noted that another woman in the same circumstances might make a completely different decision. And that’s absolutely acceptable, too.
“Every one of us handles these problems in a different way. I think, as a physician, you must help your patients and their families to make the best decisions on their behalf and support them. They are the heroes of this story, not the physicians,” he said.
Hosford advises women with breast cancer to learn about all their options before they make any decisions.
“If you can’t get yourself to City of Hope, get yourself to a place like it. That’s what they do — they do cancer. They know the most up-to-date research and have the expertise. That’s so important, no matter what cancer you have, but especially if you’re pregnant or have some sort of uniqueness to your case,” she said.
Hosford also encourages women to not “look back” once they’ve made any treatment decisions.
“You made them for a reason and did what was best for you at that time,” she said.
Paz wants women to know that breast cancer is not a single disease. Circumstances matter. So going to your friends for advice because they had cancer is not the best choice.
“There are many variables that influence treatment and prognosis. You must get advice from someone who understands this disease extremely well,” said Paz.
He also noted that not everyone can see a top specialist because of insurance or other reasons.
Nevertheless, he pointed out that doesn’t mean people who have been diagnosed can’t get their advice.
“Frankly, you can always get an opinion for a few hundred dollars out-of-pocket. To have your case reviewed by an expert is worth it. I have affected treatment for many patients I have never treated just by giving my opinion. If I see them, or one of my partners sees them, we can make sure all their questions are answered and all possibilities considered. There’s time to educate them and make the journey of treatment something better,” he said.
Cancer treatment can also take a long time, and that, Paz pointed out, takes endurance.
“You will trip. You will fall. We will get you up and make sure you get to the finish line. Knowing that you are running in the right direction is so important,” Paz said. “That’s why selecting and getting to know the people who will treat you is so critical. This is a team. But you have to run the marathon, nobody can run it for you.”
While he said he doesn’t use the word “cured” very often, he feels comfortable using it in Hosford’s case.
“Stephanie had a very aggressive type of cancer. Almost 100 percent of recurrences happen in the first three years, which is terrifying,” said Paz. “Because it was so aggressive and it’s been 11 years — she’s cured.”
Hosford shares her incredible journey in her book, Bald, Fat & Crazy. She hopes her story will help others who find themselves in similar situations.
TNBC is so called because it tests negative for three common breast cancer receptors: estrogen, progesterone, and a human epidermal growth factor known as HER2.
For women with any of those receptors, treatment can include targeted therapies to destroy cancer cells. But there are no targeted therapies for TNBC.
TNBC is more aggressive and more likely to spread outside the breast than other breast cancers. It’s also more likely to recur in the first few years after treatment, and the short-term prognosis is worse.
TNBC tends to strike younger women, those of African-American or Hispanic descent, and those who carry the BRCA1 gene mutation.
The five-year survival rate for TNBC is about 77 percent, according to BreastCancer.org. It’s about 93 percent for other types of breast cancer.
TNBC makes up approximately 10 to 20 percent of all breast cancers.