From the Duke Cancer Institute archives. Content may be out of date.
The Right Team at the Right Time
Rebecca Cook poses with her family on the last day of her latest round of chemotherapy treatments — July 21, 2021. Her cancer is currently in remission.
A DCI breast cancer care team joins forces with a genetics counselor to treat mother with high-risk genetic syndrome; prompting testing, then preventative screening for her kids.
Living a good life at age 35, Rebecca Cook thought she had more time before she needed to start thinking about screening for breast cancer. After all, she was a young mom of four kids who successfully managed to breastfeed for the past seven years, including a set of twins. (Breastfeeding, she had heard, is believed to lower breast cancer risk.)
And she thought time was on her side. (Cook hadn’t yet reached age 40, the recommended age to start screening women of average risk.)
But in February of 2020, as news reports began to swirl about the emergence in the U.S. of a potentially deadly virus, COVID-19, Cook found herself facing her own health crisis — a diagnosis of stage 3 inflammatory breast cancer.
She described the next few months on chemotherapy — 16 rounds of infusions at a clinic close to home in Norfolk, Virginia — as a whirlwind. Due to pandemic-safety rules, she was forced to attend her treatments in isolation — without the comfort of family or friends by her side.
Genetic Testing
Her doctors then suggested genetic testing, which revealed a rare, inherited, genetic disorder — Li Fraumeni Syndrome. The condition, identified by mutations in the TP53 gene, had predisposed her to cancer — not only the breast cancer she already had, but perhaps additional cancers down the road.
Cook said she felt "the deep and dark void of depression looming."
With the new diagnosis of Li Fraumeni Syndrome and with her cancer showing little sign of improvement, she requested a referral for more specialized care at Duke Cancer Institute.
"When I first arrived at Duke, I had that feeling that something was different," shared Cook. "It was a feeling that started to illuminate my dark path."
From her first appointment, she felt like she'd gained a fresh start with a care team that included breast surgical oncologist Lisa Tolnitch, MD, breast medical oncologist Michael Spiritos, MD, and radiation oncologist Diandra Ayala-Peacock, MD, as well as genetic counselor Elizabeth Wignall, MS, CGC, with the Duke Supportive Care & Survivorship Center’s Clinical Cancer Genetics program.
First, she'd undergo a double mastectomy. Unfortunately, the pathology results from her surgery showed that cancer was still present.
“The news is not what I wanted to hear, but I knew that I could put all my faith in their care,” said Cook, who then began a regimen of 14 more cycles of chemotherapy and intensive radiation at Duke Women's Cancer Care Raleigh.
When she walked into the initial appointment with genetic counselor Wignall, she was preoccupied. She wondered, "What could I have done differently?"
Wignall helped her to stop dwelling on the past and shift her focus to the future.
Because LFS is associated with a high lifetime risk for cancer — including, most commonly, soft tissue sarcomas, bone cancers (osteosarcomas), premenopausal breast cancers, colon cancer, gastric cancer, adrenal cortical tumors, and brain tumors — she advised Cook about the various types and timing of preventative scans she should undergo in order to detect any new cancers at the earliest stage possible. (More than one type of cancer may occur in the same person.)
In addition, knowing that there was a 50% chance her children shared her LFS diagnosis (and on Wignall's recommendation), Cook had her children tested for LFS. The tests came back positive for two of her four children. Next, Wignall worked with a team at Duke Children’s to get those children scheduled for preventative cancer scans — testing that will continue on a regular basis for the foreseeable future.
Taking action for herself and for her children gave Cook hope.
"Working with Elizabeth helped me to embrace that LFS is now part of my life story, NOT the defining moment of it," she shared. “While my heart may break that I passed on this gene to my kids, Duke provides a great genetics team to give us hope, as we walk this journey. Elizabeth's guidance has empowered me to educate my children that LFS is not something to be feared.They can carry on a 'normal' life. Their life just means more frequent scans, and being very aware of their bodies and any changes."
Support & Care: Rebecca Cook has all the love and support of her family and an all encompassing care team that has her back.
Cook completed the latest round of chemo treatments in July and was soon after declared "in remission." Over Labor Day weekend, she was able to participate and cross the finish line of her first half marathon.
“As much as I strive to keep the cancer away, keeping my mental health strong in this journey has been just as important. Running, counseling, medication, a healthy diet and medical providers that value mental health all help me do that,” she said.
Julie Poucher Harbin, Senior Writer, DCI, contributed to this report.
The American Cancer Society released its 2025 statistics publications, offering insights into cancer incidence, mortality, treatment and survival.Rising Cancer Incidence Rates in Younger WomenThis year’s report reveals that for women younger than 50, the risk of developing cancer is 82 percent higher than men, up from 51 percent in 2022. This marks the first time cancer incidence rates in women under 50 have surpassed men.A main contributor to this higher incidence rate is breast cancer, which predominantly affects women. Higher obesity rates, increased alcohol use, and later-in-life pregnancies have long been identified as risk factors for breast cancer; however, there are still lots of unknowns.“I often see women coming into my clinic with breast cancer who ‘did all the right things,’” said Jennifer Plichta, MD, MS, breast surgical oncologist and provider for the Duke Breast Risk Assessment Clinic. “We know some of the risk factors, but I think that we still struggle with how those risk factors come together.”While there are many examples of breast cancer research and prevention efforts for women over 50, younger women are often less involved in those efforts. Plichta said some of the reason for that may have to do with the severity of side effects of breast cancer prevention options – most commonly, surgeries that cause permanent changes to the body and medications that often produce menopausal symptoms and may make it more difficult to conceive.In view of rising incidence rates in younger women, Plichta believes it’s important for providers to clearly communicate with patients to help them really understand their risk factors and make the best choice for themselves. Plichta currently leads the Breast Risk Assessment Clinic, which focuses on understanding breast cancer risk and personalizing management strategies. Additionally, Rani Bansal, MD, a breast medical oncologist, is working on opening a clinic specifically focused on young breast cancer patients.“It’s a real worry that more younger women are getting breast cancer,” she said. “We need to start having conversations with them earlier and more often so they can know what to do.”Improving Survival Rates, Except in Uterine CancersThe incidence and mortality of many cancer types is declining in the U.S., but uterine cancer cases have been increasing by about one percent per year, and even more among non-white women. Andrew Berchuck, MD, director of the DCI gynecologic cancer group, notes this increase is mostly due to high obesity rates.“Obesity causes excessive production of estrogenic hormones that can stimulate growth and cancer development in the uterine lining,” Berchuck said. “Reducing obesity rates is important from a broad health perspective and would also reverse the rise in uterine cancer incidence.”Since 1975, the five-year survival rate for uterine cancer has decreased from 87 percent to 81 percent. It is now the fifth leading cause of cancer deaths in women. Additionally, uterine cancer has one of the largest racial disparities in survival – 84 percent in white patients, compared to 63 percent in Black patients.To address these trends, DCI researchers have developed a national uterine cancer consortium looking into molecular features of these cancers to help develop new targeted therapies, led by Angeles Secord, MD, associate director of the DCI gynecologic cancer group. The efforts of the consortium are highlighted at the annual She Dunks on Endometrial Cancer, taking place on Feb. 23 this year.“Duke is helping lead the charge in improving treatment for uterine cancer,” Berchuck said. “We are hopeful that our efforts can lead to better outcomes for our patients in the future.”
The American Cancer Society released its 2025 statistics publications, offering insights into cancer incidence, mortality, treatment and survival.Rising Cancer Incidence Rates in Younger WomenThis year’s report reveals that for women younger than 50, the risk of developing cancer is 82 percent higher than men, up from 51 percent in 2022. This marks the first time cancer incidence rates in women under 50 have surpassed men.A main contributor to this higher incidence rate is breast cancer, which predominantly affects women. Higher obesity rates, increased alcohol use, and later-in-life pregnancies have long been identified as risk factors for breast cancer; however, there are still lots of unknowns.“I often see women coming into my clinic with breast cancer who ‘did all the right things,’” said Jennifer Plichta, MD, MS, breast surgical oncologist and provider for the Duke Breast Risk Assessment Clinic. “We know some of the risk factors, but I think that we still struggle with how those risk factors come together.”While there are many examples of breast cancer research and prevention efforts for women over 50, younger women are often less involved in those efforts. Plichta said some of the reason for that may have to do with the severity of side effects of breast cancer prevention options – most commonly, surgeries that cause permanent changes to the body and medications that often produce menopausal symptoms and may make it more difficult to conceive.In view of rising incidence rates in younger women, Plichta believes it’s important for providers to clearly communicate with patients to help them really understand their risk factors and make the best choice for themselves. Plichta currently leads the Breast Risk Assessment Clinic, which focuses on understanding breast cancer risk and personalizing management strategies. Additionally, Rani Bansal, MD, a breast medical oncologist, is working on opening a clinic specifically focused on young breast cancer patients.“It’s a real worry that more younger women are getting breast cancer,” she said. “We need to start having conversations with them earlier and more often so they can know what to do.”Improving Survival Rates, Except in Uterine CancersThe incidence and mortality of many cancer types is declining in the U.S., but uterine cancer cases have been increasing by about one percent per year, and even more among non-white women. Andrew Berchuck, MD, director of the DCI gynecologic cancer group, notes this increase is mostly due to high obesity rates.“Obesity causes excessive production of estrogenic hormones that can stimulate growth and cancer development in the uterine lining,” Berchuck said. “Reducing obesity rates is important from a broad health perspective and would also reverse the rise in uterine cancer incidence.”Since 1975, the five-year survival rate for uterine cancer has decreased from 87 percent to 81 percent. It is now the fifth leading cause of cancer deaths in women. Additionally, uterine cancer has one of the largest racial disparities in survival – 84 percent in white patients, compared to 63 percent in Black patients.To address these trends, DCI researchers have developed a national uterine cancer consortium looking into molecular features of these cancers to help develop new targeted therapies, led by Angeles Secord, MD, associate director of the DCI gynecologic cancer group. The efforts of the consortium are highlighted at the annual She Dunks on Endometrial Cancer, taking place on Feb. 23 this year.“Duke is helping lead the charge in improving treatment for uterine cancer,” Berchuck said. “We are hopeful that our efforts can lead to better outcomes for our patients in the future.”