Two years after she learned she had breast cancer, Amber Derrick Schoeller can laugh about the day it was diagnosed: Saint Patrick’s Day, 2023.
She was 37 years old.
“My dad calls me lucky now,” said Schoeller, now 39. “It’s a big joke! He’ll say, ‘hey, Amber, can you go get me a scratch ticket?’ ”
That is now. But what followed her diagnosis was a course of treatment that devastated not only her body but her mind — and drew her husband and family into a crisis that at times seemed it would end with Schoeller’s death.
“I had 20 rounds of chemotherapy, the first four being double doses, and we had to start immediately,” she told Ocean State Stories. “My cancer was so aggressive, it had reached my lymph nodes and the tumor was massive. I believe they started pumping me with that poison only days after the biopsy to make sure they could shrink it while I was still at stage 3. It was a very aggressive cancer.
“After five months of chemo, we were able to remove the cancer and remove cancerous lymph nodes via bilateral mastectomy. Then we had to start radiation. My doctors were still worried about leftover cancer so I had to have 20 rounds of that, as well, five days a week, four weeks in a row. Sadly, because my breast cancer was on the left side my heart was exposed to radiation damage more than if I had had it on the right side.
“As someone who also had asthma, the radiation damaged my already weakened lungs making it very, very hard to breathe and walk for a year. Even standing at the sink washing my face was difficult. I was living like an elderly person in assisted living but it was just me at home alone all day.”
Depression set in and for many days, sometimes weeks, Schoeller did not leave her bed.
“I didn’t feel worthy of talking to anyone or being seen by anyone,” she recalled. “I just felt like damaged goods — like ‘there’s no coming back from this, I’ll never be the bubbly, happy girl that I was.’ Cancer really changes you. And I didn’t know who I was anymore.”
According to a study released in January by the American Cancer Society, the incidence of breast cancer in American women under the age of 50 has increased by 1.4% annually since the mid-2000s, compared to a 0.7% rise in women 50 and older.
“Breast cancer incidence continued an upward trend,” the Cancer Society reported, “rising by 1% annually during 2012–2021, largely confined to localized-stage and hormone receptor-positive disease.
“A steeper increase in women younger than 50 years (1.4% annually) versus 50 years and older (0.7%) overall was only significant among White women. Asian American/Pacific Islander women had the fastest increase in both age groups (2.7% and 2.5% per year, respectively).”
In Rhode Island, Non-Hispanic white women made up the great majority of females of all ages newly diagnosed with breast cancer from 2011 through 2020, the latest year for which data is available, according to the Rhode Island Department of Health; that was 8,268 new cases or 87%. Next was Hispanic women, with 597 new cases, 6%; followed by Non-Hispanic Black women, 353 new cases, 4%; Non-Hispanic Asian or Pacific Islander women, 153 new cases, 2%; and Non-Hispanic American Indian or Alaska Native, 35 new cases, or less than 1%.
Of all these groups, 780 women were 20 to 49 years old out of a total of 4,875 diagnoses during the period from 2016 to 2020, according to the Health Department. The greatest number, 1,744, were aged 50 to 64, with 1,329 aged 65 to 74, and 1,022 aged 75 or older.
Breast cancer mortality also varied by race, the Health Department reported, writing that “the number of deaths from breast cancer among non-Hispanic White women declined from 2000-2010 to 2011-2020; deaths from breast cancer among non-Hispanic Black, non-Hispanic Asian or Pacific Islander, and Hispanic women slightly increased during these years.”
In an email interview with Ocean State Stories, Dr. Ashley R. Stuckey, a gynecologic oncologist and breast surgeon at Care New England’s Women & Infants Hospital who also has an affiliation with The Warren Alpert Medical School of Brown University, broke down some of these statistics.
The increase in breast cancers in women under 50, she said, is “likely due in part to increased excess body weight, later age at first birth, and decreased number of childbirths all of which are known risk factors for breast cancer.”
Regarding mortality, Stuckey said: “African-American women have a higher mortality due to breast cancer even though they have a lower incidence of breast cancer. The reasons are probably multifactorial: They often have triple-negative breast cancers, which have a worse prognosis, and it has been suggested that they have decreased access to screening and care.
“Disparities exist in the populations of women enrolled in research trials. If we can improve racial diversity in breast cancer research trials, this will hopefully improve outcomes among such populations.”
The American Cancer Society report found that Rhode Island had America’s second lowest rate of mortality from 2018 through 2022 – and the highest rate of “mammography prevalence in women over 40 in 2021 and 2022. Stuckey told Ocean State Stories that there could be a correlation between these two data points.
Mammography, she wrote, is “the gold standard for breast cancer screening. It is the only imaging technique that has been shown to decrease breast cancer mortality. The high rates of mammography being performed in Rhode Island may correlate to the higher rates of breast cancer that are being identified (the more one screens, the more one will find). Furthermore, mammographic screening detects cancers at early stages which likely correlates to the lower rates of mortality from breast cancer we are seeing in Rhode Island.”
During the summer of 2023, Katy Gibbins landed what she describes as her “dream job”: principal of the Joseph H. Gaudet Middle School in Middletown. And there was more to celebrate: Before the school year started, she and her husband hosted a birthday party for their young son.
“It was one of those really hot August days,” she recalled. “After everyone left our house, I went to take a shower since it was so hot and I noticed that I had a huge amount of swelling in one breast, and it wasn’t normal looking. That is where I became really concerned.”
Gibbins was 39.
Her mother, a retired certified nurse midwife, “recommended that I reach out to my primary care physician immediately,” Gibbins told Ocean State Stories. “I did but they were not able to schedule an appointment for me until about three months later. My mom naturally has some connections in the field and was able to have a friend reach out to a friend and I was then seen” by an obstetrician-gynecologist. That doctor recommended an ultrasound and mammogram the next day.
“It was a very long appointment,” Gibbins said. “They kept wanting to do more pictures, and then they wanted to do more ultrasounds, and no one in the room would say anything to me. When the radiologist came in, he shared with me that he believed that I likely had breast cancer and he wanted me to return first thing the next morning [to Rhode Island Hospital] for a biopsy.”
The next day, however, was when she was to be formally introduced to Gaudet Middle School educators as their new principal. Gibbins said she would not postpone that, so the biopsy was performed and — telling no one but her husband and her parents – she was welcomed into her new position.
“It was very shortly thereafter, not even a full 24 hours,” Gibbins recalled, “that they called me to say that I had breast cancer. From there, I was scheduled to meet with a surgeon, an oncologist, a radiologist, a whole team at Rhode Island Hospital.”
The team was led by Brown University Health’s Dr. Stephanie L. Graff, Director of Breast Oncology at the Brown University Health Cancer Institute, which has offices around the state, including in Newport, and is anchored at Rhode Island Hospital.
Asked about the state’s breast cancer rates, Graff told Ocean State Stories in an email that “it’s difficult to pinpoint the exact reasons for Rhode Island’s high breast cancer rates, and that’s why Brown University Health is committed to being a leader in research, both regionally and nationally, to better understand these trends.
“By studying the interplay of genetic, environmental, and lifestyle factors, as well as the impact of early detection and screening programs, we aim to uncover insights that can guide prevention and improve outcomes.”
New detection and treatment options have been “game-changers,” according to Graff. “Breast cancer imaging and treatment options keep getting better and better!” she wrote. “We now use 3-D mammography, and ultrasound, contrast-enhanced mammography, or breast MRI if other risk factors exist; all of which enhance mammogram screening.
“Most medical insurances cover the costs of genetic testing and high-risk screening; and many women will not need the extensive surgeries of yesterday to remove their whole breast or multiple lymph nodes. For patients who need radiation, they can often have very short courses of treatment, limited to a few days rather than many weeks.
“We can better predict who will need chemotherapy, avoiding it altogether for many. Newer targeted therapies, like immunotherapy, are available as well which improves chances for survival and decreases the likelihood that cancer will return.”
After graduating from the University of Rhode Island, Amber Schoeller vacationed in Mexico. She had planned to attend law school, but during her time in Mexico, she decided she wanted to travel the world. Owning and running a logistics company, which manages the shipment and storage of goods, would provide that opportunity. With help from a family friend, she founded a firm. The internet allowed her to work remotely when she was not abroad.
“At 22, freedom seemed like the most important and exciting thing imaginable and it has allowed the world to be my office.”
Her initial cancer treatment, Schoeller was placed on a standard dose of Tamoxifen, 20mg, a commonly prescribed type of hormone therapy for patients like her.
But the drug affected her mental health, Schoeller said. A search of the medical literature confirms its adverse risks.
“Tamoxifen is widely used for the treatment of breast cancer,” according to an article in The Breast, a peer-reviewed scientific journal. “While it is generally well tolerated, clinically relevant depression may be a common side effect.
“As the use of tamoxifen increases, it will be essential to consider the potential side effect of depression, which in itself may alter immune function and overall survival. The risk and benefits of tamoxifen must be carefully weighed and depressive symptoms should be monitored and treated in women receiving tamoxifen therapy.”
“Although medications such as tamoxifen may slow the progression of cancer or eradicate tumors, such interventions may also have a negative impact on a patient’s quality of life,” an article in Psychosomatics declares. Similar findings have been reported by the MGH Center for Women’s Mental Health, the Cureus Journal of Medical Science, and Acta Haematologica Oncologica Turcica, among other sources.
Schoeller, who already lived with pre-existing depression, didn’t know the extent the medication would affect her.
She only knew that she was experiencing a mental health crisis.. Her husband and parents tried to help her, but she passed days without leaving her bed and they were afraid to leave her home alone.
She recalled telling her parents “I wish the cancer had just killed me.” I don’t want to continue to live like this. I was just breaking my parents and my husband’s hearts, and I was in pain every day… At one point, I called my psychiatrist during the day when my husband was at work, and I said, ‘I don’t want this anymore. I am a burden to everyone and I don’t know where to go or what to do.’ ”
After her initial appointments at Rhode Island Hospital, Katy Gibbins said she was “further diagnosed with stage 3 inflammatory breast cancer, which is one of the rarest forms of breast cancer and the most aggressive.
“I started chemotherapy about two weeks after that. I went through a very intensive six rounds of intensive chemotherapy with a mastectomy to follow that, and six weeks of daily radiation. And through all of that, I missed [only] about a week and a half of school.”
Gibbins chose to be “very transparent” with her superintendent and staff, and they were supportive, she said. Between them and the Rhode Island Hospital team led by Dr. Graf, Gibbins said, “That’s really what saved my life.”
The Gaudet principal said “as of right now, I am cancer-free. I’m kind of moving on now with a normal life. When you’re diagnosed with cancer, the goal is to stay alive and beat it. And I went through all the phases that you have to go through to get to that. But what I didn’t realize is that after that happens, there’s another whole phase that you have to experience, and that’s survivorship.”
Others at her middle school are sharing her journey, said Gibbins, who is 40 now.
“Through it, I’ve had five different female coworkers who have been diagnosed with breast cancer. On [one recent] Tuesday, one of the teachers on my staff finished radiation. And so on Monday, everyone came to school dressed in pink. She sent us a picture of her ringing the bell, and it was just a day that we were celebrating because she was done. And the next day, she was in my office crying.”
Gibbins received more than medical care under Dr. Graff’s leadership. Gibbins said she found compassion and empathy, which Graff told Ocean State Stories is integral to her practice of medicine.
“The patient-physician relationship is always important, and always individual,” Graff said. “The patients and I are bound by this really big important thing that has happened in their life, and that matters to me. One of the things that drew me to oncology in the first place was the way that I saw patients and their oncologists build those bonds.”
After a recent follow-up visit with her doctor, Gibbins emphasized the importance of a continuing relationship. Graff agreed.
“There is the doctoring aspect of it,” Graff said. “I continue to monitor patients for long-term effects of treatment or signs of cancer recurrence. But there is the human aspect too—I get to continue to nurture that bond and help make sure this human is thriving in every way after their cancer diagnosis, and that is a fun part. I joke that sometimes I feel like part doctor, part life coach.”
Survivorship, Graff said, is defined by the American Cancer Society as “every moment after you are diagnosed. Obviously, our care team wants it to be more than that. Ideally, it would mean cancer-free and in full health, although that is not possible for all patients. Some patients never identify with the word ‘survivor’ and that is okay too.”
Whatever description a patient prefers, Graff said the post-treatment relationship involves many professionals from many disciplines.
“Perhaps most importantly, it is not just the patient and I in partnership,” she said. “I have a whole team! Social work, nurse navigation, oncology social work, oncology psychology, palliative care, oncology rehab, sexual health, physical therapy, advanced practice providers and amazing nurses… so many people! We even have therapy dogs. But it is a lot of communication, taking stock of where any given patient is, their struggles, and then connecting the right resource for the situation.”
According to Schoeller, her psychiatrist suggested she check herself into Butler Hospital, and begin Electroconvulsive Therapy, ECT, as she was suicidal and he saw no other options.
After hanging up with her psychiatrist, Schoeller reached out to her breast cancer support coach, a woman trained in providing support for fellow survivors with the Gloria Gemma Foundation. The coach hosted a weekly Zoom call in which women shared stories they were writing about their experiences. Schoeller’s was titled The Solitary Tree, which she would later turn into a podcast.
On the next call, Schoeller told her coach about her psychiatrist’s suggestion, which she opposed. When she told her coach the dose of Tamoxifen she was taking, the coach said she experienced an extremely similar experience the year before and her doctor cut her dose in half and it saved her. Schoeller’s oncologist did the same for her the next day, reducing her to 10mg when she asked her oncologist. She credits Gloria Gemma’s support group and her coach for saving her life
“As soon as I cut that in half, I felt like myself again,” Schoeller recalled. “I’m still on 10 milligrams, but I’m thriving. I’m going to yoga and Pilates every day. I’m making new friends. I’m going to a breast cancer conference in Atlanta next month. I’ve shared my podcast, and young women have been reaching out to me for support who also have mental health issues and I love being there for them.
“I’m realizing that maybe that’s my purpose in life. Maybe my small contribution to this world is helping others. I want others with pre-existing mental health issues to be supported throughout their cancer journey and well-informed of the risks of their hormone therapy drugs. My hope is that no one will ever feel as alone as I did or feel like a burden and know there is always hope and that your lives matter no matter how dark the day.”
Anyone in immediate danger should call 911
Suicide-prevention resources: Where to turn if you are considering suicide
Other resources:
- BHLink: For confidential support and to get connected to care, call (401) 414-LINK (5465) or visit the BHLink 24-hour/7-day triage center at 975 Waterman Ave., East Providence. Website: bhlink.org
- The Samaritans of Rhode Island: (401) 272-4044 or (800) 365-4044. Website: samaritansri.org
- The National Suicide Prevention Lifeline: (800) 273-TALK, or (800) 273-8255
- The Crisis Text Line: Text HOME to 741741 “from anywhere in the USA, anytime, about any type of crisis.”
- Butler Hospital Behavioral Health Services Call Center: Available 24/7 “to guide individuals seeking advice for themselves or others regarding suicide prevention.” (844) 401-0111
- Thrive Behavioral Health’s Emergency Services: 24-hour crisis hotline (401) 738-4300.
- Prevent Suicide in Rhode Island: a Rhode Island Department of Health resource. If you are in crisis, call (800) 273-8255 or text TALK to 741741. Website: preventsuicideri.org/
My life before cancer was a big one, full of family, friends, excitement, and adventure. I traveled the world, met new people and always escaped those winter blues! I enjoyed driving my moped around my hometown of Newport, soaking up the sun around Ocean Drive. I loved the freedom, had confidence, and found joy in little and big things. Whether I was discovering hidden islands around the world, participating in sacred ceremonies, surfing in Mexico, or hiking volcanoes in Scotland I woke up excited for each day. I didn’t worry about my future, I looked forward to it! While life was full of joy and adventure it wasn’t without its challenges. My struggles with mental health were there following me wherever I went. However, It felt like I was making huge strides with this, until I was sitting alone in Mexico one sunny afternoon.
Little did I know when I was staying in MX that my life was about to be turned completely on its head when I noticed blood in my sports bra. I decided to call Planned Parenthood after a terrifying google search. I explained to the nurse I would be back home in one month to get it checked out and that would be fine right? When the nurse replied with ‘I suggest you come home now’ my heart stopped. I had considered finishing out my trip since it might be my last chance as the possibilities loomed over me. Instead with shaky hands, and teary eyes I booked two flights to get me back home. Those were the longest plane rides of my life, alone in the sky with my thoughts and fears. The next day I was in the hospital for my mammogram. “Hi Amber. Are you here with anyone? A doctor asked after I had just been taking in for way too many “closer looks” of my breast, each one furthering my worst fears. I answered no. OK, well, I’m so sorry but you do have cancer.” It felt like my death sentence. I was hardly breathing as I texted my husband “I have cancer”. I sat paralyzed trying to wrap my head around the idea that my life could be over at 37 and how much of it had been wasted battling my mental health.
The darkest days of my cancer battle also taught me the valuable lesson; that I was not alone. I’ve learned that the love in my life is much bigger than I could have imagined. While I never questioned my parents’ love for me, cancer just magnified it! They took turns driving 8 hours for chemo. They would lay next to me in bed while I cried and not leave until I fell asleep. I felt so much pain during cancer, but I have never felt more love either. This was also true with my husband John. I experienced a whole different love through cancer. There were days when I told him I didn’t know what I was even fighting for as I couldn’t see a future past cancer. He would remind me there was still “us.” He truly carried me through this nightmare and fought for me when I couldn’t fight for myself. Lastly cancer has given me the gift of pink sisters through SheRose. I now know I’m not alone with my cancer or my mental health struggles. It’s here that I have found peace, strength and support and know I will never be alone in survivorship.
Cancer took everything from me which has left me in a position to relearn everything anew. I have learned that if I can survive depression while battling cancer, I can overcome just about anything. I emerged from this battle more confident in my ability to navigate my mental health. The tree that had lost all its branches and leaves has started to show new life. I am a lot stronger and more resilient than I could have ever imagined. I hope my tree, one day, can provide shade and shelter for others. Most importantly I’ve come to realize I’m not that solitary tree, I am part of a forest.
