Christmas 2010 couldn't have been more joyful for Paris Jackson and her sister, Buffy Wilson: Jackson had just moved into a new home; their mother, Carolyn, was marking ten years since her cancer went into remission; and the seven children the sisters had between them were the heart of their extended family.
But come January, everything would change for Paris and Buffy, as they'd find themselves fighting for their lives against one of the deadliest diseases African-American women can face: triple-negative breast cancer.
"I was always told that I had fibrocystic breasts, so my breasts would be tender during my period," Wilson says. And though the condition was benign, it didn't stop Wilson from performing regular, thorough self-exams and talking to her doctors about the changes she felt.
It was the numbness she noticed one morning that prompted her to dig deeper during a self-exam, when she discovered a large, painful lump near her right armpit. Alarmed by what she found, Wilson headed to an emergency room where she was even more alarmed to hear doctors dismiss her claims and tell her that "cancer doesn't hurt."
A follow-up ultrasound, swollen lymph nodes and what Wilson describes as acid reflux-like symptoms still weren't enough to convince doctors that cancer might be present. At age 38, two years shy of the recommended age for a mammogram, she had to fight to get one. It was that mammogram, coupled with Wilson's vigilance and a biopsy, that ultimately confirmed her hunch: She had stage-2, triple-negative breast cancer.
More prevalent among African-American women and harder to treat, triple-negative breast cancer is a one whose growth is not supported by the hormones estrogen and progesterone, nor by the presence of too many HER2 receptors, explains Keith Amos, M.D., Assistant Professor of Surgery at UNC's School of Medicine (he was also the doctor who treated Buffy Wilson). As a result, the cancer does not respond to hormonal therapy (such as tamoxifen or aromatase inhibitors) or therapies that target HER2 receptors, such as Herceptin.
The BRCA1 Bombshell
Opting for treatment at the University of North Carolina at Chapel Hill School of Medicine, nearly two hours away from her home, Wilson began another series of tests, including one for a genetic mutation knowns as BRCA1, which can significantly increase the risk of breast and ovarian cancers, according to the National Cancer Institute. Wilson knew that her mom had battled breast cancer 10 years earlier, but, she says, "I wasn't really knowledgable about [BRCA1]. I had heard of it; I think it was Christina Applegate that had it, but I wasn't really familiar." Wilson would later discover that her mom also carried the genetic mutation, along with her sister and one of her sister's sons.
"If you've been diagnosed with breast cancer before age 50, have been diagnosed with cancer in both breasts at the same time, developed ovarian cancer and breast cancer, or have a repeated family history of breast cancer (especially a sister or mother), you've got the highest chance of carrying the BRCA1 mutation," Dr. Amos says.
The One-Two Punch
At the urging of her sister, Paris Jackson agreed to go in for a mammogram as well. At age 42, she would, by doctor recommendation, be getting an annual mammogram anyway. And if there was one thing she took away from her mother's bout with breast cancer in 2000 -- which she discovered a year after skipping just one annual exam -- it was that mammography was a must.
Jackson had no symptoms to speak of when she went for the mammogram. In fact, the procedure had to be redone a few times before her doctor was able to determine that she too was battling stage-2 cancer.
"My sister goes for a mammogram in March, and it just all spiraled from there," Wilson says, referring to her sister's triple-negative breast cancer diagnosis.
In The Trenches
Under Dr. Amos' care, the sisters would undergo a grueling course of treatment together, including a clinical trial, several rounds of chemotherapy, mastectomies and radiation. The side effects of their treatment, as any cancer patient knows, seemed at some points to overshadow any hope they had of recovery, especially on days when treatment called for a toxic chemo cocktail known as "The Red Devil."
"It was so lethal that when I first took it, I formed pneumonia," Jackson says. "The second time I was in the hospital and my skin literally started coming off; I had third-degree burns. And the third time, I was in so much pain I almost went into shock."
Wilson describes how her nails darkened and her sense of taste disappeared. "It's a process and you really have to have faith," she says.
How Could This Happen?
"If a woman is found to have a BRCA1 gene mutation, we know that her risk of developing breast cancer over her lifetime is at least 50 to 85 percent," Dr. Amos says.
It's important to note that having triple-negative breast cancer does not always mean that you're carrying the BRCA1 gene. "Good Morning America" anchor Robin Roberts, for example, battled triple-negative breast cancer in 2007 but does not carry the BRCA1 mutation.
Family history aside, Dr. Amos also looked for risk factors such as not having children, not breastfeeding and being overweight (though Jackson believes she wouldn't have made it through chemotherapy if it had not been for her excess weight).
She, Wilson and Dr. Amos do agree on one thing: Being diligent about screening is key. "You have way more treatment options available if you catch a breast cancer earlier," Amos says.
Jackson completed her last round of chemo on Monday; both sisters are slated to undergo reconstructive breast surgery next year.