Ashley Vassallo, 34, is young, active, and a nonsmoker, so when the Bay Area resident had a cough, doctors assumed it was due to COVID or another common ailment. But Vassallo was actually in the early stages of lung cancer, which is often considered one of the most preventable types: Roughly 70% of cases are a direct result of cigarette smoking. However, lung cancer among women under 50 is rising—and that doesn’t seem to correspond with an increase in smokers. Because it’s still relatively rare in young people, doctors often rule out a bunch of other health issues before even considering cancer, which is exactly what happened to Vassallo. Here’s her story, as told to associate health conditions director, Julia Sullivan.
I’ve spent the majority of my life focused on well-being. I eat plant-based foods, work on my mental health (I’m a social worker for people in hospice), and am active—I have a blue belt in Brazilian jiu-jitsu, lift weights, and am into yoga. My sons are also my world. I’d take them in regularly for check-ups, but I seldom went myself. Still, I did all the other things you’re told to do to be healthy.
In fall 2021, everybody in my family—me, my husband at the time, and my two boys—got sick. We went to urgent care and were tested for COVID, pneumonia, and the flu, all of which came back negative. Everyone else seemed to recover within a day or two, but not me. My cough lingered, but it was subtle. I felt like something was a little off—there was a heaviness in my chest—but I could breathe just fine.
During Christmas 2021, my symptoms took a turn. I was lying in bed and felt a sharp pain near my lung. I was having trouble breathing. I knew something was wrong, so I made an emergency telehealth appointment. The nurse practitioner said, “Honey, it sounds like stress and anxiety. You should talk to a therapist.’” (I don’t know why, but that ‘honey’ really got to me.) Sure, I was stressed—I was in the process of coming out and knew I’d be leaving my husband at some point, though I didn’t mention that over the call—but this was not anxiety. It felt like a sharp knife stabbing me in my chest.
The next day I went in for an evaluation with that same health care provider. Despite having never tested positive, she was sure I had COVID or long COVID. I also mentioned I had asthma as a young kid, so after those things were ruled out, she jumped to that as the culprit. She sent me off with an inhaler, but it didn’t help, even after using it for a few weeks. (She told me at a follow-up appointment that I probably wasn’t using it properly.) After some googling, I thought I might have acid reflux. I mentioned this to the nurse practitioner at another follow-up appointment a few weeks later, and she agreed we could try a GERD diet with foods that wouldn’t upset my digestive system. That didn’t work, either, and I was losing weight (which I thought was related to the diet at the time).
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All the while, my cough was getting worse—I was having to do it every five or so words. It’s really embarrassing to have to go into patient visits in hospice while coughing. I continued seeing the same provider, but I was getting pretty desperate. I’d tell my friends, “It’s like there’s a little alien eating me from the inside out.” (Grotesque, but it ended up being sort of true.) She ordered an X-ray but they didn’t see anything wrong. So, I told myself I was fine and pushed through it. I’d go to martial arts classes and lift weights, still in pain and tiring out really quickly. I was training for a half-marathon at the time, but I eventually had to stop—I couldn’t go longer than a few minutes without wanting to pass out.
During this time, I left my husband and was going on dates with women. I was in so much pain, but I was also in a really beautiful, authentic place in life. I was an extreme optimist, so I wanted everything to be okay. But my body had other plans: Things got so severe that I ended up in the ER with shortness of breath and chest pain. Still, the doctors dismissed my symptoms. I’d had a miscarriage eight months prior, so they assumed I was having some kind of after-effect from that. They looked at my chart with no health issues and how young I was, so they sent me on my way. Within a month, I ended up back at the ER with extreme vertigo and dizziness. After taking another X-ray of my chest, they found something (for whatever reason, they did this time, but not in my previous X-ray) and diagnosed me with “the largest pneumonia mass they’d ever seen.” I was put on antibiotics.
I wasn’t getting better, but I was determined to keep one bright spot of my life—the coming out part—flourishing. I was on a date with my now girlfriend, Erin, who noticed my cough. Things started heating up between us, and we went on more dates, so naturally, my symptoms became really obvious. By that point, I could barely wear shoes because my feet were so swollen. I remember calling her one day, utterly defeated. She said, “I’m leaving work right now to drive you to the emergency room. I’m so sick and tired of these people misdiagnosing you.” Erin, and the doctor in that particular ER, saved my life: She was the first medical provider to check for blood clots, which I had all over my body, including one near my lung. (I was at an extremely dire point, and could have died, she said.) That pushed her to give me a CT scan of my chest and a biopsy. In October 2022, I was diagnosed with stage 4 lung cancer, as there was a small lesion on my spine. The cancer had spread.
I was in shock and denial, but also in survival mode. A part of me was relieved I had an answer to a problem that took 15 ER and urgent care visits over 366 days to solve. I was also relieved that people were finally taking me seriously and that I wasn’t losing my mind. But I was also angry: Because I am a younger woman with an athletic background who appears healthy, and can “push” through pain, I feel I was dismissed. I advocated so hard for myself, but no one took me seriously. Also, this beautiful thing was happening to me—falling in love with someone—while I was dealing with cancer…. It’s been a wild ride.
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About six months after being diagnosed, I had gone through four rounds of chemo. I also had five rounds of radiation to my spine, alongside immunotherapy. They continued doing scans of my lungs, but there was still evidence of disease. There was either live cancer or dead cancer in there, the doctors just couldn’t tell. That’s when I felt like I needed to start looking for someone to remove my lung. (You don’t typically remove the lung when it’s stage 4 cancer like I had, which made my current surgeon hesitant.) But I wanted this out of me. I wanted a chance at life.
Things have changed quite a bit with one lung, but it’s manageable. I’ve learned to work on my breathing capacity, and though I can’t run and have issues with the elevation and heat, I can still do a lot of things I love, like weightlifting and yoga. What’s harder to manage are the unknowns. I’m not cancer-free and am still going in for radiation. I don’t want to do chemo right now—that took a huge toll on my body—so our current plan is to continue getting scanned, and if small spots pop up, we’ll treat them. My doctor has also brought up a few clinical trials, so it’s really just keeping me healthy and strong for the next few years as new treatments become available.
A huge part of that is awareness. The dialogue needs to shift. Yes, smoking is bad, but there’s something else going on here. I am also learning the importance of prioritizing what is best for me. With cancer, I have to eliminate all the stress I can and focus on healing. If I am giving too much to everyone around me and their feelings, my health will suffer. That includes my doctors too. If I hadn’t advocated for myself, and if I wasn’t surrounded by people who advocated for me, I might not be here today. If you get a diagnosis like this, it’s important to have a say in your treatment, who you want to see, and how often you want to see them. Trust your body.
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