35-Year-Old Woman Diagnosed With Stage 2 Triple-Positive Breast Cancer After Spotting Lump Before Showering

After the mammogram, Ayala recalls being told “right away” that she had cancer. It was later declared to be stage 2, triple-positive invasive ductal carcinoma.

According to Cancer Cell International, “Triple-positive breast cancer (TPBC), a unique subtype of luminal breast cancer, is characterized by concurrent positivity for estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2).”

This subtype accounts for only 5–10% of all breast cancer cases and typically requires a multi-pronged approach—combining chemotherapy, HER2-targeted therapy, and hormone (endocrine) therapy.

Ayala was diagnosed at a local medical center in Los Angeles County but ultimately chose to get a second opinion at City of Hope.

Since her cancer was hormone-driven, doctors recommended that Ayala undergo a hysterectomy to halt hormone production. Although, she has not yet had the surgery, she froze some eggs before starting her treatment regime.

Ayala’s treatment plan consisted of six rounds of chemotherapy, surgery to remove her left breast (mastectomy), targeted therapies, and, now, medication to suppress estrogen. It’s important to note that she was also found to have an ATM (Ataxia-Telangiectasia Mutated) gene mutation which increases her risk of developing different types of cancers.

Her oncologist, Dr. Thanh Nga Doan, M.D., tells City of Hope, “Thankfully, Janet has successfully completed her neoadjuvant targeted therapy with chemotherapy and achieved complete pathologic response.

“Now over a year later, Janet has also completed her HER2-targeted infusion therapies, and we are focusing on tailoring additional endocrine and targeted therapy to further decrease her risk of recurrence in the context of her ATM mutation. Through this all, although never easy, she remains positive and optimistic which truly made caring for her so rewarding.”

Ayala, who has already finished up chemotherapy, has also incorporated integrative therapies into her recovery, including music therapy, paimting, meditation, and acupuncture.

RELATED: What You Need to Know About Integrative Medicine

Now, as Ayala is on medically induced menopause to prevent cancer recurrence, she admits, “Survivorship is actually pretty tough. I think it’s more challenging now than it was before because with treatments, we know an end date, whereas now, it’s like, this is my life and I need to find a new normal.”

Now, Ayala focuses on eating healthy, exercising, and “removing endocrine disruptors in home care and beauty products.”

As for how her breast cancer journey has shaped her mindset, she insists her “life perspective has changed completely.”

“I honestly see life with more color these days. I wish I could tell my younger self, ‘The reward you get at the very end is worth the struggle. You will live life with less fear and chase your dreams like never before,'” she said.

Ayala, who hopes her story will bring comfort to others diagnosed with cancer at a young age, concluded, “I will do whatever I can to spread the word about early detection and to lean in and be the support for others as they go through their journey.

“No one fights alone.”

Managing Recurrence Risk

“Once a patient has finished his or her active therapy for breast cancer, we will often refer to that time as breast cancer survivorship,” Dr. Erica Mayer, a breast cancer medical oncologist at Dana Farber Cancer Institute, previously told SurvivorNet.

“This is a time when patients are still being actively monitored by their treatment team, not only to ensure that they remain healthy and cancer-free in the years ahead, but also to make sure that they have recovered from any side effects of their initial treatment, and that they are pursuing healthy behaviors for example, getting regular exercise, eating a healthy diet, and keeping up with all their other routine medical care.”

Follow Your Treatment Guidelines.

“The best way to reduce your risk of recurrence with breast cancer is to follow treatment guidelines and complete the course of treatment that’s given,” says Dr. Elisa Port, a surgical oncologist specializing in breast cancer at Mount Sinai, to SurvivorNet.

“So the challenge is to work with every individual person to make sure we give her the best chance of getting through these treatments and enjoying the benefits of these treatments, which is the lowest rate of cancer coming back,” Port says.

Limit Alcohol.

Dr. Port says the other lifestyle factor that may increase one’s risk of breast cancer recurrence is heavy alcohol intake.

Eat a Healthy Diet and Exercise.

Dr. Elizabeth Comen, a medical oncologist at Memorial Sloan Kettering Cancer Center and medical advisor to SurvivorNet, notes that while exercise is well known for supporting weight loss, research shows it may also play a meaningful role in lowering breast cancer risk.

She explains that excess weight can create chronic inflammation in the body, and fat cells can produce estrogen — a hormone that, when present at high levels over a woman’s lifetime, can raise the likelihood of developing breast cancer.

Importantly, she emphasizes that physical activity doesn’t have to be extreme or strenuous to be beneficial. A light walk can also suffice.

“Exercise doesn’t have to mean suddenly training for a triathlon or doing something completely new,” Dr. Comen says.

For many patients, she adds, a cancer diagnosis can become a catalyst to prioritize their health and build sustainable habits that support their well‑being.

Maintain a Healthy Weight.

Dr. Sairah Ahmed, an associate professor in cancer medicine at the University of Texas MD Anderson Cancer Center, tells SurvivorNet that staying as physically strong as possible can make a meaningful difference for people preparing to start treatment.

“The more physically fit you are going through your cancer treatment, the fewer side effects you’ll have and the faster you’ll get back to your normal quality of life,” she explains.

She also stresses that well‑being isn’t just about the body. Emotional resilience plays a major role for both patients and the people supporting them.

“Stress control is often something that isn’t talked about enough, but there is a lot of stress — for the patient going through cancer and for the family who has to support them,” she says.

Hormone Therapy: A Powerful Tool Against the Most Common Form of Breast Cancer

For many women diagnosed with breast cancer, the disease is fueled by hormones—specifically estrogen or progesterone. These are known as hormone receptor-positive cancers, and they represent the most common subtype of breast cancer.

Hormone therapy is designed to block or lower the hormones that help cancer cells grow. It’s a cornerstone of treatment for hormone receptor-positive breast cancer, and it plays a vital role in both treatment and prevention.

“Endocrine therapy has significant benefits in reducing the risk of breast cancer recurrence and improving breast cancer survival,” says Dr. Eleonora Teplinsky, head of Breast Medical Oncology at Valley Health System.

These therapies work in two main ways:

• Lowering estrogen levels in the body
• Blocking estrogen receptors on cancer cells so the hormone can’t fuel tumor growth

WATCH: Hormone Therapies for Breast Cancer: Aromatase Inhibitor

Types of Hormone Therapy

One widely used drug is Tamoxifen, which blocks estrogen’s ability to bind to cancer cells. It’s used not only to treat breast cancer but also to help prevent it in women with a strong family history or other risk factors.

Another class of drugs, called aromatase inhibitors, works by stopping the body from producing estrogen altogether. These are typically prescribed to postmenopausal women and include:

• Anastrozole (Arimidex)
• Letrozole (Femara)
• Exemestane (Aromasin)

All are taken as daily pills and have been shown to slow or stop the growth of estrogen-sensitive tumors.

Hormone Therapy Side Effects Can Mimic Menopause

Depending on the endocrine or hormone medication, each one may have its own side effects. Typical side effects for certain types of hormone therapy drugs may include:

• Bone pain
• Joint pain
• Loss of appetite
• Nausea and/or vomiting
• Fatigue
• Constipation

Breast Cancer Surgery

A lumpectomy is a surgery to remove cancerous or abnormal tissue from the breast. It’s also known as breast-conserving surgery because, unlike mastectomy, only the tumor and some of the surrounding tissue are removed.

WATCH: Choosing between a lumpectomy and a mastectomy.

A double mastectomy is a procedure in which both breasts are removed to get rid of cancer. The procedure may also be performed as a preventative measure for women who are at a very high risk of developing breast cancer.

“A double mastectomy typically takes about two hours for the cancer part of the operation, the removal of the tissue,” Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System, tells SurvivorNet. “The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has.”

During a mastectomy, the breast is removed. In a double mastectomy, both breasts are removed. In many cases, women choose to undergo breast reconstruction.

Reconstruction gives women the chance to have implants put in right after the mastectomy procedure. However, some women choose not to have reconstruction at all.

Dr. Port told SurvivorNet that most women do opt to have some reconstruction. Depending on what sort of surgery a woman chooses, the time spent in surgery can vary greatly.

There are many different options and techniques available for reconstruction — from implants to using a woman’s own tissue — and choices about when to get the reconstruction, meaning immediate (at the time of mastectomy) or delayed (which could be months or even years later).

WATCH: Deciding to get saline or silicone implants during a breast reconstruction.

After breast cancer surgery, women diagnosed with early-stage breast cancer may also need chemotherapy, radiation, or hormone therapy.

Radiation Therapy: A Powerful Tool with Long-Term Considerations

Radiation therapy—using high-energy rays to destroy cancer cells—is a common follow-up to breast cancer surgery, especially for patients who choose a lumpectomy over a mastectomy. Its goal: reduce the risk of recurrence by targeting any lingering cancer cells in the breast or surrounding tissue.

While effective, radiation can come with side effects, both immediate and delayed. Common symptoms include:

• Fatigue
• Swelling
• Scar tissue
• Shortness of breath

RELATED: Cancer Patients With Dark Skin At Increased Risk of Painful Radiation Side Effects, New Research Says

One of the more serious concerns involves the heart, which can unintentionally absorb radiation due to its proximity to the breast.

“When the radiation is delivered, unfortunately, the heart happens to be somewhere very near to where they have their breast cancer, and it becomes an innocent bystander absorbing some of the radiation,” explained Dr. Jean-Bernard Durand to SurvivorNet.

This exposure can lead to complications such as fatigue, shortness of breath, and even heart failure—sometimes surfacing decades after treatment.

“We make it a point to see them on a regular basis so that we can catch these things very early and treat them,” Dr. Durand added.

Even advanced techniques like proton therapy, which aim to minimize damage to healthy tissue, aren’t immune to side effects. Fatigue remains a common complaint, and the risk of long-term injury still exists.

“Radiation is a form of energy… and when we give radiation, it has the ability to scatter,” Dr. Durand said. “Even though we may target one particular area, that scattering of energy can cause injury to the local surrounding structures, including the heart.”

Over time, this injury can lead to the development of scar tissue within the heart muscle, its electrical system, and blood supply.

“We believe it is what causes all the injury, that ultimately leads to the symptoms,” he explained.

For survivors, this underscores the importance of ongoing monitoring and open conversations with care teams.

Radiation treatment continues to evolve, with ongoing debates among experts about how to reduce side effects while optimizing outcomes. Dr. Chirag Shah, radiation oncologist and the division chair of Radiation Oncology at AHN Cancer Institute, outlined three key areas of discussion:

• Whole vs. Partial Breast Radiation: Shortening treatment duration and minimizing side effects are promising, though long-term data are still emerging.
• Identifying Patients Who May Not Need Radiation: Some individuals may not benefit from radiation, and omitting it could reduce unnecessary risks.
• Technique Optimization: Advancements in delivery methods aim to improve effectiveness while limiting harm to healthy tissue.

“I think the first debate that we have is whole breast radiation versus partial breast radiation and the idea of reducing duration of treatment and reducing side effects for patients, albeit with less than 10 years’ worth of long-term data,” Dr. Shah explained to SurvivorNet.

Contributing: SurvivorNet Staff

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