Jaclyn (Jackie) Trepanowski of Loyalsock, knew her family history of breast cancer put her at a higher risk. Her father’s sisters had both been diagnosed with breast cancer in their 40s, so when her cousin told her she was positive for the BRCA gene, Jackie decided to get tested for the gene as well. While it doesn’t guarantee you will ever develop cancer, testing positive for the BRCA1 or BRCA2 gene does put you at higher risk for developing breast and ovarian cancers.
Jackie’s test came back positive for the BRCA gene on Oct. 7, 2013.
Susan Branton, MD, and Rose Czap, CRNP, at UPMC’s Kathryn Candor Lundy Breast Health Center in Williamsport explained to Jackie what her result meant.
“They gave me all of my options and talked to me about family planning,” said Jackie. “I chose to monitor closely so if I did develop cancer, it was caught early and could be treated.”
Jackie went back to see Dr. Branton and Rose every six months for the next six years. She would have a breast ultrasound and mammogram, and once a year, she would have an MRI to check for any potential cancer.
A Difficult Diagnosis
On Oct. 7, 2019, at Jackie’s routine six-month check-up they found a tumor in her breast. She was eight weeks pregnant when she found out she had cancer.
“To find out you have breast cancer at 40 when you are pregnant with your first child is devastating,” remembers Jackie. “My husband and I were so excited about the baby, but then you have this shocking diagnosis.”
Her providers caught it just in time, as Jackie’s cancer was early stage and hadn’t spread to the lymph nodes yet.
“Jackie, while high risk, was young, seemingly healthy, and excited to start her family,” said Dr. Branton. “To have to tell her ‘you have cancer,’ it was one of the most challenging conversations I’ve had with a patient. Although we knew Jackie and her family had a tough road ahead, we made her aware of our experience in successfully treating other breast cancer patients which offered her a lot of hope. What was most important was to make sure she knew she wouldn’t be in this fight alone and that she understood all of her options for treatment.”
Cancer Treatment While Pregnant
Jackie decided to have a mastectomy followed by chemotherapy as soon as she could do it safely. Both of Jackie’s aunts had a lumpectomy when they were first diagnosed, and the cancer eventually came back. Knowing she was positive for the BRCA gene, Jackie decided the double mastectomy was her best option.
“Surgery was the most emotional part of the experience,” said Jackie. “You are losing a part of yourself, and you are confronted with the fact that you have cancer — it is real.”
Once Jackie was in her second trimester, it was safe to start chemotherapy treatment. Abdalla Sholi, MD, medical oncologist, UPMC Hillman Cancer Center in Williamsport, recommended four rounds of a dose dense treatment every few weeks.
“My support system was amazing,” said Jackie. “When I started to lose my hair, my husband had a shaving party. My brother, sister-in-law, my husband, and I all shaved our heads at the same time.”
Jackie tolerated her chemo treatments well. Although the chemo didn’t make her very sick, she was exhausted. Her baby was growing, and all indications were that her baby and her pregnancy were doing just fine. A relief to her and her family.
The doctors decided to do a second round of chemotherapy using Taxol to give Jackie the best chance at a cure. Unfortunately, she was only able to finish four of the recommended 12 rounds because of the side effects.
“I got very sick on it,” said Jackie. “I got so dehydrated and I had to do IV fluids a few times to support my body. Working with Dr. Sholi, we made the decision that my body couldn’t handle any more treatment. There was no sign of cancer at that point, so it was more preventative chemotherapy.”
A Surprise Delivery
As if battling cancer while pregnant wasn’t challenging enough, Jackie developed preeclampsia, and her blood pressure was getting dangerously high. At 37 weeks, with a focus on the safety of both mom and baby, her OB/GYN decided it was time to induce labor.
After 38 hours of labor at The Birthplace at UPMC Williamsport, Jackie’s miracle baby — Mariana — was born happy and healthy.
“Through treatment and the pregnancy, I just kept going, I kept pushing,” said Jackie. “When you are fighting, you just keep fighting. After she was born, I had time to slow down a little and reflect.”
As a survivor, Jackie still undergoes blood work every few months and has an annual PET scan.
“They said I was healthy,” Jackie commented. “In June, my PET scan came back cancer-free.”
After Mariana was born, Jackie discussed her family plan with her doctor. She knew how lucky she was to have her miracle baby, but she also wanted another child before she had a hysterectomy.
“Many women are able to become pregnant as a survivor, but it’s important that we discuss if they wish to do so before we start treatment,” said Dr. Sholi. “Some treatments for breast cancer might affect a woman’s fertility. For example, chemotherapy for breast cancer might damage the ovaries, which can sometimes cause immediate or delayed infertility. Therefore, it was so important that Jackie shared with us before her treatment her wishes to potential have more children as a survivor. Those conversations helped steer our treatment plan so that we could try our best to not only beat her cancer, but also provide her with the best chances of being able to become pregnant again.”
In August, Jackie found out she is pregnant with her second child.
“My parents may describe me as stubborn,” said Jackie. “But that isn’t always bad, especially when it comes to beating cancer. I think that’s what got me here today. My stubbornness fueled my fight.”
Breast cancer screenings, whether routine or for higher-risk patients, are essential to catching the disease when it's more treatable.