[00:00:00] Adam Walker: From Susan G. Komen, this is Real Pink, a podcast exploring real stories, struggles, and triumphs related to breast cancer. We’re taking the conversation from the doctor’s office to your living room
[00:00:16] What if a simple at-home DNA test changed the entire course of your life? At 28 years old, today’s guest received a call that revealed she had a high probability of carrying the BRCA1 gene mutation. Genetic testing confirmed it, and suddenly her family’s history of cancer took on a deeply personal meaning.
[00:00:37] Her aunt, who also carried the mutation, was dying of ovarian cancer at the time. This pushed Margot Casino to make a series of decisions to protect her family’s future, including undergoing preventative surgeries and IVF with genetic screening. While in the process of taking these steps to reduce her risk, Margot was diagnosed with stage three breast cancer at just 31 years old.
[00:01:01] As a wife and a mother of two young boys, she’s already been doing everything she believed she could to protect herself from breast cancer, yet she still heard those dreaded words. Margot is here today to discuss the importance of knowing your family history, understanding your genetics, and paying attention when something feels different in your body.
[00:01:22] This October, Margot also decided to be a part of Komen’s Don’t Fail the Girls campaign because breast cancer is personal for her, and she knows how much is at stake. She’s using her voice to help make breast cancer impossible to ignore and to help drive the research, support, and action needed to end it.
[00:01:43]
[00:01:43] Margot Casino: Hi. Thank you so much for having me.
[00:01:46] Adam Walker: I’m glad you’re here. I think your story’s important and certainly, you know, very interesting. So let’s start at the beginning. You’re 28. You took an at-home 23andMe DNA test. What did it tell you, and what were your next steps to, you know, confirm those results?
[00:02:07] Margot Casino: So the results came through in about two weeks, and they called me. A representative said, “We cannot medically tell you that you definitely carry this mutation. You have to go to a genetic counselor to determine that. But we have a very high probability rate that you do carry a mutation for your BRCA1 gene.
[00:02:32] And if that is correct, your probability of developing cancer at some point in your life is also very high. So we urge you to please go see a medical professional to verify these results.” So that definitely freaked me out enough to call my parents right away. And at the same time, with my aunt battling cancer, we put the two and two together.
[00:02:58] The genetic counselor confirmed the results, and I was told that I have the exact same mutation as my aunt actually had. There are hundreds of types of mutations to the BRCA1 gene and my aunt and I happen to have the exact same one.
[00:03:16] Adam Walker: Wow. That’s– I mean that’s gotta be ter-terrifying. I mean like I was try- I was trying to think of a better word, but, like, that’s gotta be…
[00:03:25] With your aunt going through that at that moment, that’s gotta be really scary. I mean how did that feel, like, knowing you inherited this risk? And were you– and I always wonder, like, were you happy, like, glad to know that? Or was it like you wished you hadn’t known or it unlocked additional fears in you?
[00:03:44] Margot Casino: I felt like I was holding a gun playing Russian roulette, and I didn’t know when the gun was going to go off, but essentially I knew it would at some point in my life, and it felt like every day was one day closer to hearing those words. So it felt scary, but also empowering. So I’m glad to know. I’m glad that I had that information because I definitely think ultimately it led me down a path that saved my life.
[00:04:22] Adam Walker: Yeah. Well, I’m, I mean I’m glad it did as well. Now I think that as I recall, like the next step in your journey was you learned about the mutation, and then you decided to pursue IVF with genetic screening to start your family. And can you t-talk a little bit about that decision and what that meant to both you and your husband?
[00:04:40] Margot Casino: Yeah, totally. When we found out that I carried this mutation, my husband and I almost immediately had that conversation with our doctor of what’s the chances of our children inheriting this? Does it affect both genders? What are the risks associated with it for both genders? Because for men, it does pose a risk for different types of cancer than it does for women.
[00:05:08] Adam Walker: Right. Yep.
[00:05:10] Margot Casino: And our decision was to do IVF to prevent ev- every and any of our children from inheriting this mutation, because ultimately it was 50/50 regardless of gender. It was a 50/50 chance that our children would inherit the mutation. And I still remember the look on my mom’s face before I was ever even diagnosed with cancer, the look on her face of concern, knowing this risk, that I had this risk, and it was such a terrifying face that I said, ” I don’t want to ever feel that way about my own children.
[00:05:52] I don’t want my children to have to make the choices I’m making.” My husband said, “Yeah, I agree. You know, the science is there. We should absolutely utilize it.” So we met with a reproductive endocrinologist, which is just a fancy way of saying an IVF doctor, and they explained that the process is a little bit longer than standard IVF, but they will take the egg and the sperm and put it in a Petri dish and let the fertilization happen, and they grow for about six days.
[00:06:29] On day six, they’ll remove one cell that will eventually go on to become the amniotic sac, so it does not harm the embryo at all, but they are able to test that piece of DNA against a prefabricated test with my DNA that carries the mutation. So essentially they make like a, a DNA stencil, and if the embryos lines up with mine, they know that it carries the mutation.
[00:07:00] So I had 19 embryos sent for testing, which I felt very lucky to have even had that number of embryos. So many women go through IVF and don’t reach that high of a number. And the statistic is 50%. 50% of my embryos should have the mutation, and 50 should not. But it turned out that only four did not inherit the mutation So if we did not do IVF, the probability is extremely high that our children would have had this mutation.
[00:07:44] Adam Walker: Wow, that’s fascinating. I, I, and I appreciate you kind of walking us through like that whole process as well, and like, like like seeing it from your per-perspective I think is really helpful. Now I also want to talk about, you know, your decisions. I mean you made some, some decisions for yourself to undergo preventative surgeries to manage your risk.
[00:08:04] Like what went into making those decisions, and how did you prepare yourself for that emotionally?
[00:08:12] Margot Casino: So it was a lot of, like, science really that went into the decision for me at least. The risk-reducing surgeries were such a profound impact on how my life could progress, and I didn’t want anyone to look back and think she could have fought differently or more or given more effort into treatment.
[00:08:48] Right before I gave birth to my second son, my aunt passed away with cancer from her battle with cancer. So she was not afforded all of the treatments that science has afforded me because of the time in between her passing and my diagnosis. And so I really just wanted to dive into the science and make sure that all the choices that I was making were backed by studies, backed by my doctors’ support and medically and scientifically the appropriate choice for my diagnosis, especially because of my age.
[00:09:31] My treatment was a little bit different. The cancer was extremely aggressive, and I was told basically we have to be more aggressive than the cancer.
[00:09:43] Adam Walker: Right. Wow, and that makes sense. Now I also understand just eight weeks after your first stage of preventative breast surgery, you found a lump, a-and then a week later a second lump.
[00:10:01] And so, you know, that, that’s gotta be pretty horrifying. I mean, d-take us back to that moment and that time and just sort of, to like walk us through that.
[00:10:12] Margot Casino: Yeah. So when I gave birth to my second son, I knew that I was going to recover from postpartum and start the prophylactic surgeries, and the first surgery I had was January of 2025, and it was a full hysterectomy.
[00:10:33] Now, my aunt who passed away, her cancer started in her ovaries and spread to the uterus, and so I thought that’s where my first surgery will be. That’s where my first step should be because we had the same mutation. So I thought that the cancer would be similar and act similar in my body that it, and that it did in hers.
[00:11:00] So I started with the hysterectomy, and they took Both tubes, my uterus, and they left one of my ovaries because I was young and they didn’t want to throw me into full-blown menopause. There are medical risks of going into menopause too young. For instance, your bones need the, the hormones to stay strong.
[00:11:23] So that was January of 2025, and then in May I had essentially what would be considered a, a breast lift and reduction. I have a blood clot disorder, so they couldn’t do the full mastectomy in one surgery. It was too risky that my body would throw a clot. So they split it up into three surgeries that would have been a lift and reduction, then a separate surgery for the rest of the full mastectomy with expanders, and the surge surgery– third surgery to be a reconstruction where they take out the expanders and put in standard implants.
[00:12:01] So I had what was the lift and reduction in May of 2025, and eight weeks later I felt a little marble-sized lump right where the side of my armpit bends And I thought, “It’s gotta be scar tissue,” because I just had surgery in the area, and I was cleared for surgery. I had all of the pre-surgical scanning, blood work, you know, testing was all clean.
[00:12:33] Even the pathology from surgery was clean. You know, it was a lift and reduction, so they took tissue and sent it to the pathology lab to test it, knowing that my risk was high. So that came back clean. So I s- I said to myself, “It’s gotta just be scar tissue.” And I waited a little while. About a week later, another one popped up right next to it, and I called my doctor, my plastic surgeon, and he spoke to the breast surgeon, and they said, “Come in tomorrow.
[00:13:01] We’re going to do an ultrasound.” And at that ultrasound, the tech said, “I don’t really like the way that it looks. It- I’m having a hard time getting a full visual. Let’s just do a biopsy.” and I knew that doing a biopsy on the spot is probably not standard protocol for a scan. And that was my first indication of, okay this is not going to be good.
[00:13:27] Adam Walker: Yeah. A- and what… I mean, I’m… Just to finish that thought, like, what were the results of that?
[00:13:37] Margot Casino: So that took… The biopsy results took about 10 days, and it was a Wednesday at 6:00 in the afternoon, and my phone rang. And it was the doctor’s office, and I thought to myself, “6:00.”
[00:13:53] Adam Walker: Yeah, that’s not a great sign.
[00:13:54] Margot Casino: No one’s- Yeah … no one’s staying late to make the happy phone call. Yeah. You know, that’s not the one they do at the end of the day.
[00:13:59] Adam Walker: Yeah, right.
[00:14:00] Margot Casino: So I answered it, prepared myself mentally for bad news, and I thought, “It’s going to be, like, stage one,” because everything just came back clean, all my testing, everything.
[00:14:13] And the nurse said, “I’m so sorry, but this is invasive and aggressive, and it’s stage three, and we’re going to have to do some further testing to make sure that it hasn’t spread anywhere else.” And I think in that moment, the logical part of my brain took over. The emotional part just, like, turned off for a few minutes, and I had to make all of the phone calls.
[00:14:38] And my husband was in the bathroom, and I remember banging on the bathroom door to get him out. The kids, who were two and one at the time, were eating dinner in the kitchen, and I just remember it went silent. And for me, everything went silent, which if you have a two and a one-year-old, you know that it wasn’t really silent.
[00:14:59] You know, my brain just wasn’t processing, and Just recently, I think the, the logical side has, like, started to take a bit of a backseat and the emotional side has started to process what I’ve been through. And in that moment I needed the emotional side to take a backseat.
[00:15:21] Adam Walker: Yeah. Yeah. Well and I mean and kind of going back to that experience, right?
[00:15:27] Like did you feel prepared for the possibility of breast cancer? I mean, knowing, you know, knowing the risks and the testing and all that or did it still sort of blindside you even so?
[00:15:39] Margot Casino: It blindsided me for sure. I felt like I was a step ahead of the cancer, which sounds ridiculous to say out loud, of course, because you can’t predict-
[00:15:49] Adam Walker: I don’t think it sounds ridiculous.
[00:15:51] Margot Casino: There’s no prediction for cancer.
[00:15:53] Adam Walker: Yeah. But I’m but I’m just saying, like, I don’t think it… I think you feeling that way doesn’t sound ridiculous. I think you’re being- Yeah … you’re being proactive and preventative, right? Right. And so you should- Right … like, that’s how you would feel. But yeah but please continue.
[00:16:04] Yeah.
[00:16:05] Margot Casino: I felt like I was doing everything co- correctly. I was having the surgeries, and I thought that I was one step ahead. But it turns out cancer was five steps ahead, and I didn’t know it.
[00:16:21] Adam Walker: Wow. Well, I mean, it… Yeah. I mean I guess it’s good that you caught it when you did, right? Yes. But and you being proactive helped to do that, I think so.
[00:16:35] So I guess that’s good. Now but I’ll, I also understand you had some complications during your treatment, including sepsis. So, like, walk us through, through that as well, and what helped you get through, you know, some of those moments.
[00:16:50] Margot Casino: So my f- very first day of chemo was my older son’s first day of school.
[00:16:59] So my husband and I dropped him off at preschool and then drove to the infusion center, and that was one of the hardest days because of the representation of what I have at stake what I could be losing, you know? And a week after that, my port which is the little device in your chest where they give you the medicine, my port broke, and I didn’t know it, and it got infected with MRSA.
[00:17:35] And ultimately, the doctors think that my toddler probably brought some new germs home from school, which, totally normal, but my immune system was really weak at the time, so it it infected the port, which then spread the infection really quickly because of what the port is designed to do really. And I didn’t know, and it sent me into sepsis.
[00:18:02] So Sa- it was a Saturday morning, and I woke up, and it was a little red and itchy. I said to my husband, “I’ll call my oncologist, but I want to just get… let’s get through the day. I’ll put the kids to bed. It… Everything’s just easier when the kids are asleep.” So we went about our day. I started feeling worse and worse throughout the day, a headache, some chills.
[00:18:26] Then a fever started. By the time the kids were in bed, we were close to calling an ambulance. I could not drive. I was almost not able to sit up. So we went straight to the ER. They admitted me. Testing came back positive for MRSA. They had to put emergency surgery to take the port out Which then left my chest with an open wound.
[00:18:54] Because it was infected, they couldn’t sew it shut. They couldn’t stitch it shut, which makes sense now thinking about it, but they didn’t prepare me for that going into the surgery. So I thought that I was just going to have some stitches and, you know, like maybe some gauze or a bandage, but it was a fully open wound that needed debridement and cleaning, and it was not something I was prepared for, like physically, mentally, emotionally.
[00:19:21] We joke that this was like my Grey’s Anatomy year. I don’t know if you’ve ever watched that show, but there’s always-
[00:19:27] Adam Walker: I think everybody’s watched that show at some point, so yeah.
[00:19:30] Margot Casino: So we joke that this was my Grey’s Anatomy year, and I… the hospital trip really just sealed the deal for that. You know, it was just everything felt so surreal and also insane at the same time.
[00:19:46] Adam Walker: Yeah. I mean, that, that is… I mean, that was quite the journey. Yeah, I ended up in the hospital for two weeks, and right before I left, they put a PICC line in my arm, which is kind of like an IV, but it stays in for six weeks. And it didn’t hurt me or anything, but I couldn’t pick up my kids. You can’t lift anything heavy with your arms, so that was difficult to accept and get
[00:20:12] used to.
[00:20:12] That’s the worst. I mean, not being able to pick them up has gotta be just so dif- I mean, at that age when they’re that little- Yes … it’s just so difficult.
[00:20:19] Margot Casino: Yeah, and I’m lucky that I had so much support around me to help because, I mean, they were both in cribs. I… They couldn’t do anything really without being picked up, so I’m really lucky that I had so much support.
[00:20:34] And I had to administer antibiotics in that PICC line every 12 hours for the rest of that six weeks.
[00:20:41] Adam Walker: That’s a brutal journey. Wow. But you’re here, you know? Yeah and that’s- But I’m here … yeah, and that’s, man that’s the upside. But I gotta tell you, I mean, I just… that juxtaposition of dropping off your oldest at their first day of school and then driving for your first round of treatment is just…
[00:21:02] I mean-
[00:21:03] Margot Casino: The dichotomy of that just blows me away still. I Still.
[00:21:08] Adam Walker: I-
[00:21:08] Margot Casino: I mean, the universe had to pick that day?
[00:21:10] Adam Walker: Yeah, I mean I don’t know how… I’m so impressed with where you are today, you know? Thank you. Like, that’s just so… that’s so difficult. So I just wanted to mention that because it just…
[00:21:23] it really struck me. Now, I… You’ve you’ve obviously gone through a lot, right? You know, chemo- chemotherapy, double mastectomy, radiation you know, all, all the things you just mentioned as well. As you move into the next phase of survivorship, like, what does recovery and looking forward to the future mean to you?
[00:21:47] Margot Casino: I am excited to spend time with my kids. I got so much one-on-one time with my older son before I had my second, and I felt like I lost some of that one-on-one time with my second son because I was going through treatment when he was at home and my older one was starting school. So I’m really excited to spend some of that special bonding one-on-one time with my younger son, and honestly, I’m excited to watch them grow up.
[00:22:23] I’m excited to spend time with all of the family and friends that showered me with support and love and, you know, shined a light in my darkest moments, and I’m excited to reflect that light back on them.
[00:22:37] Adam Walker: Right. That’s great. And re- remind me you said your kids are one and three?
[00:22:42] Is that right?
[00:22:42] Margot Casino: So they were one and two when I started treatment, and now they’re two and three.
[00:22:49] Adam Walker: Listen I just tell you, you know, my, my kids are older and for what it’s worth you’re in the magic. Like, what, like, what you have every day is just magic. It really is. It’s tiring-
[00:23:00] Margot Casino: I feel it …
[00:23:00] Adam Walker: it’s exhausting, but there’s just nothing quite like it.
[00:23:05] In your whole life, there’s nothing quite like it. It’s just absolute magic. So,
[00:23:09]
[00:23:09] Margot Casino: It’s what I fought for Yeah. It’s everything I fought for. It’s every piece of why I fought.
[00:23:14] Adam Walker: That’s right. That’s right. That’s right. Yeah, and y- you’ve got the right attitude. So yeah, en- enjoy it. Enjoy every moment. You… That’s why you’re here. Enjoy every moment of it. So.
[00:23:23] Yeah.
[00:23:24] So shifting gears you’re part of Komen’s Go For The Girls campaign this National Breast Cancer Awareness Month. So what made you decide to participate in that?
[00:23:35] Margot Casino: Yeah. So when I was diagnosed, it was stage 3C, which one step further would’ve been metastatic stage four breast cancer.
[00:23:47] And it had started and spread so quickly. It was in my ax- axillary lymph nodes and my internal mammary nodes, and I had no symptoms except when those two lumps popped up. So I think that it’s really important for younger women to take seriously their genetic risk if they have one and to take seriously just in general the risk of breast cancer.
[00:24:18] It’s not really spoken about to be diagnosed with cancer in your early 30s, you know? And really, before that, cancer made some choices for me. Before I was even diagnosed, you know, I was going down the IVF and all of that. So I think it’s important that- The rate of diagnosis age is getting lower and lower, and it’s not something that we should be waiting until our 40s and 50s to be starting to monitor.
[00:24:54] I think that it’s important to Make sure that you are taking your body seriously and your health seriously. And I also wanted to be part of the campaign to spread some awareness for the lack of funding and research that there is for metastatic breast cancer. It’s so under-researched and underfunded, and it doesn’t only affect stage four breast cancer thrivers or survivors or fighters.
[00:25:26] You know, you– all of that science impacts every person who’s diagnosed with breast cancer or another type of cancer. A lot of the medications can cross over, you know, but there’s a lack of funding for metastatic breast cancer, and I don’t want us to forget about those girls. You know, Don’t Fail The Girls means all the girls.
[00:25:49] Adam Walker: That’s right. It does. That’s right. I love that. And I appreciate you, you know, taking the time to, to be a part of that, and I think it’s so important. Now last question. If you could speak directly to a woman who has just learned she carries a BRCA1 mutation or someone who’s navigating a breast cancer diagnosis at a young age, what would you want her to know?
[00:26:13] Margot Casino: I would say, I’m sure right now when you look around, it feels like you are in a dark tunnel You are not alone, and one day you will look up and see the light again. The only way out is through, so just keep going. Just keep going.
[00:26:38] Adam Walker: That’s right. The only way out is through. Just keep going. That’s beautiful.
[00:26:43] Margot, you’re an inspiration. Thank
[00:26:45] you … And you’ve had a, you’ve had a journey, you know? And I just, I appreciate you giving us a glimpse into that journey. And I appreciate you just sharing where you’re at today. So you’re, again, you’re an inspiration. Thank you so much for joining us on the show today.
[00:27:02] Margot Casino: Thank you so much for having me. I’m so happy to help spread awareness, and if anybody out there feels less alone because of listening to this, mission complete.
[00:27:11] Adam Walker: Yeah. They do, and they should. They should. They will. Thank you.
[00:27:18] Thanks for listening to Real Pink, a weekly podcast by Susan G. Komen. For more episodes, visit realpink.komen.org, and for more on breast cancer, visit komen.org. Make sure to check out @SusanGKomen on social media. I’m your host, Adam. You can find me on Twitter @ajwalker or on my blog, adamjwalker.com.