The Trifecta of Bad

When Rachel Goldberg wasn’t feeling well in May 2023, she spent four days in a Los Angeles hospital with her mother, Linda Dembo, by her side. She was diagnosed with mastitis, an inflammation of the breast tissue. She received antibiotics and was discharged. Linda, who had flown from St. Louis to LA to be with Rachel, breathed a sigh of relief and returned home.

But Rachel didn’t have mastitis. A followup mammogram and biopsy provided a terrible new diagnosis: stage 4 triplenegative inflammatory breast cancer.

Inflammatory breast cancer (IBC) is a rare but highly aggressive cancer that progresses very quickly, often over the course of days or weeks. Because the cancer cells grow in layers, IBC often does not cause a lump, making it harder to detect through a mammogram and harder to diagnose than other breast cancers. Also, because the cancer cells block lymph vessels in the skin of the breast, the breast begins to look swollen and red like an infection, such as mastitis, sometimes leading to misdiagnosis.

Triple-negative breast cancer (TNBC) is a type of breast cancer in which cells have tested negative for estrogen receptors, progesterone receptors, and human epidermal growth factor 2 (HER2). Unlike other invasive breast cancers, TNBC does not respond to hormone therapy or therapies that target HER2.

Although TNBC is not impossible to treat, Rachel’s biopsy showed that her cancer had already progressed to stage 4, meaning it had already spread to other parts of her body.

“It’s the trifecta of bad. The worst you can get,” Linda says. “They wanted her to start chemo right away.”

Rachel began her treatment in LA but quickly moved back to St. Louis to be with her family and receive treatment at Siteman Cancer Center.

“At the beginning, when she first started chemo, Rachel would say things like, ‘I hope I can ring that bell one day,’” Linda recalls. “And then as things progressed, she knew deep down in her heart that it wasn’t going well.”

Rachel, who had no family history of breast cancer and who had tested negative for the BRCA1 and BRCA2 breast cancer genes, passed away 16 months later, on Sept. 30, 2024.

“Inflammatory breast cancer is so rare and so aggressive, and so many more young women are getting it,” Linda says. “I feel like it’s an underrepresented type of cancer, so it’s extremely important to talk about it. If something feels off or not right in your body, you have to get it checked out.”