Woman’s Best Friend

Amanda Tasca, age 37, of Vernon, New Jersey, is a married hairdresser and the proud owner of two fun, loveable Pug dogs. But she never expected that the playful nature of one of her pugs, Daisy, would lead to her breast cancer diagnosis—and prompt her sister Amy Niosi, a 38-year-old high school teacher who lives in Wayne, New Jersey, to perform a breast self-examination and discover that she also had breast cancer.

An Accidental Discovery

One day, when Amanda was lying in bed, Daisy jumped on her chest. “After Daisy jumped on me, it really hurt,” she says. “When I checked my left breast to see if she scratched me, I felt a grape-sized lump.”

At first, Amanda didn’t think anything of the lump. She has fibrocystic breast tissue, which can cause breast tissue to feel lumpy or tender. However, she decided to mention her discovery to her OB/GYN a few weeks later during a checkup.

“My doctor had a hard time finding the lump at first, but agreed that I should have it checked out,” Amanda says. “Because I was younger than age 40 and didn’t meet the criteria for routine mammograms, I needed a prescription for a mammogram and an ultrasound.”

Imaging tests performed at Amanda’s local community hospital confirmed the presence of a 2.5 cm tumor, and a biopsy revealed that it was cancerous. Amanda was diagnosed with an early-stage invasive ductal carcinoma.

“I got the call about my diagnosis the day before Thanksgiving [2019], and that was the only time I cried,” Amanda says. “After that, I was OK. I figured that because I had no control over the situation and it is what it is, I would do what I had to do to take care of it.”

Sharing the News

Amanda shared the news of her diagnosis with her family, including her sister, Amy, a married mom of a 6-year-old daughter and a 1-year-old son. “As soon as I found out that Amanda’s lump was cancerous, I had a sick feeling in my stomach,” Amy says. “I thought, ‘I have it, too.’”

On Thanksgiving Day, Amy tried to push the worrisome thought out of her mind. But that evening, she decided to do a breast self-exam—and sure enough, she felt a hard spot on the top of her right breast.

“Because of my sister’s diagnosis, I made an appointment [at my local hospital] right away,” Amy says. “After I had my imaging tests, the radiologist came in and said that she was concerned because it looked like cancer.”

Amy later learned that in addition to the tumor in her right breast, the cancer had spread to the lymph nodes under her arm.

Starting Treatment—Together

After being diagnosed, Amy and Amanda chose to receive their cancer treatment at John Theurer Cancer Center at Hackensack University Medical Center.

“Our mom demanded that we switch to John Theurer Cancer Center for our treatment, and we thought it was a good idea,” Amanda says.

One of the first steps in developing each sister’s treatment plan was having genetic testing. Genetic testing revealed that both Amy and Amanda—as well as their other sister—were BRCA1 and BRCA2 negative, meaning that they did not carry the most common genes that are associated with an increased risk of breast cancer.

Since Amanda’s tumor was relatively small and lymph nodes did not appear to be involved, the plan was for surgery first. She was given options of a lumpectomy or a double mastectomy. “I decided that the best choice for me was a double mastectomy because I wanted to do everything I could do,” she says.

Amanda underwent a successful surgery performed by Marson T. Davidson, M.D., on Valentine’s Day 2020. She experienced a smooth recovery.

“I probably shouldn’t have been doing this, but I was up and vacuuming a few days after surgery,” Amanda says. “My mom kept telling me to relax, but other than some tightness in my chest, I felt fine.”

Tumor genetic testing revealed that chemotherapy was not likely to be of benefit, so it was not recommended. “I was relieved that I didn’t have to have chemotherapy because I am a hairdresser and I didn’t want to lose my hair,” Amanda says.

In March 2020, Amanda and her husband started in vitro fertilization to preserve their fertility, giving them the option to grow their family after Amanda’s cancer treatment is complete. The medical oncology and reproductive endocrinology teams worked closely together to coordinate this safely.

Care During COVID-19

While Amanda was preparing for surgery, Amy started chemotherapy to shrink her tumor. Because Amy’s tumor was larger than Amanda’s and had spread into the surrounding lymph nodes, Amy needed a different treatment course with a combination of chemotherapy, surgery and radiation.

Amy’s chemotherapy regimen lasted from January to April 2020, which coincided with the height of the COVID-19 pandemic in New Jersey. Because chemotherapy can weaken the immune system and increase the chances of infection with viruses in the community, such as COVID-19, her medical oncologist, Deena Mary Atieh Graham, M.D., took extra precautions.

“I never really worried about receiving treatment during COVID-19,” she says. “Going in for treatment seemed a little scary at first when everyone started wearing masks, but it was fine. Except for extra safety measures, all the staff acted normal and my treatment continued as scheduled.”

To protect her health, Amy took a leave of absence from her teaching job at Passaic Valley High School. “I got a fever at the beginning of April, so my medical oncologist tested me for COVID-19 right away,” she says. “Fortunately, my test was negative.”

Like her sister, Amy also underwent a double mastectomy performed by Dr. Davidson. She had surgery in early June, followed by five weeks of post-surgical radiation. She is also receiving anti-hormonal therapy and is enrolling in a clinical trial looking at a novel therapy to help lower breast cancer recurrence.

“Since my sister already had surgery, I had an idea of what to expect,” Amy says. “And just like my sister’s, my recovery went very well.”

Reconstruction and Survivorship

Today, Amanda and Amy are thankful for the circumstances that led to their diagnoses. If not for Daisy—and all the events that followed—the pair agree that they may not have had such favorable outcomes.

“The timing of all this happened for a reason,” Amy says.

Amanda underwent breast reconstruction surgery performed by Janet Yueh, M.D., in July 2020 and is now receiving hormone therapy with the drug tamoxifen to reduce her risk of recurrence. She is back to work as a hairdresser and is enjoying spending time with her husband and her pugs.

Amy is in the process of breast reconstruction with Stephanie Cohen, M.D., and is planning to have breast implant surgery in March 2021. She is savoring her time at home with her two children and looking forward to returning to her classroom.

Both women hope their story will encourage women—especially those under the age of 40, when routine breast cancer screenings are typically not recommended—to be proactive and advocate for their breast health.

“I think the message here is that women have to be aware of changes with their breasts, and if something isn’t right, they need to have it checked out,” Amanda says.

“I had recently had a baby and was having regular checkups with my OB/GYN, so I thought I was good,” Amy says. “However, my sister’s diagnosis inspired me to do a self-exam—something I haven’t done since high school—and I learned to be my own advocate.”

Throughout their treatment, the sisters encouraged each other and remained optimistic, which they believe was a critical part of their successful recovery.

“I took the view that my diagnosis was not the end-all. I figured, ‘Why get depressed? Why get upset?’” Amanda says. “Breast cancer is hard, but I asked for help when I needed it and was determined to stay positive.”

Learn more about breast cancer treatment available at John Theurer Cancer Center.