Tiffany Martin says she always felt she was going to end up with cancer, in one form or the other.
For that reason, the 33-year-old says she wasn't surprised to be diagnosed with inductal carcinoma, a form of breast cancer, last summer.
Martin, of St. John's, had been living in Vancouver for about three years, studying in a community social services worker program at a local college and working during the summers.
Last February she began to feel tired and unwell, she said, but was unable to pinpoint any specific symptoms.
"I had a sense that something was wrong with my body," she explained.
"I remember sitting on my bed, crying and not being able to explain it, but knowing there was something wrong. I wondered if it was depression."
After she found a small lump at the top of her breast last July, she had a nurse friend examine it. That friend advised her to see a doctor as soon as she could, and within two days, she was undergoing tests.
Seven weeks later, Martin went into surgery to remove the cancerous tumour. When it was clear she would need to have chemotherapy, she decided to move back home, to be closer to her family while she recovered.
"That was a really hard transition," she said.
"After spending two years on student loans, I came home with literally $20 in my wallet, a suitcase of clothes and a lot of memories. It's incredibly humbling at age 33."
Martin said she's been amazed by the support she's received from friends and members of the local arts community since she's been home, many of whom offer to cook for her or drive her to appointments.
In November, a benefit concert was held for her at the Rock House with bands like Fur-Packed Action, Lizband and Persona donating performances to raise funds to help with her living expenses while she undergoes chemotherapy on the condition.
Martin had been planning to share any proceeds with others in need, but the performers insisted she keep the money for herself.
Martin said she wants to work - even on a volunteer basis - but finds it difficult.
"Doing nothing is the most frustrating part of this and I'm looking for work, but it's hard because there are only about 10 days when I can, while I'm having chemo every three weeks," she explained.
"The first 10 days (after treatment) aren't so great, but the next are a lot better. Because I have to avoid getting sick, I can't do any customer service stuff, but I want to keep busy."
Martin's last chemo treatment will be Feb. 20, and sometime in the spring she'll have a double mastectomy, removing both her breasts.
Her mother died of cervical cancer in her mid-30s, and she's got quite a strong family history of the disease, so, with her doctor's recommendation, she feels it's the best thing to do to avoid her cancer coming back.
She's looking forward to having it over with and getting reconstructive surgery - but she won't be able to have the latter until she overcomes one other hurdle.
"I've been a smoker since I was little, which I'm not hiding from anybody," Martin said, adding cigarettes are an emotional crutch for her.
"I thought because the surgery is elective, (doctors) were saying if you don't want to do anything to help yourself, we're not going to spend the money on your surgery, but it apparently has to do with healing. You don't heal as well."
Martin said she's aware people judge her for smoking as a cancer patient, while others seem to take more of a "to each their own"approach. She's trying to quit, she said.
"You feel like an idiot at the best of times when you're smoking, even when you're healthy and fine. We're not dumb enough to lie to ourselves. Being a cancer patient and smoking is a whole new level of humility.
"I have full intentions of quitting. I have to if I want new breasts, and that's a great motivator, but more importantly I don't ever want to go through this process again if I can help it."
The evidence of smoking as a risk factor for breast cancer isn't clear, according to Gillian Bromfield, director of cancer control policy with the Canadian Cancer Society.
"The jury is still out. There's been quite a bit of research in this area and overall (it) doesn't show a definitive link between smoking and breast cancer," she told The Telegram.
"Smoking is associated with so many types of cancer, even if it's not associated with breast cancer, and that's definitely known. There are certainly things we can do to reduce our risk of cancer, but nothing is 100 per cent."
The rate of breast cancer among people in Martin's age group is minimal, according to the latest Canadian Cancer Statistics Report. In 2011, there were an estimated 23,400 new cases of breast cancer; 870 of those were among people aged 30-39. The age group to see the highest rate of new cases was 50-59, with 6,300 cases country-wide.
The Canadian Cancer Society recommends all women age 50 and older at average risk of developing cancer have regular mammograms to screen for breast cancer, and Martin would like to see this recommendation lowered to include women in their 20s and 30s.
Bromfield said there are actually proven risks associated with mammogram screening in younger women.
"Even though breast cancer is less common in younger women, it does happen. The question we always get is if there's an effective screening test for older women, why can't we just use that same screening test for younger women?" she said.
"Research has shown when you screen women between the ages of 50 and 69 with mammography on a regular basis, you save lives. What little research has been done in younger women is quite controversial. It hasn't been shown to save lives, and, in fact, the harms have been quite high. There are a lot of false positives, women undergoing biopsies and surgeries for essentially no cancers. You really have to balance the benefits and risks of the screening tests.
"If someone has a strong family history of breast and/or ovarian cancer, they should be talking about perhaps starting screening at an earlier age or perhaps having a different screening process."
Family history of cancer or not, Martin and Bromfield are encouraging women of all ages to perform self-exams of their breasts, long before age 50.
"As much as I don't like chemo, I know I have it really well compared to an awful lot of people, and I keep that in perspective. I don't necessarily think my story is inspiring, but I just want to tell women in their 30s and their 20s as well to just feel their breasts. I'm tempted to get a T-shirt with that written on it," she said, laughing. "It's also really important to trust your instincts and your own body."
Awareness and discussion of the disease is also very important, Martin said.
"People aren't really comfortable talking with people with cancer and the majority of us, directly or indirectly, are going to encounter at least one friend or family member or coworker with it," she said.
"This whole not-talked-about aspect of it really only goes to fuel fear and really doesn't serve any purpose."
Anyone wishing to have more information on specific types of cancer can call the Canadian Cancer Society's toll-free cancer information service at 1-888-939-3333 or visit www.cancer.ca.
firstname.lastname@example.org Twitter: @tara_bradbury
REDUCE YOUR RISK OF BREAST CANCER
Know your breasts and what's normal for you and report any changes to your doctor.
Talk to your doctor about your family history of cancer. Women at higher-than-average risk for breast cancer should talk to their doctor about a personal plan for testing.
Have a mammogram every two years if you are between the ages of 50 and 69. The benefits of screening mammography for women under 50 are still unclear. Talk to your doctor about the risks and benefits of screening if you are between 40 and 49 or over 69.
Limit alcohol use to less than one drink per day. Research shows that drinking any type of alcohol - beer, wine or spirits, increases a woman's risk of breast cancer. The less alcohol you drink, the more you reduce your risk of developing breast cancer.
Be physically active and maintain a healthy body weight. Research has shown that physical activity may lower the risk of breast cancer in post-menopausal women. Physical activity is also one of the best ways to get to and maintain a healthy body weight, which reduces the risk of developing breast cancer.
Be a non-smoker and avoid second-hand smoke.
The Canadian Cancer Society recommends that women avoid taking hormone replacement therapy (HRT) for any reason other than to relieve severe menopausal symptoms that have not responded to other treatment. Discuss the benefits and risks of (HRT) and its alternatives with your doctor.
Source: Canadian Cancer Society