“I am a twenty-year triple-negative breast cancer survivor. I didn’t just survive the challenges of a breast cancer diagnosis; I am thriving in life, teaching the Bible for life change, sharing the message of Christ, and serving others.” Talulah Ruger

Twenty years ago, on September 22, 2001, I became one of the 1 in 8 women with breast cancer. Like many Americans, I was still trying to understand and control my emotions after the September 11 attack on the World Trade Center. I was up early, getting ready to take the Advanced Oncology Certified Nurse exam. While showering, I discovered a mass in my left breast. My first thoughts were, how did I miss this, and wasn’t my last mammogram negative for cancer? However, I believed my recent weight loss enabled me to detect the mass. As I palpated the area, my experience and knowledge of what I felt caused me to suspect it was cancer.  But I also knew the medical process for confirming a diagnosis. On that Saturday morning, in my heart, I knew my life was about to change. I started praying and asking God to prepare me to accept and handle the days ahead. Although my discovery caught me off guard and left me emotionally shook, I dressed, drove to the testing site, and took the certification exam. On Monday, I contacted my primary care physician, and my cancer journey began.

I cannot overemphasize the importance of awareness of the look and feel of your breast to help alert you to changes. Don’t be afraid to step out of the shower or tub; look in a mirror and closely inspect your body. When you discover a mass or notice something different from your usual, seek medical attention immediately.

According to the American Cancer Society (ACS), breast cancer is the most common cancer among American women, except for skin cancers. In addition, 1 in 8 women in the United States will develop invasive breast cancer during their lifetime. Breast cancer is the second leading cause of cancer death in women, exceeded only by lung cancer. Although men can develop breast cancer, it is 100 times more common among women than men.  For men, ACS statistics indicate the lifetime risk of getting breast cancer is about 1 in 833.

When I learned that I had breast cancer, I was a 21-year veteran oncology nurse at MD Anderson Cancer Center in Houston. Within a few weeks I became the patient. At the time, I had no family history of breast cancer, but only 5-10 % of breast cancers are hereditary.  After completing diagnostic tests and exams, I visited a medical oncologist to review my diagnosis and discuss the treatment plan. It included the insertion of a venous access device (VAD) for long-term intravenous therapy, six cycles of chemotherapy over six months, surgery, and six weeks of external radiation.  I still remember the overwhelming and immediate feeling of powerlessness and loss of control.  The reality of what I felt at this moment was the same feeling my patients communicated to me throughout my oncology nursing career.

Patients with a new cancer diagnosis face uncertainties about their mortality, the course their illness will take, their treatment, and its potential adverse effects. They are concerned about their ability to care for themselves, continue working, and the impact treatment will have on their families and quality of life.

The initial diagnosis marks the beginning of survivorship. It is an emotionally stressful and overwhelming period as the patient tries to adapt and understand all the information physicians, nurses, and other healthcare members provide.  A cancer survivor defined by the National Cancer Institute (NCI) is anyone diagnosed with cancer, from diagnosis through the end of their life. As of 2021, there are more than 3.8 million breast cancer survivors in the United States. Survivorship has three phases: Living With, Living Through, and Living Beyond cancer.

I have lived with the treatment and side effects. I had my good days and awful days during treatment, but God was always with me.  I have lived through the period after treatment when there is the most risk for cancer to return. But I began living beyond breast cancer the day I walked out of my oncologist’s office with my treatment plan in hand.  I decided that although I had breast cancer, it was not the total of who I am. I was a survivor long before Destiny’s Child released the song in 2001. My life and survival were all based on my faith and belief in Jesus Christ.  My goal was not just survival but to live my life to the fullest. Today, I am 20-years cancer-free. Every day is a day of thanksgiving, and I am so grateful that my journey and testimony can encourage others.

So, what happened with the certification exam that I took on the day I discovered the mass in my breast? I didn’t pass! While it would be convenient for me to use the events of September 22 as an excuse, it had nothing to do with my discovery. I mastered all the subject matter except one area, and I missed passing the exam by two points. When discussing my frustration with some of the questions on the exam with a colleague, she gave me great advice. Don’t overthink and answer the questions with book theory and not what happens in my clinical practice. Keeping her suggestion in mind, I rescheduled the exam and passed.

What’s my object lesson? All of us have life trials and circumstances that we have tried very hard to understand why. Is it a test of our faith? If so, are we passing or failing the test? We overthink, rationalize, and get the opinions of others. The truth is that there are some things we may never understand the reason why, but we know who is in control. So seek God in his book, the Bible, for direction, comfort, and hope. Stay connected to your church community and surround yourself with supportive family and friends. Learn to be “OK “with not being “OK” all the time.

October is National Breast Cancer Awareness Month. It is dedicated to increasing awareness about the importance of the early detection of breast cancer through a nationwide campaign. You can lower your risk of breast cancer by changing those risk factors that are changeable.  Early detection will not prevent breast cancer, but it can help find it when a greater likelihood of successful treatment is possible. For the American Cancer Society recommended screening guidelines and cancer survivorship information, visit these websites.