Cancer Patient Juggles Pregnancy and Treatment
In January 2022, Willana Mack found out she was pregnant with her third child. The singer and music teacher was equal parts surprised—she was 38 years old, and her “baby” was six years old—and thrilled, having resigned herself to having only two children. A week later, she received a diagnosis that was sobering: she had stage 3 breast cancer.
Her doctors told her the surest way to survive the cancer would be to end the pregnancy, but Willana was determined to have the baby. “I felt like no one was in my corner,” she says. She realized she needed a second opinion. Research led Willana to breast surgeon Christina Weltz, MD, Associate Director of Surgery at the Dubin Breast Center of The Tisch Cancer Institute. Dr. Weltz was able and willing to help her fight the cancer and carry her baby. As of spring 2025, Willana was a grateful cancer-free mother of precocious toddler Casey, who has met each of his developmental milestones.
At Willana’s first appointment with Dr. Weltz, the surgeon said she thought they could treat Willana’s cancer during her pregnancy. They would just need to make a few adjustments to the typical treatment plan. Specifically, magnetic resonance imaging would not be safe for the fetus, so the team couldn’t use it to define the extent of cancer. The standard chemotherapy regimen could also be dangerous, so they would develop a different approach. And they wouldn’t start treatment until Willana reached the second trimester.
“It finally felt possible,” Willana says. “It was a matter of how they would help, not whether they would. Dr. Weltz was the first medical professional who didn’t initially say ‘Have you considered termination?’ My message to women is to get a second opinion.”
Now Willana needed a full medical team. Dr. Weltz enlisted two more doctors at The Mount Sinai Hospital: Angela Bianco, MD, Director of Maternal-Fetal Medicine in the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai, and oncologist Joseph Sparano, MD, Ezra M. Greenspan, MD, Professor in Clinical Cancer Therapeutics, Chief of the Division of Hematology Oncology, and Deputy Director of the Tisch Cancer Institute.
To develop a treatment plan, the hospital held a tumor board. This is a group of breast surgeons and medical and radiation oncologists who discussed Willana’s case to determine the safest and most effective approach. “There were a lot of opinions, but Dr. Sparano figured it out,” Willana says.
“She presented with a HER2-positive breast cancer,” Dr. Sparano says. “With that type of cancer, we usually flip the sequence and give chemotherapy first, then follow it with surgery,” he explains. “Due to the pregnancy, we also couldn’t use the standard and most effective treatment.” Instead, Dr. Sparano administered six cycles of Adriamycin (doxorubicin) and cytoxan chemotherapy to shrink the tumor. This occurred during the second and third trimesters of pregnancy, when it could be given safely. “It was the best option for both Willana and her baby, buying some time until we could deliver the baby safely,” Dr. Sparano says.” After delivery, we planned to switch to a cancer treatment that offered the best chance of being cured.”
Chemo put Willana at increased risk of low birthweight, preterm birth, and stillbirth. So Dr. Bianco monitored her closely to make sure the fetus was developing normally. She performed blood work and fetal sonograms every week, starting in week 11. Near the end of the pregnancy, Dr. Bianco administered shots of steroids to accelerate fetal lung maturity.
In addition to her hectic treatment schedule, Willana took care of her six- and ten-year-old daughters. She also worked as Director of Music and Worship at New York’s Central Baptist Church. The singer and one-time Oscar nominee explains, “Singing gets me through the day.”
At 36 weeks, Dr. Bianco induced labor, performing a Cesarean section. “At 34 to 35 weeks, the newborn outcomes are excellent,” explains Dr. Bianco, “so we didn't think there was much benefit in going beyond that.”
Willana really liked Dr. Bianco. “She cares about the whole person, not just the pregnancy and cancer.” Born on September 6, 2022, Casey weighed 5.4 pounds. “He was the size of a loaf of bread,” says Willana. Both mother and child (Casey in the neonatal intensive care unit) spent four days in the hospital recuperating, then went home together.
The doctors gave Willana one month after delivery to recuperate from the C-section and breastfeed her baby. Then she resumed treatment with chemotherapy drugs paclitaxel, trastuzumab (Herceptin), and pertuzumab (Perjeta). After three months of these drugs, Dr. Weltz performed a lumpectomy to remove the tumor. Fortunately, the tumor had shrunken considerably thanks to the chemotherapy treatment. There was some residual cancer left, putting Willana at a higher risk of developing cancer in other parts of the body, so her doctors gave her additional treatment to reduce this risk. Willana had ten months of a targeted cancer drug called trastuzumab emtansine, plus a month of radiation. The final step was a five-year course of monthly shots and daily pills to decrease the production of estrogen. This treatment put Willana into menopause. The goal of these medications is to prevent cancer from recurring other in parts of her body. “HER-2-positive cancer once had the worst prognosis,” Dr. Sparano says, “But thanks to the new drugs, which Willana received, it now has one of the best.”
Willana was concerned about possibly losing her hair during chemotherapy. “I worried that if I looked sick, I’d scare my children,” she says. Cold cap therapy kept Willana’s hair loss to a minimum. “The doctors and nurses at Mount Sinai really listened to what I needed and helped me achieve my goals. I am so grateful.”
Now Willana is cancer-free, though she will be monitored for the rest of her life. And Casey is thriving, keeping his mother on her toes. “He’s smart as a whip and such a jokester,” the doting mom says. “I definitely think I made the right choice. Casey is a reminder that miracles still happen.”