Decision-making for treatment and thriving: Gillian Lichota
After three years of enduring infertility therapies and a second-trimester miscarriage, Gillian Lichota sat in her OB-GYN’s office and heard the news she had been hoping for – she was nine weeks pregnant. On the same day, an ultrasound of a mass in one breast showed she also had breast cancer. A biopsy later confirmed that finding.
An oncologist then told Gillian she had Stage III breast cancer and would need to assemble her own team of doctors to develop a treatment plan. He strongly recommended she terminate the pregnancy. Gillian was in her first trimester, when chemotherapy can harm the fetus or cause miscarriage.
“I remember being in that room, next to my husband, and feeling like I was having an out-of-body experience,” says Gillian, who was 35 years old at the time. “I was just completely overwhelmed and in disbelief.”
While most breast lumps found during pregnancy aren’t cancerous, one in 3,000 pregnancies happens in women with breast cancer. Being diagnosed while pregnant can multiply anxieties about choosing the types and timing of treatments, as well as affecting other decisions and plans for the future.
In the 10 years after her initial diagnosis during pregnancy with her first child, including the birth of her second child and a metastatic recurrence, Gillian has faced decision-making challenges about treatment, career, parenthood, and more. She was once a working marine biologist. Now she is founder and CEO of the iRise Above Foundation, which provides health and wellness tools – programs, free webinars, outdoor adventures, and retreats – to women in their 20s through 40s, so they can rise above breast cancer’s effects and live well.
Gillian spoke with LBBC contributor Robin Warshaw about what has helped her navigate difficult decision-making since diagnosis.
Robin: That first oncologist didn’t seem to spend much time talking with and listening to you.
Gillian: To be honest, I can’t even remember his name. But I was really fortunate. My husband is a former professional hockey player and runs hockey schools where a lot of physicians send their kids. One was at a teaching hospital and assisted me in assembling a team of surgeons and oncologists. They talked with me about everything in my different options.
Because I had lost a pregnancy before, I had a high risk of losing this pregnancy as well. The options they discussed were I could terminate the pregnancy and begin treatment, or I could have surgery first, using an anesthesia technique that had low impact on the fetus, and then start chemotherapy at the 20-week point in my pregnancy. If I didn’t want option one or two, I could wait for treatment until after delivery—but with my breast cancer I was running a risk of becoming metastatic quickly.
I so wanted to be a mother, it wasn’t an option for me to abort the pregnancy. My husband supported whatever I wanted to do. Three years of dealing with fertility was a long journey, and I wanted to give it a go. I felt reassured in moving forward that they would have success with the second option (surgery first/chemo at 20 weeks).
Robin: How did you balance the elements of making that decision?
Gillian: I'm a big believer in “Lead with your head but follow your heart.” I carefully considered everything in front of me and asked myself, if I made various choices, what would I feel? I tried to imagine a life where I didn't have children. It was something I so badly wanted to share with my husband, I think I would have regretted that choice. I also felt strongly I could challenge a prognosis that was based on staging and first-line treatment only.
And I didn't want an outcome where I delayed treatment and cancer made me so sick that soon after my child was born, I died. For me, the best option was number two. I'm a scientist so I did read medical guidance, and it felt good to me all around. I've never regretted that decision. I have two beautiful children.
Robin: As your pregnancy and treatment progressed, how were you feeling?
Gillian: I was terrified. There was 11 days from finding out I had breast cancer to when I went under the knife. That's not very much time to process anything. You're literally in survival mode, going from one thing to the next.
I felt like I was in this deep valley of darkness. It seemed like a very long time until my child would be born. I thought, “How am I ever going to get through this?” As I was being wheeled into surgery, my nurse navigator said, “One breath at a time. You got this.”
I woke up thinking, “What am I going to do when this is over? How am I going to live again and reclaim my happiness?”
Robin: After delivering a healthy baby and finishing treatment, you decided to climb a mountain. That’s something many people would mean figuratively after cancer treatment, but you meant it literally. Why?
Gillian: Those who know me well know that I love adventure. That's where I thrive and feel most alive. I love being in nature. I love hiking. And I love climbing. After facing the possibility of death, I just set my goal. I said, “I'm going to do this and it's going to be very cathartic. It will be my way of closing one chapter and opening another.”
Also, having breast cancer is a very eroding experience. Breast cancer happened to me, but did not define me. I needed to reclaim my power and climb for all those who could not. I decided to climb a mountain to honor the lives of all women affected by breast cancer and those who lost their lives to the disease.
When I told my doctor that I decided to climb Mount Kilimanjaro, I think she thought I was just saying “I'm gonna climb a mountain.” At my six-month checkup after that, I showed her pictures from the expedition. She couldn't believe it. Prior to the climb, I reclaimed my health with the help of body movement and yoga practitioners, mindfulness and meditation coaches, nutritionists, as well as positive psychology and functional medicine coaches.
She asked if she could put me in contact with other young women in her clinic who were struggling emotionally. Five women reached out to me. They said, “How did you do that? I want to do that. Can you help me do that?” That’s when the idea of the iRise Above Foundation planted in my head. It didn’t have a name. It was something I wanted to do, but I was working full-time and a full-time mom. But I kept in contact with those women, some of whom have completed our programs and adventures.
Robin: Five years later, you received a metastatic diagnosis. What decision-making did that lead to?
Gillian: I was in a pretty dark place for about three weeks after getting the diagnosis. I couldn't focus, sleep, or eat. I felt paralyzed, not in control of my future. It wasn’t like me to act like that. I think I gave myself permission just to feel and be in that uncomfortable space, because I knew it was going to be temporary and there was a lesson to be learned. Somewhere in there I knew it was emotions and they come and go, and that no matter what I would be okay.
A breast cancer diagnosis is like the grief of losing somebody you love. It’s losing a sense of self, because there are all these changes in what you thought life was going to be.
A friend invited me to go swimming, one of my favorite sports. At first, I said no. Then I remember closing my eyes, taking a deep breath, and going. I took all my feelings, my aggression, my uncertainty, my sadness, my fears out in the pool. Breathing is meditative and such an important part of swimming, it just calmed me. I came out of the pool and thought to myself, “I got this!”
Just because I have a breast cancer diagnosis doesn't mean I'm gonna live any longer or less than my neighbor. It’s about how you approach life, the decisions you make about how you live, who you spend your time with, what you put in your body. The greatest gift you can give to yourself and others is time, to be fully present, and follow your passion and purpose. If I'm not giving myself time, self-love, self-acceptance, self-compassion, and space to be healthy, then I won't be able to achieve any of the other things I want to do.
Robin: Did earlier life experiences affect your decision-making?
Gillian: I grew up in an environment that wasn't healthy. My mother was bipolar and very abusive, and my father suffered from alcohol use disorder. I went through years of therapy to work through a lot of that. Those are things that happened to me. They weren't in my control, and they don't define me.
I see breast cancer as being very much like that. It happened to me, but doesn't define me. The experience can break me down and defeat me or I can use it as a transformative process, a tool for good in my life. I use it as a tool to be a better parent for myself and to have more empathy and acceptance of others and myself.
Robin: Was the decision clear-cut to leave your job and start the Foundation after your metastatic diagnosis?
Gillian: Very clear cut. I was in a stressful work environment with a lot of demands on my time. It has been a financial change for our family. I had a very good career. I made a good income and provided benefits for the family. That was the biggest change and scariest thing.
After I went to the pool the day my friend invited me, I came home with a big smile on my face. My path forward was clear. I told my husband, “I'm gonna start that foundation. I'm not going back to work because I feel I can make a huge impact by empowering young women to cultivate an outstanding quality of life, during and after breast cancer. I'm really passionate about it.”
What we do has the power to influence our wellness. I can live a healthier life and challenge my prognosis.
This article was supported by the Grant or Cooperative Agreement Number 1 U58DP006672, funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services.