When Cynthia Cosme-Cravo (45) discovered a lump in her breast in February 2019, she was already trying to process the miscarriage she had just suffered. Originally from Brazil, Cynthia moved to Dublin in 2016 to study English. It was originally intended as a temporary move, but she decided to stay after meeting her partner Fabio Astengo.
I was trying to get pregnant and then I got pregnant and then miscarried. After that, they discovered the cancer two months later,” says Cynthia.
She went to her GP, who sent her to the chest ward at St James’s Hospital. Everything happened relatively quickly, she recalls. “When I left the hospital that day, I knew it was cancer.” She still had to do a biopsy, but her doctors seemed pretty sure it was cancer.
“It was a shocking situation. In the beginning it was really hard, very stressful. It still is, but now I feel more confident, stronger. The first shock is done. But it was still tough because I started treatment, which meant I couldn’t try to conceive during that time.”
Waiting to see what kind of cancer Cynthia had was a very scary time. “What treatment would I need, it was awful. Of course I cried at first. But then I thought, ‘I can’t cry all day. I have a job. Build me up, stand up, fight, because I can’t give up now.’ It is difficult. But I think in general I did well.”
Cynthia was diagnosed with grade 3 invasive ductal carcinoma. The cancer was HER2 negative estrogen receptor and progesterone receptor so she was very sensitive to hormones. Chemotherapy wasn’t necessary, but her treatment would include radiation therapy and hormone therapy, which would require her to take tamoxifen for five years – until she turns 47.
After surgery to remove the node and lymph nodes and before radiation therapy began, Cynthia underwent IVF treatment to collect eggs. “The main thing was that the actual treatment didn’t really affect my fertility because it wasn’t chemo. But on the other hand it would affect my fertility because I would be older if I could try to have a baby again. I was already 42. Now I’m 45. And that’s when the doctor advised me to collect the eggs.”
She found this process very stressful. “You need a lot of injections, which are hormones. My cancer is very sensitive to hormones. I take two hormones to increase the chances of pregnancy, but on the other hand it increases the chances of recurring the cancer.
“It was crazy. You don’t know if you’re doing the right thing. Because the doctor advises you, but it’s not set in stone, it’s not mathematical. Nobody can give you a right answer. In the end, it’s your decision, whether you want to do it or not.” Her religious beliefs and her partner’s support were very helpful during this time. “He told me he would prefer to have me over not a baby. But if it was important to me, it is OK.”
The cycle produced only one embryo and the possibility of another cycle was touted as ideally more embryos would be implanted. “I was thinking of doing another cycle to increase my chances. I almost tried again, but in the end I was like, ‘No, it’s going to be crazy because how many cycles am I going to do? And in the end I only need one to be a mom.
“It will be with one or not. Each IVF cycle increases my risk of recurring the cancer. Because I put off the radiotherapy and other treatments and took more hormones. What I could do, I had done.”
Her stress level was understandably extremely high by now. “I cried the whole time. I’m usually a screamer. I cry sometimes when I watch Disney movies for kids,” laughs Cynthia. “I am very emotional. But sure, at that moment when you have a lot of hormones, they make you more sensitive. If it was good news, I cried. When it was bad news, I cried. But it’s normal. It was really difficult, but I think I did well.”
After radiotherapy, she started hormone therapy, which has continued for the past two years during lockdown. “It’s like I’m going through menopause.” It was a frustrating time “counting down all the time. I’ll be pregnant next Christmas.” Finally, last year, Cynthia’s doctors said she could take a break to try and conceive now that the cancer is under control. “Right now I’m clear. I’ve had a mammogram and it seems I’m clear of it.”
However, things did not go smoothly. “If you stop hormone therapy, you have to wait a few months. I stopped taking tamoxifen in July. I had to wait until September to start.” Unfortunately, at that time, in September 2021, Cynthia’s doctors discovered a cyst on her ovaries. Shortly after, she was told that surgery was required, a hysteroscopy – there was a chance it could be cancer.
“I had the news that I needed surgery the day before my birthday – it ruined my birthday,” she says. “I wanted to get pregnant and I ended up wanting to have surgery to know if I had another cancer, crazy.”
After the operation in December, her doctor told her he didn’t think it was cancer, which was confirmed by biopsy results in January this year, when the cyst was found to be a result of endometriosis. “So I started the new year again with high hopes that we would make it now,” smiles Cynthia.
After surgery, a recovery period is required before starting IVF. At the moment she is going scan by scan to see if she can start the implantation. Her last was positive. However, all of this has taken its emotional toll, explains Cynthia. “I’m a really anxious person. It’s definitely worse than that. Sometimes I’m afraid to go to the market.”
She describes the rollercoaster nature of the experience. “It was a shock at first when I discovered the cancer. And then I wanted to know exactly what I had. Hope for two years. Then it’s gone and I’m shocked again. It ebbs and flows when you see that things aren’t what you expected. And then it’s time to build yourself up and then increase hope and then let go.”
She thinks if this IVF attempt doesn’t work, it’s unlikely she’ll try to conceive again. “There is no guarantee that you will have this baby. Because I only have one embryo, I’m 45. If it doesn’t work now, if the pregnancy doesn’t continue, I don’t see myself doing it again. It is too much. Only when you are in that situation can you make a decision.”
Her partner prioritizes her well-being, she says. “The whole time I have to take hormones he worries and he doesn’t like it because he thinks it can trigger the cancer again. But he understands that this is important. We always talk to each other.”
Cynthia points to the importance of a supportive workplace, both employer and peers, and the difference it can make for those undergoing both cancer treatment and IVF, especially given the flexibility required for all appointments involved is.
At the moment she is trying to live day by day, to stay in the moment. Dealing with the uncertainty of the situation is challenging. “I try to keep myself busy all the time. I work, exercise, anything to keep me busy so I don’t think too much.
“It’s going to be really difficult. I don’t want to think about it, I want to be positive. But I have to be realistic. I have to be strong to keep going. I can’t end my life because it wasn’t the way I wanted it to be. I have a choice It won’t be the family I always dream of, but I can do other things.”
The nationwide campaign 100 km in 30 days is now open to register. All funds raised go to Breast Cancer Ireland. During the 30 days of June you can walk, jog or cycle. Visit 100kin30days.ie for more information
https://www.independent.ie/life/health-wellbeing/health-features/we-were-trying-for-a-baby-and-coming-to-terms-with-a-miscarriage-when-i-found-the-lump-it-was-breast-cancer-41583432.html “We were trying to have a baby and put up with a miscarriage when I found the lump — it was breast cancer.”