For Janet Ayala, facing breast cancer in her 30s has given her the courage to chase her dreams and build a new life. She finished primary treatment for Stage 2, triple-positive invasive ductal carcinoma — a common, aggressive breast cancer subtype — in early 2025 and rang the bell at City of Hope Los Angeles not once, but twice.
"I rang the bell first initially after I completed my last chemo, and that was a huge accomplishment for me because it meant that my body could tolerate all this toxic medication," said Ayala, noting she rang it again after 11 more rounds of targeted therapy for a total of 17 total. "I felt a sense of completion and the start of a new chapter."
Now, more than two years after her diagnosis, Ayala hasn't stopped celebrating her health and embracing an outlook that has changed her life for the better.
“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.’”
But ringing the bell to signify major milestones in cancer treatment, such as finishing chemotherapy, can bring up a range of emotions. For Ayala, the occasion brought both immense joy and a bit of sorrow for a very sweet reason.
"My whole family was there to support me, and I couldn't have been happier," she explained. "The nurses were also there cheering me on, and I also felt sad that I wouldn't be seeing them as often because at the hospital. I just feel a sense of warmness in my heart because everybody's so caring."
A World Turned Upside Down
Ayala first noticed a lump in her breast while undressing for a shower in the summer of 2024. She was just 35 years old. After a nurse practitioner examined her and said it was likely nothing to worry about, Ayala was still given 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.”
She 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 before starting treatment and worked closely with Dr. Doan to balance cancer care with her dreams of becoming a parent.
"This isn't how I would have imagined it, but I think it's still possible for me," Ayala said. "And if I can't do it myself, I can adopt."
Dr. Doan, a medical oncologist who specializes in breast cancer, recognizes the importance of preserving patients’ future family planning goals. "We must not forget that after these crucial lifesaving treatments, there is a cancer-free future that can be permanently affected by treatments," she said.
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. “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, which offers psychosocial support and resources to patients under 40.
“All of that healed me and got 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 initially found it very challenging to navigate survivorship without any estrogen in her body. 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. Dr. Bosserman discussed treatment options tailored to Ayala’s symptoms and cancer history.
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.
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.
“Before, I was afraid to take chances because I was always worried about what could go wrong. Now I think, ‘What’s the worst that could happen?’” Ayala said. “I’ve already faced one of the hardest things imaginable, and it changed the way I see life. I don’t want fear to hold me back anymore. I want to do the things that make me happy. I feel inspired, energized and more determined than ever to keep moving forward and accomplish my dreams.”
She has created a bucket list and has been busy checking things off, including a recent trip to Portugal. Ayala is also attending more concerts, preparing for another round of egg freezing and focused on more quality time with family and friends.
"I celebrate connections more than anything," Ayala said. "What got me feeling better was the connections that I built throughout my journey."
Ayala is still active in the AYA program, where she built friendships that are "forever.” She also participates in Living Beauty Cancer Foundation, an organization that brings together young women who have or have had cancer for fun social events. She has also worked to adjust her work-life balance and joined an impact committee at her job that aims to give back to others in need.
“Another one of my dreams is to open up a nonprofit one day, and this new role that I'm taking at work is allowing me to get closer to that goal,” 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 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.