Breast cancer in your 30s is a shock. Then treatment can bring more surprises.
Nicole Grabovac confronted breast cancer in May 2020, at 34. Her story underscores the importance of prioritizing your health and working with an expert medical team.
Grabovac awoke one morning to find discharge from her left breast. Four months earlier she’d had an OB-GYN visit with a breast exam: nothing wrong. She called her doctor quickly anyway. Within days, she had a mammogram.
Early in the COVID-19 pandemic, “I had to go have that done alone,” Grabovac recalled – “a 34-year-old woman who has never had a mammogram done.” It was intimidating. The radiologist sent her down the hall for an ultrasound. Next came a biopsy. In mid-May, Grabovac was diagnosed with stage 2 breast cancer. Her OB-GYN referred her to Dr. Waleed Khalaf, an oncologist at Vanderbilt-Ingram Cancer Center.
The choice of chemotherapy drug depended on whether Grabovac’s cancer was HER-2 positive or negative. HER2 is a protein fueling breast cancer’s rapid growth. (HER2 stands for human epidermal growth factor receptor 2.) About 20% of breast tumors have high levels of this protein, making them “HER2-positive.” Tumors with normal levels of this protein are “HER2-negative.”
Grabovac’s tumor brought surprises that prompted changes in chemo drugs over the course of her treatment. The lab report from the biopsy was HER2- positive, but borderline, so Khalaf ordered more lab checks. Those results were HER2-negative. In September 2020 came surgery: a double mastectomy and hysterectomy. A larger tissue sample went to the lab. This test declared Grabovac’s cancer slightly HER2-positive.
Grabovac continued with chemo, expecting to finish in January 2021. Meanwhile, her oncologist had her case before Vanderbilt’s “tumor board.” That’s a group of doctors from many cancer specialties – chemo, surgery, radiology, pathology, and more – who offer expert opinions about a patient’s treatment.
The tumor board’s consensus: Grabovac’s best treatment would be a yearlong course of the chemo drug trastuzumab (also known as Herceptin).
“I was going in there all excited, ready to finish that last chemo treatment,” Grabovac said, only to be advised that she should continue for a year. It was another in a series of challenges for her.
Grabovac’s cancer occurred two years after losing her mother to lung cancer. And at the time of her diagnosis, she was also living apart from her three sons.
She and her husband divorced in 2019. He stayed in Michigan, but she moved with their sons to Tennessee, closer to extended family. The boys spent school breaks with their dad. At ages 11, 7, and nearly 4, they were with him for spring break in March 2020, when the pandemic halted normal routines. Grabovac’s ex was furloughed from his job; the boys shifted to online school. Neither parent wanted to expose their sons to the coronavirus by traveling, so they agreed the boys would stay longer with their dad.
Then came Grabovac’s cancer news.
“It was an incredibly hard, hard decision to make,” she said, “but we agreed that it would be best for the kids to stay there for that whole next year while I was going through my treatments.” The boys didn’t return to live with her again until fall of 2021. “All I wanted to do was hug my kids, and I couldn't. I had to tell my kids over the phone that I had cancer, and that was so incredibly hard.” She reassured them that “I was going to fight with everything I had to beat it. They helped carry me, there's no doubt about it.”
After surgery, facing another year of treatment was demoralizing. But today Grabovac emphasizes the power of positive thinking. “Attitude really is a big part of everything, and I really did keep a pretty positive attitude the whole time I was going through treatment.” In February 2022, she finished chemo, with no signs of cancer.
She faces 10 years of follow-up care, from the Vanderbilt-Ingram Cancer Center team at Vanderbilt Wilson County Hospital, in Lebanon, Tenn., near her home in Alexandria.
Vanderbilt-Ingram is the only cancer center in Tennessee designated as a comprehensive cancer care center for children and adults by the National Cancer Institute. The Wilson County Center brings that high level of expertise to outpatient care (appointments that do not require an overnight hospital stay) for local patients. They receive the same quality screenings, diagnostics, treatments, and follow-up care as those at the main downtown campus, without driving into Nashville.
“Everything we’ve done downtown can be done at Wilson County,” said oncologist Dr. Suneetha Amara, who sees patients at Vanderbilt-Ingram Cancer Center at Wilson County. Providers there participate in the same tumor board that lent its wisdom to Grabovac’s treatment, Amara said. Because Vanderbilt is a leader in medical research, patients in Wilson County have opportunities to join clinical trials of up-and-coming cancer treatment being done at the downtown campus.
For people needing cancer care in Wilson County and eastward, “this is still Vanderbilt,” Amara said, “but closer to home.”
“Vanderbilt has been remarkable,” Grabovac said. “I was very blessed to have been referred to such a wonderful oncologist and a wonderful department for my treatments.”
Grabovac offers this wisdom to young women with unexpected symptoms despite a recent physical or well-woman exam: “The biggest thing is making sure that you are getting checked out. ... You never know. Taking care of yourself is a huge priority.”
All I wanted to do was hug my kids, and I couldn't. I had to tell my kids over the phone that I had cancer, and that was so incredibly hard.
Vanderbilt has been remarkable... I was very blessed to have been referred to such a wonderful oncologist and a wonderful department for my treatments.