The Mental Game – Approaching Breast Cancer with 40 Years of Experience
- Surviving Breast Cancer
- Mar 6
- 6 min read
By Joelle Kaufman
Growing up, vigilance against cancer shaped my life. My mother battled breast cancer at thirty-six and again at thirty-eight, and her experiences cast a long shadow. Every doctor wanted to know about my early onset family history and ensure I was educated on self-examination. From age thirty-three, my frequent visits to the Mills-Peninsula Women’s Center for mammograms, ultrasounds, and MRIs became a running joke; if loyalty programs existed for imaging centers, I’d be at their highest tier.
Yet nothing can prepare you for the gut punch of hearing a doctor say, “I'm sorry, you have breast cancer.” Your world stops spinning at that moment, and you’re left gasping for breath, desperate for a lifeline.
Because of my mother and sister’s breast cancers, I was regularly screened every six months alternating between a mammogram plus ultrasound with bilateral MRI with contrast. All three of us were found to have the BRCA1 genetic mutation. Out of an abundance of caution, given the combination of our history and genetics, I had multiple biopsies any time the scans showed anything irregular. I had considered having preventative (prophylactic) mastectomies with every biopsy.
In 2022, I decided to move forward with the surgery to radically reduce the possibility of breast cancer. I scheduled my bilateral mastectomies with DIEP flap reconstruction surgery for January 10, 2023. As part of the standard practice preceding a prophylactic mastectomy, I was asked to have a mammogram and ultrasound. The escalation to an MRI was not unusual for me. When my medical team said they needed to biopsy an area, I pushed to have the biopsy and results prior to the surgery to keep my 10 to 14-hour procedure including reconstruction on track. Dr. Lee Char called with the biopsy results on January 9, 2023 while I was on a Zoom call. Excusing myself, I took the call, still expecting I’d proceed with the prophylactic bilateral mastectomy planned for the next day.
“I’m so sorry,” she said, “it’s malignant.”
Breathe, I told myself. Stay calm. I planned to remove my breasts the next day—cancer had won this inning, but I was still in control of the game. “So we do the surgery tomorrow, and then what?” I asked.
“I’m sorry, Joelle,” she replied. “We can’t proceed with surgery. With your tumor pathology, the standard of care is chemotherapy before surgery. Your oncologist will explain.”
I felt sucker punched. My plan to avoid cancer had failed, and now I was facing chemotherapy. My mother’s chemo 40 years earlier and my sister’s chemo 20 years prior flooded my memory. I was committed to shaping a different experience as I faced cancer.
Batting Rituals
One of my tactics to face the speed and shape of cancer’s curveballs was to adopt a set of regular rituals and routines that I named “happiness tripwires.” These transformed the weekly cancer treatments into experiences with positive associations. I renamed infusion days as Cancer Obliteration Days. Cancer obliteration days were five and a half hours long, not including travel, as I used cold-capping to preserve my thick, iconic hair.
Every chemo day began with washing my hair. As part of my cold-capping protocol, I could only wash my hair once a week. That weekly shower, with water running over my scalp, was a self-care ritual that set the tone for the day. Afterward, I chose comfy, loose-fitting clothes and packed slippers for the infusion center. My go-bag contained comforting items like my binder with my notes, drug and side effect print-outs, letters from my son, transliteration of prayers, and other paperwork, iPad, aromatherapy oils, and a stuffed dinosaur named Stego.
With permission from my oncology team, I drank Athletic Greens for nutrients. I continued exercising five days a week, alternating between weightlifting, metabolic conditioning, and walking with my best friend, Jessica. These activities strengthened my body and kept me grounded. There’s growing evidence that regular exercise can reduce chemotherapy side effects.
Breakfast was fuel: pastured eggs with spinach, onions, and peppers paired with a glass of water. My ride to the center doubled as a social visit with a friend. Arriving early to the hospital ensured my labs were done promptly, speeding up the infusion process. After labs, I’d read a weekly letter from my son, Taylor. Away at college, he described his days and baseball games. These letters reminded me to focus on the joy of my children’s lives. My other collegiate son, Ben, provided the musical playlist for my obliteration day.
During the infusion, my rituals kept me centered. My rabbi had compiled a playlist of prayers and songs, which I’d listen to while reading my binder of personal prayers. Humor was essential—jokes with staff, funny emails from friends, and even Stego’s antics lightened the mood. These routines, paired with micro-milestones and celebrations, helped me maintain a positive mindset and broke up the monotony.
Survivorship: A New Chapter
Four months later than I had originally planned, I had the 14-hour bilateral mastectomy and DIEP flap reconstruction. Prior to the surgery, my oncologist had confirmed through a fine needle biopsy that I was clinically cancer-free, but nothing is 100% certain until the pathology is confirmed after surgery. My pathological complete response (PCR) didn’t reach me until I was back at the infusion center for immunotherapy after surgery and the nurse incorrectly suggested that I was starting Adriamycin (AC) chemotherapy. When I was surprised and resistant, a flurry of activity led the team to discover I was cancer-free but no one had told me! No AC needed, thankfully.
When I received the news that I was cancer-free, I felt massive relief and joy. But what followed was a void. The center of my universe was no longer UCSF, cancer treatment, and surgeries. The gravitational pull of cancer was lifted, leaving me in a space of not-knowing as my body used its energy to heal and my mind processed WTF just happened. Despite feeling profoundly grateful and healthy, it was not how I thought I would spend my time on this planet.
My sister, a two-time survivor, shared the sentiment: “People expect to feel relieved at the end of their cancer journey or treatment. And so I think I was surprised when I didn’t. The doctors tell you that you are healthy. Don’t smoke. Exercise regularly. Good luck to you. Which, after being in the thick of the fight, feels like a little bit of a letdown.”
The void left by cancer felt peculiar. I recognized cancer itself lacked inherent meaning—it was merely an occurrence in my life. While there were aspects of the healthcare system I’d like to enhance, I was grateful for the remarkable advancements in treatment and side effect management. My journey starkly contrasted with those of my mother and sister.
I paused within this vacuum to dwell in the space where there was neither urgency to propel forward nor battles to be fought. At the same time, my body recovered while my mind reset. Remarkably, within this calm, new possibilities began to form. I realized I needed to drift a while before charging on to the new course ahead.
Crossing into survivorship was a profound transition. With my pledge year to the survivor sorority complete, I was now an official member of this resilient fraternity. When the phone rings or email dings, I offer reassurance, a calm ear, and friendship to anyone reeling from a diagnosis. Surprisingly, the journey with cancer is interspersed with moments of joy, sprouting in response to struggles. The familiar faces and new ones around me fortified me with love, prayers, and humor.
As I peer into the future, I’m intrigued by the opportunities that might unfold and what I might conceive in my subsequent chapter. So far, it’s been a journey of profound gratification. I wish you such a journey.
Lessons Learned
Uplift yourself with humor. A funny friend, a daily joke app, or lighthearted stories can provide much-needed relief.
Create meaningful rituals. Infusion-day “happiness tripwires” that bring comfort and joy can transform the experience. Create new rituals for survivorship – gratitude is excellent.
Prepare your home. Post-treatment, create a space to relax and recover, respecting your need for peace. In survivorship, your home may reflect new directions and interests – or not. It’s up to you.
Celebrate milestones. Micro-celebrations break up the journey and provide moments of joy. Celebrate milestones of survivorship, too.
Welcome support. Let others help you. Their love and care can lighten the load.
ABOUT THE AUTHOR
Joelle Kaufman is the author of Crushing the Cancer Curveball: A Playbook for the Newly Diagnosed, their Family And Friends. Her life has been shaped by breast cancer since age 13, culminating in her own 2023 diagnosis—the fourth in her immediate family. As CEO and Founder of GTM Flow, she combines cancer-forged resilience with cutting-edge go-to-market leadership strategies. Joelle’s expertise spans healthcare and business, earning her positions on the UCSF Patient Experience Council and the Advisory Board of USC’s The Pink Test. Her insights have been featured in the New York Times, Wall Street Journal, and Fortune Magazine. You can learn more at www.joellekaufman.com.
Read More:
On the Podcast: Breast Cancer Conversations
Breast Reconstruction and Plastic Surgery Explained
Share your story, poetry, or art:
SurvivingBreastCancer.org Resources & Support:
