Young Doctor, Unexpected Diagnosis: Breck McCarty

Written By Robin Warshaw, Contributing Writer

2015McCarty-Breck_mediumAfter finishing her family medicine residency at age 29, Breck McCarty felt “as if I had been going to school forever.”

That was about to change, as she and her husband-to-be prepared for the next step in their careers: moving from South Dakota to join a medical practice in a small Wyoming town.

When she felt a breast lump, Breck let it go for a few weeks. “It persisted, so I saw a surgeon who was one of our preceptors [teachers] in our training and requested that I get a biopsy.” He told her she was young and he didn’t think it was cancer, but would biopsy it anyway.

“He came to my house to deliver the news,” Breck says.

The new doctor was diagnosed with stage IIA breast cancer. She had a mastectomy just days before moving to Wyoming.

Pregnancy planning

At first, she didn’t think about how treatment might affect her fertility. Then a friend, also a family doctor, asked her about it. “I would not have even thought of it if she hadn’t mentioned it,” Breck says. “I was so overwhelmed.”

She had no children and wanted them in the future. She learned it was important to have fertility preservation, storing embryos or eggs before chemotherapy, to avoid damage. Fertile Hope, now LIVESTRONG Fertility Services, helped Breck get discounted rates for fertility preservation services. She had eggs taken, then embryos created from them and the resulting embryos frozen.

After initial breast cancer treatment, Breck received tamoxifen because her disease was hormone receptor-positive. Tamoxifen cannot be taken while pregnant. She worried whether taking it for 5 years ( 10 years is now recommended) might be too long to wait for pregnancy. She looked for research, joined online groups and talked with other women about her concerns.

“My oncologist was very science- and data-oriented and he did not have scientific information or adequate data to help me,” she says.

After almost 3 years of tamoxifen, she decided to stop and try to get pregnant. She had to wait 3 months for the medicine to leave her body before starting the embryo implantation process. She became pregnant with twins, lost one, but the other did well. Jacob was born in April 2011.

“I chose not to breastfeed and went back on tamoxifen the night I had him,” says Breck.

Second diagnosis

The family moved again, to a larger town and new practice. In 2013, Breck felt a painful nodule on her mastectomy side. “I really wasn’t that concerned, other than it was new.”

She promptly went to a radiologist, who advised a CT scan. Later that day, he showed her and her husband worrisome areas on her liver. A biopsy confirmed she had a metastasis: that the breast cancer had spread to her liver.

“Being a doctor and knowing the statistics, I thought this was about the worst news I could receive. I didn’t anticipate ever getting my life back after that,” she says.

She was referred to an oncologist in another city who specializes in young women. They met a week later, which helped.

“I left her office thinking I would get some semblance of my life back. Having her tell me she has many women living many years with metastatic breast cancer, knowing she was actively seeing women who had lived several years, gave me some hope,” recalls Breck.

She went back on chemotherapy, which shrunk some of the liver tumors, and trastuzumab (Herceptin) for HER2-positive disease. Later, she was switched to a new anti-HER2 medicine, ado-trastuzumab emtansine (Kadcyla), when it received FDA approval. Her uterus and ovaries were surgically removed and she began taking an aromatase inhibitor.

Breck says she found more support after her metastatic diagnosis than the first time. After recurrence, she met another young woman affected by breast cancer and they became close friends. There are no local support groups, but she reaches out to area young women who are diagnosed.

“As a physician, my experience is widely known in the community. All my patients are aware – I never hid anything that was going on,” she says. “Some people come to me because of it.”

Breck has also found – and given – help through Casting for Recovery, other organizations and an international Facebook group for women with metastatic breast cancer. “I try to be there for support and encouraging words,” she says.

PrintThis article was supported by the Grant or Cooperative Agreement Number 1 U58 DP005403, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.

Financial Help for Fertility Preservation: Ryann Chamberlain

Written By Robin Warshaw, Contributing Writer
Reviewed By Andrea Mechanick Braverman, PhD

Ready to become pregnant at age 33, Ryann Chamberlain began taking prenatal vitamins. She and her husband figured they would “actively try” to have a baby about 3 months after Ryann started taking the vitamins.

Just before reaching that point, she noticed nipple discharge from her right breast.

“At the time, not knowing how prenatal vitamins work, I thought maybe my body was kicking into gear,” says Ryann, who lives in Portland, Maine, and works as a self-employed caterer and as a waitress in an Italian restaurant.

That nipple discharge led to a breast cancer diagnosis at a local hospital. Because Ryann found the diagnostic process there disorganized, her mother suggested she go to a larger cancer center in Boston, about 100 miles away.

Ryann’s new oncologist told her that before beginning breast cancer treatment she needed to consult with a fertility specialist about methods of fertility preservation that would protect her ability to become pregnant at a later date. Chemotherapy and other treatments can damage eggs and cause early menopause.

Her providers back home had not discussed anything about treatment-related infertility with her. “It was the first time it had dawned on me,” Ryann says.

Saving Fertility Before Treatment

If Ryann chose fertility preservation, her doctor would remove eggs from her body before breast cancer treatment, fertilize them with her husband’s sperm and freeze healthy embryos for use later. (Women without a male partner, or whose partner is infertile, may use donor sperm. Freezing unfertilized eggs is also now an option and becoming more available.)

Ryann needed to see a fertility specialist before her next menstrual cycle, and met with one 2 days later, but her period started on the drive home. It was a Friday, so the doctor phoned in a prescription for an injectable medicine to stop her period until Ryann could see her on Monday.

Ryann and her husband wanted time to think about whether they could afford the estimated $12,000 for one fertility preservation cycle,which their health insurance did not cover. With her period starting, they were suddenly under pressure to make a big decision quickly.

“We decided it was better to resent the cost of preserving the ability to have children than to resent not having children,” Ryann says.The big question was: How would they fund that decision?

Quick Help With Costs

The fertility specialist’s office told them about Fertile Hope, an initiative of LIVESTRONG. The group’s Sharing Hope Program for Women provides financial assistance with fertility preservation for women whose cancer treatments could cause infertility.

Fertile Hope arranged for a discounted fee, reducing the charges by $5,000. The couple paid the remainder, about $7,000, with credit cards.

Ryann was put on medicine to hyperstimulate her ovaries so several eggs could be extracted at once. After fertilization with her husband’s sperm, six viable embryos were then frozen.

“I call them ice babies,” says Ryann. “We joke that they’re already named Chase, Visa, Discover, AmEx, MC and Citi.”

Waiting for Treatment Break

In just a little over one month, Ryann went from diagnosis through fertility preservation to surgery for stage I, hormone-positive, HER2 positive breast cancer. She wants to breastfeed, so had a single mastectomy instead of the double she originally considered.

After surgery, treatment included trastuzumab (Herceptin), chemotherapy, leuprolide (Lupron) and a painkiller for joint and muscle pain. She felt “very manic,” had severe temperature changes and other side effects, some of which she thinks were due to the painkiller. She was taken off all medicines, supplements, and vitamins for one month and then went back on tamoxifen and a different pain medicine. Her side effects have since lessened.

Ryann’s doctor wants her on tamoxifen for at least 3 years before stopping to have a baby. Tamoxifen can damage a fetus, so treatment must stop a few months before becoming pregnant.

Now, 2 years after diagnosis, pregnancy is still on a back burner. “I don’t allow myself to think deeply about it,” she says. “It’s very hard when you finally decide you’re ready to have a family and then your world turns upside down and you might not be able to.”

She says it’s a “huge relief” to have the six frozen embryos holding hope for parenthood to come. “I think it would have weighed a lot heavier on my heart if we hadn’t gone through that process.”

But she has met several young women who were diagnosed with breast cancer and not told about fertility preservation before their treatments began.

“I just want to go yell at their doctors,” she says. “There needs to be a shift in patient care from just trying to eradicate the cancer itself to caring for the patient as a whole. Having cancer at any age poses its own challenges, but for young women, fertility issues need to be addressed. It has to become the standard.”

PrintThis article was supported by Cooperative Agreement Number DP11-1111 from The Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.