If you meet Grace, it is likely that her shiny brown eyes will light a spark in your heart. You will admire the energy she attaches to performing mundane errands like shuffling her sons to recitals and training the church youth choir. However, if you are not careful, you just might miss the tinge of sadness at the end of her breath cause behind the super-woman veneer is a single mother fighting for her life. Over a year ago, Grace was diagnosed with stage III breast cancer. For the next eleven months she endured an aggressive combination of chemotherapy and radiation, but just when she started to regain her health, she made another discovery and she hit rock bottom.
Three weeks ago, Grace was lying in bed gazing lazily at the ceiling when she placed her palm on her chest. Instinctively, she began to knead her right breast pressing clockwise like she has been taught. Gently, she repeated this well practiced exercise across the topography of her breast. Two inches before she reached her armpit, she felt a wobbly mass beneath the skin. She withdrew her hand like she had been pricked by a shard of glass.
‘Dear God, not again, not again…” She muttered in quiet desperation.
Without warning, hot tears streamed from the corners of her eyes and flooded her pillow. Her instinct was to fold her body into a fetal position and sob, but she rolled off the bed and stumbled to the bathroom, a crumpled duvet trailing behind her. She stood before the oval mirror and peeled off her T-shirt. For the first time in a year, she forced herself to look at the scarred woman staring back at her. Tears raced to her eyes and gushed over her cheekbones before they hit the formica counter. Two years ago, a pair of voluptuous breasts adorned her chest. They fitted comfortably in a D cup and made her feel beautiful and sexy. Now, a shiny brown scar was all that remained of the beautiful pear-shaped breast. Her mammary glands had been severed and her breast tissue scraped out. Her cup was empty.
Grace continued peering at her reflection as if she wanted to erase the memory of that fateful morning in December 2011 when the specialist, told her that the lump she found in left breast was malignant. He wanted to act fast because her biopsy showed that the strain of breast cancer she had is aggressive and less responsive to treatment.
Researchers have known for a long time that breast cancer is not one disease but a study by Funmi Olopade, Professor in Medicine and Director of the Center for Clinical Cancer Genetics at Chicago has given credibility to this concept. Dr. Olopade studied the pattern of gene expression in breast cancer tissue from 378 women in Nigeria and Senegal. When she compared the results with a database of breast cancer tissue from 930 Canadian women, she found three significant differences. First, breast cancer in African women is more likely to arise from basal-like cells, rather than the inner milk-secreting luminal cells, which are the most common source of breast cancers for U.S. and European women. Secondly, breast cancer from African women is slightly less likely to respond to the drug Herceptin, which has been approved for metastatic breast cancer. Finally, breast cancers in African women often lacked estrogen receptors. These tumors do not depend on estrogen and thus will not respond to drugs, such as Tamoxifen, which prevent estrogen from reaching the cancer cells. In the medical community, this strain is called the triple negative breast cancer (TNBC). 
When I first met Grace at her home in Toronto, she explained to me that her biopsy confirmed that she was carrying a virulent strain of the breast cancer. To increase her chances of survival, her oncologist recommended that they cut off her left breast.
“My world came to a crashing halt.” She recounted. “The first person I called was my pastor. He prayed for me and asked me to have faith.” In February 2012, Grace had a mastectomy and braced herself for worse.
Chemo was rough. It zapped out her energy and her self-esteem. She lost her appetite and her kinky Afro. Her nails darkened and her warm cocoa complexion turned black like burnt coffee. On days when she was too weak to walk, her sons, Matt and Kaleb would snuggle next to her and comfort her with Bible stories. Eleven months into the treatment, the pain was manageable and the nausea had worn off. Color was returning to her nails and specks of hair was growing on her once baldhead. She could move up and down the stairs of her townhouse without the aid of Kaleb or the banister. Life was returning to normal again – at least that is what she thought. Which is why she was devastated when she found a new lump in her only remaining breast.
When the tears hitting her bathroom counter stopped and the shock of her discovery faded, Grace booked an appointment with her doctor and he scheduled a biopsy. Fortunately, the results were favorable – the tumor was benign. But because of her history with breast cancer, the specialist recommended a lumpectomy, to minimize any chances of cells mutating again.
On the day of her surgery, we met at the Scarborough General hospital. The surgery was scheduled for 2:45pm, but by 10am, Grace was seated in a sterile waiting room. She was clothed in a faded hospital gown and an IV needle had been inserted into her wrist. Although she is usually very talkative, on this day, she had few words to share. Likely thinking about who will raise her sons if she does not make it? About the countries she has not seen and dreams she has not conquered… At 2:30pm, two nurses came into the waiting room and wheeled her to the operating room.
About an hour later, the surgeon had successfully removed the lump. Grace was recuperating in a private room. She seemed groggy and uncomfortable. A nurse was standing over her reciting a list of things she could not do for the next twenty four hours: “You can’t eat any solids, you should not operate a vehicle, you… before she could finish, Grace’s eyes rolled back and she drifted into sleep again…
When she reopened her eyes, she moved her hand tentatively towards her breast as if she was afraid the doctor had chopped it off. When her fingers felt the sore, but familiar mound, her eyes glistened with relief. Early intervention combined with sophisticated medicine had saved her life. Sadly, there are many other women around Africa who are not as fortunate as Grace.
A startling example is Rakia, a petty trader from one of Ghana’s poorest regions. Rakia found a tumor in her breast about the same time that Grace discovered her first lump. Instead of seeking medical attention, she consulted with a local witch doctor who convinced her that the lump was a curse from the gods. The witch doctor counseled her to massage her breasts with rare herbs and roots that she claimed would shrink the size of the lump. By the time Rakia made it to a medical specialist, the cancer had spread through her body. As you read this, a thin sheet of skin covers her skeletal frame. Bedridden and weak, she is unable to eat or sit without help.
Grace, on the contrary, is the picture of health. Two weeks after the second lump was removed, she is running errands and chasing after her rambunctious boys. Next month, she returns to work, but before that, she wants to redesign her garden and pick out new clothes for a family photo shoot. These are things she used to take for granted, but the battle with cancer has given her a new perspective on life. Her cup runneth over
 Journal of Clinical Oncology, Vol 27, September 2009