Former Duke Fertility Doctor Bounces Back After Breast Cancer
Published
From the Duke Cancer Institute archives. Content may be out of date.
Jen Eaton, MD, was a textbook example of a woman at low risk for breast cancer. At almost 43 years old, she did high-intensity workouts five days a week, all her screening mammograms had been normal, and she did not have a strong family history of the disease. “I was in the best shape of my life,” she says.
So in May 2020, when Eaton happened to feel a lump in her right breast, she told herself it was probably nothing. As a fertility doctor and Medical Director of Assisted Reproductive Technology at Duke Fertility Center, she was well aware of the data -- most lumps aren’t cancer, and breast self-exams aren’t routinely recommended because the data suggest that they don’t improve survival outcomes.
But her concerns lingered. So she called her own ob-gyn, Louise Highley, MD, MSPH. “I was embarrassed to tell Dr. Highley that I had a lump because I felt that it was silly,” Eaton says. “But she took it seriously. Had it not been for that, I might have waited another six months to a year. Her willingness to pay attention to my concern saved my life.”
Know Your Own Body
A diagnostic mammogram was normal, but after an ultrasound, Eaton could tell her doctor was worried. Eaton had a biopsy. On her 43rd birthday, she looked at her own results in the electronic medical record. She had cancer — invasive ductal carcinoma.
The next day, Eaton met with Duke Cancer Institute (DCI) surgical oncologist Laura Rosenberger, MD, chief of breast surgery at Duke Regional Hospital. She felt a second lump in Eaton’s left breast. That led to an MRI and two more biopsies, which showed invasive ductal carcinoma, as well as a third area of concern.
In just one month, Eaton was supposed to be moving her family to Rhode Island for a new job at Brown University.
Rosenberger performed a double mastectomy. The surgery and subsequent testing revealed the third concerning area was invasive lobular carcinoma. This cancer was positive for a protein called HER2/neu, which meant she would need chemotherapy as well as a year of the targeted drug, Herceptin.
Eaton had a port placed for chemotherapy before moving to Rhode Island.
She says the care she received at DCI was amazing. “I have recommended Laura Rosenberger to multiple friends since I’ve left,” she says. “She is absolutely kind and brilliant and an amazing surgeon.”
Eaton stayed in touch with her Duke oncologist, Kelly Westbrook, MD. “I trust her opinion more than anyone else’s that I’ve ever encountered in oncology,” she says. “She called me back quite late in the evening when she should have been at home with her own family.” When there were differing opinions about what chemotherapy regimen to use, Westbrook took it back to a team of other medical oncologists at Duke to get recommendations.
In addition, a child life specialist from Duke’s Cancer Patient Support Program advised Eaton about how to talk to her children, who were five and eight at the time. “She was incredibly helpful and gave me tons of information about how to educate my children about my cancer,” Eaton says. The specialist advised her to be honest, and to use the word “cancer.”
Exercising Through Chemo
Jen Eaton, MD, was determined to keeping running and biking throughout cancer treatment. She posted this photo to her Instagram account, @no_excuses_chick, shortly before her chemotherapy port was de-accessed.
After moving, Eaton still had a long treatment regimen ahead. She has tackled it all with tenacity. She went for a run the day after she started chemotherapy.
“It was very stressful for me to hear that I was going to need all of this treatment that could potentially impact my ability to be able to be active and maintain my healthy lifestyle,” she says. “I talked to Dr. Westbrook about whether it would be possible for me to keep exercising during chemotherapy. She explained that not only would it be possible, but it is recommended because data shows that it significantly reduces negative side effects.”
Eaton has had her share of setbacks, including a serious infection in the tissue around one of the tissue expanders she had placed to prepare for reconstructive surgery. After that healed, she found a surgeon in Boston who was willing to try placing another, and it was successful.
Finished with reconstruction, Eaton is now back at work full time as director of the Division of Reproductive Endocrinology and Infertility at Brown University.
Advocating for Yourself
“It has been hard to bounce back, but now that I’ve completed all my surgery, I’m working hard to rebuild my strength,” she says. Eaton posts workout inspiration and reflections on life as a cancer survivor on Instagram at @no_excuses_chick.
For her, the experience has driven home the point that ”breast cancer is common and often quite random.”
“I was healthy, active, had a normal BMI. I breastfed my children. I did all the things I was supposed to do,” she says.
Eaton advises women to advocate for themselves and know their own bodies. “Ask that your doctor listen to your concerns even if they don’t fit the algorithm,” she says. All of her mammograms were normal, and it wasn’t that they were misread; the cancer simply did not show up. Eaton has dense breast tissue, as 40 to 50 percent of women ages 40 to 74 do.
“If you have any concerns about the reliability of your routine screening or whether or not it’s meaningful for you, ask your doctor — ‘should I be getting an ultrasound, should I be getting an MRI, should I be doing routine self exams?’” Eaton says. “Being a doctor myself, I would always take whatever my doctor said as verbatim, and now I’m more likely to ask questions and not feel like I’m annoying or contradicting the physician.”
What's Best for Breasts?
Watch cancer survivor Jen Eaton, MD, and others speak at this recorded DCI educational symposium.
For decades, a diagnosis of metastatic breast cancer has carried a clear message: while treatments can help control the disease and extend life, the disease is generally considered incurable. As a result, treatment strategies have traditionally focused on managing cancer and maintaining quality of life rather than pursuing a cure.New advances in breast cancer therapies are changing that conversation. Research led by Duke Cancer Institute breast surgical oncologist Jennifer Plichta, MD, suggests that some patients with limited metastatic breast cancer may benefit from a more aggressive treatment approach than has traditionally been offered. The findings, published in JAMA Surgery, add to growing evidence that metastatic breast cancer is not the same for every patient and that treatment decisions may need to become more personalized.Plichta's research builds on years of work focused on improving how physicians classify and predict outcomes for patients with breast cancer. Historically, a diagnosis of metastatic, or stage IV, breast cancer, was associated with poor survival. However, the development of targeted therapies and other advances in systemic treatment have dramatically improved outcomes for many patients."Many women with metastatic breast cancer are now living for years and sometimes even a decade after diagnosis," Plichta said. "We've come a long way in terms of treatment options and survival."At the same time, researchers have discovered significant variation among patients with metastatic disease. Some experience aggressive cancer that progresses quickly, while others have relatively limited disease that remains controlled for long periods.This variability led Plichta and her colleagues to ask an important question: Are there certain patients with metastatic breast cancer who could benefit from treatment strategies typically reserved for patients with earlier-stage disease?The study focused on patients with what is known as oligometastatic breast cancer, a form of metastatic disease in which cancer has spread to only a limited number of sites. Researchers believe this group may represent a distinct subset of patients whose disease behaves differently than widespread metastatic cancer.Using data from the National Cancer Database, which captures information on many newly diagnosed breast cancers in the U.S., the team analyzed outcomes among patients with limited metastatic disease. They examined whether patients received treatment directed at the primary breast tumor, treatment directed at metastatic sites, both treatments, or neither.The goal was to determine whether a treatment approach that more closely resembles care for stage III breast cancer—combining systemic therapy with aggressive local treatment—might improve outcomes for selected patients."What stood out was that removing the primary breast tumor seemed to be the factor most strongly associated with improved survival," Plichta said. "Treating the distant sites did not appear to offer the same survival advantage on its own."While previous studies have explored surgery for patients with metastatic breast cancer, results have been mixed. Plichta believes one reason may be that metastatic breast cancer is often treated as a single category, even though patients can have vastly different disease characteristics and prognoses.One of the most significant implications of this research is how clinicians think about treatment goals. Patients with stage III breast cancer are typically treated with curative intent, meaning doctors use every appropriate therapy available, including chemotherapy, surgery, and radiation, in an effort to eliminate the disease. Patients with metastatic breast cancer, by contrast, are usually treated with palliative intent, focusing on disease control rather than cure.But as outcomes improve, the line between those groups may not be as clear as it once was."We're seeing some patients with metastatic disease living longer than patients with locally advanced breast cancer," Plichta said. "That raises important questions about whether some patients with limited metastatic disease should be approached differently."Because the study was retrospective, the results point to an important association that warrants further study. Several clinical trials are now being developed to investigate curative-intent treatment strategies in specific subgroups of metastatic breast cancer patients, including those with HER2-positive disease. Duke hopes to participate in these multi-institutional studies as the field continues to evolve.As breast cancer treatments continue to improve, researchers are gaining a more nuanced understanding of metastatic disease. For Plichta, the study represents an important step toward that goal."I hope this work encourages further research into which patients may benefit from a curative-intent approach," she said. "The ultimate goal is to find the right treatment strategy for the right patient."
For decades, a diagnosis of metastatic breast cancer has carried a clear message: while treatments can help control the disease and extend life, the disease is generally considered incurable. As a result, treatment strategies have traditionally focused on managing cancer and maintaining quality of life rather than pursuing a cure.New advances in breast cancer therapies are changing that conversation. Research led by Duke Cancer Institute breast surgical oncologist Jennifer Plichta, MD, suggests that some patients with limited metastatic breast cancer may benefit from a more aggressive treatment approach than has traditionally been offered. The findings, published in JAMA Surgery, add to growing evidence that metastatic breast cancer is not the same for every patient and that treatment decisions may need to become more personalized.Plichta's research builds on years of work focused on improving how physicians classify and predict outcomes for patients with breast cancer. Historically, a diagnosis of metastatic, or stage IV, breast cancer, was associated with poor survival. However, the development of targeted therapies and other advances in systemic treatment have dramatically improved outcomes for many patients."Many women with metastatic breast cancer are now living for years and sometimes even a decade after diagnosis," Plichta said. "We've come a long way in terms of treatment options and survival."At the same time, researchers have discovered significant variation among patients with metastatic disease. Some experience aggressive cancer that progresses quickly, while others have relatively limited disease that remains controlled for long periods.This variability led Plichta and her colleagues to ask an important question: Are there certain patients with metastatic breast cancer who could benefit from treatment strategies typically reserved for patients with earlier-stage disease?The study focused on patients with what is known as oligometastatic breast cancer, a form of metastatic disease in which cancer has spread to only a limited number of sites. Researchers believe this group may represent a distinct subset of patients whose disease behaves differently than widespread metastatic cancer.Using data from the National Cancer Database, which captures information on many newly diagnosed breast cancers in the U.S., the team analyzed outcomes among patients with limited metastatic disease. They examined whether patients received treatment directed at the primary breast tumor, treatment directed at metastatic sites, both treatments, or neither.The goal was to determine whether a treatment approach that more closely resembles care for stage III breast cancer—combining systemic therapy with aggressive local treatment—might improve outcomes for selected patients."What stood out was that removing the primary breast tumor seemed to be the factor most strongly associated with improved survival," Plichta said. "Treating the distant sites did not appear to offer the same survival advantage on its own."While previous studies have explored surgery for patients with metastatic breast cancer, results have been mixed. Plichta believes one reason may be that metastatic breast cancer is often treated as a single category, even though patients can have vastly different disease characteristics and prognoses.One of the most significant implications of this research is how clinicians think about treatment goals. Patients with stage III breast cancer are typically treated with curative intent, meaning doctors use every appropriate therapy available, including chemotherapy, surgery, and radiation, in an effort to eliminate the disease. Patients with metastatic breast cancer, by contrast, are usually treated with palliative intent, focusing on disease control rather than cure.But as outcomes improve, the line between those groups may not be as clear as it once was."We're seeing some patients with metastatic disease living longer than patients with locally advanced breast cancer," Plichta said. "That raises important questions about whether some patients with limited metastatic disease should be approached differently."Because the study was retrospective, the results point to an important association that warrants further study. Several clinical trials are now being developed to investigate curative-intent treatment strategies in specific subgroups of metastatic breast cancer patients, including those with HER2-positive disease. Duke hopes to participate in these multi-institutional studies as the field continues to evolve.As breast cancer treatments continue to improve, researchers are gaining a more nuanced understanding of metastatic disease. For Plichta, the study represents an important step toward that goal."I hope this work encourages further research into which patients may benefit from a curative-intent approach," she said. "The ultimate goal is to find the right treatment strategy for the right patient."
