New insights into the correlations between circulating tumor cells and target organ metastasis

'I Was Diagnosed With Late-Stage Breast Cancer At 28. Six Months Later, It Came For My Sister.'

On March 27, 2024, I was trying to sleep after my night shift as a paramedic when I rolled over in bed and felt a lump in my breast. I wasn't concerned about it, and neither was my primary care physician, who thought it was a fibroadenoma (non-cancerous breast tumor) or just some swelling from hormones.

To be safe, I got an ultrasound. The tech who did my scan called in the radiologist, who looked at the images for a while, which I knew wasn't good. My biopsy the next week confirmed it: I had invasive ductal carcinoma. Breast cancer. Doctors weren't sure how long it had been there, but decided to treat it as Stage III cancer and told me they thought it was curable.

Many doctor's appointments later, my oncologist found that the tumor was bigger than they thought, and that it might have spread to my lymph nodes, sternum, and sacrum. So the plan was to do chemotherapy to shrink it, then a double mastectomy, then radiation. Everything was happening so fast, and it was a lot to digest, but I wanted to start as soon as possible. I knew this medical condition was time-sensitive and didn't want the cancer to spread, plus, I wanted to be proactive and not just sit around.

It's crazy that you can take care of yourself and be healthy and this can still happen. Ironically, the summer after I graduated college in 2019, I ran 4,000 miles across the country from San Francisco to Boston with the Ulman Foundation to raise money for young adults with cancer. Two of the three New York marathons I ran were with the same group. I raised money for young adults with cancer and then suddenly became one.

My sister Elizabeth and me after I finished running my second marathon, which was also in support of young adults affected by cancer.Kate Singletary

My life was a roller coaster after that initial diagnosis.

Not only was I dealing with a major life change, but it directly impacted my family as well. I was tested for genetic mutations after my diagnosis, and they found that I have the CHEK2 gene (one of the gene mutations linked to different types of cancer) from my dad's side. I'm a triplet, and when my sister Elizabeth got checked, they not only found the gene, but also Stage I breast cancer, which is something I never imagined would happen.

It was around mid-September when she received her diagnosis—about half a year after my own, and right after I'd finished my last round of chemo.

She told me the news right when I got home from a walk around the block. I started crying. I didn't want her to have to go through all of this too. But she's faced it with a lot of courage and grace, and told me that she would be much more scared about her diagnosis if she hadn't seen me already go through chemo with a later-stage cancer.

Elizabeth and me taking our first walk after our double mastectomies.Kate Singletary

Part of me keeps wondering what else I could've done to prevent this. I beat myself up for not noticing the lump sooner, but breast cancer can sneak up on you. I had been doing self breast checks every few months because my cousin is a breast surgeon. I shadowed her during college and watched breast exams on patients because I knew I wanted to go into some field of medicine. But I started forgetting to do them because I'm only 28, so I wasn't worried about getting cancer. The last time I checked was the fall of 2023, but I'm not sure if the lump was even there yet because I have dense breast tissue, which makes it hard to feel lumps. But I couldn't help thinking: if I'd used my hands instead of a loofah to wash myself in the shower, I would've felt the lump sooner.

I began 16 rounds of chemotherapy on May 1.

The process was tough—and 20 weeks long. I didn't have much energy and I struggled with anxiety because there were so many unknowns: What if chemo doesn't work? What if the cancer spreads? What if treatment works, but then the cancer comes back? If I'd had the double mastectomy first, I would've at least had some peace of mind knowing the root problem was gone. But instead, the cancer was still present in my body throughout chemo.

One of the few things that could take my mind off these spinning thoughts was my day job—I could still do some work at my desk as a paramedic.

Chemo went well, and as the weeks went by, I could literally feel the lump getting smaller in my breast, like it was melting away. Still, I was experiencing some side effects: I had nausea the week before chemo (probably from stress and a shot that basically puts me into a temporary menopause to protect my ovaries from the chemo, which also gave me hot flashes), I lost weight from anxiety, and I was constantly fatigued. I also started losing my hair 12 days after starting chemo, and that's when it felt real because I actually looked like a cancer patient—it was difficult and my mom and I cried together when she shaved my head. By my last day of treatment on September 11, the tumor and lymph nodes in my armpits had shrunk significantly.

Elizabeth and I had our double mastectomies five days apart.

Hers was on October 3. Mine was on October 8. While I don't want her to go through this, it's been nice to support each other through it and spend time together while we're both living at home again. We're holding onto each other through this, even helping each other empty our drains for fluid that leaves our bodies after surgery.

My results post double-mastectomy look good—the doctors think the spot on my sacrum is now benign, and they did another MRI on me to see if cancerous spots showed up, and the spot on my sternum was gone. They also thought that the cancer in my lymph nodes was gone, which made me feel relieved, thinking I was almost done with this whole process.

I rallied around Elizabeth with our brother Jack after her mastectomy, which was five days before my own surgery.Kate Singletary

Unfortunately, it turns out that there is still cancer in that area, so I'll have to have them removed in another surgery, which makes me feel like I'm back at the beginning of this journey because I'm facing unknowns once again. But at the end of the day, this is just another bump in the road. I felt better once I visited my oncologist and came up with a plan to make sure everything goes as well as possible so the cancer doesn't return. I'll have the lymph nodes removed, then six more weeks of radiation after this.

I'm staying motivated through this knowing that other people have had cancer—and beat it. My dad was also diagnosed with multiple myeloma in 2018, but he's been in remission since 2019. Seeing two of my family members go through cancer treatments—and to have their support now—has made me feel more hopeful.

Some days I still can't believe this is real.

Before surgery, I had no idea how I was going to feel—mentally—once my breasts were removed. I wanted to give myself the freedom to feel all of the emotions and not feel pressure to feel "okay" about it. Seeing Elizabeth be so strong through her surgery really helped me, especially because it showed me what I'd look like after surgery.

The first time I saw my incisions after surgery, I was in shock, and definitely emotional, but I didn't have a breakdown over it. I've looked in the mirror a couple times and thought, Wow, my boobs are gone. But I know this is another step in fighting cancer—I had to take away part of myself to make myself whole again.

I miss working out, but I'm just trying to treat my body with what it needs right now. During my chemo treatment, my oncologist told me to not push myself too hard. One of the first times I tried exercising, I jogged two miles, but my body was so tired, it felt like too much. So now, I just walk anywhere from one to seven miles a day, and occasionally lift some light weights. Eventually, I'll get back to marathon training.

I want women to know that cancer doesn't discriminate based on age.

Do your self breast exams once a month and put a reminder on your phone so you never forget. Make sure to also feel your neck, lymph nodes, armpits, and groin. The more you check yourself, the more familiar you'll become with the feeling of your normal breast tissue, and if something feels different, you can get it checked out. If your work offers free mammograms for all ages, go for it. It's easy to procrastinate these health checks when you're young, but the more you know, the more you can prevent.

My mentality about the future changes so much day to day. Sometimes my anxiety makes me wonder if I'll have a future, and whether my cancer will go away, then come back. What's helped in these moments is to just live my life and treat my body well, knowing that things might happen that are out of my control. Sometimes, when I'm stressed, I take a step back and look at the bigger picture. I'm trying to take things slowly, one day at a time—or one mile at a time, like a marathon.

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Mom Diagnosed With Breast Cancer At 37 Recalls The Subtle Nipple Change That Was The 1st Sign

As Emily Bond, then 37, soaked in her bathtub, she glanced at her breasts and noticed her left nipple appeared flatter than her right. In the past, she might have thought little of it, but a college friend was recently diagnosed with breast cancer after noticing a nipple change. Bond wondered if her flattened nipple was a worrisome sign. 

"It just caught my eye and I thought, 'That doesn't look good,'" Bond, 38, author of novels "Hot Mess" and "Husband Material" of suburban Chicago, tells TODAY.Com. "I hunched over and saw like does that change the shape? Does gravity pull it down?"

No matter what she did, her left nipple looked different than her right. Thinking of her friend, she made an appointment with her OB-GYN for a breast exam and eventually learned she had Stage 2 estrogen and progesterone receptor positive breast cancer with a BRCA2 mutation in July 2023.

"I had never heard in my life that a nipple change of any kind — color, size, shape, texture — was associated with breast cancer until I third-hand heard about this woman and how she found her cancer," Bond says. "If I hadn't heard my friend's story, I would have just said, 'Well, this is what my body looks like now. I'm 37.'"

A friend's diagnosis led to caution

Bond had lost touch with her college friend diagnosed with breast cancer, but a mutual friend told her that nipple changes led to their college friend's diagnosis. That surprised Bond.

After completing chemotherapy, Emily Bond and her husband, Matt Bond, took a trip.Courtesy Emily Bond

"We're looking for lumps and bumps," Bond says. "But that was not her symptom." After hearing about her friend, Bond made an appointment for a mammogram even though she had not yet turned 40, the year that experts recommend routine mammograms begin. At the time, she also experienced some armpit pain, which she attributed to muscle strain from painting a mural on a wall in her house. 

The results from that mammogram were "unremarkable" but noted Bond had dense breast tissue. Since last month, mammogram facilities must tell patients about breast density and how dense breast tissue can hide some tumors, according to past TODAY.Com reporting. 

"I was unaware of the relationship of dense breast tissue and what that means," Bond says.

When she noticed her nipple change, she thought perhaps she had an infection and scheduled a breast exam.

"The office staff were a little taken aback when I called and made the appointment," she says. "This was not giving me anxiety at all. It was just like let me get a second opinion from a doctor."

The next week, she saw her OB-GYN who noticed something during the breast exam.

"He said, 'There's a slight firmness on this nipple that's not on that nipple.' The word lump or bump was never used," Bond says. "He really didn't feel anything other than a little bit of firmness."

She asked what caused the firmness and he replied, "That's what we need to find out." Then he recommended an ultrasound and gave her the name of a breast surgeon. He thought perhaps she had something called duct ectasia, a benign condition where a milk duct expands and develops thick walls, according to the American Cancer Society.

"There wasn't necessarily a sense of urgency," she says. "It was OK, I'll make the next appointment."

While the ultrasound didn't find anything worrisome, Bond also had MRI images taken of the nipple and needed to wait for the doctor to share results. Still, she wasn't concerned.  

"The doctor came in. She sat down across from me and the very first word out of her mouth was 'unfortunately,'" Bond recalls. "The room went black."

When Emily Bond received her biopsy results, her son Atlas was 'scribbling on the carpet,' unaware that his mom received devastating news.Courtesy Emily Bond

Bond remembers pieces of the conversation, such as solid mass and lymph node involvement.

"My immediate question was, 'Do I have cancer?'" she says. "She was being very politically correct. I think she's seen enough of these situations to know that it was absolutely was cancer, but (she said) the next step is to do a biopsy and find out exactly what kind it is and what stage it is."

Bond soon underwent a biopsy that confirmed she had Stage 2 breast cancer. Now, she knows that her nipple flattened because of the tumor's location.

"My lump was sitting directly behind my nipple, which is why you could not feel it," she says. "(My nipple was) pulled in by the tumor."

She met with an oncologist and a geneticist to undergo genetic testing and she learned she had a BRCA 2 mutation. Her cancer was HER2 negative, estrogen positive and progesterone positive, meaning that it has receptors that attract estrogen and progesterone. Bond first underwent 16 rounds of chemotherapy, which she finished in December 2023.

"I knew that the chemo was working because my nipple started to come back," she says.

Still, she experienced some bad days with Bond feeling so unwell she couldn't care for her then-2-year-old son, Atlas, or even herself.

"That first chemo I got, it just kicked my ass," she says. "I was laying on the floor of my bathroom in my mom and dad's house … sick as a dog." 

By January, she underwent a double mastectomy and later had a hysterectomy with ovary removal to reduce her chances ovarian cancer. She will undergo hormone blocking and oral chemotherapy treatment for the next decade. BRCA mutations are pass down in families to many of her cousins and mother underwent genetic testing for mutations, too.

"My diagnosis kind of blew up in the family in that sense," she says. "Everybody's going along with the normal lives and all of a sudden this happens. I tell everybody there's this genetic mutation running through our family."

While anti-nausea medications and other drugs help make chemotherapy more bearable, Emily Bond still experienced side-effects, including exhaustion, nausea and hair loss. Courtesy Emily Bond

One of her cousins and her mother learned they also had a BRCA mutation after undergoing genetic testing.

"It's a personal choice whether someone wants to do this testing," Bond says.

A year later

On July 23, 2024, Bond graduated to the Survivorship Clinic at Northwestern, less than one full year following her July 24, 2023, breast cancer diagnosis. She feels stunned by how far she's come.

"I had this wonderful outcome. I truly had what everybody in my situation aspires for, which is a complete pathological response," she says. "It's just an unbelievable completely surreal year of my life." 

Since finishing treatment, Emily Bond has embraced the joy mundane things and appreciates the moments with her loved ones. Courtesy Emily Bond

Bond believes her attitude toward treatment helped her navigate it well.

"I wasn't happy about this, but I was understanding the assignment," she says. "I was there to show up and do the damn thing."

As she reflects on her experience with breast cancer, she hopes that her story encourages people to feel empowered when it comes to their health.

"Take action to make an appointment to have that thing looked at," Bond says.

She also hopes that others don't become complacent about their health.

"You could be going along in your life, completely unaware, and all of a sudden, two weeks later, you're thrust into chemo. Two weeks later you're dealing with a diagnosis you never thought would impact you let alone at age 37," she says. "Just don't take these things for granted because I'm so glad that my life is, by and large, pretty boring again."

CORRECTION (Oct. 30, 2024, 11:35 a.M. ET): A previous version of this article said Bond had HER2 positive cancer. It was HER2 negative.

Diagnosed With Breast Cancer At Age 33 While Pregnant, A Mother's Instinct Keeps Her Fighting

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.

36-year old Siobhan Donovan of Worcester, MA a wife and mother of 3 children, stays strong while battling metastatic breast cancer

Marilyn Schairer GBH News

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.

Siobhan Donovan is greeted by her children at mile 13 along the 2024 Boston Marathon route. Donovan has stage 4 metastatic breast cancer and finished the race with her sister after raising $20,000 for Dana-Farber Cancer Institute.

Siobhan Donovan

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."

 

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