Luck and Privilege (from CBCS 2025)

This speech was originally shared by Jaclyn at the Canadian Breast Cancer Symposium in June 2025

 

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Good morning everyone.

Thank you to Christine, MJ, and everyone here for welcoming me this morning.

I know time is tight so I’ll dive right in.

I’ve framed my story through two themes: luck and privilege.

Let’s start with the privilege part.

By which I mean understanding, evaluating and decision-making privilege.

I hold these privileges. I wish more people in my shoes did.

I hold these privileges. I hold them largely because I’m a health lawyer — by the time I found the lump, I had spent years working with doctors on issues of informed consent, risks and benefits, and so on.

And also, I hold these privileges because cancer was the third in what I like to think of as a trilogy of serious health issues. So I knew myself and my body.

And when it came to managing my fertility in the face of breast cancer, I would need every ounce of every ingredient.

Now to the luck part.

By which I mean, to get cancer-free, stay cancer-free and then live life with the family I dreamed of having.

This luck took time. In fact, it took about four years.

In March 2019

At 34, Stage 3b ER/PR+ IDC, the BRCA2 gene, and a toddler at home, everything filtered through one question: what’s the best, most aggressive path to assure I live?

But this funny thing happens when you’re a woman in her prime baby making years.

Suddenly, the urgency of treating cancer gets conditioned on the need to preserve and promote reproduction.

My notes from that time show I met with an army of experts, including multiple oncologists, a cancer researcher, a bioethicist, a pathologist, several of my smartest health lawyer friends and an OBG specializing in oncology.

And everyone said it was reasonable to delay chemo to undergo IVF — or, to borrow a phrase from one oncologist, “not unreasonable”.

This was even with knowing that my husband and I were planning a single child family.

Still – every single one of them supported my doing IVF, even encouraged it.

Because, of course, there are no take backs once chemo starts.

But when I question how it made sense to spur hormone production and delay treatment for my hormone responsive cancer no one could say it was safe.

Reasonable, not unreasonable, but not safe.

Ultimately, my husband and I landed on the DM’g framework to filter our choices

– do everything to become cancer free and stay cancer free.

We’d think about our future family only after we protected the one we had.

I got first my Lupron injection that April and launched towards that goal.

A year later, “Pretty Quiet”

was how the OBG described my ovaries during a pelvic ultrasound after a brief 3 month Lupron pause before starting endocrine therapy. Plus, my FSH levels were through the roof.

“Pretty futile,” was how she described my hopes for IVF according to my journal that day.

Natural pregnancy? Out of the question.

Diagnosis: primary ovarian insufficiency. She mentioned egg donation and surrogacy.

With the pandemic raging and the radiation burns still visible on my chest, and that toddler at home while I tried to work, I didn’t have the mental space to question it.

Episode 3: Open to Second Opinions

But that fall and later in the winter of 2021, two separate providers question that diagnosed.

First, my gynecologist told me, “Look, chemo takes its time leaving and ovaries can recover.”

Then, an oncology nurse practitioner, one of these elder stateswomen whose seen it all, was more direct. She flatly told me the POI diagnosis was premature and to get a second opinion.

I didn’t really mourn the loss of my breasts – I remain flat now, a choice worthy of its talk – but I did mourn the loss of my choices.

The fact that, while the choice to prioritize treatment was the right one for me, it didn’t change how painful living with the consequences was turning out to be.

And, with regular reminders of the looming oophorectomy deadline thanks to my BRCA gene, it seemed to be getting more painful with time, not less.

Still, I didn’t do anything right away.

I kept moving through Iife as a working parent in the pandemic and then added a new project, relocating my family back home to Toronto.

Episode 4: Shifting my DM-Paradigm

The question of trying for more children came up again once I had moved back to Toronto and was meeting with a new oncologist for the first time.

I told that doctor I was still thinking about it and planned to take some time to settle back in before deciding. I mentioned the happy child at home I was grateful for and my struggling with the idea of going off of endocrine therapy – my safety blanket — given that I remained high risk for recurrence. But I knew that at 37 the decision couldn’t wait for long. I told the doctor I would let them know soon about referrals and next steps.

That oncologist misheard me and a week I received a surprise phone call from a surgeon’s office calling to schedule the oophorectomy consult.

Here’s where my privilege mattered most of all.

• I didn’t take that appointment with the surgeon.
• And I didn’t see that doctor again.
• What I did do, was ask my primary care doc for help finding a better fit.

I needed an oncologist who could help me manage dueling priorities –

• On the one hand, minimize the greatest extent possible, my risk of recurrence
• And on the other, identifying an opportunity to explore my fertility

My doc found me that oncologist, who had a study I might join – a study where I would screen in or out with a ctDNA test.

It was a natural fork in the road.

If it came back positive, I would enter the study and brace for possible recurrence

If it came back negative, that was as green a light to explore what if — as I could ask for.

I signed the forms. Sent the blood, found the tissue. Joined a waitlist for a fertility clinic and waited.

Episode 5: Luck arrives

Three months later, in February 2022, the fertility clinic called with a cancellation appointment. I felt a rush of excitement.

But then I hesitated. How could I go to that appointment with out knowing the result of the cTDNA test?

I felt I couldn’t engage the fertility discussion without a clear answer.

And I swear to you all now, no sooner had that thought entered my head, did the phone ring with the news that the ctDNA was negative.

Forget lucky. It felt cosmic.

I got my green light to really explore my options at this stage:

• I poured over the data,
• weighed it with my docs and key advisors
• learned about egg donation and IVF, still the only viable option
• created a carefully sequenced roadmap for take an endocrine drug holiday,

and,

• sat with the hardest question of all – was I ready to change my DM’g framework?

In the end, I was.

The question was no longer: What’s the best chance of keeping me alive?

Now: What would I do if I wasn’t driven by fear?

I knew my answer.

Pregnancy & Birth

In May 2022, 3 years after I started Lupron, I went off it.

By July, my FSH was normal.

By August, I was ovulating.

That October, I learned I was pregnant.

Today, I am back on endocrine therapy, proudly on the CAMBRIA trial, my son is 8 and my daughter – that scientifically unexplainable creature – is two.

Now comes my ask of all of you.

No one in this room can promise the women with my profile, and my treatment path this wild happy life I get to live. I’m not here to suggest otherwise.

But here’s my ask of all of you –

Be the kind of doctor who helps your patients to see the full 360 degree of their present and future states – so they too can identify their own decision-making paradigms – not follow those society tells them they should follow just because.

In the end, you all have the power to bridge the privilege gap – so no one needs my kind of background to get to a place there they might just get lucky.

Thank you.

— Jaclyn Greenberg