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The outlook for patients diagnosed with breast cancer has been changing for the better over time, with several significant advances coming through in the past 10 years. Along with more-effective therapies with fewer side effects than traditional treatment, a greater understanding of risk and accessible preventive measures has given women everyday tools to protect themselves against the disease.

Five particular advances have made a notable impact on the lives of breast cancer patients during the past 10 years. These include HER2-directed therapies, gene expression testing, hormonal therapy, less-invasive surgery, and healthy lifestyle choices aimed at prevention.

1. HER2-Directed Therapies

Wendy Chen, MD, MPH, medical oncologist at the Dana-Farber Cancer Institute, says that therapies targeted at HER2—human epidermal growth factor receptor 2, a protein that promotes the growth of cancer cells—have had an important impact on breast cancer survival. Though not all breast cancers overexpress HER2, those that do (about one in five) can be effectively treated with drugs that target this protein. These include Herceptin® (trastuzumab), Tykerb® (lapatinib), and the recently approved Perjeta™ (pertuzumab).

“HER2-directed therapies have revolutionized the treatment of HER2-positive breast cancer,” says Dr. Chen. She explains that because these drugs are used for both early- and late-stage breast cancer, they can benefit a wide range of patients (so long as the cancers overexpress HER2) and can help reduce recurrence risk in early-stage disease.

2. Gene Expression Testing

Tests to determine the types of genes that a cancer expresses (also known as assays) have allowed doctors to tailor therapies to a patient’s individual needs. In breast cancer doctors are using two assays—Oncotype DX® and MammaPrint®—to help determine a patient’s risk of recurrence or spread (metastasis) based on the types of genes that the cancer expresses (a process known as gene subtyping) and to plan treatment to most effectively reduce this risk. Specifically, these tests help determine which patients are more likely to benefit from treatment with chemotherapy in addition to hormonal therapy.

“These [tests] have been very effective in helping us see who would most benefit from chemotherapy and who would most benefit from just [hormonal] therapy,” says Jennifer Litton, MD, a medical oncologist and assistant professor in the department of breast medical oncology at the University of Texas MD Anderson Cancer Center.

3. Hormonal Therapy

Hormonal therapy, which is used to prevent estrogen from binding to the estrogen receptor–positive disease (cancer that is stimulated to grow by estrogen) is not new to breast cancer; tamoxifen, for example, has been available for more than 30 years. Continuing refinement of this type of treatment, however, has given patients more options. With these improvements, says Dr. Litton, “we’re able to really effectively block estrogen synthesis and effectively treat many cancers using [hormonal] therapies without having to use chemotherapy.”

4. Less-Extensive Surgery

It now appears that some women with early-stage breast cancer may be candidates for less-extensive surgery to stage the disease. To determine whether and to what extent cancer may have spread to a woman’s lymph nodes, nodes are removed for evaluation. Surgical options include an axillary node dissection, in which many nodes may be removed, and a sentinel node biopsy, in which only the sentinel nodes (those most likely for cancer to have spread to first) are removed. Women with no evidence of cancer in their sentinel nodes may be able to skip further axillary node dissection as well as the side effects associated with more-extensive surgery.

Though not every breast cancer patient is a candidate for less-extensive types of surgery, these approaches have become more widely used. Dr. Chen says that there is a “general trend toward less-invasive surgeries.” She explains that surgeons, for example, “do more sentinel node biopsies instead of axillary node dissections.” She adds, however, that not all patients are eligible for sentinel node biopsies alone and that some need the more-extensive surgery to determine the extent to which the cancer has spread; only those without cancer found in a sentinel node biopsy are eligible for the less-extensive approach (sentinel node biopsy only). Dr. Litton also stresses that trial findings indicate less need for extensive surgeries in some breast cancer patients but that more-extensive approaches are still indicated for others.

5. Exercising and Maintaining a Healthy Weight

“Over the past five to 10 years, there has been increasing understanding of the role of overweight and obesity and physical activity in terms of breast cancer risk,” says Dr. Chen. The benefits of these healthy lifestyle measures, she explains, apply to survivors, as they can reduce the risk of recurrence, and also to people who have not been diagnosed, as maintaining a healthy weight and exercising appear to help prevent a primary diagnosis.

“There’s no magic diet,” Dr. Litton explains, “but across the board weight loss and exercise have been shown to improve outcomes, and obesity has been shown to worsen outcomes.” These findings are significant because they give survivors and those looking to prevent breast cancer a way to control risk with everyday choices.

Today’s Outlook

With the past 10 years of progress in breast cancer treatment and research, women facing the disease today have many promising options as therapies become more tailored to particular disease types and are designed to minimize side effects. And with greater understanding of risk factors and preventive lifestyle choices, women are gaining more ways to reduce the risk of diagnosis and recurrence on a daily basis. All in all, it’s progress worth celebrating.

Advances Made, Lives Saved

Two breast cancer survivors share their stories.

Valerie Tabak of Albany, New York, didn’t think her outlook was good when she was diagnosed with Stage IIIB inflammatory breast cancer in 2002. “I left thinking that I was going to be dead,” she says of her reaction to the diagnosis of aggressive disease. And with two children, ages 15 and 20 the time, Valerie was particularly concerned about the prognosis. Her own mother had died of ovarian cancer, so Valerie knew what it was like to lose a parent.

Twelve years later, however, Valerie is in good health. She credits much of her survival to receiving Herceptin for the HER2-positive disease. She says that, at the time, the targeted therapy was given to patients with more-advanced (Stage IV) disease but not to Stage III patients like her. Dr. Chen, who treated Valerie at the Dana-Farber Cancer Institute, recommended that she enroll in a clinical trial using Herceptin in Stage III breast cancer. Now, in addition to seeing her children become young adults, Valerie is helping a friend who is undergoing treatment for inflammatory breast cancer. “It’s really amazing,” she says. “I’ve been the luckiest person.”

When Erin Oian of East Texas was diagnosed with breast cancer at age 29, she was determined to enter her next decade with a clean bill of health. “My one wish for my thirtieth birthday was to be cancer-free,” she says, a goal she met just before she turned 30. “I actually finished my last treatment the day before my thirtieth birthday.”

Because Erin was diagnosed with Stage I invasive ductal carcinoma that was both estrogen receptor–positive and HER2-positive, she received two of the advances highlighted in this article—hormonal therapy and HER2-directed therapy—in addition to a lumpectomy. As hormonal therapy, Erin, who was treated at MD Anderson, received tamoxifen to block the effects of estrogen on cancer growth; she’ll continue to take tamoxifen daily for about three more years. And for HER2-directed therapy, she was given Herceptin.

Living with Metastatic Breast Cancer

The View from the IVth Floor

One woman shares some hard-won wisdom from years of living with metastatic cancer—and encourages laughter along the way.

Borrowed time—technically, that’s what I’m living on. Diagnosed a second time with Stage IV breast cancer metastases to brain, liver, lung and bones, research told me I had two years to live. Fortunately for me, new treatments and good doctors have kept me alive beyond the two years and have inspired the hope of many more. The reality is I can still get hit by a bus tomorrow regardless of my cancer diagnosis, so how has a cancer diagnosis changed my perspective?

For me cancer has been both a blessing and a curse. It has allowed me to get back to things I love, like painting, which is the most relaxing and gratifying thing I can do for myself. I also keep busy with civic groups, ballroom dancing classes, seeing friends, and writing; in other words, “living my life.” In my journey the important thing has been to focus on what I really love and to make time to do it…like traveling and eating ice cream for breakfast! Cancer has taught me what is important to me and how I want to live the rest of my life, regardless of how long it is.

I have also learned that though I haven’t chosen the journey I’m on, I can choose to share the discoveries I’ve made along the way. In some small way, these experiences may help someone else struggling to find their path.

My hair, or the lack thereof, has taught me more than I could have imagined. When I was diagnosed the first time, I started to prepare for the road ahead: I spent a fortune on a wig made of real hair only to find it hot and uncomfortable. In its place, on hot days, I would wear a scarf, and people would inevitably recognize the telltale “cancer coif.” In fact, while out shopping one day, a woman came up to me and identified herself as a fellow survivor: “I recognize that hairdo…I had that too!” She hugged me, and instantly I felt part of a sisterhood.

When I did choose to wear my wig, I found that wearing a wig is very different when you have hair and when you don’t. I found salvation from the irritation the wig caused my skin by placing paper towels between my scalp and the wig to form a cushion to the scalp and absorb the perspiration. (If paper towel manufacturers only knew how thankful I was for the help!)

And finally, having found a wig that is not uncomfortable—it’s synthetic, well-aerated, and looks very natural—people now approach me to ask where I get my hair colored or just to compliment me on my hair. I pause before I answer, but I guess it is mine since I bought it—online, of course!

Since those first days of wig shopping and hair dilemmas, I have finally lost all of my hair. The eyebrow issue was easily solved with an eyebrow pencil, but the trick was finding the eyebrow pencil with the brush attached. Penciling the brow in a shape I liked and using the brush to soften the lines created a more natural look. As for lashes, boy am I glad I had tattoo eyeliner years ago. At last count, I had about five lashes on each eye. (Adding insult to injury, when they fall out, they fall into your eye.) Arm and finally leg hair is gone too. It had seemed so unfair to have to shave my legs and armpits when I had no hair on my head. Now there is equity! On the bright side, I consider how much money I save on hair care products and hair removal.

And yes, years of teasing my husband about being bald finally caught up with me; there I was, post-chemo, with less hair than him. We now joke and say our hair color is “clear.”

Coming to terms with hair loss—and learning to laugh along the way—has been a journey in itself; coping with my prosthetic breast has provided a whole new set of lessons…and laughs. Initially, I went to get my prosthesis and the necessary bras only to end up feeling like I had missile-shaped breasts. I switched back to my regular bras after my incision healed, at first sewing a pocket in for the prosthesis.

After years of doing this I got lazy and would just place the breast in my bras, against the skin, which provided a few memorable moments, like the day I was vigorously digging a hole while gardening and saw what looked like a chicken breast in the dirt. Puzzled, I went to move it with the shovel. Thank goodness I recognized what it was before I touched it: my prosthesis had popped out unnoticed. I stood in the yard laughing at myself; I’m sure the neighbors thought I had lost my mind!

The comic moments that the prosthesis provided were joined by genuine discomfort as I tried to develop a comfortable way to “wear” my new breast. Now, though I still wear my usual bras, I have found a solution for the discomfort of the prosthesis against the skin: I buy a pair of ankle socks and put one on the side that touches the skin. For me this works—as long as I am not doing anything like digging!

Helping my family come to terms with my illness and managing the emotional aspects of this journey has not always been as easy as having a good laugh, but we’ve still managed to find our way. I am a caretaker. I find it eases my mind to look after others, and I’m calmed knowing everyone else is going to be fine. My husband and I talk frequently about cancer and mortality—fortunately for me, he is a psychologist and a good man. My son can question my husband about the cancer without feeling uncomfortable. My stepson calls regularly. I send e-mail updates to my sisters, cousins, and friends because it allows me to give the information without getting emotional. My mother died of AML a few years ago, and my father is a cancer survivor and shows me every day how important it is to enjoy your life. Both have provided good models not only in how to live but in how to say goodbye. Ultimately, I have my faith, and I feel immense support from friends and loved ones.

Managing my hair loss and my prosthetic breast has provided me with just a few of the discoveries I’ve made on this journey, and knowing that my loved ones are taken care of has given me peace at home. The view from the IVth floor is not always pretty, but I hope by sharing what I see, I can help others and maybe share a laugh along the way. There is still joy and hope in my life, and I wish the same thing for all of my fellow survivors.

Outside the Box of a Metastatic Cancer Diagnosis

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Remembering that there are exceptions to every rule keeps hope alive in the face of Stage IV breast cancer.

By Diana Price

When Kaillee Perry was diagnosed with Stage IV breast cancer at 34, it wasn’t the first time she would have to hear a dire prognosis—and then make up her mind to beat it. When she was 13, Kaillee suffered a head injury that caved in one side of her skull (to this day she has no bone there) and caused the treating physician in the emergency room to read her a laundry list of things she would never be able to do again. “Well,” says Kaillee, describing the fighting spirit that refused the grim forecast, “I’ve done every one of those things—with the exception of scuba diving—at least twice. There were so many things they told me that I couldn’t do; I think I lived to spite that doctor.”

Now, facing another tough road when an initial Stage IIB diagnosis of breast cancer metastasized to her liver, lungs, and brain, Kaillee warned her oncologist that she might just be around a while this time, too. In this case, however, she had a supportive doctor on her side as she came to terms with her Stage IV diagnosis: statistics are not set in stone, and there’s no one-size-fits-all strategy here, he told her; every case is different, and everybody responds differently to treatment.

Kaillee respected this response, noting, “In my life I’ve found that more often than not I’m the exception to the rule, whether that works in my favor or not.”

In Kaillee’s family, cancer has appeared often enough that she was aware that it was a possibility. Her maternal grandmother and two aunts were all diagnosed with breast cancer; her father passed away at age 33 from testicular cancer that had metastasized to his kidney and lung before being properly diagnosed; and she has a cousin who currently has thyroid cancer. But again, she was the exception to the pattern where breast cancer was concerned: she was diagnosed 20 years earlier than the other women in her family.

With her initial diagnosis, she says, she felt that “my body was acting funny” as early as two years before she went to the doctor; but at the time she thought that the symptoms she was experiencing were perhaps early signs of menopause (although at 30 she knew that was strange). She felt a lump in her breast, but she thought that it didn’t feel like a cancer lump should—it was soft and more fleshy than she thought was “normal” for cancer, and she figured it might be a cyst similar to those that an aunt had had removed. In addition, she had recently seen her doctor and had not raised any red flags.

By the time she was diagnosed, in January 2003, she had a tumor the size of a robin’s egg and lymph node involvement. Now, she says, she urges women to go to the doctor early. “If it doesn’t feel like a cancer ‘should,’ it doesn’t mean it’s not a cancer,” she cautions. “If you’ve got a lump in there—even if it’s soft—or if you even feel like something is just off, get it checked out.”

Because of her youth and the advanced stage of her cancer, Kaillee’s treatment plan was intense from the beginning. The dose-dense chemotherapy that she endured made her extremely ill and was followed by a mastectomy, reconstruction, and radiation. The process, Kaillee says, was overwhelming and confusing. “There’s nobody there to guide you after you leave your oncologist,” she says, “and we were at a bit of a loss.”

To add to the trauma, the first reconstruction was not done correctly, and she ultimately had to undergo a second surgery to repair it. Here too she cautions other women to listen to their instincts and be proactive: “There were warning signs there,” she says, hints that the reconstruction plan was not going well and that the doctor was not as qualified as he should have been. “He didn’t have photos to show of previous surgery results,” Kaillee says, thinking of the signs that in retrospect may have tipped her off. “He took weeks to return calls; his waiting room was always overly crowded, which I though meant he was good but which I think actually probably meant he was burning the candle at both ends and couldn’t really fully assess a patient’s history properly before making recommendations. But at the time I just didn’t know what to look for.”

Following her treatment and reconstruction ordeal, and after making the decision with her doctor to stop the series of Lupron® (leuprolide) shots because they were causing her too much pain, Kaillee had a brief period of respite. Brief, it turns out, because by summer her blood count was off, although it would take several months to determine where the cancer had metastasized. By October doctors found a few spots on her liver and one on her lung. Kaillee recalls her initial hopefulness—as she told her doctors, “Oh, great, you caught them early; it’s Stage I, right?”—and then the disappointment and the regrouping that followed the doctor’s explanation of metastases and the fact that this was actually a Stage IV breast cancer diagnosis.

Doctors prescribed Herceptin® (trastuzumab), which had a positive effect on her liver right away—two spots went away, and one shrunk considerably. The spot on her lung, however, was not affected and in fact grew a bit after nearly a year on Herceptin. It was biopsied to determine if it was a separate cancer but was found to be of the same origin. It was while Kaillee was in for a CT scan to further investigate her lung that shadows were detected at the base of her skull.

It was back to the drawing board. Facing an entirely new treatment plan, from the beginning Kaillee was clear about her priorities for this new challenge. She would pursue treatment, but she would also focus on her family—including her husband, Rich, and her sons, Pat and Devin—and take the time to enjoy her life. She and Rich decided to take out a life insurance line of credit offered by Fifth Season Financial, a process that they say was made extremely easy and taken care of quickly by the company, as they planned Kaillee’s treatment and thought about how they would like to proceed. With the funds from Fifth Season, the family brought over relatives from England for a family vacation and were also able to buy their elder son Pat the car he needed to commute to work, which they presented to him on his nineteenth birthday. Life was made a little sweeter and easier as they looked down the road toward the treatment that lay ahead.

This time what lay ahead was full brain radiation followed by an oral chemotherapy plan and Tykerb® (lapatinib). And though she was ready to begin this next stage, Kaillee was determined to enjoy her family vacation before embarking on the journey before her. “I plan for the worst, but I don’t lay down to it or live in constant fear of it either,” Kaillee says, referring to her diagnosis with metastatic disease and the many challenges she has encountered already. “There’s still a good fight in me yet.”

The fighting spirit that Kaillee has demonstrated throughout her life—from the childhood injury that she refused to let sideline her to the challenges of her metastatic diagnosis today—is bolstered by the inspiring advances being made in breast cancer research. Her transition from Herceptin to Tykerb, she says, demonstrates the speed at which research is accommodating cases like hers. “Herceptin was just in time for me, and I had very little trouble with it for 15 months; and now Tykerb, which works by breaking through the blood-brain barrier, is helping me along at this stage. There is new stuff happening every day, and they are getting closer to a cure.”

Ultimately, Kaillee says, she encourages women who are delivered a metastatic diagnosis to remain hopeful and to think outside the box. “It’s not that cut and dried,” she says of the statistics about Stage IV disease that they might be handed. “Don’t read too much into it. It’s a very good guideline, but if you buy into it as is, you’ve already lost the fight.” Powerful words, spoken directly from the front lines. |

Together with three dedicated friends, Stage IV breast cancer survivor Michelle Nicastro puts her gratitude and her passion for motherhood to work in a company created to help busy moms spend time where it really counts.

“I’m just so happy to be here,” says Stage IV breast cancer survivor Michelle Nicastro, her joy apparent through the phone lines, “and I feel so grateful and so lucky.”

Originally diagnosed with calcifications in her right breast after undergoing a baseline mammogram shortly before her fortieth birthday, Michelle underwent a lumpectomy at the time and was told she required no further treatment. “I was told that it would have taken two years for the calcification to even develop into a lump and that it was basically precancer,” she says, “so I had my lumpectomy and went on my way.” Still, Michelle didn’t feel she was in the clear: “I felt a cloud hanging over me.”

The storm hit in force three years later when she began experiencing back pain. “I had started playing tennis again, and I thought that’s what had caused it—I hadn’t played in about 15 years. I saw a couple of sports medicine doctors, and they thought that was probably it, also.” But the pain became so severe that Michelle was finally sent for a magnetic resonance imaging (MRI) test, at which point her skeletal system was found to be riddled with cancer. “My spine, my shoulders, my hips—it was everywhere,” she says of the discovery of the now Stage IV cancer.

Michelle and her husband, Steve, sought treatment with John Glaspy, MD, at UCLA’s Jonsson Comprehensive Cancer Center, but Michelle was worried about his prescribed treatment. “At the time,” she says, “he was recommending chemo, radiation, and Herceptin® [trastuzumab]. I had just lost my mother to cancer, and I had seen a really bad side of it. I was beyond petrified about chemo after seeing what it had done to her.”

Michelle had also recently lost her father to a heart attack, and the combined loss, she says, left her totally bereft. “I was empty, and I was so scared of chemo.” For that reason, she says, she did not start chemo right away but instead began receiving infusions of the targeted therapy Herceptin while she tried to sort out her feelings about what the rest of her treatment would entail.

While she was making her decision, however, Michelle’s condition deteriorated to the point that she became confined to a wheelchair. “I couldn’t walk up the stairs in my own house,” she says, remembering that scary time. Michelle is the mother of two daughters, who were eight and 11 at the time, and her feelings were intensified by their reaction to her condition. They were scared, she says, but she did her best to remain focused on a positive outcome. “I kept focusing on the fact that I was going to be alright.”

More than anything, she wanted to show her girls that she could carry on and that so could they. “I think one of the greatest gifts we can give our kids is to be resilient,” she says. “If I can teach them that we can go on, that life sure can throw curves at you—which they saw when they saw me lose my mother, my father, and then during my own illness—but that you can persevere, then I feel good.”

Ultimately, it was the look in her girls’ eyes that got Michelle back to Dr. Glaspy and into the chemo chair. “Finally, I couldn’t see my kids looking at me anymore; I just had to go for the chemotherapy.” Knowing that chemo would be a tough road, Michelle gave herself a powerful incentive: she told herself and her friends that she would be out of her wheelchair and walking on the first day of school so she could walk her kids through the door. As tough as the treatment was—and the nausea, hair loss, and other side effects did hit her hard—as she started to see results she knew it was all worth it. “I started at the end of June, and in August I was walking with a walker; in September I walked into school.”

Despite the obvious improvement, Michelle’s doctors needed to be sure that Herceptin would make a difference on its own. Several months after she finished chemo, her results remained positive, and her team felt confident that the treatment was successful.

Now, three years later, Michelle continues to receive Herceptin infusions every three weeks and the hormonal treatment Faslodex® (fulvestrant) every month. “I lead a really full, great life,” she says. The side affects of her ongoing treatment, which have included allergic reactions that mimic asthmatic symptoms and a significant weight gain, are manageable, she says, because she’s so aware of the gratitude she feels and the gifts she has received. “I appreciate things in such a different way. In some ways there are really positive things that have come out of this.”

One of the really positive things to have emerged from Michelle’s journey was the opportunity to focus on what really made her happy—to realize where the value in her life lay. And it was not, she soon discovered, her career (she had worked as a singer and a stage and television actress) or any of the many other areas of her busy life that she missed. What emerged instead was the singular importance of her role as a mom and of the little, everyday expressions of that role. “I didn’t miss singing on a stage; I didn’t miss getting a paycheck. I missed packing my daughters’ lunch; I missed picking them up from school.” Along with her sadness at not being able to spend time with her kids came the revelation of all the time wasted on things that were just not important.

It was this perspective that remained after treatment and which brought Michelle, together with good friends Maria Newton and Kim Arial and her sister, Kristin Nicastro, around to what would become an expression of Michelle’s desire to give all moms a little more of what she learned was so precious: time. Maria, Kim, and Kristin had played invaluable roles during Michelle’s treatment, offering friendship, support, and inspiration when she needed it most. As Michelle recovered and they continued to come together to support her and one another in their busy lives as moms, they reflected often on the lessons of Michelle’s journey, always coming back to their desire to prioritize their time with their kids.

The four women’s ongoing conversation eventually led to a decision that would transform their coffee chats into serious business. “We were at Starbucks one day, and we thought that because as women and moms we lead very different lives from men, we needed a way to focus our lives and blend our children’s lives with ours. What our children do each day is very important—it’s part of our lives.” The idea, Michelle says, led to a prototype of a special kind of planner that would allow them to organize their busy days and highlight their kids’ activities. It helped that the foursome was filled with artistic talent and overflowing with enthusiasm: “Maria is an artist and hadn’t done anything with that in a while,” Michelle says, describing the gifts they each brought to the table. “Kristin is a graphic artist; Kim had always wanted to be involved in something like this; it just came together.” They distributed the prototypes to 25 of their friends over the busy holiday season, and the response was extremely positive. “One of our friends said it changed her life,” Michelle says.

From there Truly Mom, LLC, was off and running—a business born not of entrepreneurial aspirations but of a desire to help other women achieve a little clarity and maybe a little extra time amidst the chaos of a busy mom’s life. The company name, Michelle says, was inspired by the recurring theme of her cancer journey: think about what’s truly important; be true to your beliefs. “If you’re true to what’s important to you, everything else falls into place,” she says. And she hopes she can help other women with the same perspective she achieved without having to take the same rough road she did. “We talk about the little things a lot, but I saw it—I truly didn’t know if I was going to live one more day, and I knew what was important to me. I thought if I could let people know, without their having to go to the edge like I did, maybe I could help them.”

It’s clear already, from the success the company is seeing, that Truly Mom is helping a lot of women. In addition to the planners, the company now also produces custom stationery, note cards, and a few clothing items. But the women’s dreams for their company don’t end there. “We have huge hopes for the company,” says Michelle. “I want us to be that home base for moms. I want people to come to us for quick sanity, for healthy-living tips, for a sense of clarity. We hope to someday have a magazine and maybe a store stocked with things that would make you feel good and appreciate every second.” And because Truly Mom remains focused on the original inspiration—and Michelle’s gratitude for her health is never far from her mind—the company donates 10 percent of all proceeds across the board to UCLA’s Jonsson Comprehensive Cancer Center.

As the company grows and thrives, Michelle says, she tries hard to keep the success of the business—and its growing demands on her time—in perspective. “This is getting really big, really fast for us,” she says of the recent publicity Truly Mom has received and the growing demand for its products. “We all want to be able to practice what we preach and remain focused on why we did this in the first place.”

For Michelle that reason remains the priority of her family and the emphasis on recognizing the value in the simple, true pleasures of life. Though her girls still get scared for her, she says, she continues to emphasize their inner strength as she shows them her own amazing fortitude. “They still say, ‘I don’t want you to die.’ But I tell them, ‘You can do anything; you can handle anything.'”

And it’s clear: with a role model like Michelle, those girls will be able to handle any challenge that comes their way.