Two Central Texas doctors worry pregnant and breastfeeding women are delaying screenings and missing key warning signs for breast cancer. They believe patients’ and doctors’ misconceptions about screening guidelines could be putting women at risk. KXAN investigators dig into why experts think these types of late diagnoses are happening more frequently — and how it affects expecting mothers.

KYLE, Texas (KXAN) — When asked about her family, it’s hard for Yvonne Gonzales not to get emotional.

“I have been wanting to be a mother for the longest time and never thought that I could have any,” she said through tears.

The Central Texas woman and her husband struggled to get pregnant, and she had a miscarriage in her twenties. Finally, at age 33, she got the good news: she was pregnant with a little girl. After that, her family continued to grow. She gave birth to another girl and, a short time later, found out she was pregnant with a third baby.

“I thought of my children… to not be here for them would be the hardest, hardest thing ever.”

Yvonne Gonzales, cancer survivor

While still breastfeeding her second daughter, she noticed a painful lump in one of her breasts and “couldn’t stand it anymore.” She went to her OB-GYN, who sent off her for scans.

The American Cancer Society suggests women consider getting annual mammograms beginning at age 40 but recommends they start those annual scans no later than age 45. At the time she found the lump, Gonzales wasn’t yet getting regular scans.

		Yvonne Gonzales and her husband struggled to get pregnant, but she said the day she found out she was having a baby was the 'best day ever.' (Photo provided by: Gonzales family)
Yvonne Gonzales and her husband struggled to get pregnant, but she said the day she found out she was having a baby was the “best day ever.” (Courtesy Gonzales family)

She received a different type of imaging: an ultrasound, which uses sound waves to create images and determine whether a lump is solid or filled with fluid.

“With the first exam that I got, I got in the car with my husband, and I was just emotional because I had a feeling that it was going to be cancer,” Gonzales said.

However, the results of her ultrasound didn’t show an obvious mass.

“She did all the right things,” said Austin breast surgeon Dr. Sangeetha Kolluri.

Dr. Kolluri works with other oncology experts at the Austin Cancer Center, such as hematologist and oncologist Dr. Aneesha Hossain. They explained that an ultrasound is a common first screening step for younger women with a breast abnormality, before a mammogram is performed. Hossain said, in Gonzales case, no one recommended a follow-up mammogram, primarily because she was pregnant.

‘Hesitations’ around pregnant women

A quick search online reveals a seemingly endless amount of questions, myths, misconceptions and concerns for pregnant and breastfeeding women — with differing advice, even among medical professionals.

“Can I drink caffeine?”

“Will spicy food induce labor?”

“Is it safe to get a mammogram?”

Much of the hesitation surrounding mammograms and other health screenings for these women stem from concerns about radiation exposure.

“That risk of possibly, ‘What is happening to baby?’ is something that throughout civilization we haven’t really understood,” Dr. Hossain said. “There is a lot of concern about the fetus and about the quality of the breast milk — that some practitioners really are not educated about or are afraid to take responsibility for should anything go wrong, to be brutally honest.”

Dr. Hossain and Dr. Kolluri both pointed to guidelines from the American College of Radiology, which state the level of radiation exposure in modern mammography is low enough to be considered generally safe and appropriate for pregnant women.

“The machines have gotten better and better with lower doses of radiation,” Dr. Kolluri said.

Breast cancer affects one in every 3,000 pregnant women, according to the American Cancer Society. However, several studies predict more expectant mothers will be diagnosed with cancer in the future, as some women are getting pregnant later in life.

KXAN investigators asked the Austin Cancer Center doctors how much difference nine months can make for someone’s diagnosis and prognosis.

“It could be the difference of stage,” Dr. Kolluri said.

Dr. Hossain added, “Someone can go from a Stage Zero to a Stage Four in nine months, depending on how incredibly aggressive the tumor is. Someone can stay a Stage Zero and remain a Stage Zero.”

While prognosis and outcomes are generally similar among pregnant and non-pregnant women, some research shows pregnant women are more likely to be diagnosed later or with a more aggressive “triple-negative” breast cancer. Triple-negative cancer does not have any of the three hormone or protein receptors that are commonly found in other breast cancers, limiting a patient’s treatment options.

Dr. Kolluri said she believes the medical field is slowly “chipping away” at some of the misconceptions and hesitations about caring for pregnant and breastfeeding women. She said Gonzales’ story is a perfect example.

The ‘game-changer’

“I was in tune with my body, and I kept, you know, telling my doctors, ‘Something’s wrong. It’s not normal,'” she said.

When her pain persisted, so did Gonzales. She went back to her doctor and this time, she was sent for a mammogram. That’s when she met Dr. Kolluri and Dr. Hossain at the Austin Cancer Center. They reviewed the results of her mammogram and diagnosed the mass.

“Thank God that Yvonne didn’t let it go, and she went and got it checked out because then the mammogram showed 14 1/2 centimeters of calcification — spanning the entirety of her breasts, from here to here,” Dr. Kolluri said, demonstrating on her own body. “That’s a very large area of calcifications. And all of that was cancer.”

Dr. Hossain added that “a second evaluation was honestly the game-changer” in preventing Gonzales’ mass from developing into a more invasive and less curable cancer.

“Yvonne really did catch it right at the nick of time,” she said, noting that she’s had other patients even recently who weren’t as lucky.

Still, a cancer diagnosis was terrifying for Gonzales.

“I automatically thought of dying. That I didn’t — I don’t — want to die,” she said. “I thought of my children. of me finally becoming a mother. Having not just one but three. To not be here for them would be the hardest, hardest thing ever.”

Dr. Kolluri had to perform a mastectomy on Gonzales to remove the cancer. She noted how cautious they have to be when performing any surgical procedure on a pregnant patient, but said Gonzales and her baby did “wonderfully.”

“Be an advocate for yourself.”

Dr. Aneesha Hossain, Austin Cancer Center

A few months later, Gonzales gave birth to a healthy baby boy, named Mason. Someday, she said, she’ll tell him about their incredible survival story. For now, she’s educating her oldest daughter on what happened and how to advocate for herself.

“I explained to her, ‘If the doctor hadn’t removed my breast, then I would no longer be here,'” she said. “She’s smart … so, she’ll ask from time to time. She’ll put her arms around me, and she’ll tell me she loves me. That’s just the best feeling.”

The doctors want her story to be a lesson for women everywhere.

“You know your body better than any physician knows your body,” Dr. Hossain said. “Understand your concerns and be an advocate for yourself. At the end of the day, if we do a workup and everything is negative, you’re reassured that you were empowered and you took control of your body — and that you feel good about your negative results.”

The road ahead

Yvonne Gonzales pictured with a certificate from the Austin Cancer Center, after finishing radiation treatment for her breast cancer. (Photo provided by: Gonzales family)
Yvonne Gonzales pictured with a certificate from the Austin Cancer Center, after finishing radiation treatment for her breast cancer. (Photo provided by: Gonzales family)

After her surgery, Gonzales had to wait until after Mason was born to begin radiation treatments to her chest wall.

“The great news is that she was able to continue breastfeeding from her healthy breast for the duration of time postpartum, including all through radiation — and that is safe and appropriate to do,” Dr. Kolluri said, referencing another common misconception.

Unfortunately, Gonzales had to stop breastfeeding when she began hormonal medications to lessen the chance her cancer will return. She’s scheduled to continue these treatments for the next five years, and they also prevent her from trying to get pregnant again.

“If I could have another one, I would,” Gonzales said, through tears. “I have three beautiful kids — two beautiful girls and a son that I’ve always wanted. It’s more than I can ever ask for. At the time, when I couldn’t be a mother, I spoke with God. I told him, ‘If I can just have one, I’ll be fine … Now, I have three.”

She encourages other women with a lump, pain or other concerns to not ignore them — or chalk them up to typical “pregnancy symptoms.”

“Go get checked. No matter what you think, don’t put it off,” she warned. “I’m glad they caught it when they did. Now, I’m cancer-free, and I’m able to be here for my — for my babies and for my family.”

  • Yvonne Gonzales, pictured with her three children and her husband at the Austin Cancer Center in June of 2021. (KXAN Photo/Avery Travis)
  • Dr. Sangeetha Kolluri performed Yvonne Gonzales' mastectomy, after she was diagnosed with cancer. Here, Dr. Kolluri is pictured with Yvonne's son, Mason. (KXAN Photo)
  • Breast cancer survivor, Yvonne Gonzales, pictured with her healthy baby boy. (KXAN Photo/Avery Travis)
  • Yvonne's husband, pictured with their two daughters and newborn son. (Photo provided by: Gonzales family)
  • Yvonne Gonzales, pictured with her three children (KXAN Photo/Avery Travis)with her three children and her husband at the Austin Cancer Center in June of 2021. (KXAN Photo/Avery Travis)

The pandemic’s effect

Dr. Kolluri and Dr. Hossain said misconceptions about pregnancy aren’t the only reason they have seen patients with more-developed cancers or delayed diagnoses.

They said the pandemic kept people from seeing their OB-GYN and primary care doctors who often catch things “early on.” Preventative scans were also delayed, as people stayed home to prevent the spread of coronavirus.

“Even when we were able to go back into the mammogram offices to get mammograms done, people were afraid to do so,” Dr. Kolluri said. “We’re seeing that not just in breast cancer, but in cancers across the board.”

They underlined the importance of breast self-exams for women and vigilance for everyone about changes with their bodies.