Mother's Day has special meaning for mom who received breast cancer diagnosis while pregnant
Christelle Jorda wore maternity clothes to her chemotherapy sessions at UCLA Health, a sign of the jarring dichotomy at play in her body.
As a growing baby kicked in her womb, powerful drugs worked to shrink the aggressive tumor invading her breast.
Two years ago, after Jorda was diagnosed with invasive ductal carcinoma during her first trimester of pregnancy, her UCLA Health team of doctors worked to treat her and safeguard the health of her long-anticipated second child.
This Mother’s Day, Jorda, 35, celebrates a year of remission since completing breast cancer treatment, as her daughter, who went through nine rounds of chemotherapy in utero, hits milestones of her own.
Cléo, 21 months, loves food and is learning to speak new words in French and English.
“She is the happiest girl ever, no health issues and right on track for her age,” Jorda said. “I’m extremely happy. I know how to value every day, every hour, every second.”
Ready for another baby
Jorda and her husband, Julien, are originally from France. They moved to California 11 years ago for his post-doctoral fellowship in computational biology at UCLA.
The couple have a son, Timothé, 7. In 2019, the Jordas, who live in Los Angeles, decided to try for a second child. Jorda got pregnant easily but miscarried three times in a row that year.
Shaken and saddened, she consulted her primary care doctor who referred her to UCLA Health reproductive endocrinologist Lindsay Kroener, MD. Dr. Kroener did a full fertility workup and found nothing wrong, Jorda said.
In the fall of 2019, she got pregnant again, with a due date of August 2020. The plan was for Dr. Kroener to oversee her first trimester before Jorda transitioned to a regular obstetrician.
“Everything went well,” Jorda said. “It was pure happiness. This time, wow, I felt life – a heart beating really hard.”
A growing lump
In October, about a month before her positive pregnancy test, Jorda, then 32, had noticed a pea-size lump in her left breast while in the shower. She thought maybe it was a cyst.
“In my head it was like, ‘Oh I was pregnant three times this year,’” she said. “It’s probably hormones.”
She didn’t think much about the lump as she focused on her pregnancy. But when she was about nine weeks pregnant, it seemed a little bigger. Since she saw Dr. Kroener frequently, she decided she should mention it.
Jorda was sent for an ultrasound and then a mammogram. The radiologist said she would need a biopsy.
In January 2020, with the biopsy appointment a week or two out, Dr. Kroener called Jorda to share the results of the free-cell DNA blood test Jorda underwent to look for genetic abnormalities in the baby.
But rather than find out the sex and other results, the test detected chromosomal abnormalities across the board. The results were a red flag for potential malignancy because as cancer divides cells, it creates mistakes, which can be misinterpreted as an abnormal result.
Dr. Kroener pushed Jorda’s biopsy to the next day, but Jorda already was certain she had cancer.
“A baby cannot be malignant,” she said. “It’s my blood and I have this lump. This is nothing else.”
A devastating diagnosis
The day after the biopsy, Dr. Kroener called to tell Jorda she had an aggressive form of breast cancer called triple-negative, which is not hormonally driven and grows quickly. It also has fewer treatment options and tends to have a poorer diagnosis, according to the American Cancer Society. Overall, 77% of all patients with triple-negative are alive five years after diagnosis.
Jorda began to shake and cry in her husband’s arms.
“My main concern was what about the baby,” Jorda said. “If I have to terminate this pregnancy because of the cancer, I don’t know what kind of depression I will be in.”
Dr. Kroener referred her to Rashmi Rao, MD, assistant clinical professor in the division of Maternal Fetal Medicine at the David Geffen School of Medicine at UCLA.
Dr. Rao counseled Jorda to discuss safe treatment options in pregnancy while ensuring that her cancer team would be able to safely treat her the same way as if she were not pregnant.
“I always tell my patients, ‘You’re my patient first,’” Dr. Rao said. “Any decision we make for the baby will be made in concert with the mom. It’s a very, very tough balancing act.”
Dr. Rao said that while the risk of birth defects caused by chemotherapy is lower after the first trimester, the baby could experience restricted growth or be born prematurely because of the treatment.
“With Dr. Rao, every word that is going out of her mouth is just the right amount of caring and professionalism,” Jorda said. “I don’t know how to explain this perfection she has. She was being honest but at the same time being supportive.”
Dr. Rao said Jorda’s diagnosis is a reminder that even during pregnancy, women should report any symptoms that are out of the ordinary.
“Just because they’re pregnant, we don’t discount other kinds of health screenings,” Dr. Rao said. “Unfortunately, women do get cancer in pregnancy.”
Jorda met with an oncologist and surgeon who assured her that she would receive the same standard of care, regardless of pregnancy. She could start chemotherapy once she entered her second trimester, with a plan to shrink the tumor before surgically removing it.
“You’re your own guinea pig,” she said. “You have to try chemos to know which one works.”
Jorda said she was told that the placenta would shield the baby from most of the chemotherapy but she was still nervous. She put her faith in her doctors while also researching and learning all she could.
“I was in a position where I had to believe them,” she said. “I believe in science. I knew it would be an exceptional journey.”
Jorda’s husband accompanied her to her first chemotherapy session in late February. By the time of her second appointment, the COVID-19 shutdown was underway and she had to go alone.
“My attitude for each infusion was it was a good day,” Jorda said. “It was a fighting day.”
After her first two sessions of chemotherapy, spaced three weeks apart, her tumor had grown to the size of a large grape. After a third session, it was bigger still, with imaging revealing that it had doubled in size since January.
“That was the darkest moment,” Jorda said.
Dr. Rao recalled calling Jorda about the progression.
“We were both in tears. I felt so terrible for her,” Dr. Rao said. “I just remember telling her we would get her through, she was going to be OK, and she was going to be there for her daughter.”
Dr. Rao said most cancers are not affected by pregnancy. While there is some concern that some types of breast cancer may be fueled by hormones that increase in pregnancy, Jorda’s tumor had receptors that were negative for estrogen and progesterone.
“I would have to say for her in particular, I don’t think pregnancy changed anything,” Dr. Rao said. “She’d had the lump there before pregnancy and in general triple-negative breast cancer tends to be aggressive.”
Jorda switched to another combination of chemotherapy drugs. The tumor shrunk a little and she began to ask when she could undergo surgery.
“I said, ‘Please remove that monster now,” Jorda said. “I felt it had to be out now.”
On May 27, in her third trimester, Jorda underwent a lumpectomy and lymph node removal at Ronald Reagan UCLA Medical Center.
One half of the surgery room was staged with equipment for an emergency Cesarean section if necessary.
Again because of COVID-19 protocols, Jorda could not have her husband with her and woke up starving and hurting.
“That moment was the hardest physically,” she said. “I was alone and I was in pain.”
The pathology report found some cancer cells on the margin of the tumor but no spread to surrounding lymph nodes, placing her cancer at stage 2, Jorda said.
“This thing was a bomb, but a bomb that was not spreading yet,” she said.
A beautiful birth
Jorda continued to undergo chemotherapy and felt like she could finally give her full attention to her pregnancy with the tumor gone. She prepared the baby’s room and embroidered decorations to go in it, including a black-and-white copy of an ultrasound image.
“My belly grew so much,” she said. “I felt more beautiful. My hair was growing a little.”
About six weeks after surgery, Jorda returned to Ronald Reagan UCLA Medical Center, this time to deliver her baby four weeks before her due date.
Dr. Rao said the induction was timed for two weeks after Jorda’s last chemotherapy infusion to allow the baby’s blood cell lines to recover from Jorda’s treatment, which would reduce the risk of infection or low blood counts.
Dr. Rao delivered Cléo on July 11. She weighed 5 pounds, 15 ounces.
“She was like a miracle baby,” Dr. Rao said. “Everyone was crying in there. It was just amazing. (Christelle) makes everything look easy. It was a beautiful birth.”
In a birth announcement, Jorda wrote, in part, “You are now free, my love, and I thank you for all the strength you gave me. I will have to finish the war without you but you just gave me an extraordinary new weapon today: your love. Long life to you little baby girl.”
Cléo’s blood sugar was low so she spent a few days in the neonatal intensive care unit. On the way home from the hospital, Jorda reflected on the end of their bodily connection.
“Every step was, ‘We did it’; now she’s out,” Jorda said. “I could not thank her more for being by my side. I’m sorry I made her live this with me. We took a risk with her and even if she was fine, she was receiving some chemo. The guilt around this exists.”
Jorda breastfed Cléo for two weeks before she had to resume chemotherapy. Chemotherapy drugs are excreted into breast milk so nursing is not considered safe while receiving treatment.
“It was a comforting moment for me and her,” she said. “It was something I wanted to give back. I breastfed my son and I remembered how beautiful it was. I did not want cancer to rob this opportunity with her. Even if it was just for a few days and a few drops, it was symbolic - like a rebellious act against cancer.”
After her cancer diagnosis and after giving birth, Jorda was offered psychological support. She said she would like to see that kind of care and acknowledgment after pregnancy loss.
“In the head of a woman, even at six weeks, you know the color of the nursery, you have options of name,” she said. “My suggestion would be this: having a therapist calling you after you experience a miscarriage, maybe spending 20 minutes with you.”
With a newborn at home, Jorda’s treatment continued. She underwent weekly chemotherapy six more times. She finished intravenous treatment in September when Cléo was 2 months old.
In October 2020, Jorda underwent a double mastectomy and began the process of breast reconstruction. She started six months of oral chemotherapy pills, intended to prevent a recurrence.
She completed the medication at the end of April, 2021. A month later, she had her final surgery to replace the breast expanders with silicone implants.
Jorda displays a picture on her refrigerator of Dr. Rao cradling a sleeping Cléo after her birth.
She often sends Dr. Rao pictures of Cléo. She’s become close friends with another woman who had breast cancer during pregnancy after Dr. Rao introduced them.
“She has such a special place in my heart,” Dr. Rao said. “There are some patients that just touch you. She’s constantly in my thoughts.”
Jorda said she’s most at risk of a recurrence until five years after her diagnosis. So far all her tests show no sign of cancer.
“I’m always worried it will come back,” she said. “I’m exhausted because I keep myself extremely busy. The more I do, the less I think about it.”
Yet she also knows that she’s stronger than before.
“I was extremely motivated,” Jorda said. “I never gave up at all. I’m still never giving up now.”
Learn more about the Maternal Fetal Medicine program at UCLA Health.
Courtney Perkes is the author of this article.