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On March 19, while attending a five-day work meeting in San Francisco, April Bloch got a phone call from her doctor with the news that she had stage 1 infiltrating ductal carcinoma of the breast. Six hours after that diagnosis, she and her husband, Rob, also learned that April was pregnant. The couple, who live in Phoenix, had been married for less than a year.
"I think I'm still in denial today,'' said April. "I kept thinking, 'I'm too young, I have no risk factors.' Then add in the pregnancy, which complicated things even more. This should have been the happiest day of my life, but it turned out to be the worst. I couldn't stop crying."
Her husband couldn't grasp the news either.
"I think we were both a little shell shocked. It's a lot to process — the diagnosis and the positive pregnancy test," he said. "For me, I knew right away that the most important thing was to preserve her health."
At the end of February 2015 and while doing a breast self-exam, April felt a small yet firm, pea-shaped lump in one of her breasts. Her doctor ordered a mammogram, ultrasound and biopsy.
When she got the diagnosis, "it was like I was driving along and all of a sudden I was completely blindsided by another vehicle,'' said April, a regional sales director of a West Coast company. "It was 8 a.m. I immediately called my husband. I started thinking about how we had been trying for three or four months to get pregnant so I went out and got some pregnancy tests. For the first time, I was praying they would come back negative."
"I think young women are looking for more options, especially as it relates to the most minimally invasive procedures."
— Armando E. Giuliano, MD, associate director of Surgical Oncology
After recovering from the initial shock, April and Rob focused on treatment options. Her doctor in Arizona recommended a local breast surgeon. Rob and April, however, wanted the best.
Friends, family and colleagues gave feedback on breast surgeons. The two met surgeons across the country. The same name — Armando E. Giuliano, MD — kept coming up.
"I talked to some buddies on the East Coast and they mentioned Dr. Giuliano. Then I spoke with another buddy I grew up with in Los Angeles and again Dr. Giuliano's name came up," Rob said. "It was one of those things where a name just kept popping up from multiple regions of the country."
As soon as Giuliano, associate director of Surgical Oncology in the Samuel Oschin Comprehensive Cancer Institute, walked in the room, April and Rob knew he was the one.
"He was the only one who gave us a straight answer. We asked other surgeons, 'What would you do if you were in this position? What would you do about the pregnancy?'" Giuliano suggested the couple focus on April's health first.
April underwent a lumpectomy in April and a sentinel node biopsy in May. Giuliano performed both procedures. But before she began four rounds of chemotherapy, April and Rob had to decide about the pregnancy.
"It's always heartbreaking to see a pregnant patient with breast cancer,'' said Giuliano, also co-director of the Saul and Joyce Brandman Breast Center — A Project of Women's Guild. "It's tough because you've got some decisions to make and it all depends on timing."
At 36, April's initial thought was to protect the pregnancy. She and Rob met with obstetricians and gynecologists who specialize in high-risk pregnancies.
"It was just so strange because we were given all this advice about avoiding tuna, soy products and dark chocolate and a host of other things during the pregnancy, but the oncologist said it was OK to undergo chemotherapy,'' Rob said. "This just sounded so illogical to us."
April eventually made the tough decision to terminate the pregnancy. But the day before her scheduled procedure, she went in for an ultrasound and there was no sign of a beating heart.
"Everyone knew this was a hard decision for me,'' April agreed. "And to miscarry, while I was still devastated, it did provide a small ounce of relief."
Although breast cancer typically impacts women in their mid-50s, Giuliano said you're never too young or too old to think about breast cancer prevention.
"Breast cancer affects women of all ages,'' he said. "Women under 40 should do self-exams and get annual physical breast exams, and no matter how old or young you are, if you feel a lump, get it checked. Never assume a lump is benign, no matter your age."
In recent years, the Cedars-Sinai Breast Cancer Program has seen an increase in patients close to April's age. Giuliano says this isn't necessarily because breast cancer is occurring more now in young women, but is more attributable to the Breast Cancer Program's reputation for minimally invasive procedures.
"I think young women are looking for more options, especially as it relates to the most minimally invasive procedures,'' he said. "Our program has brought together an expert team with experience in the newest technology and procedures."
Women are also catching breast cancer much earlier, thanks to the advent of awareness campaigns.
"If you check yourself enough, you'll know if something isn't right," April said. "If it doesn't feel right, it probably isn't right."
Because April's breast cancer was stage 1, Giuliano said, her prognosis is excellent.
As for April and Rob, the two are still trying to heal emotionally.
"My husband led the charge," April said. "He's my best friend, and I know I can get through anything with him by my side. And I can't say enough about Giuliano, his nurse practitioner Sherry Goldman and everyone at Cedars-Sinai."