In Carlette Knox' home growing up, cancer was an everyday word.
Her father died of colon cancer. Her mother was a two-time breast cancer survivor. Two aunts lost their battles, and other relatives fought various forms of the disease.
Still, when Carlette felt a lump in her breast in 2009 at just 34 years old, she hoped it would go away on its own.
"My mother was going through treatment for pancreatic cancer at the time," she remembers. "I'd just had a mammogram a few months before, so the thought of this lump being cancer was the furthest thing from my mind."
But when it was still there a few weeks later, Carlette scheduled another mammogram. It confirmed what she'd known deep down – she had breast cancer.
BRCA Mutation Diagnosis
What Carlette didn't know was that she would test positive for BRCA, a mutation on the breast cancer gene that predisposes her to breast and ovarian cancer.
"When I learned about the genetic mutation after my diagnosis, I felt targeted, but at the same time equipped to make smarter decisions about my treatment options."
The news was shocking, but not entirely surprising in light of Carlette's family history.
"My mother was diagnosed with breast cancer at 35, and she experienced the devastating loss of her mother to this disease growing up."
With the support of a genetic counselor, Carlette underwent risk assessment testing to determine her risks more specifically. The results offered clarity - but weren't easy to hear.
"The need to attack this diagnosis head on was evident," she says.
Carlette decided to undergo preventative treatment: a bilateral mastectomy (the complete removal and reconstruction of both her breasts) as well as an oophorectomy (removal of her ovaries to reduce the chances of breast and ovarian cancer). She was already undergoing chemotherapy for the existing breast cancer.
"My decision to remove the non-impacted breast tissue was supported by clinical trial data as well as my personal experience."
Personal experience that was hitting a fever pitch. Carlette's mother lost her fight with pancreatic cancer in 2011. Around the same time, Carlette was coming to terms with the toll the procedures had taken on her own body while also dealing with other massive life changes.
"I lost my breasts. I lost my ability to have more children, and shortly after the end of my treatment, I lost my marriage to divorce. When you go through such a significant change as a woman, you can't help thinking, 'Who's ever going to want me?' I didn't think a second chance at love would be part of my future."
Setbacks and Surprises
For almost seven years after her mastectomy and oophorectomy, Carlette lived cancer-free, seeing her son through his teen years, serving as worship leader at her church, working full-time in IT, and visiting Penn Medicine for follow-ups every six months. Then, in 2016, strange symptoms surfaced.
"I started having back pain. I also had some blurriness in my right eye."
Her oncologist, Susan Domchek, MD, ordered scans that delivered sobering news.
"She called me on a Friday night to tell me," Carlette remembers. "I remember her saying, 'I'm so sorry.'"
Now metastatic, the breast cancer had returned, spreading to Carlette's back, abdomen, and pelvis. There were also lesions on her brain stem that caused a short-term loss of vision in her right eye.
"It happened so fast. I'd just gotten clean scans a few months before. Even Dr. Domchek seemed shocked."
Six rounds of aggressive chemotherapy and two weeks of radiation took the edge off of the cancer almost immediately. After the second round of chemo, Carlette's vision was fully restored.
Today, Carlette's treatment plan consists of bone strengthening injections once monthly and oral PARP inhibitors she takes twice daily.
"That drug has really been the secret sauce for us, keeping my levels under control. It's pretty cutting edge, which is one of the things I appreciate about Dr. Domchek. She looks at every option to help me maintain my quality of life."
It's a quality of life that doesn't look too much different than life before cancer's return. Carlette still works full-time. She visits Penn Medicine for monthly follow-up visits and gets scans every three months.
"There are side effects," she admits. "I have a lot of fatigue and a lot of bone pain at times. But I have to look at it in a way that causes me to be positive. I have committed to myself and to others around me to live my best life everyday! I am not looking for pity; that's not where I am."
And in the last year, Carlette's life has gotten a boost by the very thing she thought was behind her: a second chance at true love.
Carlette and Chris
She didn't see it coming.
"Like I said, you undergo a mastectomy and oophorectomy, and you think, 'Love probably isn't in the cards.'"
Then came Chris – another member of Carlette's church's singles' Bible study. He and Carlette had known of each other for two years, but never really had a chance to interact. When they did, the connection was impossible to ignore.
"Our singles Bible study encourages us to have tough conversations up front," Chris said. "So after a few dates, that's what we did. I knew about Carlette's cancer. When she said, 'I need to tell you something,' I said, 'I think I know where you're going with this. It's not going to bother me or make me look at you differently,'" he says of her mastectomy and breast reconstruction. "That part of your body is just one part of the amazing woman you are."
It's been a little under a year since they started dating, and Carlette and Chris are excited about the future.
"God continues to use what the enemy meant for my demise – cancer – for a greater good," Carlette says. "I might have stayed in an unhealthy marriage if I hadn't been diagnosed. I look at my oophorectomy – it kept me from the possibility of more children. But then I met Chris, who has a beautiful five-year-old daughter who brings so much joy to me, and to my son. He now has a little sister to protect!"
And even though cancer's back in the picture, Carlette never regrets her preventative treatment.
"If I hadn't undergone the mastectomy and oophorectomy, it probably would've been only two or three years until I saw a reoccurrence. I was coming up on seven years when I was diagnosed the second time. I have no doubt this is a much better outcome than I otherwise could have expected."
Read more about preventative methods and treatment for breast cancer