Brinlee Luster brushed off the exhaustion and stomach cramps as stress. She was finishing college, planning a wedding, and racing toward graduation. At first, the changes were easy to dismiss. A cold that wouldn’t clear up. An unsettled, uncomfortable feeling in her gut that could be anxiety. Feeling winded on an easy hike.
But as the pain sharpened and she started leaving class 10 times to use the bathroom, she knew something was seriously wrong.
Or more accurately, her sister did. Mariela Luster and Brinlee are identical twins who share everything together — attending the same college, in the same program, even meeting their husbands on the same day at the same community event. Their voices are nearly indistinguishable; even their parents struggle to keep track of who’s who on their podcast.
Mariela was the first to flag that Brinlee, normally energetic and enthusiastic, was not just under the weather.
“Her whole personality started shifting because Brinlee has always been a super go-getter and then all of a sudden she started just getting really depressed,” Mariela told me when I visited them at their family home in Heber City, Utah. Brinlee lost interest in things she used to love, like decorating their house, her sister said.
After more than a year of intensifying pain, debilitating fatigue, and medical visits that raised more questions than answers, doctors found a tumor so large it was blocking her colon. At 21, Brinlee was diagnosed with stage 4 colon cancer that had already spread to her lymph nodes and her liver.
Kim Raff for BI
Over the months I’ve spent getting to know Brinlee, over Zoom and in person, she seems like any healthy, cheerful 24-year-old. You’d never guess she spent the past year and a half enduring round after round of chemo and surgery. Brinlee’s case is among the sharply rising number of young people diagnosed with colon cancer, often at late stages, baffling researchers.
As identical twins, the Luster sisters show how impossible it is to isolate a single cause driving cancer in young adults, and how devastating it can be for patients at a crucial life stage. Brinlee’s diagnosis changed the trajectory of her life as she navigated surgeries, bills, and fertility treatments to preserve her hopes of having a family. Mariela tried to stay on track with her own plans, starting a career, and later moving to a new city with her husband, while quietly shouldering survivor’s guilt.
Their diverging paths capture the challenging reality for this young generation of patients, forced to make irreversible choices about their bodies, finances, and futures that no one in their 20s expects to face.
Born in Port Angeles, Washington, the twins moved to Utah with their parents, Justin and Alyse Luster, when they were 10. Their acre-and-a-half childhood home backed out onto nature preserves and farmland, and the girls spent their summer vacations biking and trekking around the wide desert of the Southwest with their three siblings. The family was robustly healthy and, as a result, fairly stoic about their health.
“I was raised by a mother who was like, if you’re not having a high fever, if I can’t see the bone out of your arm, you’re fine,” Alyse told me.
The day of her July wedding, in the backyard garden of her parents’ house, Brinlee smiled through waves of stomach pains.
As a newlywed, it became harder for her to keep the symptoms to herself. That fall, she told her husband Parker she had been seeing blood in her stool — a telltale warning sign of colon cancer.
“You don’t want to talk about your poop, but then you realize that it’s serious. If I would’ve known how serious it was, then I would’ve said something earlier,” Brinlee said.
Parker urged her to get professional medical care. A nurse practitioner said it was probably irritable bowel syndrome and prescribed medication, which resolved the cramps and bloating for a few weeks. The pain came back, sharper this time, along with a deep exhaustion she couldn’t sleep off.
Then everything escalated. After routine surgery to remove her wisdom teeth led to an infection, Brinlee started taking antibiotics, and her symptoms abruptly took a turn for the worse.
One night, while Brinlee and Parker were watching a movie, pain ripped through Brinlee’s abdomen, so sharp she nearly passed out. Eerily, the film was “Black Panther: Wakanda Forever,” which started with a tribute to actor Chadwick Boseman, who died of colon cancer at the age of 43.
Brinlee called her doctor, imploring them to book a colonoscopy, but the medical staff were reluctant because of her age. Eventually, her mom got on the phone to insist. Brinlee had to wait a week for the procedure, grappling with the pain. Finally, in the operating room, the doctors hit a tumor so large that they couldn’t move past it.
Brinlee remembers hearing the word “cancer” through the haze of anesthesia, her mother sobbing beside her, her husband frozen in place. Her doctor, a cancer survivor himself, broke the news gently.
“I remember his voice telling me I had cancer and tears running down his face,” Brinlee said. “I finally had something that was an answer. There’s almost relief at that point.”
Mariela missed the appointment because she was working, assuming the colonoscopy would find something routine and treatable. Her mother’s phone call with the news was a crushing, overwhelming blur. She remembers crumpling against the wall with the weight of the diagnosis, tears streaming down her face. She cried for days, then compulsively cleaned the apartment, unable to sit still as the family weighed the options for treatment. She felt guilty as her sister remained stubbornly cheerful and upbeat.
“I was looking like a ghost. People were like, ‘Are you sure you weren’t the one diagnosed?'” Mariela said. “Brinlee was the most positive one of any of us. She really had this sense that everything was going to work out and be OK.”
I met Brinlee and Mariela for an early dinner in Midway, Utah, at a restaurant they frequented during high school. They ordered the same meal, shrimp tacos, in unison — Brinlee with fries, Mariela with a side salad.
They look similar, but even though this was the first time I’d seen them both outside a Zoom call, I could immediately tell them apart. Mariela is a touch more assertive, prone to taking control of situations since the twins’ youth, when she jumped into student government during high school. She was the first to greet me.
Kim Raff for BI
Brinlee, the more laid-back twin, followed with a quick hello hug. She spoke with a gravity beyond her years, an undercurrent of exhaustion that was evident despite the cheerful, warm small talk we exchanged over dinner. She looked like any other 24-year-old, until she showed me the large scars running over her stomach and across her side.
Brinlee’s diagnosis in February 2023 set off a flurry of activity that shifted the family’s lives for the foreseeable future. She had been looking forward to the busy social life of a recent college grad, planning weekend trips with friends and summer adventures. Instead, she was booking a major surgery. Further on, the calendar filled with chemo and follow-up appointments in lieu of lake weekends, hikes, and double dates with her sister and their new husbands.
Finding out she had cancer also prompted an upheaval in Brinlee’s long-term future. The first question her surgeon asked was whether she ever wanted to have children. The surgery to excise the tumor from her colon would cut into her digestive tract, potentially hurting her odds of a viable pregnancy. Egg or embryo freezing would cost between $15,000 to $20,000 out of pocket. With less than two weeks to make a call, the couple decided to go for it, hoping that family and their community could help them foot the bill.
Hours of frantic Googling turned up a few financial resources specifically for fertility treatment in young cancer patients. The couple applied for aid, which covered some of the initial treatment: they received a discount on the treatment through Livestrong (a cancer advocacy nonprofit), and a small grant from Worth the Wait (a nonprofit providing financial assistance for young adults undergoing cancer treatment who want to become parents).
Brinlee and Parker now pay $85 a month to store their 17 frozen embryos in a petri dish at a clinic. Brinlee said the procedure was “excruciatingly painful.” The hormones she took to balloon her ovaries for optimal egg retrieval exacerbated the cramps and bloating she had endured for months.
After surgery came the opening salvo of chemo, treatments scheduled every other week for half a year. Brinlee approached it the way she approaches everything — with meticulous planning. The dry-erase calendar on the wall of her home filled up with notes, reminders, affirmations, and Post-Its, with “on weeks” for infusions and “off weeks” for recovery.
At first, through the spring of 2023, she kept working remotely nearly full-time, her husband recounted in awe. The initial side effects felt like a flu or fever; on good days, she played tennis with Parker or planned weekend hikes, determined to hold on to the joys in her life.
“My doctor was pretty shocked with how I was able to bounce back,” Brinlee said of her weeks between infusions.
But as the months went on, her rhythm changed. The fatigue deepened, the nausea hit harder, and her off weeks took on an almost manic energy as she raced to fit as much life as possible between chemo sessions. Parker said he could barely keep up.
Somewhere in that blur, the twins started The Port Studio — a business born out of their need for purpose. Between chemo sessions, Mariela and Brinlee painted affirmation cards for other patients. They named their project after their birthplace, Port Angeles, and the medical port implanted in Brinlee’s chest. It developed into a small brand of soft, port-friendly sweaters.
Kim Raff for BI
By late 2023, Brinlee had moved back home into their parents’ house, working remotely until she was too sick to work at all. Parker joined her even though he worked in Salt Lake City, commuting an hour to work each way daily so he could talk with his wife even for just 10 minutes before she fell asleep.
For a time, Brinlee slept in the home office downstairs, which her family made into an impromptu bedroom when she was too sick to walk upstairs to her childhood room.
Every Monday, her mother, Alyse, drove her to treatments every other week at Intermountain Medical Center in Salt Lake City, an hour through the canyon. In the infusion room, Brinlee passed the first hour of the four-hour sessions chatting with the nurses or drawing on an iPad, before the chemicals left her wordless and withdrawn.
“Extreme nausea. How do I say this? You know when you’re so uncomfortable, in so much pain you can’t sit still?” Brinlee told me. “It feels like dying.”
When it was done, Alyse drove her home. Brinlee fought dizziness on the mountain roads, looking out the window at the Wasatch range as the chemicals infused her body. The family came to dread Sundays — the day before her next round — as she anticipated the incapacitating nausea and exhaustion.
On the worst days, Parker would come home to find her scrolling through photos on her phone of hikes, weddings, and friends — memories of life before cancer.
“I loved to look back on pictures and remember the times when I wasn’t sick,” she said.
Meanwhile, Mariela was living what Brinlee’s life might have looked like without cancer.
While Brinlee’s world narrowed to hospital rooms and scan results, Mariela’s expanded. She had just graduated from college, married her college boyfriend, and started her first job in marketing at a venture-backed healthcare firm.
The contrast ate at Mariela. She struggled with the guilt of being the visibly healthy twin as Brinlee lost hair, developed an all-over rash, and dwindled to less than 100 pounds. Why her and not me? She scheduled a colonoscopy, just in case. It revealed no cancer, although there were polyps, non-cancerous growths that can develop into cancer over time, and which were removed as a precaution.
Still, she kept moving forward. Mariela had always been driven, her mom told me — high-achieving, organized, imaginative. At work, she was on track for a promotion from marketing assistant to brand manager, a move that promised more responsibilities and a higher paycheck. Mariela arranged to work remotely so she could help manage the family’s caregiving schedule and finances.
Even with the distance that work provided, she couldn’t escape the feeling that her freedom to plan, choose, and save was unfair. “It was hard to be excited about me starting my career when everything was stopping for her,” she told me on the phone more than a month after my trip to Utah. It was one of the few times we spoke without Brinlee present — Mariela had just moved to Nashville and was settling in, not yet employed full-time as she weighed her options for a career change.
Watching Brinlee maneuver through a healthcare system that decided who got care and how fast, Mariela had questioned her career in the profit side of the industry and started seeking a role that could be more patient-focused.
Keeping up with the hustle came with tradeoffs. A mix of guilt and anxiety over the randomness of cancer drove Mariela to a fixation with “clean” eating that she said became disordered.
“Social media was a huge dark hole that made it easy to numb myself to what was happening,” Mariela said. “But turning my phone off and putting it away finally made me less stressed.”
On the surface, Mariela was the lucky one, able to throw herself into her career, planning for her future, without the impossible pressure of a diagnosis condensing life into the single, focused goal of survival. But each milestone — an adult paycheck, a big project, a promotion — felt hollow without her twin.
“I didn’t want to do anything but be there for my sister,” she said.
Dr. Mark Lewis, the oncologist who treated Brinlee’s cancer, works with a growing number of patients in their 20s and 30s. He was one himself.
An upbeat, energetic man in his mid-40s with a penchant for posting medical memes on X, Lewis is a survivor of multiple endocrine neoplasia type I, a rare genetic syndrome that causes tumors to grow in hormone-producing glands. He joined the field before his diagnosis, after watching his father’s battle with cancer.
Cases like Brinlee’s are still rare but rising, and theories abound about why younger people are being diagnosed with colon cancer more often. Is it our diets, high in processed food? Our sedentary lifestyles? Our environments full of artificial light and microplastics? Lewis believes early-life antibiotics could be an underappreciated driver, based on compelling research, but says that the full answer remains frustratingly opaque. He’s not alone: There is a growing consensus among cancer researchers that antibiotics, and their effect on the gut, may play a role.
When they do happen, gastrointestinal cancers in young people traverse a liminal space in healthcare.
“You have these really weird in-between cases. It doesn’t make sense to take patients in Brinlee’s demographic and put them in children’s hospitals with cartoons on the wall,” Lewis said. “The treatments that we were using in children weren’t working in young adults.”
Kim Raff for BI
In the oncology wing of the hospital, Brinlee was the youngest patient by decades. Some of the most effective medications for her treatment weren’t cutting-edge designer drugs, but an older generation of chemotherapies, less expensive but more prone to side effects like hair loss.
Then came the bills: A nausea drug, making it possible to eat, can cost about $10,000 per two-week cycle; each chemo infusion $10,000. Three surgeries — one of which was $70,000 alone — pushed the total billed from 2023 to 2024 to nearly $1 million, mostly covered by her father’s insurance through his job as a software engineer. That included colonoscopies for the rest of the family, to rule out additional cancer cases.
The family was also billed thousands of dollars for tests like Signatera, which scans the blood for lingering cancer cells by identifying tiny traces of specific tumor DNA. The first test cost nearly $15,000; later ones ran $4,900 to $8,500. Insurance covered some, and the testing company absorbed some of the cost because the tests aren’t yet a standard of care.
Other out-of-pocket expenses included travel to Houston’s MD Anderson, one of the leading cancer centers in the country, to get second opinions.
For what insurance didn’t cover, friends, church members, and even strangers chipped in — covering meals, housing, and flights. One stranger, overhearing Brinlee’s story at a Mexican restaurant, quietly paid for their family’s entire meal and left a note: “Remember the Lord knows and loves you — from someone who noticed.”
The experience forced the twins to grow up quickly as they were thrown into the deep end of adult financial challenges, their mother told me.
Brinlee, the focus of all the efforts, somehow found the energy to comfort others, to be the calm center amid the storm, her sister said. Despite her strained financial resources, she went out of her way to give small gifts to friends and family, like a necklace with a note that said “have faith” for Mariela.
“She was the one lifting up her family,” Mariela said.
In December 2024, 10 months after her diagnosis, Brinlee got a notification on her phone that her latest test results had dropped in the patient portal. Anxiously, she and Parker logged in, hardly daring to hope.
The blood test — a custom diagnostic that can detect the unique signature of cancer cells — came back negative. A clean zero. Lewis contacted them soon after to confirm the news. Brinlee was in remission.
Relief came first; questions followed. For colon cancer, a “cure” isn’t definitive until at least five years have passed with no sign of malignant cells returning. The Lusters were also still grappling with the question of why. Brinlee’s medical team scoured more than 100 of her genes and found no predisposition for cancer in her DNA. A 2016 study found that twins share the same elevated lifetime risk, yet no one can pinpoint why one might get cancer and the other wouldn’t.
Lewis said it’s likely down to the hardest factor to accept: bad luck.
“People like to believe that it’s possible through rigorous diet and exercise to be able to prevent cancer,” he said. “I can’t imagine a healthier young woman than Brinlee, and yet she still got colon cancer.”
Kim Raff for BI
Brinlee said an unexpected challenge is learning how to live after cancer. During treatment, she took a contract role with the marketing team at the Huntsman Cancer Institute, writing press releases and posts about her personal story — helping her re-envision what work could look like after cancer treatment.
At 26, she’ll age out of her father’s health insurance. She hopes to have coverage through full-time employment by then, but she’s taking it slow, picking up some contract opportunities instead of rushing into a long-term role.
“It’s a little bit scary to just be thrown back into the real world,” she said.
Mariela recently moved to Nashville, the farthest she’s ever lived from her twin, and she is also rethinking her career and looking for a new role in healthcare access.
They’re feeling cautiously optimistic about the change, the twins told me, finishing each other’s sentences. The distance is a challenge, but the chance to start a new chapter is exciting. Their shared experience — and drive to make meaning from it — still connects them.
Their company, The Port Studio, recently filled a bulk order of port-friendly clothing for a nursing company. Messages, photos, and videos from customers sharing their cancer journeys fill their inbox. The reminders are bittersweet, Brinlee said, but grounding.
“I can’t control if it comes back or not. The only thing I can control is how I respond to things,” Brinlee said. “We try to just be in that moment; not thinking too far into the future, not thinking about the past, just being present.”
