Kimmy Fasani and Dr. Mark Lewis | Conquer Cancer, the ASCO Foundation

Dr. Mark Lewis:
This podcast is brought to you by Conquer Cancer, the ASCO Foundation. Our mission is to accelerate breakthroughs in life-saving research and to empower people everywhere to conquer cancer. Welcome to Your Stories, a podcast where we hear candid stories from people conquering cancer. I'm your host, Dr. Mark Lewis.

Like so many women before her, when professional snowboarder Kimmy Fasani had her first child, the question lingered: Could her career survive motherhood? Spoiler alert: It not only could, but it would soon also survive an aggressive breast cancer diagnosis, along with the chemotherapy, radiation, and double mastectomy that came with it. It's an experience she documents with unflinching honesty and candor in her recently released documentary, Butterfly in a Blizzard, walking viewers through a 5-year stretch when her life was upended by pregnancy and cancer.

For some, either of these experiences could easily, and understandably, mark the end of an athlete's career, especially one whose livelihood involves flying down steep and snow-covered mountain faces at breathtaking speeds. But for Fasani, who has been ‘Rider of the Year’ and the first woman snowboarder to ever land a double backflip, these experiences, while certainly life-altering, have proven what she always knew to be true. She could, in fact, have it all, do it all, and come through it all stronger, more resilient, and more determined to live a life that inspires others to believe and do the same.

Welcome, Kimmy. It's truly an honor to have you with us. Can you tell us where you're joining us from today? .

Kimmy Fasani:
Yes, I'm so honored to be here, and I'm actually in Mammoth Lakes, California.

Dr. Mark Lewis:
Oh, that sounds idyllic and obviously, with your line of work, what a beautiful place to live and experience nature and adventure.

So your documentary is truly inspiring and a little bit hair-raising in places. I know you encountered multiple challenges while filming it, and we're probably starting in the middle here, but, you know, your cancer diagnosis came when you were already experiencing a huge life change with the birth of your second child. What went through your mind when you first received your diagnosis?

Kimmy Fasani:
When I first received my diagnosis, I was 9 months postpartum with my second baby, still breastfeeding, and I hadn't even introduced a bottle because my first one really refused to take a bottle. So I decided that wasn't going to be part of my challenge this time around. I'd had this mass in my breast that I just equated to mastitis or breastfeeding, the changes in my breasts, and then I was doing a self-check, and I felt the lump under my armpit, and I realized that I was in trouble. And my husband was actually my biggest advocate of calling the doctor as quickly as possible. Two days later, I was seeing a breast surgeon that only comes to my area twice a month, and she looked at my breast even after my ultrasound and my mammogram. She could tell as soon as she looked at my breast what was going on. I had inflammatory breast cancer, and she laid out this whole protocol that I was going to have to go through and said, "It is so urgent for you to get to chemotherapy immediately."

I thought that I was going to the doctor to rule things out. So to sit there and know that like my 9-month-old baby and my husband are sitting in the waiting room because I'm still breastfeeding, she's like, "You need to stop breastfeeding as quickly as possible." And within 3 weeks, I was sitting in chemo. My whole life shifted drastically, but my biggest concern immediately was, "Will I survive?"

Dr. Mark Lewis:
Well, thank you for recounting that. It's interesting, Kimmy, so in the era of telehealth, and necessity being the mother of invention, we switched a lot of oncology actually to telehealth in the first days or years of the pandemic. We did realize that there are certain encounters that still require in-person presence. And like you said, inflammatory breast cancer is truly a clinical diagnosis. And of all the patients that we take care of in my oncology practice, it was actually our breast cancer patients who felt the most that, “No, I still need to come in person. I still require exams, and just doing a conversation with my oncologist through the screen is not adequate.” And I agree with that.

I'm always curious because your husband is a professional athlete as well, right? I should know that. I'm always curious with what you both do for a living, sort of your wiring, I think, is probably different from the “normal person”, air quotes. And I want to see how that sort of affected your interpretation of cancer. I mean, your feats as a snowboarder are incredible. You've landed a double backflip, a sort of pioneering move. I can barely make it down a green slope, full disclosure. My point is, for your line of work, you do these things that, at least to someone like me, look incredibly scary and intimidating. And again, there's probably some part of your brain that helps you process fear. I don't want to draw conclusions here, but did any of that, like, help you sort of as you were processing the emotions of what is often a very terrifying diagnosis?

Kimmy Fasani:
Yes, 100%. There were so many moments as I was navigating my cancer journey that I was so incredibly grateful for every moment that I had ever spent in the mountains. The mountains teach us so much about adaptability and being flexible and having a plan but having to shift and pivot. And Mother Nature has her own way of laying out a canvas for us to ride every storm cycle. So every time I would go out in the mountains, there was an approach to the mountain where I had to be open-minded. And I would work hard to get there. I would take big slogs or big falls, and I had lots of injuries, but I kept coming back to it. And there was so much life-giving energy in every single one of those moments. And it taught me a lot about resilience.

Then, flash forward to my own diagnosis, and as scary as it was, I started taking it step by step, day by day, the same way I would in the mountains because this diagnosis, in a similar fashion, it felt so unpredictable. But if I could ground myself into this concept of, "Every day is unpredictable anyways," it would make it feel a lot more manageable moment by moment, day by day, taking it for just that, taking it for this adventure that wasn't necessarily planned or expected or something I wanted to do, but knowing that my mental fortitude and the way that I've always approached mountains was really going to be my greatest strength in navigating this diagnosis.

Dr. Mark Lewis:
That is so well said. This whole sort of idea that you were sort of conditioned to pivot is what I'm hearing. I think it was John Lennon who said, "Life is what happens when we're making other plans." And you might appreciate this. Even as an oncologist- so let's be clear, you're the very cool athlete, and I'm the nerdy doctor here, but even as an oncologist, when I sit down with my patients, at the very beginning, I lay out what I think is going to happen. But as you're well aware, oftentimes what transpires is different than that. And so I try my best to be transparent that I'm contingency planning. The analogy I often use with my patients is it's like a chess match. So if you want to be really good at chess, you actually have to think several moves ahead, and that's what I'm trying to do, actually more and more overtly. Because if I've only laid out one sort of possible outcome and that ends up not being the case, you know, disappointment is the gap between expectation and reality. And so I think, weirdly enough, I think on both sides of the table, both patient and doctor, I think pivoting actually is really important, and I love the notion of you kind of, again, having been sort of trained to adapt.

But let's be honest. I mean, this was so disruptive for you. I mean, you already spelled out that you were really in the throes of motherhood. You were 9 months into life with your second child when this, frankly, harrowing diagnosis arrived. I also was reading about you that this wasn't your first experience with cancer in your family and that you had lost loved ones to cancer before. You may also know this, but a lot of oncologists actually enter the field sort of between the head and the heart. So we love the science, and we love the progress, but most of us have some sort of emotional connection to cancer. I lost my father when he was 49 and I was 14 to this wretched disease. Can you tell me a little bit about that, if it's not too painful, and then how did that affect how you processed your own diagnosis and treatment?

Kimmy Fasani:
Yeah, well, thank you for sharing about your father, and that's a really interesting comparison in your line of work because it makes sense. And for me, I've lost both of my parents. I lost my father when I was 14 years old to lung cancer, and then I lost my mother in 2017 to large B-cell lymphoma, which had mutated from follicular non-Hodgkin's lymphoma. Then almost every single sibling of my mom's- she was one of five- has had some form of cancer. And then my husband's father also died from cancer. So we've had so much of this scary connotation towards this disease, and it typically doesn't work out. As soon as I was diagnosed, I was trying desperately not to categorize myself as that. But when we hear that word, it becomes so triggering, especially when we've lost friends and family to it because it immediately puts this fear, subconscious or not, behind it.

Dr. Mark Lewis:
I mean, the memories are indelible, right? You wouldn't know it on the slopes, but you and I have so much in common, losing a parent at the same age to cancer. And of course, that's going to loom large in our minds when we're diagnosed ourselves. But you also sort of give the sense of you weren't going to let history repeat itself. You weren't going to allow yourself to be categorized in the same way. Can you just elaborate on that for us?

Kimmy Fasani:
After my mom was diagnosed, my father smoked and drank his whole life. So in some capacity, there was a predicting marker that something like that could potentially take place in his life. For my mom, having a blood cancer seemed- I didn't have a way of putting a pinpoint into how that happened. And then when I got diagnosed with breast cancer, I was completely humbled because I had thought I was navigating a life of eating well, being healthy and active. I was an ambassador for Boarding for Breast Cancer for the previous decade.

Dr. Mark Lewis:
Is that right?

Kimmy Fasani:
I was taking all these initiatives to check myself and speak up and be healthy and active. The beauty in the moment of when I was feeling really overwhelmed during my diagnosis, I was talking to my breast surgeon, and I was just like, "But I'm so- like, I've dedicated my life to being healthy and active. I'm an athlete. And I've cared because I know the ramifications that I could potentially carry this. I could be diagnosed because my family has.” And she said, "You know, your biggest strength is that you are healthy and active, and that makes you a better patient." And that totally shifted my perspective. But I thought that I was going to be immune to getting cancer, and I think that was my biggest learning curve through the diagnosis.

Dr. Mark Lewis:
Yeah, it's interesting, Kimmy, you may know this already, but the word "prevention" is actually a little bit more controversial in oncology than it might first seem. So a lot of us think that the better way to phrase it is "risk reduction." I mean, you're proof positive. And as we discussed at the beginning, you know, I practice in Salt Lake City and Park City. Without violating anyone's confidentiality, I'll say I take care of plenty of professional athletes in my practice. And I always look at them as, you know, this tangible example that being rigorous about exercise and diet is great, but it only gets you so far. And, you know, one of the true thought leaders in our field is this physician-author, Dr. Siddhartha Mukherjee, and his theory behind cancer, which I 100% stand behind, is it's the combination of our genetics, our environment, lifestyle, and chance. And I think it's that last one that you just can't control for.

On the other hand, like you said yourself, we also have a phrase that we use as healthcare professionals called "performance status," which essentially means how much do we think that you can endure in terms of the intensity of treatment? And I think someone like you, coming into clinic, facing, you know, let's be honest, the beast of inflammatory breast cancer, no wonder your oncologist looked at you and thought that you were an excellent candidate for very, very intense treatment that you then endured. On that note, you've been really open about your diagnosis and treatment. I mean, just so candid, including about mastectomy. What was it like with your documentary, revisiting those experiences on the screen, especially now that you're, thankfully, cancer-free? Was there ever a moment where you thought, "Hm, maybe I've shared too much here"?

Kimmy Fasani:
100%. I felt that many times, and especially when I rewatch the movie. You know, it's very vulnerable and sensitive, and not everybody will feel comfortable watching or being that person. For me, I felt really inspired to share the journey openly because I had so many questions when I was diagnosed, and I was researching, and I was Googling and doing all the things that are really scary. You know, you can lean into all this information, and it might not all be valid, but you're just trying to find answers. And one of them specifically was, "What is it going to look like when I choose to stay flat?" And it was so hard to get thorough information on how I would personally feel. You know, nobody can do that for you. I felt that it was for myself and for anybody that was also curious, that if I could open up a conversation and try to help normalize what this might look like, maybe there's other women and people out there that will find comfort in seeing images and also just understanding for my personal reasons why I chose to stay flat and that it's an okay option. But it's a huge transformation, and it's a sense of identity in our women's bodies. And there's so much to it. But for me, really, and now when I watch the film, I'm proud. I'm proud that I was able to have the courage to show others what this journey looked like in the most vulnerable and raw and real ways so hopefully other people don't feel alone as they are navigating their own journey.

Dr. Mark Lewis:
I'll tell you this. I mean, I thought it was very brave. I think you're brave whether you're careening down a mountain or whether you're, you know, giving people access to, like you said, these most vulnerable moments. And Kimmy, you know, you mentioned the decision that you faced, probably the most personal decision of all, regarding sort of reconstruction options after mastectomy. I'm just really curious how that conversation went because again, it's- I think a different aspect of breast cancer management to say the cancers that I deal with, in the pancreas or the colon, is this notion of how should the chest wall be reconstructed? How does the woman see that as affecting her body image going forward? Obviously, as a man, this is going to look different to me as a male oncologist. I'm really curious to you as the patient, how did these conversations occur and how did you ultimately make your decision?

Kimmy Fasani:
Yeah, it's a very personal decision, and we can all navigate it the way we feel most comfortable. For me, when I was talking with my breast surgeon- and mind you, at the time I'm 39 years old, I've had two kids, I've breastfed, I've done certain things. So feeling comfortable with not having breasts made me feel okay, and that was my personal feeling. My surgeon was really concerned because I had inflammatory breast cancer. It affects the skin on the breast tissue, on the external breast. And she had to take so much of that skin away during my mastectomy that there wasn't really going to be room for fillers. And then having so much radiation to follow was going to make it very hard to stretch, and there was most likely going to be some complications with that. And in my own mind, I didn't want to go through any more surgeries. I wanted to minimize my risk of reoccurrence, and I wanted to be able to spend more time with my kids. So I wanted to heal as quickly as I could and not let this be a factor that I was concerned about because I have heard so many different sides of how reconstruction can go. And so it was really just a peace that I came to inside my own heart and my body and just said, "You know, this is not a priority for me. I would rather all of those things that I just mentioned than trying to reconstruct something to have breasts. I'm just going to stay flat."

Dr. Mark Lewis:
Thank you for sharing that with us. It's interesting, Kimmy, in my practice, you know, I often tell my patients, you know, a picture is worth a thousand words. And often where I'm invoking that is these days- and you may have had this experience- you can actually log in and read the text of a scan that you've been through. But I find it doesn't quite hit home until I show them the images in clinic. And so you're right, it's one thing to describe a mastectomy, and it's completely another, I think, to sort of view it. And so again, thank you for being so open. I really do think that will help lots of people who watch your film.

I think the other thread of the documentary to me was, you know, you really talked a lot about the challenges of motherhood, particularly for a performance athlete. Did the mental work you were already doing to reconcile motherhood with your snowboarding career, did that help with how you processed your diagnosis and treatment?

Kimmy Fasani:
Yeah, I love this question because it really did. I had learned how to use my voice, and that had happened for a handful of years prior to me starting motherhood, throughout my career, being in a male-dominated field in the backcountry or whatever. I'm learning and conditioning how to use my voice in a constructive way, how to be a team player, how to be an asset in the backcountry, how to stand up for things that are important to me, whether that's changing verbiage in contracts while I'm navigating my own pregnancy. And then stepping into cancer for me, I was able to really speak up about my needs and ask for help, which was something that was not easy prior. And I was able to really trust myself. My journey through motherhood was so much about my inner spirit and my inner feeling of, "I'm trying to balance my career, and this is hard. I need help. I need support."

And stepping into cancer was the same thing. Having two very small children - my oldest was three at the time, and my youngest is 9 months as I'm starting my journey - I needed help. My husband was going to be staying home while I was going 6 hours to treatment. I was going to be gone for a week. There was so much juggling that had to take place. When I realized that I needed to ask for help, that meant that I had to lean into the community that surrounded me. Those people that said, "We're here for you anytime," I knew that that was my moment that I had to call my closest friends and ask them to support my kids. And really, I had to delegate. I had to delegate tasks, whether it was having somebody cook for my family because I had no appetite. I had to delegate for people to stay with me so that if I had side effects that needed to be managed, I had somebody that I could lean on. I needed my community to come forward, and it reminded me how important it is to be a community to those who are going through a struggle. And I also had to have boundaries for my body, how it felt, my symptoms, my side effects. All of it required my voice and my ability to speak up for what I felt like was even advocacy for my own journey through my diagnosis.

Dr. Mark Lewis:
The perfect word I was hoping you would use is self-advocacy. I think is really important. Just like self-care isn't selfish, there's this phrase I absolutely loathe in my field, which is, quote, unquote, "the difficult patient." And for years, the people that got labeled as "difficult," which should never have happened, they were sort of going against the grain of paternalism. You know, someone like me in a white coat walking into an exam room and telling you what you were going to do, which should never have been the paradigm, but it was for a long time. And now in the era of shared decision-making, I would argue that actually self-advocacy on your side of the table helps me on my side of the table. Like if I know your preferences, and you said yourself, it is such a personal choice, how you handled your surgery in particular, that, you know, that's your preference. No doctor can tell you how to make that choice. And so I just want to, again, validate who you are and what you did. And I think anyone listening to this should know that advocating for yourself as a patient actually is a wonderful thing to do. And you're right, you took a skill set from your professional life and then applied it to being a patient.

You know, you've been very open about your experience. You've used the word "journey" at least once. Was there a moment in your recovery where you thought you were kind of at an inflection point, like, "Okay, I'm done with treatment now"?

Kimmy Fasani:
I found that it was really helpful when the doctor had laid out my protocol. In my mind, I was able to kind of compartmentalize it similar to an injury where it's like, "Okay, you're in this cast for this amount of time." For my protocol, it was, "You're going to do six rounds of chemo, double mastectomy, 30 rounds of radiation, and then an infusion." So I had a road map. That road map definitely became a tool that I was able to know that each stage was temporary, and that made me feel like I had a little bit of control during the time because I was able to see the light at the end of the tunnel. There was a moment where, I believe it was after my third chemotherapy, and they saw that my tumor was rapidly shrinking. It may have even been my second chemo. And the doctor had said, "You are HER2-positive. You are most likely going to see this tumor melt away." And I was like, "There's no way. It's 7 cm by 7 cm. Like it's massive." And it went. Just having that hope and that positive reminder that it was working made it feel possible to navigate the rest of it.

After getting through with my surgery, it created this strength in my new body. "My body is capable of so many things. Look how far we've come. This wasn't as scary as I thought it was going to be." And being able to harness that energy and take it forward. And then same thing after radiation. You know, it's exhausting. It's tiring. The burning is painful. But when you get to the end of that, you're able to see how far you've come. And though cancer will always have some faint voice in my head, it made me feel like, at least for now- and it gave me such a different sense of how I'm going to manage my time moving forward.

Dr. Mark Lewis:
Oh, wow. I can't possibly improve upon that. I think that's a great segue, actually, Kimmy, to our last question. And we actually ask this of everybody that comes on the show, and I think you're going to be the perfect person to answer it. What does it mean to you to conquer cancer?

Kimmy Fasani:
Conquering cancer to me doesn't mean that it's out of your life forever, which some people still will say to me, like, "Oh, yay, you're all done. Isn't that so nice it's behind you?" For a cancer patient, especially for me personally, I have found that conquering cancer is about coming to peace with where I'm at every day and knowing that it hasn't returned is such a gift and that I have time now to enjoy my family and that I went through these huge, very big obstacles to get here, but it's made me a stronger and more resilient person. It's made me a more resilient mother. It's made me a better partner. It's made me enjoy the present moment even deeper.

Dr. Mark Lewis:
Oh, that's just beautiful. It's interesting, again, you and I have so much in common with our parents. My father, when he was going through the rigors of chemo, number one, like you, he had a very aggressive cancer. He actually could see it regress quite quickly during treatment. He said, "Anything is tolerable if you can see the end point." So I love the way that you kind of broke down your treatment into slightly more sort of digestible phases. And then like you said, on the other side, you're just so intentional with how you use your time and how you spend it with your family and just an example to all of us. So, Kimmy, thank you. I knew coming in here that I was going to be inspired by your athletic achievements, but I have to tell you, the way that you have handled being a patient and the way you've shared of yourself through your documentary in particular, is really inspiring to me as an oncologist. So thank you so very much.

Kimmy Fasani:
Thank you so much for having me. It's such an honor.

Dr. Mark Lewis:
And thank you for listening to this podcast brought to you by Conquer Cancer, the ASCO Foundation. Conquer Cancer is creating a world where cancer is prevented or cured and every survivor is healthy. You can make a gift at conquer.org/podcast.

The participants of this podcast report no conflicts of interest relevant to this podcast. Full disclosures can be found on the episode page on conquer.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.

Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.