VINTON, Va. (AP) — In a perfect world, her radiation oncologist told her in 2003, a young woman stricken twice with breast cancer would have a complete hysterectomy — to reduce her risk of a cancer recurrence.

But Cara Cubitt, 29 at the time and childless, was not swayed by her doctor's perfect world.

In Cara's perfect world, the one she shared with her husband, Todd, in their Vinton home, she pictured a baby swing in the back yard and a tricycle out front.

She had already lost her breasts and her hair. There were days when she felt like she might lose her marriage, too.

But Cara was determined not to lose her shot at motherhood — not even if it meant risking her life.

Of the 140,000 people under 45 diagnosed with cancer each year, roughly half receive treatments that render them sterile. But the data hasn't focused on patients as young as Cara, who had her first bout with breast cancer in 1996 at the age of 22.

"The biggest risk of all to my getting pregnant was, they don't really know the risks," she said.

She was single then, a student at Virginia Western Community College. Breast cancer didn't even run in her family. "For this to be cancer at your age, you would make the newspaper," said her doctor, who'd never treated anyone that young.

But cancer it was, of the noninvasive kind. Cara had a lumpectomy and radiation and went on with her life. She thought the 95 percent chance of her remaining cancer-free sounded pretty good. Offered a five-year regimen of Tamoxifen to further increase her odds, she turned it down, a decision she would later regret.

In the months leading up to their 2000 wedding, the couple discussed her health; Cara was 26 at the time. Todd recalled his mother asking him weeks before the wedding, "What would you do if she got cancer again?"

"Growing up, mowing the lawn, I was the kind of kid who'd stop halfway through the job," said Todd, now 37 and an information systems technician for Advance Auto Parts. "They didn't have a lot of faith in my ability to be responsible."

Three years later, Todd had the chance to prove them wrong. The cancer had returned to Cara's right breast, and this time was worse than the first: invasive intraductal carcinoma.

Removal of the breast was a given, but doctors wanted to remove the left breast, too, a preventive measure. "You don't want to be back here in five years with cancer in your left side," her surgeon said.

Chemotherapy was ordered, too, because they couldn't be positive that the cancer hadn't already spread. But Cara was adamant about her wish to have children, choosing her chemo drugs based on fertility preservation — even though they were less protective than the ones her doctors urged.

"She's a very gutsy woman," said Aileen Pandapas, a breast-cancer survivor and volunteer who met Cara at church. "It was a risky thing she did, but Cara doesn't take no for an answer if it's not the right answer."

Everywhere she went for treatment, 29-year-old Cara was the youngest person in the room. When she asked doctors if they knew other breast-cancer survivors who went on to have children, they recalled two. But they were older than Cara, and they hadn't had cancer twice.

When she asked outright, "Will I be able to have kids?" her doctor would only say, "It's rare but not impossible," or, "It's in God's hands."

Todd resigned himself to not having children. He focused on taking care of Cara, changing the bandages from her reconstructive surgery, taking her to chemo, telling her how beautiful she was.

When they went out to restaurants and spotted a baby — "he's like a baby magnet; they're always smiling at him," Cara said — he played it off.

"I don't care if we have kids," he reassured her.

Cara didn't believe him.

"She'd go in the shower in the morning, and I could hear her crying, and I knew she'd looked at herself," Todd recalled. He cried, too, but not before burying his head in his pillow — so Cara wouldn't hear.

Eager to conceive, Cara ended her post-cancer treatment after three years — even though the recommended course was five.

One of the drugs had put her in a chemically induced menopause for a year and a half, during which time her obstetrician opined: "I don't think you'll ever have periods again."

Cara found a new doctor — one who was more open to her conceiving a child, although he had never personally treated someone in Cara's situation before.

But things at home were strained. Todd was out of work for several months, and their finances were a mess. Cara resented that she'd had to be the breadwinner, administering accounts at Catawba Capital Management, even when she didn't feel well.

No matter how many times Todd said she was beautiful, she didn't believe him. "There was actually a moment when she said, 'Todd, I'll understand if you want to quit now,' " he recalled.

"I just didn't feel like he could find me attractive," Cara said.

They went to couples counseling and marriage-enrichment seminars. "We'd never had time to talk about it," Todd recalled. "At some point, you're drained. There's nothing left, and you're going on what real love is.

"It's bare bones, and it puts you over the edge."

It wasn't uncommon, he knew, for couples dealing with breast cancer to end up divorced. "The stress can take you to where you might be tempted ...," he said, not finishing the sentence.

"I was being more responsible than I had ever been in my life, but I had to see past the physical."

It didn't help, either, when some of his guy friends said, "If that ever happened to me, I don't know how I'd be taking it," and other, even ruder things.

Todd was watching "Everybody Loves Raymond" a year ago in May, when Cara walked into the room and announced, "I'm pregnant."

He did not believe the news until he heard it himself in the ultrasound room: the sound of a tiny beating heart.

"I felt Jesus in that room," he said. "It was such a release, I broke down and cried."

The baby weighed in at 8 pounds, 4 ounces on March 28. It was almost five years to the day since Cara had been rendered cancer-free.

The couple sighed with equal parts astonishment and relief when the nurses declared Hannah Grace Cubitt "perfect in every way."

The name came from a story in the first chapter of Samuel: A barren woman named Hannah prays to have a child and, by God's grace, her wish is granted.

"The nurses got on us for holding her too much at the hospital," Cara recalled. "They said she'd get used to it and we'd be in trouble when we got home."

The Cubitts have seen trouble before. One day they may see it again, though their relationship is stronger now and Cara is vigilant about her health.

But this trouble? This trouble goes by the nicknames "potty toots" when she's gassy and "ladybug" and "pretty girl" when she's not.

This trouble is so strikingly pretty that a stranger approached the Cubitts at Red Lobster not long ago and could not stop fawning over Hannah's smile. "You must have been especially happy when you were carrying her for her to smile this much," she said.

"Miracle baby" is another name they call their sweet bundle of trouble, who, in fact, is anything but.

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Information from: The Roanoke Times, http://www.roanoketimes.com