Evening gown, Maria Lucia Hohan ($920). Long chain diamond tassel necklace, David Yurman ($2,275). 40 E. Oak St., 312-787-7779. Elsa Peretti Continuous Diamond necklace, Tiffany & Co. ($65,500). 730 N. Michigan Ave., 312-944-7500. Darling sandals, Jimmy Choo (price on request). 63 E. Oak St., 312-255-1170

Cancer has become the answer to a lot of personal questions for Giuliana Rancic. Why were she and husband Bill having such a hard time conceiving, she would often wonder, despite the fact that repeated fertility tests turned up nothing wrong? Or even before she began her struggle with infertility three years ago, Rancic would have nagging doubts about her meteoric rise in a business where she says she didn’t always feel worthy.

Now, she says, a clear picture has emerged. It began last fall, when all eyes were on Rancic as she publicly underwent treatment for estrogen-receptor-positive breast cancer—first a double lumpectomy, and then, when cancer remained in her right breast, a double mastectomy in December. Her diagnosis was the result of a mammogram ordered by a doctor as part of an IVF protocol that revealed early-stage breast cancer. At 36, she was four years away from her first mammogram, and if she had gotten pregnant through one of her previous fertility treatments, her doctors have told her that the prolonged hormone surge would have accelerated the growth of her cancer.

“Do you realize that if we had gotten pregnant, I would have been done?” she says. “That would have catapulted this cancer into another level. By the time I was 40 or 41, I’m scared to think about what they would have told me. I now know the reason why I wasn’t ever supposed to get pregnant. People come up and they have sadness in their eyes, and I think, at a time when everyone’s looking at me with pity, I look at myself as lucky. I think I just dodged the biggest bullet of my life.”

As the cancer was cleared away, what took its place was a pressing belief that talking about it was an important part of her life’s purpose. “I remember when I first came to Hollywood I would sit in these casting calls. I wasn’t the prettiest, I had a funny name, I certainly wasn’t the smartest—but at the same time, I always thought when I started getting the jobs, How did I get that job, and these girls didn’t?” But now, she says, she understands that the platform she has built over the last 10 years at E!—and the relationships with millions of young women who hang on her every word about Kim Kardashian or Britney Spears—can serve a greater good. “Maybe in some way I’m a little bit of a messenger,” she says. “Maybe God knew that I have a big mouth, that I’m a loud Italian chick, that I wouldn’t hide anything. It now starts to make some sense to me why I think I got the cool job, because I think He knew I would do some cool stuff with it.”

While Rancic has been incredibly open about nearly every stage of her diagnosis, she has also guarded some parts of her story very closely. Like when she first learned of the results of a biopsy on her left breast in early September, but doctors wanted to postpone a lumpectomy until they checked her right breast via MRI as well. “Every single second of the day I was thinking, I have cancer. It totally consumed me, and no one knew.”

A biopsy on her right breast was inconclusive, so her doctors decided to perform a smaller lumpectomy on that breast. The day before her treatment, on Monday, October 17, she went on the Today show to talk about it. On the one hand, she knew going public would be helpful to some women, but she also knew it would become a permanent label attached to her name. She decided to go forward with the announcement, had the procedure on Tuesday, and by Friday received the devastating news that the margins on her right breast were not clear.

Giuliana's Watershed Decision
Her physician, Dr. Armando Giuliano of Cedars-Sinai Medical Center, presented her with options. A double mastectomy would be the quickest and most decisive treatment—giving her only a one percent chance of recurrence—but also the most extreme. “He said, ‘Obviously your breasts will never be the same, and you’re also going to lose all sensitivity and feeling,’” says Rancic. “He thought it was a more major loss than I did. I just thought, If that’s the worst, that’s a trade I’m willing to make.” By the end of that weekend, after discussing it with Bill and a small circle of friends that included Dr. Paul Song (Lisa Ling’s husband, who is a radiation oncologist), she was nearly certain she wanted to do it. The deciding factor was a Halloween weekend visit to LA from Chicagoan Lindsay Avner, founder of breast cancer nonprofit Bright Pink and someone who had herself undergone a double mastectomy. “I had seen all these images on the Internet—a lot of them are really scary and terrifying. Lindsay showed me her breasts and that really brought it home. I was like, Okay, I’m doing it, because she looks amazing.”

Like what you're reading? Get it delivered straight to your inbox. Sign up now for our newsletters >>