Breast cancer is one of the most studied forms of the disease, largely because it is the most common type of cancer, according to the National Cancer Institute. More than 290,000 people in the United States are expected to be diagnosed with it this year, including approximately 2,700 men.
Those are scary stats, but Dr. Molly Sebastian, medical director of the Reinsch Pierce Family Center for Breast Health at Virginia Hospital Center, says the disease’s prevalence leads to additional research and new treatment options.
“There’s constantly new improvements — some little, some big — based on new research coming out,” Sebastian says. “They have improved outcomes.”
For instance, genetics is a major factor in treatment today. Changes in DNA that get passed on can “create a glitch in the immune system,” Sebastian says, thus making carriers more vulnerable to breast cancers. As a result, testing someone for the presence of harmful variants of BRCA1 and BRCA2 — the breast cancer gene — provides a warning sign to monitor for indications of cancer.
Breast self-exams and regular clinical wellness checks can go a long way toward early detection, but “if people are going to do one thing to be proactive about breast cancer and help prevent themselves from having a bad breast cancer, it’s the annual mammogram,” Sebastian says.
We spoke with two women, both in their 40s, who took very different approaches to mammograms but arrived at the same conclusion after undergoing breast cancer treatment at Virginia Cancer Specialists. Their experiences, like so many others, are lessons to listen to cues from your body and mind and advocate for yourself.
Here are their stories.
First mammogram leads to diagnosis
At 43, Yasmeen Roman had not yet gone in for her first mammogram, even though the recommended age to start screening is 40. She just wasn’t one for frequent doctor visits.
But in May 2021, an email she would usually gloss over caught her attention. The breast imaging center at Reston Hospital Center had extended its hours as a Mother’s Day special. It was time to make an appointment, the South Riding resident decided.
Calcifications — calcium deposits that look like white spots on mammograms — showed up in Roman’s imagery. Although she had no family history of breast cancer, the disease was on her mind. Her 50-year-old brother had been diagnosed in 2019 with colon cancer after his first colonoscopy.
After follow-up images, the doctor recommended that Roman get mammograms every six months for the next two years to monitor the spots.
“I went to change out of my gown and into my clothes, and my heart just started racing,” says Roman, who’s now 44. “Suddenly, I just felt so nervous, and it was like I was screaming to myself, ‘No, you can’t wait six months!’”
A nurse told her to ask the doctor for a biopsy, a procedure in which a sample of breast tissue is removed for testing.
“I felt like I was going against what the doctor had suggested,” Roman says, but the doctor agreed to do it.
The results showed stage 1 invasive breast cancer. It was a small growth that had not spread. Roman figured she’d have it removed and move on. More tests, however, revealed that she was triple positive, meaning the scans showed cancer cells that grow in response to estrogen, progesterone, and a protein outside of all breast cells called HER2.
Because of that, it was considered fast-growing, Roman says, and the breast surgeon recommended a yearlong treatment of chemotherapy followed by surgery and radiation.
“That really hit me hard,” says the mom of two sons, who are now ages 8 and 10. “That was the first time, after that conversation, that I burst into tears.”
Roman began chemo on August 18, 2021, the day she would have returned from summer break as an English language teacher with Loudoun County Public Schools. Instead, she decided to take the year off to commit to her health. Roman went through six chemo sessions every three weeks, receiving TCHP (a combination of four medications) through a port in her chest.
On December 29, Roman underwent a lumpectomy to remove the growth, and in February, she started a radiation regimen of 16 consecutive weekdays. She also began immunotherapy, which blocks a protein on immune system T cells from attacking other cells, boosting the immune response against breast cancer cells, according to the American Cancer Society.
As of press time, Roman was slated to receive those infusions every three weeks through early September. The port, meanwhile, was expected to be removed a few weeks later. From now on, Roman — who credits family and friends with helping her through the experience — will get yearly mammograms.
“My biggest supporter in terms of my family has been my husband,” she says, adding that her spouse, a postal carrier in Springfield, took time off to nurse her through the side effects of chemo and helped her recover from surgery.
As for the rest of the family, Roman’s mother lives with her, her dad and brother are in McLean, and her husband’s family — about 30 of them total — are all local, too. All of them made meals and sent food, she says. Roman’s former coworkers at Smart’s Mill Middle School in Leesburg also chipped in, sending soup, fuzzy socks, and candles.
“When you’re not feeling good and you don’t know exactly what’s to come, all of that was really great,” says Roman, who started working at Sterling Middle School this year.
The experience has also led to some lifestyle changes, Roman says. Namely, she joined Gateway Community Church in South Riding.
“The timing of how everything happened … I just felt like it was meant to be,” she says. “I needed to go through this process for whatever reason. I do feel like it was a bigger picture, that God and other people were looking out for me. [I just] had to pay attention to the cues.”
Hyperawareness pays off
As a board member of the Women’s Health Circle at VHC Foundation, Vienna resident Nancy Popovich has, for years, raised money for 3D mammography equipment. So it’s only logical that she has been fastidious about her own yearly mammograms.
When her April 2020 appointment at Fairfax Radiology was canceled due to COVID-19 concerns, Popovich, 47, decided to explore mammogram referral options.
First, she sought out her own OB-GYN, but he’d retired. Another doctor she tried making an appointment with stopped taking Popovich’s insurance just before seeing her. By the time Popovich was finally scheduled to be seen by another doctor, in June 2021, she noticed a tightening of the skin on one breast.
“The craziness for me is I take a bath every day,” says Popovich, who is the managing director of the Popovich Financial Group at Baird. “I stood in front of a mirror every single day when I got out of my bathtub, so how it could have gone from me not noticing it to today I notice it, I have no idea. I definitely was not trying to ignore it.”
She called her primary care physician the following day, went for a mammogram the day after, had a biopsy the next, and got her first dose of chemo nine days later.
“I turned into a hustler,” Popovich says. “I hustled as best I could to use any card I had ever been given. Don’t let anybody say that it’s going to take time. … Don’t be afraid to say really nicely that you could always check another place.”
Popovich’s tests revealed stage 3 cancer that was in her lymph nodes. Like Roman, she was HER2 positive and needed chemotherapy, surgery, radiation, and immunotherapy.
“It sucked, and it’s cumulative, so it got worse and worse and worse, and then it was done,” says Popovich, who has three children who were ages 11, 9, and 3 when she was diagnosed. “Then I had a double mastectomy [in November 2021] and that sucked. … I recovered from that, and I went to radiation and I got that done every day for 16 rounds.”
To deal with anxiety, Popovich turned to medication — and she talked about the disease, a lot.
“One of my friends joked to me recently, ‘Wait, do you have cancer?’” she says. “Because I would bring it up to the cab driver. I would bring it up to anyone. I needed to talk about it.”
Popovich spoke with a woman she’d never met who had undergone a similar diagnosis and treatment plan, she attended INOVA’s Life with Cancer programs and joined a Facebook group with international members who had been diagnosed as HER2 positive. She then started a spreadsheet of every breast surgeon, oncologist, and plastic surgeon discussed by every woman she’d spoken with, noting whether they were happy with the results.
“I would count the number of years that somebody was alive and say, ‘OK, how old would my kids be by then?’” she says. “Someone said to me once it’s a sisterhood you would never want your dearest sister or friend to be a part of. It is the truth. It is the most wonderful, wonderful group of women on the planet, and you hope that none of your friends have to ever meet them.”
Most recently, Popovich joined the Vienna VA Cancer Support Squad, a months-old group that consists of “people sitting around complaining about how hard this is and wanting support,” she says. “I needed that external support.”
Like Roman, Popovich is scheduled to finish her treatment in September. Because of her surgery, she no longer needs mammograms.
“How you feel determines everything,” she says, and “that is incredibly scary.”
Through it all, Popovich, who first got into health fundraising as a tribute to her mother, a nurse who died of lung cancer when Popovich was 22, found that the experience reinforced her philosophy on life: to treat people well.
“It increases your gratitude in how wonderful people are,” Popovich says. “It makes me realize that people are people first. They’re human beings first. Nobody is more or less important than another.”