Juggling motherhood and breast cancer, Long Island women face impossible decisions

Kristen Toffales, 28 weeks pregnant with her first child, sat in her car outside her oncologist's office in Port Jefferson Station, gripping her steering wheel. Her baby kicking inside her reminded her to breathe as she had what she called "a full-on panic attack."

Her doctor had just told her she was to have one round of chemotherapy to try to stop breast cancer from spreading inside her so they could get the baby to 37 weeks gestation and deliver early.

"The concept of having chemotherapy while pregnant was horrendous to me," says Toffales, now 37 and a Realtor from Port Jefferson. 

That day last year wasn't the first time during her cancer journey that Toffales thought: "I'm pregnant. This can't be happening."

But it can.

Breast cancer is the most common cancer found during pregnancy, according to the Breast Cancer Research Foundation, and it's also more complicated to detect during this time. In general, pregnant women are diagnosed with cancer during 1 in 3,000 pregnancies, says Dr. Ruby Sharma, medical director of the Center for Cancer, Pregnancy and Reproduction at the Northwell Health Cancer Institute.

The number of women experiencing breast cancer during pregnancy has been rising because the number of women experiencing childbirth in their 30s and older is also rising, Sharma says. According to a recent report from the Centers for Disease Control and Prevention, 27,136 new cases of breast cancer in women under age 45 were reported in the United States in 2022. The incidence of breast cancer balloons with age — at 25 to 30, the incidence is 10 in 100,000 women, but it increases sharply in the mid-40s, to 125 in 100,000, Sharma says. "That’s why we are seeing more women getting cancer during pregnancy," she says.

Fortunately, while it’s complicated, women can typically be treated during their second and third trimesters without harming the baby, Sharma says. "When I tell them we are not talking about terminating at all, they take such a deep breath, deep sigh of relief," she says. "That discussion relieves half of the anxiety. ‘OK, I’m not losing my baby.’ "

Diagnosis while pregnant, during breastfeeding or postpartum can have its own emotional and physical challenges. Here are the stories of Toffales and three other Long Island women who juggled motherhood while fighting cancer.

'I couldn't even hold the baby'

On the day after Christmas in 2023, Toffales was standing at her mother's kitchen counter in Port Jefferson with her mother and Toffales’ best friend. Toffales was just moving into her third trimester.

"Feel this cyst. It's enormous!" she said to the women. Toffales, then 36, wasn’t alarmed, just amazed. She had a history of benign breast cysts, and now she thought she had one that felt like it was size of a strawberry in the top right breast along her bra line. What followed was a biopsy that confirmed breast cancer.

Her baby, Noelle, was delivered by a scheduled cesarean section early, at 5 pounds 11 ounces in March of last year. "She was perfect," Toffales says. Toffales was unable to breastfeed, but the New York Milk Bank and other mothers donated breast milk so Noelle could have it through 4 months old.

The first year of her newborn's life is a blur, Toffales says. "I don't remember a lot of it, and that bothers me very much," she says. "I couldn't even hold the baby. My mom put pillows around me so I could hold her." Her mother and, of course, Toffales' husband, Anthony Karperis, now 37, a personal trainer, cared for Noelle when needed through Toffales’ last round of chemo in July 2024, which was followed by a double mastectomy the next month.

I don't remember a lot of it, and that bothers me very much. I couldn't even hold the baby.

— Kristen Toffales

Toffales had no time to go through egg retrieval to preserve her fertility before her cancer treatment, so she won’t have more biological children.

Toffales is now cancer-free and starting to feel "normal," she says. 

'I thought I had a clogged milk duct'

Lisa Aquino had never imagined that breast cancer could manifest itself in an armpit.

Aquino, 40, a lawyer from South Huntington, was still breastfeeding her baby, Jack, when she felt the bump. "I thought I had a clogged milk duct under my right arm," Aquino says.

When it didn’t go away, she insisted her doctor send her for an ultrasound even though the doctor also thought it was likely a clogged duct or even mastitis, an inflammation of the breast tissue that can be caused by an infection. 

At the ultrasound appointment, Aquino could see something on the screen. "I said, ‘Is that a tumor?’ She said, ‘No, those are your lymph nodes.’ " Aquino was told she could just come back in six months to see if the lymph node swelling had resolved. She asked for alternatives. "I was actually proud of myself for speaking up. The radiologist kind of rolled his eyes and said, ‘We could do a biopsy, but I think it’s a total waste of time.’ "

It wasn’t.

The pathology results showed malignancy, that breast cancer had spread to her lymph nodes. That was in December 2021, when Aquino was 36. 

"I was just like, ‘Get this out of my body right now.’ I have two young children. My daughter had just turned 5. My son wasn’t even 1 yet. As a mother, when you get that kind of diagnosis, the very first thing you think about is your children. For me, that was the only focus: I’m not ready to leave them."

She first had 16 rounds of chemo, once a week for about four months, which she completed in May 2022.

As soon as she started that treatment, she had to stop breastfeeding so the cancer-fighting drugs wouldn’t pass to Jack through her breast milk. "That was stripped away. He had to quit cold turkey, which was hard for him," Aquino says.

Aquino and her husband, Jason, now 40, who works in accounting, didn’t share many details with their daughter. When Aquino’s hair fell out from chemo, "I told her I got a really bad haircut, and it was going to grow back."

Aquino has had no evidence of disease since June 2022. She had her double mastectomy that summer, and in March 2023 she received breast implants. She also had to do radiation treatments and have immunotherapy infusions to help prevent a cancer recurrence. She’s still on other oral maintenance medication.

She initially missed many of her daughter Aria’s dance classes or school functions. "I felt like that time was being robbed from me," Aquino says. "This was supposed to be the best time in my life."

Aquino says she’s making up for the lost time now. "Every school play, every book fair, I’m volunteering at," she says.

As a parent, and as any kind of survivor, you have the constant worry that it’s going to come back.

— Lisa Aquino

"As a parent, and as any kind of survivor, you have the constant worry that it’s going to come back," Aquino says. "In the beginning, I couldn’t sleep, I couldn’t eat. I was talking to therapists about these feelings that every ache or pain in any part of my body was cancer coming back. It dissipates with time."

'Everything was stripped from me'

Krystina Buksa didn’t feel a lump — she saw one.

Getting out of the shower, drying off with a towel, she saw in the mirror a bulge near her collarbone in December. "It was like you put a frozen pea under my skin. It literally popped overnight," says Buksa, 36.

Her son, Eli, was just 6 months old. Buksa, who lives in Islip, had just returned from maternity leave to her job as a middle school special education teacher in Queens when she had to stop working again to get 16 rounds of chemotherapy, followed by a double mastectomy.

She learned — which she hadn’t known before — that she had the BRCA1 gene, which predisposed her genetically to breast and other cancers. "I never thought I was going to die because they kept repeating it was so early," she says.

Still, she had to face some harsh realities. "Your breastfeeding journey is done," she says, because the drugs can pass through the breast milk. "Your eggs are done," she says, alluding to how chemo can negatively affect a woman’s fertility. "Everything was stripped from me so quickly. Breastfeeding. My job. My ability to have more children."

Everything was stripped from me so quickly. Breastfeeding. My job. My ability to have more children.

— Krystina Buksa

Buksa had wanted four children and says now she and her husband, Ken, 32, a project manager, will be fortunate to have one more, which may need to happen through a gestational carrier or adoption. "What breaks my heart is my son not having a sibling," she says.

Buksa was afraid Eli wouldn’t recognize her without her hair, or that he would be scared of her, but that didn’t happen, even when she wasn’t wearing her wig. He’d want "Mommy!" no matter how sick she was, she says. "Every day my No. 1 priority was getting out of bed and being with him," she says.

'I didn’t want to miss any part of their life'

During Kate Brennan's breast cancer treatments, she wore a stack of bracelets on her right wrist that people gave her or made for her, including beaded ones that said "Strength" or "You got this" or, simply, "Mom."

"One of the favorite gifts I received, and love giving to other people, is a bracelet with holy water from Lourdes, France," says Brennan, 42, displaying the bracelet with a cross as she sat in her Garden City living room, with a toddler-size plastic basketball hoop nearby. The water is said to have healing power due to the alleged sighting of the Virgin Mary in the town in the 1800s.

The bracelets helped Brennan cope with what she called the hardest part of being diagnosed as the mother of four children younger than 10: the doctor telling her she had to have chemo. "When he said, ‘I’m sorry to tell you,’ I fell to the floor," Brennan says.

When [the doctor] said, 'I'm sorry to tell you,' I fell to the floor.

— Kate Brennan

She didn’t want her hair to fall out; she didn’t want to look like a cancer patient to her children, she says. "I didn’t want them to see me as sick or see people having pity on me. I didn’t want them to be nervous," she says.

Brennan and her husband, Kevin, 44, who works in finance, are the parents of Izzy, 11, Summer, 9, Mary-Claire, 5, and Beau, 2. "I didn’t want to miss any part of their life. You spend a lot of time in bed. We moved a TV into our room. ‘Let’s find a movie we love and watch a movie together in bed.’ "

Before her diagnosis, Brennan co-coached her oldest daughter’s lacrosse team. As soon as she finished chemotherapy treatments in January, she and her co-coach launched a program called Neon Lacrosse, offering lacrosse clinics and events for girls. "We have a lemon in our logo," Brennan says. "Life is going to give you lemons. You have to crush them and make lemonade. It just felt like an opportunity to encourage these girls to be competent and lift them up. I wanted to be one of the positive motivations in their lives."

Her advice to young mothers with breast cancer: Let others help. "It’s very raw and vulnerable to let people in," Brennan says. But when you do? "You are going to see that there is beauty in these really dark moments."