Young Woman Relishes Motherhood after Special Therapy Protects Fertility during Breast Cancer Treatment

Podcast Transcript

Kyle: Hey everybody welcome to The Comeback, I'm your host Kyle Michael Miller. During this episode we're talking with Brittney Rinella who beat breast cancer and is now a new mom to a baby boy. We'll tell you how a special therapy protected her fertility while she was undergoing cancer treatments. Also joining us is breast cancer oncologist Dr. Halle Moore. But first, here's Brittany in her own words.

Brittany: Hi my name is Brittney Rinella and I'm from Willowick, Ohio. When I was 26 years old I found out that I had stage one breast cancer. Hearing the news of the diagnosis was overwhelming. I chose to have a double mastectomy and chemotherapy. During chemotherapy I had a special treatment to protect my ovaries so I could have children later on. Two years after I had beat breast cancer I was able to get pregnant naturally. My son Colsen is almost a year old now and being a mom is just the best.

Kyle: Brittney, Dr. Moore, welcome to the show.

Brittney: Thank you.

Dr. Moore: Thank you for having us.

Kyle: It's good to see you guys. Brittany, you were 26 years old and battling breast cancer. Out of everything you could have possibly had to overcome at such a young age did you ever think that breast cancer would be one of them?

Brittney: Absolutely not. No.

Kyle: How did you find out that something was wrong?

Brittney: Just doing breast exams. I felt like a twitch. I felt my breasts and I felt something that was not normally there, it was abnormal. I called my OB at the time and she was the one that made everything start going.

Kyle: So you went through some different tests?

Brittney: Yeah. There were testing, ultrasounds, mammograms, biopsies, and then that's when I got the news.

Kyle: Did you have any inkling that something was wrong when you were going through those tests, and had you been having regular checkups?

Brittney: Yes. Six months prior I had just had my check up with my OB. Six months had gone by, I was having regular checkups and everything. When I found that, I was like, it’s probably just a cyst. My mother actually has a history of some cysts in her breasts so I thought that's probably what it is. So no, I did not think by any means that it was going to be cancer.

Kyle: You're young. You're healthy, active. You're a nurse. You take care of yourself. You treat patients all the time. What was it like when you heard those words breast cancer when you got that call?

Brittney: Unreal. It felt like my world was tumbling down. I can't really describe it.

Kyle: You had a lot thrown at you at once and thankfully you were in good hands. Dr. Moore, you treated Brittney. Can you walk us through the treatment plan for Brittney and how it's helped her overcome breast cancer?

Dr. Moore: When I first met Brittany she was at a very busy time in her life. She was planning her wedding. She was working. I think you were in school?

Brittney: Yes.

Dr. Moore: She’s very typical of our very young women who are diagnosed with breast cancer. It's a very challenging time in life even without a cancer diagnosis. All the decision-making that needs to be accomplished during a relatively short period of time after a diagnosis can be a real challenge. We did some additional testing to make sure that chemotherapy was actually necessary. We determined that it would be in her best interest to have chemotherapy, which has a lot of side effects including the risk for early menopause and infertility that can be increased with the use of the type of chemotherapy that we were recommending for Brittney. She was looking forward at that time to having a family. She did not have any children yet so we discussed the options for trying to improve the chances for future fertility. We always want to think about the patient first, come up with what our best treatment plan is for her, and then think what we can do to lessen the long term side effects and help this fit in with her goals outside of this cancer diagnosis. The recommendation for her was both chemotherapy and anti-estrogen treatment which tends to be a longer term treatment. That also adds to the issues with fertility because the older you are after having completed your treatment, the lower your chances may be for conceiving.

Kyle: Right. Brittany, you probably had this emotional rollercoaster you were on. You had a lot of things going on in your life and you get this breast cancer diagnosis. Did you have any idea that it would possibly impact your fertility?

Brittney: No not at the time. That was not even on my radar at all. When they had brought that up to me, brought up genetics, brought up all those things, I pushed it away at first. I was very, oh my gosh, I don't want to have to think about that now too on top of everything that I'm doing right now. The first genetics thing that was brought up I denied at that moment because I felt like there are so many things I have to decide on now. What kind of surgery am I going to have? Am I going to need radiation? Am I going to need chemo? Am I going to do reconstruction? All those things were going through my mind that the last thing I want to think about was how is this going to affect my future family. So yeah, I had no idea.

Kyle: You went through four rounds of chemotherapy.

Brittney: Correct.

Kyle: Were those tough treatments? Was it once a month?

Brittney: It was once a month. Surprisingly out of everything the chemo, other than the losing of my hair which of course is every girl’s worst nightmare, I did really well with it. I did not get sick. I worked through it. I worked sometimes the same day or that night. I thankfully had very little side effects from it and during. I ate. I had family. I had the max amount of people that could be in the room because I have a huge support system. We would play games and try to make light of it as much as we could.

Kyle: Dr. Moore, can you talk about some of the injections, the shots, that Brittany received during chemotherapy to help preserve her fertility? I know you've done research on this topic too.

Dr. Moore: Yes. Our recommendations for people who want to preserve fertility are both to meet with a reproductive endocrinologist to see if there are options regarding freezing eggs or freezing embryos so that you have those in the future. Actually Brittany took advantage of that option but she also took advantage of a newer treatment option which is to suppress the function of the ovaries with shots, a drug called goserelin. That's given once a month during the course of the chemotherapy treatment with the thought being that by shutting down the ovarian function during chemotherapy they would be less susceptible to the damaging effects of chemotherapy. It turns out from our research that indeed this not only reduces the chances of going into early menopause as a result of chemotherapy, but also improves the chances for having successful pregnancies.

Kyle: Brittney, what were those shots like? Probably not fun.

Brittney: Oh my gosh. They had to ice my stomach beforehand so that was a huge indicator of how it was going to be. When they told me they going to ice my stomach I was like, okay this is not going to be fun. But in the long run I was thinking ahead, like this could possibly prevent me from having some infertility issues. I had to do it.

Kyle: How many injections did you receive?

Brittney: Four total to accommodate my chemotherapy.

Kyle: Then afterwards, after chemotherapy is complete, what's the treatment after the fact?

Brittney: I’m currently on tamoxifen daily and then I get Lupron injections monthly.

Kyle: Dr. Moore, how long after a patient's done with chemotherapy, goes through these injections and any other medications, is it safe to try to conceive naturally?

Dr. Moore: There's no magic time at which we know it's best to try to conceive. We really individualize these decisions. For somebody with a lower risk breast cancer it might make sense to interrupt treatment earlier in order to conceive. Somebody with a very high risk cancer we may prefer to wait a few years. What we really don't want to see is somebody having a dangerous recurrence of their cancer during pregnancy because that could be very difficult to manage. Brittany had a lower risk cancer. There's actually a large international clinical trial going on looking at interrupting hormonal treatment for breast cancer in order to attempt pregnancy. In that study, the recommendation is to complete two to three years of hormonal therapy. Then the hope to interrupt treatment for no more than two years, and then get back on to the treatment to finish the plan of five to ten years of treatment which is typical for treating the breast cancer.

Kyle: Brittney, so how soon after you were done with chemotherapy did you decide to try to conceive?

Brittney: I did two years on the treatment plan. Every six months I was going to see Halle for my regular checkups. I felt like every time I went I was like itching, itching, itching, but I knew in my head I was minimum two. I knew I had to get some out of the way after everything. It was just more so that everybody in my life was having kids and I wanted a kid type of thing. But yes, I finished the two years on the treatment and then I talked with Halle about it and my family. I talked to everybody and made the decision to take my chances because I did have a lower risk. My biggest thing was I didn't want to have cancer completely stop every plan from my life. Despite everything I went through, I still went through with my wedding. I still did all the things I wanted to do despite getting the diagnosis.

Kyle: How long did it take for you to get pregnant?

Brittney: Actually the first round of ovulation tests I got pregnant.

Kyle: Wow, so you were pregnant with baby Colsen.

Brittney: Correct.

Kyle: In January of 2018?

Brittney: Yes. January is when I found out I was pregnant.

Kyle: A great way to start a year after everything you had been through.

Brittney: Definitely. It was amazing.

Kyle: What was it like that moment that you met him for the first time?

Brittney: My Lord, the craziest! I say it was like an aura was around me. It just felt like finally everything was falling into place. All I've ever wanted was to be a mom so seeing him for the first time was the best. I call him, and my family calls him, my little miracle baby.

Kyle: Dr. Moore, it probably gives you joy when you get to see patients come through the other side of this. For Brittney to see this little baby boy, who’s so cute…

Brittney: Thank you!

Dr. Moore: It's extremely satisfying to see them both doing so well. It's interesting because with the clinical trials we were talking about the safety, when is it safe to interrupt your hormonal therapy? There have been studies looking at the safety of pregnancy in women who have a history of breast cancer. Consistently those studies don't demonstrate any increased risk of recurrence of the cancer even when they specifically look at women with hormone sensitive breast cancers like Brittney. It's very reassuring and nice to know that you can treat your cancer well and aggressively but still have all those other things in your life.

Kyle: Brittney, are there things that you used to take for granted in your life that you cherish now?

Brittney: I have a whole new outlook for life in general. I know that sounds so cheesy but I feel like my overall outlook is so much more positive where maybe I was more negative in some instances. I look at everything. Like how lucky I am to be here, how lucky I am to have a beautiful son, and despite everything I'm happy so that's all that matters.

Kyle: Should we bring him back into the studio for the last segment where we’re going to pull a few questions out of the fishbowl?

Brittney: Sure.

Kyle: Let's bring the man of the hour in.

Laughter

Brittney: Hi, love. (Speaking to baby Colsen)

Kyle: How are you doing? (Speaking to baby Colsen)

Baby babbling and laughter

Brittney: Are you going to talk? (Speaking to baby Colsen)

Kyle: Oh you found the microphone. (Speaking to baby Colsen)

Brittney: He found it.

Kyle: We're going to do a segment where we’re going to play Go Fish. Dr. Moore, do you want to open the fishbowl for us? Brittney, these questions are for you so if you want to dig in there. Grab one. Read the question. Then give us your answer.

Brittney: What would you like women diagnosed with breast cancer to know about cancer treatments? It would be individualized, for one. The biggest thing would be to just stay positive through everything. That's what helped me through. I trusted my team that I chose to help with everything. I trusted that in the end I would succeed and everything would be okay.

Kyle: Good answer. Two more questions in there. Next one, and they don’t get harder either.

Brittney: What's the first thing you would tell a young woman recently diagnosed with breast cancer about her dreams of becoming a mom? Talk with your team. You get that cancer diagnosis and it's not the end all be all. It’s not like it can't happen because I'm living proof that it can. You might have to wait a little longer than you would have liked. I feel like some women have a timeline kind of thing. Stay positive and know that they have your best interests. Just make sure you talk with your team about it so that they know what your plan is so they can alter treatment for you.

Kyle: Last question.

Brittney: When you look at Colsen what's the first thing that pops into your head? Lucky. Blessed. He's the best. Maybe I just say that because he's my own! But those are the two words I would use.

Kyle: And miracle baby.

Brittney: Miracle baby for sure.

Kyle: Right little guy? It looks like he's going to attack the microphone.

Brittney: I know, he’s like, I want to talk.

Brittney: What do you want to say? (Speaking to baby Colsen)

Kyle: Would you like to say something? (Speaking to baby Colsen)

Brittney: Say hello. (Speaking to baby Colsen)

Kyle: Dr. Moore, do you have any final thoughts before we close today?

Dr. Moore: I just think that Brittney is an inspiration for all of us. That same new gratitude that she feels in life, I mean, taking care of people like her gives us that same sense of gratitude.

Kyle: Brittney, what about you?

Brittney: Last words?

Kyle: Yeah.

Brittney: I'm just so grateful for everything. As much as everybody says I'm such an inspiration, I believe it, but it's hard when you're living it you forget what you went through. You look back and you're like, oh my gosh. The fact that it was four years ago. I was just telling her before we started that I can't believe everything that's changed in my life. It’s just crazy, but I'm super happy where my life is now. I'm excited to see how Colsen grows and everything with him.

Kyle: And he's always got a great story to tell about how he got here.

Brittney: Exactly.

Kyle: Well thank you so much both of you for sharing your story today. And thank you everybody for taking time to listen. You can find additional podcast episodes on our website https://my.clevelandclinic.org/podcasts, on iTunes, SoundCloud, Stitcher and Google Play.