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At the start of the summer of 2020, just a few months after the COVID-19 pandemic began, Morgen Chesonis-Gonzalez, a Miami public school clinical art therapist, felt a persistent pain in her right armpit that set off some internal alarm bells. She knew something in her body wasn’t quite right.

Chesonis-Gonzalez, 47, had always been diligent about getting her annual mammograms, even though she has no family history of breast cancer. She followed guidelines set by the American Cancer Society, which recommends all women with an average risk of breast cancer start getting mammograms by age 40. But in spring of 2020, fear of catching the virus kept her from going to her scheduled exam.

“It was still early in the pandemic when schools were online, everything was upside down, and there was a lot of uncertainty,” Chesonis-Gonzalez tells Well+Good. “I decided to delay my mammogram since I had been fine, and at that stage of the pandemic, the message was to stay home if you were not an essential worker.”

But after a month of unexplainable pain, her armpit swollen and inflamed, Chesonis-Gonzalez knew it was time for a mammogram. Her fear was, to some degree, confirmed when doctors asked she follow up her mammogram with an ultrasound and biopsy. By August 20, 2020, she was officially diagnosed with breast cancer. But her diagnosis had an interesting twist.

Chesonis-Gonzalez was diagnosed with not one, but two different types of breast cancer at the same time. Her armpit pain was from two malignant tumors in her breast. One was stage 2 triple-negative breast cancer, which Chesonis-Gonzalez calls “a particularly aggressive type of breast cancer that can metastasize rapidly.” The other was a type called ER+/PR+/HER2-, a cancer that grows in response to estrogen, per the Mayo Clinic.

The shock of the news was compounded by the fact that Chesonis-Gonzalez had to take it all in by herself. Because of COVID-19 restrictions, her husband had to wait in the parking lot, listening to the diagnosis on the phone and taking notes. Chesonis-Gonzalez’s first reaction was shock—her prior mammogram had had no abnormalities. “I kept thinking how this would affect my children,” she says.

The odds of having two types of cancer at the same time is rare, especially two types of breast cancer. The dual diagnosis meant Chesonis-Gonzalez had to undergo multiple types of treatment back-to-back. And because of the pandemic, she had to go through them alone, and always with the fear she’d catch the virus.

How common (or rare) is it to get diagnosed with two breast cancers at the same time?

Chesonis-Gonzalez’s diagnosis is particularly rare. Starr Koslow Mautner, MD, a breast cancer surgeon at the Miami Cancer Institute, part of Baptist Health South Florida, says cases with two different types of cancer (one of which being triple-negative) is rare, occurring in roughly five percent of patients. While multiple tumors of the same type of breast cancer are not rare, multiple with different amounts of ER (estrogen), PR (progesterone), and HER2 (human epidermal growth factor) receptors are, Dr. Mautner adds.

“The patient’s prognosis is usually dictated by the cancer that is larger or has more aggressive features,” Dr. Mautner says. According to Dr. Mautner, if tumors are located in different quadrants of the breast, it often means you’ll need to get a mastectomy (i.e., surgery to remove the entire breast) rather than a breast-preserving lumpectomy (i.e., surgery to remove the tumor). It also means the treatment plan might include a variety of medications meant to target the different individual receptors of each tumor.

In Chesonis-Gonzalez’s case, this led to two different treatments: chemotherapy for the triple-negative mass, and endocrine therapy for the estrogen-receptor positive mass.

Difference between triple-negative breast cancer and other types

Triple-negative breast cancer, written as ER-/PR-/HER2-, is considered an “invasive ductal cancer that lacks receptors,” according to Dr. Mautner. Meaning, the cancer cells don’t have estrogen or progesterone receptors, and they don’t make too much of the growth-promoting protein HER2, per the American Cancer Society.

This type of cancer can spread quickly and is often more difficult to treat. It makes up only 10 to 15 percent of all breast cancers, and is more commonly diagnosed in people who are under 40, Black, or have the BRCA1 genetic mutation, which can increase your overall breast cancer risk, per the American Cancer Society. (For context, Chesonis-Gonzalez does not have the BRCA1 mutation.)

In these cases, patients will almost always need chemotherapy, before or after surgery, because it cannot be treated with targeted medication, says Dr. Mautner.

Hormone-positive breast cancer is more common

Chesonis-Gonzalez’s second tumor bore different characteristics—it was a smaller, stage 1 tumor (meaning it was contained to one area) called a Luminal A tumor. Luminal A tumors (medically known as ER+/PR+/HER2-) are a “very common” type of hormone-positive breast cancer, says Dr. Mautner. This type of cancer is slow-growing and is highly responsive to endocrine therapy—a treatment that involves taking an oral medication to block the estrogen receptor for at least five years.

Hormone-positive breast cancer is more common, making up roughly 70 to 80 percent of newly diagnosed breast cancers, per Susan G. Komen.

In sum, hormone receptor-negative breast cancers (like triple-negative) respond to chemotherapy, while hormone receptor-positive breast cancers respond to endocrine (i.e., hormone) therapies. While endocri