Resilient in the Face of Cancer, Twice: Rosanna’s Story
Rosanna Silber was 31 and looking forward to some big milestones: finishing her doctorate in nursing, her upcoming wedding, and starting her family. But two consecutive cancer diagnoses threatened to derail her plans. Her care teams at MSK were committed to keeping her life on track.
In August 2016, Rosanna Silber was sitting in a hotel room during a vacation in Sweden with her fiancé, Arthur, when she had a terrible gut feeling: “I have breast cancer.”
It wasn’t just a premonition. Just a few weeks earlier, the 31-year-old called her doctor after noticing a pea-sized lump in her left breast. Her family history — her mom and grandmother had breast cancer — and a career as a nurse meant she was extra-vigilant about her health.
Despite that family history, Dr. Silber’s doctor at a local hospital in New York City didn’t think the lump was any cause for concern. He wrote it off as most likely being a benign cyst and sent her on vacation.
When she returned from Sweden, she asked her doctor for more testing. “I knew what was normal for me,” she says. “But this was very abnormal.” Her instincts were right. An ultrasound, mammogram, and then a biopsy confirmed that Dr. Silber had stage I breast cancer.
“I was in shock and wasn’t able to process what they said,” she recalls. “I’m well educated in the medical field and have a good understanding of what those words mean, but in that moment, I lost all understanding.”
Taking the First Step
Dr. Silber transferred her care to Memorial Sloan Kettering and met with surgical oncologist Kimberly Van Zee. They determined that surgery would be the best first step in treatment.
As Dr. Silber laid out her concerns — “Will I be alive for my wedding? Will I be able to have kids?” — Dr. Van Zee carefully took them into account as she put forth treatment options. Breastfeeding was a key topic of discussion during their first appointment. “As a neo-natal intensive care nurse for five years, I had seen how important breast milk was to my patients, so it was really sad and hard to think that I might not even be given the chance to try,” Dr. Silber says.
Dr. Van Zee proposed removing just her left breast, leaving the possibility that she might be able to breastfeed in the future, but ultimately, Dr. Silber opted for a double mastectomy.
“Because I was diagnosed at such a young age, there were factors that made my decision-making process so difficult,” she recalls. “I have so many years left for the possibility of recurrence. I felt like the right decision was to remove them both.”
Focusing on the Future
After her mastectomy, Dr. Silber froze her eggs, knowing that the chemotherapy she would be starting could affect her ability to conceive. Medical oncologist Andrew Seidman oversaw her chemo treatment — she received eight infusions over 16 weeks to destroy any lingering cancer cells.
Dr. Silber experienced side effects that can follow chemo treatments, including debilitating nausea and fatigue, which required her to stop working.
While she rested at home, she had some upcoming milestones to focus on: “There were two things I could do from my couch: plan our wedding and work on my doctorate in nursing,” Dr. Silber says. “Everyone on my care team worked so hard to make sure we could keep our wedding date, which was scheduled for a month after my last treatment. It was exciting to think about ‘the next big thing’ after chemo was over,” she adds.
The anticipation of her wedding, plus an incredible support network of friends and family led by her fiancé, helped her push through difficult days. Still, Dr. Silber was often left with feelings of loneliness.
“I was usually the youngest person in the waiting room” for treatment, she recalls. “I didn’t know about support groups then, so it was just isolating.” And because she didn’t lose her hair — a side effect of chemotherapy — Dr. Silber says it was almost like “not really being a cancer patient.”
Looking back, there’s a particular day of her cancer experience where there were no traces of loneliness: her last chemo treatment on April 1, 2017.
“I had a big group of people with me and it was a massive party,” Dr. Silber recalls, with happy tears in her eyes. “At a time when I was so vulnerable and felt so alone, it was beautiful.”
The Next Chapter
With chemotherapy behind her, Dr. Silber could focus on the next exciting chapter of her life: her wedding day.
“I finally got to honor this man who stood beside me through all these hard times,” she says of her now-husband, Arthur. “And just the fact that I was able to be there for that day, with all the people we love, it was a celebration.”
Shortly after her nuptials, Dr. Silber experienced another big life event: she left her job at the hospital where she was first diagnosed with breast cancer and joined MSK Kids as a pediatric nurse practitioner. As a patient, she had experienced firsthand the passion and dedication that runs deep at MSK and was excited to be a part of it.
As she was adjusting to a new job, she and her husband received the surprise of a lifetime: They were expecting a baby. “It was an incredible day to see that positive pregnancy test after being told [getting pregnant naturally] likely wasn’t going to happen,” Dr. Silber says.
Pregnancy was manageable, by all accounts — “it was nothing compared to chemo” — but a routine pap smear threatened to derail everything. Her doctor noticed some abnormalities and after further testing, Dr. Silber was diagnosed with cervical cancer when she was 23 weeks pregnant.
“It was terrifying,” she recalls. “It’s not just about my life anymore. It’s about my child’s life.” Dr. Silber saw gynecologic oncologist Kara Long Roche, a member of MSK’s top-ranked Gynecology Service.
It was a relief to be able to continue her care at MSK, Dr. Silber says. Between her first cancer experience and now being part of the staff, “MSK was like my family; why would I want to leave them?”
Dr. Long Roche worked with MSK’s expert pathologists to carefully evaluate and confirm Dr. Silber’s diagnosis, which led to two options: proceed with surgery during pregnancy or closely monitor the disease and delay treatment until after delivery.
“We were confident that Rosanna could safely carry on with her pregnancy,” Dr. Long Roche says. “And we wanted to help her feel confident so that she could make the decision that was right for her.”
Dr. Silber opted to wait but knowing cancer could be slowly growing alongside her developing baby was nerve-wracking. “It took a lot of me really having to trust my care providers,” she says. “I knew they would do whatever was needed to help me and my baby.”
“Even though there’s a waiting period, we’re with our patients every step of the way,” Dr. Long Roche says. “We monitored everything closely so that Rosanna could give some of her worry to us and focus on the happy parts.”
On August 13, 2018, she gave birth to a girl named Pia. Six weeks later, Dr. Silber prepared for another cancer surgery. But this time, it was different: “Going into a procedure is always scary but leaving your child behind — I just had to hope I would see Pia again.” The surgery went as planned and Dr. Long Roche successfully removed the cancerous cells while leaving her reproductive organs intact.
Today, Dr. Silber has no evidence of cancer and gets check-ups every six months for cervical cancer and annually for breast cancer. Pia, now a happy, energetic two-year-old, made a cameo at one of those follow-ups where she got to meet Dr. Long Roche: “For us oncologists, that is just the best.”
Paying It Forward
Two cancer diagnoses, a wedding, a completed doctorate in nursing, and a daughter later, Dr. Silber doesn’t often share the specifics of her own cancer experiences with her pediatric patients and their families. But there’s no doubt her journey has left an indelible mark. “I had really great role models,” she says of her own MSK care teams. “My experience taught me how to do my job better and be more compassionate, more humble, and to really listen to my patients’ stories.”
Dr. Silber knows how she’ll share her experience with her daughter someday. “I’ll be very open with her because I think education and knowing your body is so important,” she says. And she hopes their conversation will mean much more: “I hope I inspire her. Even before I knew I could have her, everything I did and still do is for her.”