Janet Ayala was 35 when she noticed a lump in her breast while undressing for a shower in the summer of 2024. After a nurse practitioner examined her and said it was likely nothing to worry about, the practitioner still wrote a referral for a diagnostic mammogram. But Ayala had trouble making an appointment for the procedure.
“They were giving me appointments for the following year, and this was in June,” she remembered. “I called other places but the earliest I could get in anywhere was October."
Thankfully, a chance comment by a coworker about their upcoming mammogram led Ayala to try for an appointment at the same location, which she was able to secure for September.
“I went to get checked, and right away they told me it was breast cancer,” Ayala remembered. “My whole world kind of turned upside down from that moment on, because everything moved so quickly thereafter.”
Now, more than 16 months post-diagnosis with stage 2, triple-positive invasive ductal carcinoma — a common, aggressive breast cancer subtype — Ayala has completed her primary therapies at City of Hope in Duarte, California and is committed to making the most of every day.
“I feel like before I was afraid of doing things, but now I’m like, ‘What’s the worst that could happen?’ I felt like I almost died,” Ayala said. “Why not let go of that fear and just do things that make you happy? Lately, I’ve been full of inspiration, energy and fire, because I just want to keep going and continue to accomplish my dreams.”
Finding a Place of Peace
Ayala was initially diagnosed at a local medical center in the South Bay region of Los Angeles County but decided to seek a second opinion at City of Hope.
“I had heard from friends and family members about City of Hope, and they all had rave reviews,” said Ayala. “When I got there, I felt really at peace. I don’t think I could have felt that anywhere else. Right away I was like, ‘This is my place.”
Because of Ayala’s triple-positive status, meaning her cancer was fueled by estrogen receptors, progesterone receptors and the HER2 protein, her oncologist, Thanh Nga Doan, M.D., recommended a hysterectomy to stop hormone production.
“I've always wanted to be a mom, so I wanted to make sure that I had that option,” said Ayala, who has held off on the surgery so far.
Instead, she froze some of her eggs prior to starting treatment and is working closely with Dr. Doan to balance cancer care with her dreams of becoming a parent.
“While we recognized the importance of starting treatment as soon as possible, it was equally important to complete fertility preservation first so that we can preserve her future family planning goals,” said Dr. Doan, a medical oncologist who specializes in breast cancer. “We also were able to employ strategies for ovarian protection during chemotherapy as well. We must not forget that after these crucial lifesaving treatments, there is a cancer-free future that can be permanently affected by treatments.”
Once her eggs were harvested, Ayala underwent six rounds of chemotherapy and had a single mastectomy of her left breast. She also received targeted therapies to address her subtype of cancer and is currently on medications to suppress estrogen. Genetic testing revealed that she has an ATM gene mutation, which puts carriers at a higher risk for breast and other cancers, so Ayala and Dr. Doan are also considering treatments to help prevent future disease.
“Thankfully, Janet has successfully completed her neoadjuvant targeted therapy with chemotherapy and achieved complete pathologic response,” Dr. Doan said. “Now over a year later, Janet has also completed her HER2-targeted infusion therapies, and we are focusing on tailoring additional endocrine and targeted therapy to further decrease her risk of recurrence in the context of her ATM mutation. Through this all, although never easy, she remains positive and optimistic which truly made caring for her so rewarding.”
A New Normal
Ayala credits a lot of her positivity to the care she received at City of Hope from Dr. Doan and her entire care team.
“All my doctors had my best interest in mind, and they didn't minimize what I was going through,” Ayala said. “These people will hold your hand and will walk you through it all. I am so thankful for the compassion, the care and the hugs I received while I went through some of the most challenging days of my life. City of Hope will forever hold a special place in my heart.”
She says that integrative therapies offered at The Cherng Family Center for Integrative Oncology at City of Hope were also integral to her recovery. Among the many offerings, she participated in music therapy, group drumming, group painting, meditation, acupuncture and massage. In addition, Ayala is part of City of Hope's Childhood, Adolescent, and Young Adult (AYA) Cancer Survivorship Program that offers psychosocial support and resources to patients under 40.
“All of that healed me and got to me to where I am today,” she said. “Being part of these groups, I felt seen, I felt heard, I felt understood.”
But despite getting through chemotherapy and finding resources to help her heal, Ayala says many challenges remain.
“Survivorship is actually pretty tough,” she said. “I think it’s more challenging now than it was before because with treatments, we know an end date, whereas now, it’s like, this is my life and I need to find a new normal.”
Due to having a hormone receptor-positive breast cancer, Ayala is on medicated menopause to reduce the risk of recurrence. The lack of estrogen comes with many side effects including hot flashes, fatigue, joint pain, mood changes and bone density loss.
“I didn’t realize how important hormones were until I didn’t have them,” confessed Ayala, who was referred to Linda Bosserman, M.D., Ph.D., a medical oncologist at City of Hope who has studied hormones in cancer patients for more than a decade. “My life after seeing Dr. Bosserman has changed completely! She reassured me that the low dose hormones she quicky prescribed me were safe, even for hormone positive breast cancer survivors, and they have been game changers.”
Ayala says she no longer suffers from dark moods and her hot flashes have diminished. While she still gets joint pain occasionally, she’s learned to manage it by exercising regularly.
“My new normal includes exercising, eating a healthy balanced diet and removing endocrine disruptors in home care and beauty products,” Ayala said.
Beyond the physical struggles, cancer also took a toll on her personal life; Ayala ended an engagement while going through treatment. Luckily, she had others to lean on and now sees the breakup as a lesson for others who might experience something similar during illness.
“I’m so much happier on my own,” she said. “As long as you have your family and friends, you don’t necessarily need someone like a partner. I feel extremely optimistic that I’ll find a partner that will love me for all of me, including my battle scars from this journey.”
Living with Less Fear
Life has thrown a lot of hardships at Ayala in the past two years, but she’s grateful for how they have altered her outlook.
“My life perspective has changed completely; I honestly see life with more color these days,” Ayala said. “I wish I could tell my younger self, ‘The reward you get at the very end is worth the struggle. You will live life with less fear and chase your dreams like never before.’”
To chase those dreams, Ayala created a bucket list and has been busy checking things off. She traveled to Spain by herself and is attending more concerts. She bought a house and has spent time volunteering.
“Another one of my dreams is to open up a nonprofit one day,” Ayala said. “Giving back has always been a passion of mine, even before the whole cancer thing.”
In the meantime, she is already helping others by participating in research related to the ATM gene mutation she carries and is dedicated to building connections by sharing her story. She wants others to know that there is light at the end of the tunnel.
“Cancer feels extremely isolating, especially at a young age, but connection is key; connection truly heals,” Ayala said. “I will continue to rave about the care that I received at City of Hope and let others know that there is hope that we can all heal. I will do whatever I can to spread the word about early detection and to lean in and be the support for others as they go through their journey. No one fights alone.”
If you or a loved one is concerned about possible signs or symptoms of cancer and would like an initial appointment or a second opinion, call us 24/7 at (833) 902-5220.