Breast cancer survivor Zunilda Guzman, 39, lives in the Miami area. Guzman noticed a lump on her chest in April 2008 and thought it might be related to her breast implants. She asked her gynecologist to schedule a mammogram, and the mammogram showed no red flags. So her doctor sent her to the plastic surgeon who'd given her the implants, and he did a biopsy.
"He called me the following day and told me that it was positive, that it was cancer," Guzman says.
"I was devastated. I wanted the world to end," she says. "But immediately, I said, 'I have to deal with this. I have a daughter [Summer, then 9 years old]. She needs to see me very strong because help me God, this does not happen to her, [but if it does] I want her to look back and say, if my mom did it, why can't I do it?"
Guzman has no family history of breast cancer. That's the case with most breast cancer patients -- a family history of the disease is a risk factor, but not having a family history doesn't rule it out.
"I never thought that it could happen to me," says Guzman, who was too young at the time for routine screening mammograms. If she hadn't acted, her cancer might not have been found.
Taking action: After getting diagnosed, Guzman kicked into high gear. She got MRI and PET scans, and learned that she had a large tumor -- more than 5 centimeters -- that looked like a spider in her left breast, and another suspicious spot in her other breast.
When her doctor at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine outlined her surgical options, Guzman didn't hesitate.
"He told me, you have a choice of just getting one breast removed and me just cleaning up the other one. And I told him, 'No. For my sake, I want both removed.' I didn't even consult my husband. Me, myself, I said this is what I want to do."
Guzman got both breasts surgically removed (a bilateral mastectomy) in June 2009. Then she got genetic testing, which showed she had a BRCA gene mutation that meant she was at high risk not only for breast cancer, but also for ovarian cancer, which has no screening tests.
Again, Guzman quickly opted for aggressive treatment -- having surgery to remove her ovaries and uterus.
"I don't want to wait," she told her doctors. "I want to have everything done so I can start my chemo and get rid of this right away." She had her ovaries and uterus surgically removed a month and a half after her double mastectomy.
Chemotherapy and radiation therapy followed. Guzman also takes the drug Arimidex and will do so for five years to help prevent cancer's return.
Quick recoveries: Guzman says she took four days off work after her mastectomy and was back at work the second day after her ovaries and uterus were removed.
"I was also at the gym," she says. "I'm a runner. I would run 5 miles a day.... I was very active before all this." Guzman says.
She kept working out through chemotherapy. "During chemo, I never stopped going to the gym," Guzman says. She took a few days off her workouts after each chemotherapy session, and she says the exercise helped her relieve stress and recover.
Guzman's husband, who often went with her to the gym, encouraged her to stay active. "My husband never told me, 'Babe, lie down because you feel bad.' No. 'Let's go around the block and walk the dogs.' Things like that -- always kept me active. And I feel that that helps a lot. "Working out, being active while you're going through all this is very helpful."
Reconstruction planned: Guzman intends to undergo breast reconstruction. "I like to look good," she says. "I like to wear cleavage, I like to wear dresses. But I'm also like a tomboy. I like to wear shorts, go out in the yard, play football, play baseball," she says.
There are several ways that breast reconstruction can be done. One way is for doctors to insert tissue expanders in the area where the breasts were. Those expanders stretch the chest tissue, and over several months, doctors insert fluid into the expanders, making room for implants, which are surgically exchanged for the expanders once the expanders are the right side.
That's the type of reconstruction Guzman says she wants. But she had gotten radiation therapy on one breast, and the radiation may have made her skin not right for expanders.
"They're thinking that maybe the skin is not going to give so much," Guzman says. If that's the case, she'll get another type of breast reconstruction in which doctors transplant tissue from elsewhere in the patient's body to the breast area. That’s a more complicated process.
The breast reconstruction process often starts at the same time as mastectomy, but it doesn't have to. It can be done months or even years later.
No pity wanted: Guzman made it clear to her family and friends that she didn't want pity. "I didn't want, 'Oh, poor thing.' No. I didn't want that at all."
What she wanted was positive support. She says her brother even told people, "If you're going to walk into her house to give her pity, I don't want you in that house." Her family and friends rallied. Her cousins took her to the mall to go shopping, her husband went walking with her and their dogs. And when she was laid off from work a few months ago, she found another accounting job.
"The house is not good," she says. "Being home and that couch and just feeling bad -- no, that's not good. Get out. Go out. Why can't you do things? Why? OK, you're going to feel sick one day from chemo. Fine, but get up, go out. It doesn't matter."
At the gym, she's heard pity from women in the locker room who notice her condition. Guzman sets them straight, saying, "I'm alive and that's what counts."
But of course, having cancer has been hard. Very hard.
"It gets real tough," Guzman says. "Chemo is tough, and looking at myself in the mirror every day is very, very tough, especially that scar across the chest and [having] hardly [any] hair."
"But you know what?" Guzman asks. "I looked to the side and I saw my family and I saw my daughter -- my number one. And whoever has kids, it doesn't matter. Look that you have life. You get up every morning and you say, 'I have a life and today is a good day.' And that's what you have to give thanks to God every day for.... and have lots of faith in God, that he is always listening."
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