MADISON, Wis. – In 2024, April Premo was set to take her medical dosimetrist board certification exam and planned to start a family with her husband the following year, but on Sept. 13, 2024 — a week before a planned vacation — Premo was diagnosed with breast cancer.
Between her age and lack of family history, she found the diagnosis difficult to accept.
“All these years we were go-go-go, live your life in your 20s, and all of a sudden one day all of these happy, wonderful things just come to a pause,” she said.
Premo’s diagnosis, Stage 3 invasive lobular carcinoma, can be more difficult to detect than other breast cancers because it doesn’t often show typical symptoms, like a lump, skin changes or nipple changes, according to Dr. Marina Sharifi, her medical oncologist at UW Health | Carbone Cancer Center.
Instead, Premo asked her primary care provider about an increased firmness in one breast, which led to her diagnosis.
Invasive lobular carcinoma feeds on estrogen that the body makes naturally, so Premo’s treatment includes taking medication to stop that hormone production for the next seven to 10 years to prevent new cancer growth.
Chemotherapy alone can cause fertility issues and multiple years of hormone-blocking medications would delay a possible pregnancy, so Sharifi, who is also an assistant professor of medicine at the University of Wisconsin School of Medicine and Pubic Health, discussed fertility preservation options with Premo before starting treatment.
“It’s something I talk about with any patient who is premenopausal and about to start chemotherapy,” Sharifi said.
The UW Health Fertility Clinic helped Premo prepare for an egg retrieval in late October 2024, which resulted in four healthy embryos through in vitro fertilization. Premo and her husband held a private gender reveal for the embryos — all boys — to celebrate their new path to parenthood. The celebration included plenty of blue-frosted cupcakes.
“Having children is going to look different for us, so if we can, I want to find joy in those little special moments,” she said.
Premo remains grateful she was consulted about fertility options right after diagnosis, even though it felt a bit overwhelming at the time.
“I think bringing that up immediately is very, very important,” she said.
On Oct. 23, just five days after her egg retrieval, Premo started eight rounds of chemotherapy. In February, she had a double mastectomy and had the surrounding lymph nodes removed. She received radiation therapy in the summer to eliminate any remaining cancer cells.
There is a growing trend of young women being diagnosed with estrogen-driven breast cancer, even among women with no family history or a known genetic risk, Sharifi said.
“I’ve seen more and more young patients with these estrogen-positive cancers well before the age we would start screening,” Sharifi said. “Routine screenings don’t start until age 40, so, in that situation, the cancer tends to be picked up when it’s more advanced and spread to the lymph nodes.”
Premo has continued to work while she’s able during her treatments. As a medical dosimetrist at UW Health | Carbone Cancer Center, she helps design radiation therapy plans for cancer patients. She worked as a radiation therapist for years before training to become a medical dosimetrist.
Premo took her medical dosimetry board certification exam in January while undergoing chemotherapy. A week after her double mastectomy, she found out she had passed.
Working in cancer care while also being a patient has been a difficult balance for Premo, she said. She and her husband have a strong support network of family, colleagues and friends, but anxiety about her diagnosis was still overwhelming, which led her to seek professional help.
“There was probably a good month or two after my diagnosis where I was crying every day,” she said.
Anxiety medication has helped Premo regain her positivity and feel like herself again.
“I try to ask my patients how they’re coping with their diagnosis, changes in care and new treatments,” Sharifi said. “I always try to help them find the right kind of support, whether that’s counseling, medication, their faith or whatever it is that helps them.”
Premo hopes sharing her story will reduce the stigma of mental health care and medication, and validate the difficulties faced by patients like her.
Social media has also helped Premo connect with other young adults with cancer who understand how the diagnosis can disrupt what should be a fun phase in life.
“There are people all over the world who are supporting each other and sharing each other’s journeys and giving tips and tricks on how to make it through treatment,” she said. “Having that virtual community has made a big difference and has been so helpful.”
Interviews and B-roll: https://bynder.uwhealth.org/share/9E6E85DA-470B-485F-934070118B7CA5C5/
Photos: https://bynder.uwhealth.org/share/A4038572-39C9-423A-AAB2A57F102035D5/
