April Premo was enjoying her 20s. The UW Health employee and her husband, Alex, were about to take a trip to their 10th different country to celebrate her master’s program graduation.
She was set to take her medical dosimetrist board certification exam and start a family the following year, but on Sept. 13, 2024 — a week before their planned vacation — Premo was diagnosed with breast cancer.
Between her age and lack of family history, she found the diagnosis difficult to accept.
“All these years we were go-go-go, live your life in your 20s, and all of the sudden one day all of these happy, wonderful things just come to a pause,” she said.
Premo's diagnosis, stage 3 invasive lobular carcinoma, can be more difficult to detect than other breast cancers because it doesn't show typical symptoms. Instead of reporting symptoms, she asked her primary care provider about an increased firmness in one breast, which led to her diagnosis.
“I didn’t have a lump feeling. I didn’t have skin changes. I didn’t have nipple changes. I didn’t have any discharge,” Premo recounted. “It was just this very slow growing tumor that felt like dense breast tissue.”
Preserving fertility
Invasive lobular carcinoma feeds on estrogen the body makes naturally, so Premo’s treatment includes taking medication to stop that hormone production for the next 7 to 10 years to prevent new cancer growth.
Chemotherapy alone can cause fertility issues and multiple years of hormone blocking medications would delay a possible pregnancy, so Premo's medical oncologist, Dr. Marina Sharifi, discussed fertility preservation options before starting treatment.
“It's something that's part of every conversation with a premenopausal patient about to start chemo,” Sharifi said.
UW Health Fertility Clinic helped Premo prepare for an egg retrieval in late October, which resulted in four healthy embryos through in vitro fertilization. Premo and her husband held a gender reveal party for the embryos — all boys — to celebrate their new path to parenthood. The celebration included plenty of blue-frosted cupcakes.
“Having children is going to look different for us, so if we can, I want to find joy in those little special moments,” she said.
Premo remains grateful she was consulted about fertility options right after diagnosis, even though it felt a bit overwhelming at the time.
“I think bringing that up immediately is very, very important,” she said.
On Oct. 23, just five days after her egg retrieval, Premo started eight rounds of chemotherapy. In February, she had a double mastectomy and had the surrounding lymph nodes removed. She will tentatively start radiation therapy in May to eliminate any remaining cancer cells.
There is a growing trend of young women being diagnosed with estrogen-driven breast cancer, even among women with no family history or a known genetic risk, Sharifi said.
“I've seen more and more young patients with these estrogen-positive cancers well before the age we would start screening,” Sharifi said, noting routine mammograms don't start for women until age 40. “So, in that situation, the cancer tends to be picked up when it’s more advanced and spread to the lymph nodes.”
Finding emotional support
Premo has continued to work while she’s able during her treatments. As a medical dosimetrist, she helps design radiation therapy plans for cancer patients. She worked as a radiation therapist for years before training to become a medical dosimetrist.
Premo took her medical dosimetry board certification exam in January while undergoing chemotherapy. A week after her double mastectomy, she found out she passed.
Working in cancer care while also being a patient has been a difficult balance for Premo. She and her husband have a strong support network of family, colleagues and friends, but anxiety about her diagnosis became overwhelming, prompting her to seek professional help.
“There was probably a good month or two after my diagnosis where I was crying every day. I was having panic attacks — I think especially because of my background in radiation oncology,” she said.
Anxiety medication has helped Premo regain her "strong, positive personality" and feel like herself again.
“I always try to help my patients find the right kind of support — whether that's counseling, medication, their faith, or whatever it is that helps them,” said Sharifi, who frequently asks patients how they’re coping with their diagnosis, changes in care and new treatments.
A cancer diagnosis is life changing and we try to normalize that most people are going to need some extra support of some kind — whatever that might be — to get through these different phases.
Premo is open on about her struggles with anxiety and has been documenting her treatment journey on social media. She hopes it will reduce the stigma of medication and validate the difficulties faced by patients like her.
Social media has also helped Premo connect with other young adult cancer patients who understand the disruption of cancer at phase in life that is supposed to be more fun.
“I’m talking about people all over the world who are supporting each other and sharing each other’s journeys and giving tips and tricks on how to make it through treatment,” she said. “Having that virtual community has made a big difference and has been so helpful.”