Editor’s note: When she was just 13 years old, Audrey Lane Snoor, an RN program coordinator with Atrium Health’s Levine Cancer Institute, was diagnosed with Stage IIA Hodgkin’s lymphoma. She beat that disease, but it left her with a higher risk of developing cancer later in life. Read Audrey’s incredible story, in her words, about what it was like to be diagnosed with cancer at such a young age for a second time, how she battled through it and how surviving cancer played in integral role in her career path, her empathy toward patients and her perspective on life.
For more information about our cancer survivorship programs at Levine Cancer Institute, call 980-442-5176.
My story with cancer started in 2003 when I was just 13 years old and discovered a lump which I was told was probably “just due to an infection.” Unfortunately, the biopsy results revealed something more. It turned out to be Stage II Hodgkin’s lymphoma.
Instead of the usual teen summer activities of playing sports and going to the pool, my days were filled with endless trips to downtown Chicago (I lived in the city’s suburbs at the time) for scans and testing, intense chemotherapy, and symptom management.
After my final scan showed I was in remission, I had to endure daily radiation treatments for another month. This was not quite how I expected to start my high school years!
Upon graduating from treatment, I was able to begin spacing out my follow-up appointments and by the time I was celebrating five years in remission, I only had to return to clinic once a year. My appointments were much less consistent through my college years, but the fear of a recurrence or new diagnosis always lingered in the back of my mind.
One of the biggest blessings to come out of my first battle with cancer was my passion and desire to become an oncology nurse. I received my bachelor’s degree in nursing in 2011 and after a year of gaining experience on an inpatient unit, I began my dream job working in outpatient oncology in the Chicago area.
It was in conversation with one of our advanced practice providers that I first heard about “NCCN (National Comprehensive Cancer Network) guidelines” and “survivorship plans.” I was quickly scheduled to see a physician who took the time to explain to me the research that had been done on long-term survivorship, specifically in Hodgkin’s patients.
Having hit the 10-year mark since treatment it was time to begin certain screenings, including an echocardiogram and a mammogram. All my initial tests came back normal (yay!) and I was free to breathe again … for another six months.
Based on my prior treatments, I was at an increased risk for secondary breast cancer and would need to be screened every six months – rotating between mammograms and MRIs. It was early December (2012) when I had my first MRI, and I didn’t have to wait long before I got the call that the physician “saw something.” Fast-forward through a terrifying experience having my first biopsy, it was Christmas Eve – and several agonizing days later – when my oncologist came and found me while I was out working in the infusion room to tell me the result of the biopsy was negative!
Screenings became a normal part of life since then, and I was blessed to have to put them temporarily on hold when I found out I was pregnant with my first child.
When my son was only 5 months old, we made the move to warmer weather and relocated to Charlotte, NC. I was fortunate that there was an opening for an infusion nurse at Levine Cancer Institute-Ballantyne , got hired and quickly found my rhythm again doing the job I loved. My screenings remained on hold while I was breastfeeding as it can interfere with the results, and I had yet to figure out who would take over my care.
It was a conversation with Sridhar Pal, MD , a medical oncologist at the Ballantyne office, that led me to discover the Department of Supportive Oncology and the survivorship care offered by Chasse Bailey-Dorton, MD . It sounded perfect for my needs and I made an appointment a few weeks later. My first appointment ended up being filled with tears as she helped me begin to explore and process just how much emotion I carried regarding my young experience with cancer. I was so impressed at how truly present she was with me during that visit and how important it was that she cared for the whole person. I left with a renewed sense of hope, a plan for processing the emotions, some recommendations for my diet and activity, and a referral for my next screening, which would be an MRI.
It was December (2016) once again, and the wonderful staff at Charlotte Radiology helped me through the not-so-comfortable process of the breast MRI. With the joy of the holiday season and the chaos of work, I didn’t think much about the results during the next few days. I was in the middle of work when I got the call that made my stomach churn. Once again, my care team had “seen something” – this time on the other side. A biopsy was recommended. Someone would call soon to schedule. I was numb, and I tried to rationalize the news. I knew they would want to be extra careful given my history, but it was negative before and would be again. A few days later, I was back on the table for the biopsy, a particularly uncomfortable experience this time around. I am forever grateful to the angel in scrubs who held my hand and let me squeeze hers so tight!
Dr. Bailey-Dorton was the one to give me the news just a few days later: ductal carcinoma in situ (non-invasive breast cancer). The following weeks became a whirlwind as consult appointments were made and family was called. They were confident the cancer was caught early and that there were no invasive components, but could not say for certain until surgery.
Lejla Hadzikadic Gusic, MD , a surgical oncologist with Levine Cancer Institute (and another angel in my eyes), carefully talked me through all my options and the risks and benefits of each. She showed me the scans, and I remember her saying that even she had a hard time seeing exactly what it was that caused the radiologist to recommend the biopsy. I don’t think I could ever adequately express my gratitude to that radiologist!
After long discussions I was leaning towards a double mastectomy as I was tired of living in fear and knew how blessed I was that it was caught so early this time. Before that decision was finalized I had a consult with Nicholas W. Clavin, MD , a cosmetic and plastic surgeon for reconstruction, as well as a genetics consult due to my young age and multiple diagnoses. It was the genetics appointment that made up my mind. While I was BRCA negative (an identified gene mutation which is tied to an increased risk in breast cancer), my results did show I had the ATM mutation – which unfortunately has nothing to do with money and all to do with increased risk of numerous types of cancer, including breast.
In February (2017) I underwent a double mastectomy with sentinel lymph node biopsy and reconstruction. Dr. Hadzikadic warned me the final pathology may take a few days and it would determine my next steps – which included the potential for chemotherapy if there was any invasive tissue found or positive lymph nodes.
After spending one night as an inpatient, I headed home, anxiously awaiting the results but I didn’t have to wait long. Within hours, Dr. Hadzikadic was calling me herself. The pathology was perfect, everything we had hoped for. I dissolved into tears and disbelief. I was done, surgery was curative.
Fast-forward through the next few months, life got a little crazy as all my doctors gave me a bill of clean health, it was confirmed no further treatment was needed, and I found out I was expecting my second precious child. As the dust settled, I finally got back to seeing Dr. Bailey-Dorton. We reviewed and reassessed what my future screenings would look like and made a plan. With the breast cancer being the focus for the past few years, it was time to get back on track with my other high-risk screening. Due to the type of chemotherapy I had received – along with the chest irradiation – I needed to be closely monitored for late cardiac effects. The timing was perfect as the cardio-oncology clinic had just opened at the supportive care center. My physician there, Samuel Zimmern, MD, carefully reviewed my history, including any issues I had, and I was set up for the necessary testing. At a follow-up appointment a few weeks later, he confirmed my tests were all normal, reviewed screenings going forward, and sent me on my way!
I am now almost 16 years out from my Hodgkin’s diagnosis and already two years from the breast cancer. I am back to yearly follow-ups and thanks to my surgery, I have much less frequent screening requirements.
I quite literally owe my life to Dr. Chasse Bailey-Dorton and the survivorship care plan she developed for me. Being a young adult cancer survivor has always had its unique challenges. I received many surprised looks walking in for my mammograms. No one is expecting a 20-something to come through those doors. And heaven forbid a diagnosis code was inadvertently missing for any of my screenings, insurance is not quick to pay for a test usually reserved for those over 40 without good reason. The team at the center for supportive care advocated for me and made sure I was well-informed through the development of my care plan. It scares me to think how different my story could have been. Had I not been informed about the risks and delayed effects of my treatment as a teenager I could have easily gone through life feeling okay. Who knows when the breast cancer would have been caught, and how different the prognosis could have been.
Having worked in oncology for nearly eight years now, I know there are others like me. People who would love to keep cancer locked up in the past, but who will forever live with the late effects of their treatments and potential secondary diagnoses. I am incredibly passionate about being an advocate for survivorship care, especially in the young adult population. I will also never stop jumping up on my soapbox to preach the importance of early detection. These two things saved my life, allowing me to continue my work in oncology, and even more importantly – to be a wife and a mother to my two beautiful kids.
