Rana Fowlkes’ breast cancer diagnosis came as a complete shock. But thanks to research, she was able to achieve two of her biggest dreams
Rana Fowlkes has always been a planner, and in November 2019 she had big plans indeed. She was in her last year at Weill Cornell Medical College in New York and thinking about her next step: a residency in obstetrics and gynecology. Her wedding was in three months. She and her fiancé, John, were excited to start a family in the near future. And then she found a lump in her breast.
She didn’t rush to get it checked out. After all, she was only 27 and had no family history of breast cancer.
“I figured it was probably just a fibroadenoma,” Rana said. “I was a busy medical student and thought: I’ll get to this when I get to it.”
But when the lump became painful, she scheduled an appointment with her primary care physician. Based on ultrasound results, her doctor agreed that the lump had the classic indicators of a benign fibroadenoma—but since it seemed to be getting larger, he ordered a biopsy just to be sure.
“Then he called and said, ‘I have the results, and I think you should come in.’ I knew it was going to be bad,” Rana said.
In his office, the doctor told her and John the news: Rana had breast cancer.
“It felt really strange because as a medical student you learn so much about the techniques for breaking bad news, and to be on the other side of it felt very surreal,” she said. “At the end of the day, as much as we’re all physicians, we’re all going to be patients.”
The following days brought a flurry of appointments. Her breast surgeon told her the tumor was too close to the skin to be surgically removed first. Her oncologist recommended chemotherapy, followed by surgery and possibly radiation. Genetic testing revealed, unexpectedly, that Rana carried a BRCA1 gene mutation. Cascade testing for her family members revealed that the gene had come from her father’s side, and her mother and sister were negative.
While she was grappling with all this new information, she learned that if she wanted to preserve her fertility, she needed to do an egg retrieval as soon as possible, so she hurried to schedule one before chemo began less than two weeks later.
At first, Rana assumed that despite her diagnosis, she’d just keep going as usual, interviewing for residencies in between chemo sessions. Ultimately, however, she decided to take a year off to focus on her health. Although she knew it was the right decision, it was a struggle to let go of the timeline she’d envisioned for herself.
“I’m someone who’s always moving on to the next step, and with medical training there’s a clear path forward,” Rana said. “The hardest part for me was taking a break.”
One plan, however, she didn’t have to give up.
“I told my oncologist our wedding date was February 29 and asked if we should postpone it,” Rana said. “She said, ‘No, we’ll time your chemo and make it work.’ And we had a wonderful wedding.”
She and her fiancé personalized the ceremony with their own highly unconventional ritual.
“By that point, I was losing a ton of hair. Instead of having me shave my head alone, which would be kind of sad, we decided that on the day of the wedding that we’d have it done together, in front of everyone,” Rana said. “It was really fun, and very positive.”
The February 2020 wedding was planned brilliantly, as it turned out, because the following month, the world was shut down by a pandemic. COVID restrictions meant that Rana was on her own for her weekly chemotherapy appointments, which continued throughout the spring, as well as her double mastectomy in June. About a week after her surgery, the pathology report came back negative.
“They couldn’t find anything at all,” Rana said. “I was in remission, and we were just so happy.”
Because her breast cancer was both HER2-positive and hormone receptor–positive, she continued receiving infusions of HER2-targeted treatments, Herceptin and Perjeta, for the next year, and she began hormone therapy to reduce her risk of recurrence. Despite her relief, Rana said one question loomed large: “What’s the minimum amount of time that I need to be on these medications before I can have a kid?” Her doctor cautiously advised two years. When the two-year period was up in 2022, Rana began a difficult fertility journey.
Because Rana had also had a risk-reducing salpingectomy, she needed to pursue in vitro fertilization in order to become pregnant. Her embryos were tested for genetic abnormalities, including a BRCA1 mutation. Out of three embryos, one implanted, but Rana miscarried at around 14 weeks.
“That was tough, and that was also our last embryo, so we decided to do more retrievals,” Rana says. “It turns out chemo wasn’t the best for my ovaries, and I had a really hard time retrieving any eggs. I probably did three more retrievals, but there were so many failed transfers, and the process takes so long because you’re waiting for your next cycle to start.”
Meanwhile, every month that passed was another month she’d been off Tamoxifen and Lupron, which weighed on her mind constantly.
“It was so scary and stressful, but [having a child] is something John and I really wanted,” she said.
With a narrowing window of time, the couple signed up for an egg donor. They used up the fertility benefits from John’s insurance. They decided to try another clinic, where Rana underwent yet another retrieval, which yielded a single viable embryo.
After that transfer, the doctor had the best news: Rana was pregnant. She gave birth to a healthy baby girl in the spring.
Although there has previously been sparse research about the effects of cancer treatment on pregnancy, recent BCRF-supported research has given Rana tremendous reassurance about the many anxious months she went medication-free to get pregnant.
According to the results of the first-of-its kind POSITIVE trial, women of child-bearing age who temporarily interrupt hormone therapy for up to two years to get pregnant experience no negative breast cancer effects over the short term.
“Things like that are so reassuring and make such a big difference for doctors who are counseling patients,” said Rana. She’s now completing her medical residency and plans to become a maternal-fetal medicine specialist.
“I’m excited to be able to take care of them as someone who had this kind of high-risk pregnancy myself,” she said. “It’s so meaningful to give back even in the littlest way.”
That’s not the only way she’s given back: Rana and her husband have raised more than $14,000 for research through BCRF.
Though unplanned and unwelcome, Rana’s breast cancer experience has not only left her more committed than ever to the importance of research but deepened her compassion as a doctor.
“I can talk to my patients about side effects and ports and what it’s like to lose your hair—things doctors can sometimes forget about because it has nothing to do with getting rid of the cancer,” Rana said. “As someone who’s been through it, I feel like I understand so much more about what it’s like to be a patient.”
Read more stories from BCRF’s Research Is the Reason storytelling initiative here.
