Finding a new ‘normal’


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Focusing on family, health, and living in the present are among the secrets to a breast cancer survivor’s success.

Three years ago, Brianna Hinojosa-Flores was, by her own admission, “rushing through life.”

The then-40-year-old wife, mother of two, and patent attorney for a major telecommunications company had just completed two consecutive terms on the Coppell City Council and was running for Congress while also serving 
on the board of directors of several Dallas-area organizations and training for an upcoming half-marathon.

Running, literally and figuratively, defined her days.

With all of her commitments and with the holidays fast approaching that fall
 of 2012, Brianna for the first time missed a mammogram appointment scheduled that November. Following her Ob/Gyn’s advice, she’d been having mammograms since age 35; following the advice of her mom, a retired nurse practitioner, she’d been performing breast self-exams even longer. Missing that appointment was one of the few lapses in her normal routine.

Triple-negative diagnosis

Fast forward six months. Returning home after a workout in mid-May 2013, Brianna felt a lump above her right breast while doing a self-exam. A subsequent mammogram, ultrasound, and biopsy revealed triple-negative breast cancer (TNBC)—so named because it does not have any of the receptors that are targeted by 80 to 90 percent of all treatments for breast cancer.

Of breast cancer’s known subtypes, TNBC is one of the rarest and most aggressive, and because less is known about it, its prognosis is poorest.

“With this type of cancer, getting the patient into chemotherapy immediately is vital,” says UT Southwestern surgical oncologist Roshni Rao, M.D., who initially saw Brianna. “Because I work alongside medical oncologist Dr. Dawn Klemow-Reed on the same floor, I was able to walk into her office and say, ‘Here is someone you need to see right away.’ ”

Collaboration among specialists is one of the hallmarks of care at UT Southwestern’s Harold C. Simmons Comprehensive Cancer Center, where cancer specialists are part of multidisciplinary teams that focus on a particular cancer. The ability to identify and
 treat aggressive cancers like Brianna’s is another distinction, consistent with Simmons Cancer Center’s designation 
as one of the nation’s top-tier cancer facilities.

Brianna’s treatment began almost from that minute. So did her determination to survive whatever came next.

Fighter mode

Within two weeks of being diagnosed, Brianna had her first surgery to insert a port for chemotherapy infusion, and over the next several months she completed eight rounds of chemo. The treatment seemed to be working, but it had a cost.

In addition to chemotherapy’s signature side effects, such as nausea, fatigue, and hair loss, Brianna had to adjust to other conditions of the treatment that directly affected her busy and involved lifestyle.

Among other things, because chemo lowers the immune system, she suddenly had to minimize her exposure to crowds of people and places like public pools that could potentially make her sick. She also had to minimize her exposure to the sun.

By the time of her planned double mastectomy in November 2013, pathology results showed that Brianna had a 100 percent response to the chemotherapy. No live cancer cells remained in the right breast area, and she did not need additional treatment, such as radiation.

Redefining limits

Now almost two and a half years since her diagnosis, Brianna continues to have checkups every six months and has some reconstructive surgery remaining, but is otherwise doing well. She has, however, by her own account, “slowed down—I’m no longer going 100 miles per hour.” But that speed assessment is subjective.

In addition to her full-time legal work and voluntary memberships, including serving as Chair of the Las Colinas Medical Center, she is an Associate Professor of Intellectual Property at Collin College and earlier this year ran unopposed to reclaim her role on the Coppell City Council—a position that has a three-year commitment.

“I’m keeping my political career local, for now,” she says. “I’ve redefined the limits of what I can do as I continue
 to heal.”

A big part of her redefinition includes living in the present and spending more quality time with her family. She and her children, now ages 10 and 6, go for walks and swim together. School parties and field trips are not-to-be-missed occasions. She and her husband of 15 years, Juan Carlos, plan more family time together and explore how to live healthier lives in general.

“I wasn’t the only one who went through this journey,” she notes. “My whole family was part of it, and they, too, need 
to heal.”

Because triple-negative breast cancer is more likely
 to recur than other subtypes 
of breast cancer, Brianna
 says she lives with a certain vigilance. According to Dr. Rao, Brianna’s risk of recurrence will lessen at the three-year mark and then decrease even further at year five.

“You don’t want to live in fear,” Brianna says, “but you do have to listen to your body.”

Preparing for the next thing

No matter what other commitments she has, Brianna regularly spends time talking with other patients diagnosed with breast cancer, many of whom are referrals from Dr. Rao and her colleagues. Brianna says sharing her experience with these women, who are in various stages of the breast cancer journey, has in turn helped her heal.

“I’ve learned that survivors need each other,” she says. “We need to know we’re not alone. We all are part of a club we did not ask to join.”

She adds, “What many people don’t fully understand is that it’s harder the year after than the year you’re going through your battle. That next year, when suddenly you’ve gone from being in fighter mode to survival mode, is difficult because it’s about identifying your new ‘normal.’

“You’re having to learn to live again with restrictions caused by the cancer, chemo, and/or surgery. You’re always preparing for that next thing—for the possibility of another treatment, another surgery—and you’re constantly trying 
to make sure that whatever you do, you don’t compromise your body or your immune system. It can be an emotional, physical, and mental struggle to find and live under your new normal. The breast cancer journey doesn’t end after treatment or surgery.”

It’s a challenge recognized at Simmons Cancer Center, where survivorship programs in areas such as nutrition, exercise, meditation, family relationships, and counseling are offered to help patients adjust to their new lives.

Swimming again

The summer of 2015 was a season of milestones in the recovery process for Brianna and her family, particularly during the trip they took to Hawaii. Because of her various surgeries and the associated risks of infection during the previous two summers, Brianna had to essentially sit on the sidelines during her family’s vacations to Myrtle Beach, watching her children play in the water. This year, she was able to jump right in.

Her new normal is looking better every day.

Triple-negative breast cancer: pinpointing the risk factors

The National Cancer Institute notes that while triple-negative breast cancer (TNBC) can affect women of any ethnicity, it is more commonly diagnosed in African- Americans (23 percent) and Hispanics (15 percent) than Caucasians (11 percent) and Asian/Pacific Islanders (10 percent).

UT Southwestern’s Dr. Roshni Rao is leading the local arm of a national clinical trial that is collecting DNA samples of TNBC survivors in hopes of identifying risk factors for the hard-to-treat disease. Brianna Hinojosa-Flores is participating in that trial.

“Triple-negative breast cancer leads to a disproportionate number of breast cancer deaths, particularly among young breast cancer patients,” Dr. Rao says. “This study will help us determine if there is a pattern that predicts triple-negative breast cancer. When we can identify risk factors, women at high risk can be screened earlier and more frequently.”