Many of us, when we’re young, think we’re invincible. We’ll often take for granted such experiences as visiting family and friends, exercising, even going for a walk. It’s not until something happens and these are taken away that we realise how grateful we should be for even the simplest of life’s pleasures.
It’s also important to realise we’re not superhuman. We’re not invincible or immune to developing the harshest of health concerns, no matter what age we may be.
For Juliana Cipolla, recently married, living in Sydney with her husband, and working as an occupational therapist in aged care, this realisation came when the vibrant 26-year-old was just beginning to live her life to the full. She discovered a lump in her breast.
“I was married for maybe a year and a half at the time … we were settling into a routine of everyday life … and I was just going about my daily routine,” she said. “I was having a shower one evening and I felt a lump the size of a golf ball.”
Thinking it was nothing to worry about because “women my age get cysts in their breasts all the time”, it wasn’t until a couple of days later that she confided in her mum and husband about her discovery. “My mum encouraged me to go to the doctor straight away,” she said.
On seeing her doctor, the initial strategy was to have the cyst aspirated, which she did and “the fluid had fully gone”.
“But it came back within a couple of days,” Ms Cipolla said. “My doctor had called me and said, ‘Juliana, there’s nothing wrong with the fluid and the cyst – it’s presenting as normal. If it comes back, let me know’.”
The cyst did come back but, believing there was nothing to worry about and that it would simply “go away”, Ms Cipolla recalls leaving it for “a couple of months because my doctor said it was normal”.
As the days and weeks went by, her mum eventually intervened, prompting her to revisit the doctor, which she did. However, by this point, after having the cyst aspirated again and on consulting her surgeon, she was instructed to avoid physical activity and to compress the area. “Don’t do any work, don’t do anything,” the doctors told her. But the cyst returned again.
“At that time, the doctor called and said there’s something not right,” Ms Cipolla said. She was called in for a biopsy from the wall of the cyst and was subsequently diagnosed with triple-negative breast cancer in March this year, commencing chemotherapy in April.
The importance of regular health checks at all ages and having any issues checked immediately has never been more evident.
“My cancer presented as a cyst,” Ms Cipolla said, adding that she had simply believed that “people my age don’t get breast cancer”.
“Being so young, I was probably a bit naïve,” she continued, but with the help of her family and persistence of her doctors, the necessary tests were done and “we were able to investigate what was wrong and what the diagnosis was”.
Ms Cipolla says that while she regrets waiting a couple of months before having the cyst biopsied, she puts this down to being in denial initially. However, since that experience, she has become a strong advocate for regular health checks and seeing a doctor if one feels something is wrong.
“In terms of encouraging women [and men] to get checked, this is something you can’t really leave at all,” she said. “I think people are very intuitive in [regard to] their own bodies, and they know when something’s not right. So go with your gut … and get checked. And get that second opinion if you’re not really happy with what one doctor has presented you with.”
Beginning chemotherapy is daunting at the best of times, let alone during a global pandemic when lockdown measures and restrictions add complications.
“When I started chemotherapy, it was in April, so there was no lockdown in Sydney,” Ms Cipolla said. “So, I had my mum and my husband at every appointment with me. During every chemotherapy session, they would sit with me and keep me company. But as time went on I ended up all by myself in the chemotherapy chair. Even though the nurses and the staff were so supportive, there’s nothing like having a loved one there. So that was really difficult.”
Ms Cipolla says she has had genetic testing, which has revealed the BRCA1 gene, and a lumpectomy to remove the cyst. In March 2022, she is due to have a double mastectomy.
“I’d known there was breast cancer in my family, on my dad’s side,” she said. “My grandmother on my dad’s side has the BRCA1 gene. My aunty was tested about 15 years or so ago, and she tested positive for the BRCA1 gene. But because [when it comes to breast cancer risk] everyone is focused on the genetic link between mothers and daughters, and no one really told my dad to get tested for the gene, it wasn’t until I was diagnosed that it was evident that I had the BRCA1 gene.”
Ms Cipolla continued: “I would encourage everyone, if you do have breast cancer in your family, genetic testing would be beneficial. Not that I could have avoided my breast cancer, but I would have taken precautionary measures and had tests done. I’d never had a mammogram before, never an ultrasound before my breast cancer.”
The decision to undergo a mastectomy, at any age, is a difficult one, but for someone in her 20s with goals of starting a family and plans to breastfeed one day, it certainly wasn’t an easy choice for Ms Cipolla, despite having the diagnosis and the genetic testing revealing the BRCA1 gene.
“I’ve had to make some big decisions in my life,” she said. “It’s either me [keeping my breasts] or my [future] family not having a mum.”
Arriving at this realisation made it “pretty much a no brainer” for Ms Cipolla “that a double mastectomy was going to be on the cards”.
“But that does mean that I [won’t be able to] breastfeed my [future] babies,” she said. “At the end of the day, though, I want to be alive and healthy for my family. So, if I have to make these small sacrifices in my life, then so be it. [So] that’s happening in March next year. And because I do have the BRCA1 gene, I’m eligible to have both breasts removed.”
Speaking with Ms Cipolla, her positive attitude to life and willingness to help others becomes clear very quickly, her enthusiasm for life infectious.
“I just take it day by day,” she said, revealing that her coping strategy includes walks when she has enough energy and distracting herself with various hobbies. “I did a knitting project … and a painting project … and [there’s been] plenty of Netflix.”
“I have great supports around me,” she added. Since the diagnosis she has moved back, with her husband, to live with her parents. “Everyone’s been so amazing.”
“I also feel that … I tend to tell everyone that I’m OK … because I don’t want to upset anyone else in the process as well. I always feel like I’m worrying about what other people’s mental health is like. I don’t want to … affect them in any way [simply] because I’m going through this.”
Despite facing a long dark tunnel of treatment and serious surgery, Ms Cipolla has used this positive attitude and willingness to help others – by becoming an ambassador of the National Breast Cancer Foundation (NBCF) to share her message and story with others.
“I’m not working at the moment, I’m taking leave, so it’s something to do … it’s great to be an advocate for something you truly believe in,” she said of her role as NBCF ambassador. “And because I’m going through it at the moment, I think it’s such a good time for me [to do this] as well. Meeting all the other ambassadors has been so much fun. Everyone’s been great and so supportive, and I’m really looking forward to the year ahead with them.”
While those going through breast cancer are obviously ideal as ambassadors for organisations such as the NBCF, Ms Cipolla says that others, such as pharmacy assistants who are on the frontline of healthcare, can play an important advocacy role as well, including for organisations such as the NBCF, and they can do so by raising awareness within their communities through programs and recommending that their customers make sure they arrange regular health checks.
As for Ms Cipolla, what’s next?
“I just completed lumpectomy surgery where they removed the tumour and a couple of lymph nodes … I’ll find out the results of that and I’m hoping they’re positive – I’m sure they will be. And then, at the end of [October], I’m starting radiation for three weeks. So, I should be cancer-free by about mid-November. And then I can fully recover and recuperate before my mastectomy in March. So, I’m on the home stretch.”
The invincible feeling of youth is shattered when something goes wrong, yet Ms Cipolla’s drive for life beyond cancer is unstoppable.
“I’m really looking forward to catching up with some family and friends – just to go outside of my four walls at home after lockdown, too,” she said. “I want to exercise more, with more walking, and perhaps try something a bit more relaxing, like yoga.
“I’m just trying to get my strength back. Obviously, with the medications, I’ve put on a little bit of weight. So I want to try and manage that in a healthy way by eating well. Yeah, just trying to get back to everyday life and everyday normality. Maybe at the end of the year, I’ll think about going back to work and getting back to more of a routine.”
For more and to read this feature in full, as it appears in the October issue of Retail Pharmacy Assistants e-magazine, visit: rpassistants.com.au/magazines/retail-pharmacy-assistants-october-2021/
