Tears, laughter and sparkling pink grape juice flowed as Kelly Singer Marquis rang a bell to celebrate her 12th and final round of chemotherapy treatment.
“It’s just overwhelming,” Singer Marquis of Jeannette said Friday. “I’m just so blessed to make it to this moment.”
Her journey had started just over nine months ago.
The 39-year-old pharmaceutical sales representative, marathon runner and mother of three first noticed something was wrong in late 2017, while doing a self exam — a quick-but-methodical check of the breasts, feeling for irregularities. She noticed a lump in her left breast.
She was due for a yearly check-up at the gynecologist anyway, so she made an appointment for Jan. 15. With no family history of breast cancer, Singer Marquis didn’t expect the lump to be anything. She thought her doctor would send her home with a clean bill of health and a pat on the back for playing it safe.
Instead, she was sent for a mammogram and an ultrasound, then a biopsy of the suspected tumors. The tests were completed Jan. 19.
By Jan. 23, she had a diagnosis: Stage 2 Invasive Ductal Carcinoma. She had breast cancer.
“I was just blown away,” Singer Marquis said. She told her parents, who were planning to leave for a trip to Florida the next day.
“Needless to say, we unloaded the car,” said her father, Ed Singer, 66, of Jeannette.
Checking, treating early
Breast cancer is the most common cancer in American women other than skin cancers, according to the American Cancer Society. The group projects that about 266,120 new cases of breast cancer will be diagnosed in women this year and recommends that women at average risk of breast cancer should start having yearly mammograms by age 45, according to updated guidelines released in 2015.
Though breast cancer is uncommon in young women — less than 5 percent of breast cancers diagnosed in the United States occur in women under 40, according to the most recent statistics available from the American Cancer Society — it tends to be more aggressive in younger women compared to older patients. Tumors found in young women than are typically caught later. By the time they’re found, they can be fast-growing and high-grade.
Younger, premenopausal women have more estrogen in their bodies, which means they also typically have denser breasts, according to Adam Brufsky, a medical oncologist at UPMC Magee-Womens Hospital who treated Singer Marquis. That tissue makes it more difficult to feel lumps or irregularities, or to see them even if a patient is receiving regular mammograms. Young women without a family history or other factors that put them at a higher risk of breast cancer typically aren’t being screened at all.
“I think the big thing is awareness,” Brufsky said. “If a woman really has a lump in their breast, and it persists there for a couple menstrual periods, at least one or two, that thing needs to be worked up.”
Most of the time, the lump is going to be benign, he said. But that’s why it’s important for young women to be aware of what is normal for their bodies.
“It’s not only what you feel, it’s what you see,” said Jennifer Steiman, a breast cancer surgeon at Magee-Womens Hospital who also treated Singer Marquis. Though the American Cancer Society no longer issues a guideline for monthly self breast exams, Steiman still recommends that women check regularly for any changes in shape, position, lumps or inverted nipples, for example.
Young women also should initiate conversations with their primary care providers or gynecologists about their family and menstrual histories, Steiman said. This will help doctors put patients in the right category for low, middle or high risk of developing breast cancer.
“I think making sure that patients are in the right category and getting the recommended screening is really where I think we’re falling short,” Steiman said.
With young women, the goal is to catch the cancer before it grows enough to impact mortality, she said.
“I like to tell patients, mammograms don’t prevent breast cancer, but they catch it at early stages,” Steiman said.
Singer Marquis turns 40 on Oct. 18. She said it’s likely that she wouldn’t have made a mammogram appointment for months.
“This whole process could have not started until a year from now,” Singer Marquis said. “Which is scary to think — what could have happened in those whole two years?”
Stage 2 Invasive Ductal Carcinoma is the most common type of breast cancer — about 80 percent of all breast cancers are this type. By the time she was diagnosed, Singer Marquis’ cancer had reached only one lymph node. She had two tumors that had to be treated differently due to their makeup and the factors that influence their growth.
Her cancer was relatively small. But doctors pursued an aggressive treatment path because she is young. The goal was to do everything they could to keep the cancer from coming back, Brufsky said.
Singer Marquis opted for a mastectomy on her left side and plans to eventually have her right breast removed as well. She had to pursue chemotherapy because genetic testing determined that she was at high risk for the cancer to reoccur, Brufsky said. Then, she’ll move on to several weeks of radiation treatment followed by as many as 10 years of hormone therapy.
Planning treatment for young women can be challenging, Brufsky said. In addition to compensating for the physical impact of treatments such as chemotherapy — hair loss, lack of energy and symptoms of early menopause like bone loss — young women also often are dealing with family or work commitments. Those without children may be concerned about fertility or how to continue their birth control regimen. Patients often worry about being able to interact with their kids and whether they will see them grow up, he said.
Running, then waiting
Prior to her diagnosis, Singer Marquis ran four miles and did 25 push-ups every day. She dutifully climbed the hills that roll through residential neighborhoods in Jeannette whenever she could find the time: before or after work, or in between her kids’ soccer practices and homework time.
She started running about three years ago, determined to check a marathon off her bucket list. In 2016, she ran the half marathon in Pittsburgh, finishing the 13.1 mile race in 2 hours and 38 minutes.
“After the marathon was over, I fell in love,” she said.
By 2017, she cut that time by over 30 minutes, finishing in 2 hours and 3 minutes. She started running and didn’t stop — until her surgery March 8 to remove her left breast as well as four lymph nodes.
She squeezed in an elliptical workout the morning of the surgery. But it would be six months before she could hit the road again.
“And that drove me crazy,” she said.
Singer Marquis started training for a 5K race in September. The race — the Fight Like Kelly 5K on Oct. 13 in Jeannette — is being organized by Singer Marquis’ friends in her honor.
On the morning of Sept. 7, she left home just before 6 a.m. to make her 7:15 chemotherapy appointment in Pittsburgh’s Oakland neighborhood. She came home, napped for about an hour, then worked from home for a bit. That afternoon, she ran more than three miles. It was the first time she tried running the same day as a chemotherapy treatment. It was also one of the only times she had ventured out without a wig since losing her hair.
Singer Marquis said she can feel where her muscles are less toned. She has to walk up hills and take it easy in the late-summer humidity.
She was primed for a quick recovery from surgery thanks to her healthy lifestyle and strict running schedule. But the 12 weeks of chemotherapy still took a toll on her body, sometimes in unexpected ways.
“Nobody told me that I was going to gain weight,” Singer Marquis said as she ran through her neighborhood at a 10-minute mile pace, a step back from the brisk 8- or 9-minute miles she ran before her diagnosis. “I was prepared for my hair to be lost. I was prepared to throw up a little bit.”
She wasn’t prepared to gain 20 pounds or to have trouble sleeping from the steroids she takes to help with nausea. It was difficult to explain why she lost her hair to her 5-year-old daughter, who was used to seeing her mother with shoulder-length, blonde hair.
“It just kind of strips you,” she said of the disease and treatment. “You really just have to have this strong mindset of, ‘This is temporary. I’m not going to let this take me down. And I’m going to get back to where I was a year ago, in the best shape of my life, and I’m going to have hair in a ponytail again.’”
Singer Marquis’ story isn’t unusual, said Diana Napper, founder of A Glimmer of Hope, a Pittsburgh-based foundation that supports research in the field of breast cancer impacting young women. Proceeds from the Fight Like Kelly 5K will benefit the foundation.
Napper started the foundation in 1994 after a close friend passed away from breast cancer in 1990 at 49. Her goal is to not only support research and testing of breast cancer in young women, but also to make sure young women have the practical support they need to keep their lives going after a diagnosis.
“Women my age, our kids are grown,” Napper said. “We have tools in place to diagnose us. There’s all these programs in place to screen us.”
Younger women are often caught off guard by a breast cancer diagnosis, Napper said. They have jobs and families — getting the kids to school and dinner on the table might be prioritized over treatment and self-care. Communicating changes like hair loss to children can be challenging.
“As mothers, we are always last to do whatever we need for ourselves,” Napper said.
Support to the end
And because fewer young women are diagnosed with breast cancer, the community is smaller. At times, it can be a lonely journey.
“That support system is where it’s at. It gets you through the roughest times,” said Carol Onufer, a registered nurse at Magee-Womens Hospital who works with patients receiving chemotherapy. She helped to administer Singer Marquis’ final round Friday.
Cancer treatment is an emotional journey for patients as well as friends and family, Onufer said. She thinks it helps patients to have someone accompanying them to appointments and sitting with them for the sometimes hours-long treatments.
Singer Marquis’ mother, Patty Singer, 64, of Jeannette, attended every chemotherapy appointment with her daughter. Every Friday since April, the pair stopped at a Panera near the hospital to grab breakfast. The day of the final treatment, they were joined by Singer Marquis’ father. The last time he dined at that Panera was in 1978, when it was a Howard Johnson’s, he said. It was his first meal as a father, when his daughter was born.
“I wouldn’t have thought not to be here, that was never an option,” Patty Singer said, her eyes tearing up as she watched a nurse disconnect the tube that delivered the chemo drugs from a port in her daughter’s chest for the last time. Singer Marquis stood up from the treatment chair and began hugging the nurses, including some who were introducing themselves for the first time.
Singer and her husband gathered up their belongings — a bouquet of flowers, a cooler packed with two bottles of sparkling pink grape juice and plastic champagne flutes — and shuffled into the hallway in between hugs. The crowd gathered around a small, golden bell in the hallway as nurses and doctors from nearby offices and treatment rooms stepped out to join the celebration.
Together, Ed and Patty Singer raised a glass and toasted their daughter: “The strongest woman I know.”
Jamie Martines is a Tribune-Review
staff writer. You can contact Jamie at 724-850-2867, [email protected] or via Twitter @Jamie_Martines.