During basketball season for her sons, Nediva Monroe would arrive at the gym with other parents to wait for their children to hit the court.

But before she cheered on her kids, she made sure to secure a win for herself. That included walking around the school to get in her daily steps, eating a healthy snack and practicing positive thinking.

As the high schoolers fought it out in the gym, Nediva was battling her own foe in the bleachers — metastatic breast cancer.

When breast cancer returns

The terrifying news came in late 2019, when she was just 38 years old and planning a party to commemorate five years of being cancer free.

Nediva was previously diagnosed with breast cancer in 2014 and thought she had overcome it after having endured 16 rounds of chemotherapy, a double mastectomy and years of hormone blockers.

So it was a huge blow to get the call from her UCHealth oncologist that the cancer not only had returned, but that it had spread to other parts of her body.

“It was absolutely devastating and shocking. It was a really challenging time mentally and physically,” she said. “That was supposed to be the time I was celebrating, and I was looking forward to being ‘released’ back into the world. But sure enough, the cancer came back at my fifth-year checkup.”

The five-year marker of being “cancer free” is a significant one for cancer survivors, as it represents getting through the first milestone in breast cancer survivorship.

But results from Nediva’s bloodwork at her five-year annual check-up had raised concern for  her doctor, and follow-up CT scans and biopsies showed tumors on her right clavicle, left rib and left hip.

For Nediva and her family and friends, the party would have to wait.

She soon faced a treatment regimen including targeted therapy, injections, estrogen blockers, radiation, and regular scans, tests and blood work.

Nediva would be mentally and physically tested yet again and eventually overhauled her entire health and wellness routine that would ironically, put her in the best shape of her life as she faced the stage 4 cancer.

“I was so worried and scared, so I had to find control over what was going on in my body,” she said. “I am super proud of myself as I’ve been very intentional about the changes I made with my diet, and adding movement into my daily life so that everything would be sustainable.”

Realizing that she needed to prioritize her health didn’t happen overnight. But as she grappled with the new diagnosis, Nediva, a financial analyst, understood that her role as a wife and mother did not include shortchanging herself, and she saw the importance of paying attention to feeding her mind, body and spirt.

“I have always taken care of everyone else, but I knew I needed to make sure I was taking care of myself too, now more than ever.”

A devastating breast cancer diagnosis when Nediva was only 33

A Colorado native, Nediva graduated from a Denver high school and years later, reconnected with a former classmate, Mark. They would marry and have three sons: Ajaree, Alante and Avren, and they settled into making a home in the Mile High City.

In 2013, the couple was excited to be adding to their family of five when Nediva became pregnant with twins. Sadly, in January 2014 she lost the babies six months into her pregnancy, and more awful news would follow.

A few months later in April, she felt a lump in her right breast. Hoping it was a clogged milk duct, she contacted her primary care physician. An ultrasound and biopsy showed she had stage 1 invasive ductal carcinoma (IDC), a breast cancer that has spread from the milk ducts to the breast tissue.

Nediva was 33, and her youngest son Avren was just 2½.

“It was breathtaking in how horrible it was … having just lost the twins, and then for this to happen,” she recalled. “It was a heartbreaking time.”

Doctors caught Nediva’s cancer early, while it was categorized as stage 1, but she elected to have a double mastectomy as a way to both outrun and outsmart a cancer reoccurrence.

Breast cancer in younger women

Breast cancer in younger women like Nediva is more tenacious and typically more dangerous than when it occurs in older women. Women 45 and younger account for about 10% of new cases of breast cancer in the United States, according to the medical experts at the U.S. Centers for Disease Control and Prevention.

Breast cancer in younger women is:

• More likely to be hereditary than in older women. Nediva’s paternal aunt died of breast cancer at 47.
• More common among African American women.
• More often found at a later stage.

“I wanted to be as aggressive as possible because I was a young mom.”

She underwent 12 chemotherapy sessions (interrupted by a gallbladder infection which required her gallbladder to be removed) and then completed four more chemo rounds before finishing up in November 2014. A month later she had a double mastectomy. After reconstructive surgery in spring 2015, she was put on Tamoxifen for ovarian and hormone suppression.

Nediva received all of her cancer treatment at the UCHealth Diane O’Connor Thompson Breast Center, named one of 57 National Cancer Institutes-designated Comprehensive Cancer Centers in the U.S. and the only one in Colorado.

She would be under the care of Dr. Virginia Borges, an oncologist who leads the hospital’s Young Women’s Breast Cancer Translational Program at the Anschutz Medical Campus. The program has been providing unique care to women 45 and younger with breast cancer and conducting ground-breaking research since its inception in 2004, with a strong focus on life after breast cancer.

Why is breast cancer so dangerous in younger women?

Borges has spent the past 20 years of her career searching for answers as to why younger women with breast cancer face worse outcomes, and specifically, women who are diagnosed five to 10 years after they give birth

Borges and team have identified and defined “postpartum breast cancer.” This type of breast cancer is associated with an increased risk of metastasis and risk for death, which happens when the cancer cells spread from the breast to other parts of the body, as it did with Nediva.

While the exact reasons are not definitive, Borges said research is showing some interesting clues.

“We’re looking at why cancers in certain young moms behave more aggressively. We have identified that it involves the natural changes the breast undergoes when a woman delivers a baby and goes from pregnant to not being pregnant.”

She and her team are studying the how and why an initial breast cancer diagnosis for someone like Nediva turned into metastatic breast cancer years later despite having been treated aggressively at its onset.

“It was not a cancer that would necessarily raise our concerns that we were not going to be able to cure her,” Borges said. “But these cancers are deceptive. The young moms with kids 10 and younger face a higher risk of developing metastatic disease later in life, even with a stage 1 or 2 tumor.”

UCHealth breast cancer patients have been involved in clinical trials and groundbreaking therapies using drugs that extend life expectancy far beyond what was once thought possible.

After Nediva would be diagnosed with metastatic breast cancer, she would benefit from the Breast Cancer Research Program’s team, led by Borges, using cancer drugs that were not in existence a decade ago.

“There are cancer diagnoses where people do everything right but because of the biology of their cancer, sometimes it’s not enough,” Borges said. “That’s why cancer centers like this exist and the clinical trials we have move the field forward.”

Nediva is part of new and promising drugs to manage metastatic breast cancer

When Nediva’s cancer returned she was put on a treatment plan that included hormone receptive blocking drugs (these work by stopping estrogen from fueling the growth of cancer cells), along with medication called CDK4/6 inhibitor therapy which targets cancer cells and interrupts their ability to divide and multiply.

She also underwent radiation on the three spots where the cancer had returned.

“She took it like a champ,” Borges said, adding that she is encouraged that Nediva has responded well being on the same drug treatment plan for more than five years, and that currently, there is no evidence of any active cancer.

“My hope is that it’s a good, long time before we see any tumors progress. Twenty-five years ago, when I would make calls like the one to Nediva, I would basically ruin their lives since I could tell them with unfortunate accuracy how long they had to live, and it was a painful number to share. But now, I can’t tell them how long because the outer limit is very unclear.

“The more time passes, the more chance there is that the field will develop better drugs. My hope is that there are many more drugs coming that I don’t even know the name of, and that they are better than what we have in today’s cancer toolbox.” 

Nediva takes estrogen blockers and targeted cancer pills daily, receives injections and bloodwork every three months and has body scans taken twice a year. While the medication has kept her alive, it’s also affected her quality of life. Among other symptoms, she’s had to contend with early menopause, sore and stiff joints and brain fog.

And she had to manage the first few years of her illness during COVID-19, which meant being as careful as possible to avoid infections – no small feat with three active and growing boys.

It was during this time in early 2020 when Nediva took stock of her health.

She faced a cancer that was treatable but not curable; she took multiple cancer drugs daily; she knew it was a regimen she would be on indefinitely.

And while she was “honored and lucky to be under such good care” of Borges, she realized she needed to get back in the driver’s seat and take control of what she could in her life.

“That January, I took the time to look at my health and wellness and realized I needed to make some changes,” she said.

Fighting metastatic breast cancer: Nediva adopts a plant-based diet, adds strength and fitness into her routine and loses 50 pounds

The one upside to COVID-19 was her ability to gain traction with self-care amid the pandemic.

“I was struggling to be a mom with extreme fatigue and exhaustion, so I added fitness into my routine, as well as ways to strengthen my bones.”

She reduced her intake of processed food, dairy and meat, and through adopting a plant-based diet, was able to lose 50 pounds – an accomplishment she’s been able to maintain for the past five years. She drinks lots of water, makes sure she exercises, and she uses a treadmill during Denver’s cold and snowy weather when she can’t walk outside.

“I wanted better overall wellness, and to make the environment in my body one that cancer wouldn’t like.”

An important component of her self-care is mindfulness: That includes dealing with the past trauma of losing her twins and the anxiety and fear of living with cancer.

“Part of it is you are grieving your own mortality while you are still alive. You could have two, five or 10 years…you don’t know how much time you have. I just focus on the ‘right now’ and allow myself to look ahead in little chunks of the future to make plans.”

The ‘duality’ of living with metastatic breast cancer: Being both realistic and hopeful

In December, Nediva commemorated five years of living with metastatic breast cancer.

She acknowledged the statistics but doesn’t let them define her. She has grieved over friends who have died and tries not to feel guilty about her own survival. She faces the future with both the promise of seeing her boys mature into young men, coupled with the pragmatism that tomorrows are not guaranteed.

“I’m doing really well overall and have learned to live with this disease. I find joy and peace where I can. I have survivor’s guilt when friends die – you live with that grief because I know so many young women taken from their friends and family early – sometimes it comes so fast for them. But I also have friends still alive, so that is very special.”

The sadness of losing friends and the pleasures she finds in everyday living are not contradictory.

“It’s living with the duality of having a chronic disease and being present in the moment – that is my challenge. You look for things to be happy about and continue to see things differently.”

Nediva’s older sister Jamila, a nurse, has witnessed her younger sister navigate the highs and lows of cancer treatment and come through strong.

“She is able to just know and respect her capacity and her limits. She’s about really being in the moment, taking each day as it comes, and not taking opportunities for granted.”

A long-overdue party to celebrate Nediva

Then there was the matter of the party that never happened in 2019 when she was supposed to celebrate five years of being cancer free.

Nediva hadn’t forgotten.

But instead, it was now a 10-year celebration with her “tribe of friends” to commemorate her first bout with cancer, along with her living with this second round.

They held a fundraiser this winter, with proceeds going to metastatic breast cancer research and toward a project near and dear to her heart called Pockets of Peace. While the micro-grant program allows recipients to use funds as they see fit, she encourages cancer patients to participate in holistic care and complementary therapy such as acupuncture and massage therapy that provide restorative healing, care and comfort but are not always covered by insurance.

The future? Nediva has a passport and will be traveling to Spain this spring with her mother and sister to visit her sister’s daughter.

She loves watching her sons flourish with two already in college. Another favorite passion is to be outside hiking where she is immersed in nature.

“She is a stunning representation of someone who has taken her diagnosis by the horns. She has told it, ‘I can’t get rid of you, but I am not going to let you control me, and I am going to keep myself as healthy, as strong, and as fit as I can.’ She is the poster child of someone who has made this as a non-negotiable part of her life,’’ Borges said.

Jamila agreed that her sister is bold in how she has dictated the terms of her life, and not let cancer take center stage.

“She’s a warrior and at the same time, she’s thoughtful, intentional, and genuine. She’s kind and clear, and she’s worthy of all the good, care and love that can be possible for her. She’s the real deal.”

Son Alante agreed that his mom has a “warrior spirit.”

“My mother is a very genuine, kind and beautiful person. If I feel down, I know I can call her, and she will bring light to my dark mood. She always makes sure we have what we need. My mother is by far the most loving and caring woman I know.”

For Nediva, a decade worth of pain and loss has also brought the serenity that comes with personal growth, and she cherishes the love and support of her family and friends.

“Just because you have a devastating diagnosis or a terminal illness, you can make intentional changes and live a full life and find peace. That’s not to say there aren’t hard times: But you are the power. You literally are the power.”