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Tuesday, October 23, 2012

‘You can’t be a non-survivor,’ breast cancer patient, advocate Rhonda Nunley believes

Rhonda Nunley waits in the UK Markey Cancer Center's chemotherapy suite for treatment. (Photo from UKNow)


By Allison Perry
University of Kentucky

When she was first diagnosed with breast cancer, Rhonda Nunley of South Shore wasn’t too keen on being a breast cancer advocate.

She attended the first “Making Strides Against Breast Cancer” event in nearby Ashland in October 2010, just three months after receiving a life-changing diagnosis — stage IV breast cancer, metastasized to her bones. At that event, Nunley said she kept mostly to herself and was hesitant to join the survivors’ group.

“I think it’s an identity thing,” said Nunley. “You don’t want to have cancer, and you don’t want to be identified as someone who has cancer. I didn’t want that sympathy.”

At only 39 years old — 37 at the time of her diagnosis — most people might comment that Nunley doesn’t look like a typical cancer patient. She has a full head of hair, though she keeps it cropped short. She’s young, talkative and energetic. Though she is currently on disability leave from her regular job as a care worker for Greenup Co. School District, she stays active in her role as president of the Greenup Co. Habitat for Humanity and as the mother of two rambunctious young boys.

Wanting to be around to watch her boys grow up plays a big part in her strength, Nunley says.

“I’m trying to be as healthy as I can for my kids,” she said. “It’s motivation.”

When Nunley first visited her local doctors in January 2010, complaining of tenderness in her left breast, they first assumed it was a milk duct infection — Nunley was only 36 at the time and had only recently stopped breastfeeding her youngest son.

But as the pain continued despite treatment, Nunley went back to her doctors. Mammograms and ultrasounds were ordered, but radiologists found nothing amiss in the tests. After 30 days of hormone treatment, Nunley went to see a surgeon at King’s Daughters Hospital in Ashland and received an MRI. There, the surgeon delivered the bad news — breast cancer.

The news was shocking, especially coming after months of diagnostic testing that revealed nothing, but Nunley points out that her young age may have played a factor. Most women don’t begin receiving mammograms until the age of 40, based on national guidelines.

“I had a mammogram, but I was so young that they didn’t have anything to compare that mammogram to,” Nunley said.

After the diagnosis, Nunley came to Lexington Clinic and had a mastectomy on her left breast — she says the surgeons removed a 12-centimeter tumor. Further testing showed that the cancer had gotten into 10 of her lymph nodes, and the cancer had spread into her bones.

As a metastatic cancer patient, she will need additional cancer therapies for the rest of her life.

Markey patient Rhonda Nunley, center, poses with her two sisters and her parents at the Ashland Making Strides Against Breast Cancer walk. (Photo from UKNow)

Based on a recommendation from a friend, Nunley sought help from Dr. Suleiman Massarweh, a breast oncologist at the University of Kentucky Markey Cancer Center. Determined to shop around for the most effective cancer treatments, she also visited the Cleveland Clinic and MD Anderson Cancer Center in Houston for second opinions.

Massarweh actually encouraged her to seek a second opinion, Nunley said, a fact that surprised her but gave her confidence about his abilities.

“He encouraged me to go, and even said that if I decided to go (to MD Anderson) that I should go before the weather in Houston got too hot,” Nunley said.

Massarweh is a strong advocate of second opinions, pointing out that patients are often rushed into treatment without time to thoroughly examine their options.

“It’s critical for patients diagnosed with breast cancer to spend an adequate amount of time learning about the disease, its prognosis, and all available treatment options,” Massarweh said. “This understanding will help them make the best decision they can to optimize their outcome.”

After speaking with the other oncologists, Nunley decided to stay at Markey. Even though she lives two hours away, she visits the Markey Cancer Center for chemotherapy on a weekly basis, usually accompanied by her husband.

And these days, she’s much more willing to speak about her cancer experience, particularly to share an important message — your family history is important. After her diagnosis, she discovered that her paternal grandmother had also been diagnosed with breast cancer in her 30s. Nunley and her family knew her grandmother had received treatment for breast cancer in her 60s, but they hadn’t realized that its first occurrence had come at such an early age.

Subsequent genetic testing showed that Nunley had inherited the BRCA1 gene mutation from that side of her family. Women with an abnormal BRCA1 or BRCA2 gene have up to a 60 percent risk of developing breast cancer by age 90, and they are often encouraged to get mammograms earlier than the standard age 40.

“The big thing was the family history link,” Nunley said. “That would have been a big red flag for me and my health professionals.”

There’s a perception that breast cancer mainly affects older patients, but Massarweh says patients of any age should take any unusual symptoms seriously.

“It’s unfortunate that many primary care providers don’t think of breast cancer as a possibility when young women present with breast symptoms,” Massarweh said. “Age is not a guard against breast cancer, and all too often symptoms are dismissed until cancer becomes more advanced. In this particular instance, Rhonda happened to harbor a mutation that was the underlying cause for her breast cancer, something that was only known after the fact once she was diagnosed.”

Having just completed her third “Making Strides Against Breast Cancer” walk, Nunley says she has grown more comfortable into her role as a breast cancer advocate.

“You can’t be a ‘non-survivor,’” Nunley said. “There’s a certain power to (being a cancer survivor). If you’re quiet about it, people aren’t going to know. Cancer can be part of your life, but it doesn’t have to consume your life.”



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