I’ve always been an overachiever – someone who puts their mind to something and delivers more than was expected, someone who strives for greatness. I never wanted to be an overachiever when it comes to cancer, but here I am! In February 2024, at 45, I received a de novo metastatic breast cancer diagnosis – not just one type of breast cancer but two! Metastatic invasive lobular (breast, bone marrow, ovary, omentum) and ductal (lymph nodes). A particular slide of irony was that I received a clear mammogram six months earlier and was told the combination of lobular breast cancer[i] and my dense breast tissue likely contributed to the missed diagnosis, not just six months earlier but each year prior.

I’m not alone though. A recent patient survey presented at the San Antonio Breast Cancer Symposium found that 25% of patients with advanced lobular breast cancer were misdiagnosed and 50% of patients had a 12-month or longer delay in diagnosis.[ii]

Being the ‘make a plan and spring into action’ kind of person I am, I dove into figuring out what this new reality meant and how to navigate it. Here are three tips from my journey over the last two years that I hope may be useful for others finding themselves navigating a life-changing diagnosis.

Tip #1 – If you have the means, find a care team that “gets” you and will fight for you.

Living in a small, rural town of 10,000 people meant that treatment options were limited. My partner and I decided to drive 3-hours roundtrip to an integrated care facility for a second opinion. This was key after my local oncologist chose not to appeal a medication denial to my insurance, despite a genetic mutation that made this medication uniquely suited to treat my cancer. This monthly (and more frequent trek for scans) isn’t easy on our pocketbook or work schedules, but it is critical to having a care team that I trust, that answers all my questions and empowers my decisions.

Tip #2 – Redefine success to reduce stress.

I’ve heard a lot about how cancer patients should reduce stress and bet you have too. We know that 1/3 of cancer patients experience mental health challenges. We also know that chronic stress in cancer patients is related to poor prognosis and higher mortality. After my diagnosis, my oncologist urged me to find a way to lower my stress. At the time, I was working 70+ hours a week in a job I loved, caring for my family, trying to be a supportive spouse, and tending a garden. See what being an overachiever can get you?

With the help of a wonderful therapist, I learned to redefine success. Switching to a less demanding job eased my physical symptoms — my ocular migraines disappeared, my sleep improved, and I became more emotionally steady. It took time to make peace with stepping back in my career, but it was absolutely the right choice. I now feel deeply fulfilled by my work and believe this shift has supported my positive treatment response. I’ve come to see that professional success isn’t about climbing to the next rung; it’s about delivering quality work, mentoring others, and helping people.

Tip #3 – Find your cancer community.

Social support has been shown to support longer survival in breast and ovarian cancers. Having a supportive family and close friend network is wonderful but finding your cancer community is something special. Living in a small town, this can be particularly challenging, particularly finding that community when you’re diagnosed in your mid-40s. I was able to find an incredible network of metastatic breast cancer Thrivers online, and that has been game changing. To share stories, learn from each other, and feel like someone else really understands what you’re going through because they’re living it too, is invaluable. Keep looking until you find this support system as it will provide support you didn’t know you needed until you have it.

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About the author:

Katrina Pielli is an outdoor enthusiast, dedicated public servant, and avid gardener living in a rural town. She is a de novo metastatic breast cancer Thriver traveling the world with her husband and enjoying time at home with her adorable (and bossy) cat. Katrina is passionate about empowering other Thrivers to deeply learn about their unique cancer situation (e.g., genetic mutations, family history, new drug trials) and take control of their narrative (e.g., attitude, outlook, treatment care team options) to live their best life.

[i] Lobular breast cancer makes up 10-15% of all invasive breast cancers and has unique features from other types of breast cancers, such as ductal. When lobular cancer metastasizes, it can do so differently and spread to unusual areas of the body such as gastrointestinal tract (e.g., stomach), reproductive organs (e.g., ovaries, uterus), and the abdominal lining (e.g., peritoneum).

[ii] https://www.sabcsmeetingnews.org/special-session-to-offer-updates-on-lobular-breast-cancer/