August 13, 2019
Yearly mammograms are not recommended for women under age 40. Young women should perform monthly self-exams, but not everyone does.
That’s why Jamie Wagner, DO, is so proud of Kelsey Coplen, RN. At age 28, Kelsey felt something different in her left breast and did not ignore it.
“It’s not always easy to find a lump,” explains Dr. Wagner, chief of breast surgical oncology at The University of Kansas Cancer Center. “But if you know your own body, you can recognize a change and get help.”
Kelsey told her gynecologist, Madhuri Reddy, MD, at The University of Kansas Health System. Dr. Reddy ordered an ultrasound, which led to several other tests.
On February 22, 2018, Kelsey learned she had stage 2, HER2-positive invasive ductal carcinoma. And the cancer had spread from her left breast to 1 lymph node.
Easing fear after breast cancer diagnosis
As a cardiovascular operating room nurse and unit educator at The University of Kansas Health System, Kelsey knew the dangers of lymph node involvement.
But that wasn’t the only reason she and her family were overwhelmed by the news.
Kelsey’s mom, Lisa, was simultaneously going through chemotherapy for stage 4 peritoneal cancer, a rare cancer of the abdominal lining. The same week Kelsey received her diagnosis, her family learned that Lisa’s cancer had grown and stopped responding to her chemotherapy.
Breast medical oncologist Qamar Khan, MD, was able to ease the family’s fears about Kelsey’s diagnosis. He told them aggressive stage 2 and 3 cancers are often curable thanks to the remarkable medical breakthroughs available at a National Cancer Institute-designated cancer center.
“Kelsey’s cancer cells tested positive for a protein called HER2,” says Dr. Khan. “A targeted immunotherapy drug called Herceptin® has proved very effective against HER2-positive tumors. It uses the body’s immune system to attack cancer cells.”
Targeted immunotherapy can greatly improve overall survival and significantly reduce the risk of recurrence. Kelsey’s care plan included a combination of immunotherapy and traditional chemotherapy, followed by surgery and radiation.
Family planning and breast cancer treatment
Given Kelsey’s young age, her cancer team recommended a fertility consultation with reproductive endocrinology and infertility specialist Courtney Marsh, MD, MPH.
Chemotherapy is a powerful drug that destroys cancer cells, but it also attacks a woman’s reproductive system and can lead to fertility issues.
“It was hard to have all these conversations at 28,” says Kelsey. “I just started dating my boyfriend in late December. I imagined getting married and having children someday, but I wasn’t there yet.”
Before starting chemotherapy, Kelsey began the egg production and retrieval process with Dr. Marsh. She had fertility shots 3 times daily to increase egg production, then on March 16, 3 weeks after being diagnosed with breast cancer, her eggs were retrieved and frozen for future use.
One week later, Kelsey began 6 cycles of chemotherapy followed by Herceptin, which she will continue taking for a year.
“My team postponed my chemo so I could carry out the egg retrieval process,” Kelsey says. “They did such a great job of making sure no time was wasted.”
Too much cancer
In 2013, Kelsey’s mom, Lisa, tested positive for Lynch syndrome, a condition caused by a mutation in 1 of 5 genes. It leads to an increased risk of colorectal, endometrial and other cancers – often before the age of 50.
Fortunately, Kelsey tested negative for Lynch syndrome. But here she was, facing breast cancer at such a young age.
“For a while, my mom and I commiserated about our cancers,” Kelsey remembers. “I’d go to her chemo. She’d go to mine. Sometimes we shared the same treatment bed and napped together.”
But on May 5, 2018, Kelsey’s mom passed away.
“She showed me how to be positive and keep a sense of humor,” says Kelsey, “even when you have cancer.”
Putting one foot in front of the other
Kelsey was in mourning. But she still had to go to chemotherapy. She worked as much as she could. And she faced making several life-changing decisions.
Dr. Wagner and her team explained her surgery and reconstruction options, then let Kelsey make the final call.
“I could have had a single mastectomy,” Kelsey shares. “But I didn’t want to take any chances of going through this again down the road, so I decided to do the bilateral (double) mastectomy.”
“A bilateral nipple-sparing mastectomy with reconstruction is the epitome of mastectomy today,” says Dr. Wagner. “We’re actually able to save all the skin, the nipple and the areola complex.”
Expert dissection is critical to this procedure. Done properly, there’s no difference in survival or risk of recurrence than when the nipple is removed. And cosmetically, it offers the most natural appearance.
Successful breast cancer treatment and surgery
Thanks to thousands of women who have participated in clinical trials, our physicians know how to treat tumors like Kelsey’s.
“It’s wonderful when research makes its way to your patient,” says Dr. Wagner. “Before surgery, we could see a reduction in the size of her breast tumor and cancerous lymph node, proving the chemotherapy worked.”
When chemotherapy is effective, fewer lymph nodes need to be removed. Preserving lymph nodes greatly improves quality of life after cancer.
During Kelsey’s mastectomy, Dr. Wagner removed both breasts, the cancerous lymph node, plus a small number of lymph nodes to test. “Not so long ago, the only choice would have been to remove all her lymph nodes,” says Dr. Wagner.
Plastic surgeon Eric Lai, MD, who specializes in breast reconstruction, initiated the reconstruction process following the mastectomy. He placed tissue expanders under Kelsey’s skin and chest muscle to prepare her for implant placement at a later date.
“It was hard going in for a double mastectomy and not having your mom there to comfort you,” shares Kelsey. “But I felt cared for by the cancer team. Dr. Wagner has a calming aura about her. She’s warm and personable. And she explains everything so well.”
Within days, Kelsey learned that all her lymph nodes were negative for cancer, including the one that had tested positive at diagnosis. All the cancer had been eradicated.
“Kelsey is reaping the benefits of an entire generation of women before her. And now she’s preparing to participate in a clinical study that will help us understand more about radiation therapy,” says Dr. Wagner.
Embracing support as a breast cancer survivor
Kelsey has received an outpouring of support from her former classmates at St. Thomas Aquinas High School and the University of Kansas, plus other friends, family, co-workers and even strangers.
“People I don’t even know have sent me cards and prayers and bracelets. Friends are mowing my grass, letting my dogs out, bringing me food,” says Kelsey. “It’s so heartwarming.”
Kelsey also gives a lot of credit to her cat and 2 dogs. “They’ve kept me busy,” she laughs, “and my golden retriever puppy is really snuggly.”
Of course, Kelsey’s family is at the heart of her care. A sister moved in with Kelsey after their mom died. Her other sister and dad live nearby. And Kelsey’s boyfriend, Spencer, has been a positive influence through it all.
Kelsey’s words of wisdom for other cancer patients? “Don’t let your diagnosis and treatment hold you back from life,” she says. “Go to your friend’s birthday party. Go to the Elite 8 basketball tournament in Omaha. Go sit at dinners with your family even if you have zero appetite. Be there. And let your loved ones be there for you.”
Dr. Wagner is in awe of Kelsey’s tenacity. “From a physician’s standpoint, it’s humbling to watch a young woman with so much poise and optimism,” she says.
When people ask Kelsey how she can be so fearless, she shrugs and says, “That’s the way my momma raised me.”
This individual participated in a clinical trial of an investigational treatment. Clinical trials are different from standard medical care. As with all research studies, clinical trial participant outcomes vary. Before participating in a clinical trial, it is important to discuss the risks and benefits with your healthcare provider.