While crawling on the floor with her youngest child, a toddler at the time, Katrece Nolen caught a glimpse down the front of her shirt. One breast appeared slightly larger than the other.
“Something is off,” she remembered thinking. So she called her doctor.
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But her doctor was away that day, and the receptionist asked if she wanted to make an appointment for a later date.
“I said, ‘No, I need to see somebody today,’ ” Nolen recalled. And that’s what she did.
It was 2013. Nolen would be diagnosed with inflammatory breast cancer, which is especially aggressive. She would beat it, though, and her urgent pursuit of a diagnosis and treatment was a big part of the reason.
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“The most important thing about self-advocacy is don’t give up,” said Nolen, who is 47, African American and cancer-free for nine years. “You have to push through the despair to get the test results, the diagnosis and the appointments you need.”
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I talked with her after seeing a recent report by the American Cancer Society that highlighted racial disparities in breast cancer outcomes. Although Black women have a 4 percent lower incidence of breast cancer than White women, the death rate for Black women is 41 percent higher, the report said.
The Black-White disparity was due largely to “decades of structural racism,” the report said, which consigns millions of low-income Black people to environmentally toxic neighborhoods and severely limits their access to health care, quality food and good schools.
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Although the risk of cancer mortality decreases as socioeconomic status improves, the report said, “Black people have a higher mortality than White people at every economic level.”
Nolen is on the upper rungs of that socioeconomic ladder. She’s an entrepreneur, civic activist and book author. She holds a bachelor’s degree in industrial engineering from Oklahoma State. She lives in wealthy Loudoun County with her husband, who is an electrical engineer, and their two children.
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She’s got health insurance, work flexibility and access to the best medical facilities in the region. Still, to get the care she needed and the respect she deserved, she had to push.
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After seeing a doctor about the swelling in her breast back in 2013, Nolen had a mammogram and an ultrasound exam. But results were inconclusive.
“So, a couple of weeks later, I was trying to button my shirt and I couldn’t button my shirt, it had swollen up that much that fast,” Nolen recalled.
She returned to the doctor’s office and was given the name of a specialist. But when Nolen called to make an appointment, she was told that the specialist would not be available for two months.
“I said, ‘You know, this swelling occurred in just a few weeks. I don’t think waiting two months will work out for me. Can she see me sooner?’ ” Nolen recalled asking. “And they said, ‘No, she’s booked up.’ ”
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Just before hanging up, Nolen asked if another doctor was available. Turned out there was. Good thing she’d asked. You’d have thought the doctor’s office would have suggested that first, given Nolen’s symptoms.
Inflammatory breast cancer, though rare, moves fast and can spread to other parts of the body within weeks. It kills roughly 60 percent of the women who get it within five years. And Black women with the disease tend to live about two years less than White women.
Taking an appointment two months down the road could have been a fatal mistake.
This year alone, an estimated 36,260 Black women will be diagnosed with breast cancer and 6,800 Black women will die of the disease, according to the ACS report.
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Given the skills and resources that Nolen needed to get herself well, it’s no wonder Black women in the poorest parts of cities such as Chicago, Baltimore, Richmond and the District have some of the highest breast cancer death rates in the nation.
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Not that Nolen’s survival was guaranteed.
At her next appointment, she still had to push. She’d brought her mammogram results on a compact disc, only to be told that the medical equipment reads film. She would have to reschedule, the receptionist said.
“I said, ‘No, you didn’t mention anything about film,’ ” Nolen recalled. “ ’I’m here. I’ve been waiting. I can at least have a talk with the doctor, right?’ ” The receptionist said no.
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“And I said, ‘No, no, no. I need to be seen today,’ ” Nolen insisted.
Nolen was discussing the matter with the office manager when the doctor she was scheduled to see walked in. She apologized for the delay, explained why film was required then stopped to look at Nolen.
“She said, ‘Ms. Nolen, looking at your records and looking at you, standing right here in front of me, I think you may have inflammatory breast cancer,’ ” Nolen recalled. “And I was like, ‘What? I don’t even know what that is, but, oh, Lord.’ ”
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The doctor requested a skin biopsy and Nolen had the procedure done the next day, which was a Friday. She spent a nerve-racking weekend waiting on the results and reading about the disease. On Monday, the doctor called to say the diagnosis had been confirmed. The next day, Nolen was back in the doctor’s office, helping to assemble a cancer treatment team.
After nine months of rigorous treatment, the cancer was gone. In 2020, Nolen wrote a book about her experience, “I’ve Been Diagnosed. Now What?”
Now what? That was a life-or-death question, and Nolen had advocated hard for the right answer.
For too many others, the prognosis did not look so good.