Deep down, Michelle James knew something was wrong when she ran her hand along the side of her left breast and felt a hard, well-defined, almond-sized lump.
But there was no reason to panic. After all, it wasn’t James’ first scare.
In November 2014, doctors had found a mass during a routine mammogram, that time in her right breast. But it was small, and doctors found it wasn’t cancerous. They waited and monitored it, but by late 2015, nothing had changed. James was in the clear.
This would be the same, she thought.
But something bothered her. It was December 2016, and her next mammogram wasn’t for another 10 months. So she called her general practitioner and asked her to move it up.
“I actually felt something, and I really wasn’t sure what it was,” she said. “But because I was feeling something, it got me thinking I really need to have them look at this.”
She prayed to God for a negative result.
But a few days after her biopsy in May, James was about to leave her office at Miami Dade College’s Wolfson campus when the radiologist called.
“Is this a good time to talk?” she asked.
James stopped. She sat down. She said yes. And she braced herself for the diagnosis she knew was coming.
She didn’t cry. Instead, she turned her focus to her new immediate future.
“Okay, what’s next?” she asked the radiologist. “I’m going to get through this. I need to know what’s next.”
James didn’t tell a lot of people at first.
For about two weeks, only her mom knew. She didn’t want to tell her brother until she met with the oncologist and had a plan. And though she was very matter-of-fact when telling her mom, James was scared.
Penned in her black notebook, on the day of her diagnosis, she asked God whether this diagnosis and journey would end in death.
“I don’t want to die. I want to live: Isn’t there more for me to accomplish here God?” she wrote. “Even as I write it on paper I feel ... I feel like it’s not quite real. I know that will change.”
And it did.
But she stayed calm, keeping faith in God and praying to Him.
“The fact that I had this unexplainable peace meant I was going to be OK,” she said. “If it meant I was going to pass away, God was going to see me through that, too.”
Days after her diagnosis, she went to see Dr. Danny Yakoub, a Miami surgical oncologist with Sylvester Comprehensive Cancer Center. In his office, Yakoub pulled up her medical record, brow furrowed, before turning to look her in the eye as he began to spell out the next six to 12 months: chemotherapy, a lumpectomy or mastectomy, radiation and BRCA tests that can determine the likelihood a woman will develop breast cancer in the future.
And with that, for the first time, James burst into tears.
After a few minutes and several deep breaths, Yakoub asked James about her support network and whether she was a woman of faith.
Yes, James said.
Good, he replied. Patients with faith tend to do better in treatment.
As far as breast cancer goes, James, who came to Miami from Jamaica in her mid-20s, was young, just 45 years old, when diagnosed. The median age for diagnosis in the United States is 62, according to the Susan G. Komen Breast Cancer Foundation, which holds its Race for the Cure on Saturday nationwide, including in Miami.
But research done by Dr. Judith Hurley, a breast oncologist at the University of Miami Health System and the Sylvester Comprehensive Cancer Center, shows Caribbean women are at a high risk of finding breast cancer at a younger age. At the core of this are different inherited mutations held by women in the Caribbean.
“There’s virtually no overlap,” Hurley said. “Each island is incredibly unique.”
But what is common is that it’s occurring earlier in women throughout the Caribbean, with 63 percent being pre-menopausal. The average age is below 50.
And trying to get some from the region to seek modern medical treatment can be difficult, said Dr. Carmen Calfa, a medical oncologist with the Sylvester Comprehensive Cancer Center. Some from the culture are still fearful of side effects of chemotherapy. She said advances in medicine have led to mitigation of these symptoms.
She still sees patients who will seek natural remedies that are less effective, she said. She’s had patients drink baking soda, believing that would help while the cancer advances, sometimes to the point where it can’t be stopped. If a woman wants to try natural remedies, Calfa recommends discussing it with an oncologist.
“It’s a big mistake, and most of them pay with their lives,” she said.
Though friends mentioned natural remedies, James said she picked the treatment that would give her the best chance.
“I didn’t explain it to anybody,” she said. “I didn’t try to. I thought it was my decision.”
And as chemo worked to kill the cancerous cells, God helped her spirits. In church, she’d come in between treatments, leading Sunday services as she had for years at Metropolitan Baptist Church in Hollywood. They were her family. Her pastor came to her first chemo treatment, saying a prayer with her at the start. Members reached out, telling her they were survivors who had kept their stories quiet.
When she got scared, she’d remember her favorite Bible verse, Jeremiah 29:11,
For I know the plans I have for you, declares the LORD, plans to prosper you and not to harm you, plans to give you hope and a future.
“It reassures me. It is comforting to me,” she said. “He has plans for this life.”
James has since become an advocate, telling others not to skip a mammogram, to do self-examinations and to always check rather than wait.
“Do it now,” she said. “Don’t let fear stop you. You have power over fear.”