When Zakeya Nichols ran her hand across her chest while standing in her kitchen in July of 2023, she wasn’t expecting to feel anything unusual.
“There was no pain, nothing. Something just compelled me to rub my hand across my chest, so I did,” she recalled. “I felt a small nodule about the size of a green pea in my left breast.”
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At 38 years old, Nichols had just been to the doctor for her annual visit with no symptoms. All of her labs had come back normal.
“I did everything that I was supposed to do, but yet this was growing inside of my body,” Nichols said.
The American Cancer Society recommends women of average risk, like Nichols, begin getting annual mammograms at age 40. Those with a known family history are recommended to start sooner.
“I would have had a whole entire year with cancer growing inside of me and not knowing how large it would have gotten or if it could have spread elsewhere — it was really scary,” Nichols said. “It’s still scary today. Usually, you’re sick or you feel something and you go to the doctor and know something is wrong, but if you don’t have any of that you don’t know anything is wrong.”
Zakeya’s husband, Ronnie Nichols, said fear was the first emotion he felt.
“Hearing the word cancer – being that my mom passed away from cancer – I didn’t know what to do,” Ronnie Nichols said. “It was just a tearful moment trying to console her and let her know that everything was going to be okay. It was very difficult trying to hold my composure and trying to show her that I’m not worried, but it was tearing me up inside.”
That’s when the couple had an even bigger decision to make: how to tell their children.
“I can't leave this world, and my babies still be here,” Zakeya Nichols said. “That was the first thought: What happens and how do I tell them?”
“My initial thought was don’t tell them because I wasn’t sure how they would react,” Ronnie Nichols said. “Then, the more we talked about it, I was like, ‘It makes sense.’”
Amari, their youngest, was just 2, but the couple said their bigger concern was how their 8-year-old daughter Aryana Nichols would take the news.
Aryana Nichols said that she remembers her mom telling her she was sick.
“She and my dad told me about it, but that’s pretty much the only thing I can remember about it,” Aryana Nichols said. “She was on the verge of crying.”
Now a few years older, Aryana Nichols said she better understands the situation.
“I understand that she was scared at that point. I would be too if I thought I was about to die,” Aryana Nichols said.
Not knowing how to best navigate that difficult conversation between parents and their children is something Justin Yopp sees often.
The UNC Health clinical psychologist has worked with parents within the Chapel Hill hospital system since 2009. Yopp runs the Parenting with Cancer Clinic within the UNC Lineberger Comprehensive Cancer Center Patient & Family Resource Center, offering various wellness and support services.
He said parents often tell him their biggest concern after diagnosis is how to tell their children.
“I think a parent's concerns, worries and questions have a lot to do with how old their children are and what developmental stage they're at,” Yopp said. “If you have a very young child, obviously communicating with them is going to be much different than if you have a teenager, or even a young adult.”
Yopp said he encourages parents to be open and honest regarding their diagnosis with their children, regardless of age.
To help families navigate those conversations, Yopp and his team developed an online resource called FACT: Families and Cancer Together.
“We’ve been developing this website and algorithm for five years now,” Yopp shared. “Our research shows that parents who access the fact website are more likely to and have more confidence in initiating conversations with their children around cancer.”
The online tool is accessible to any cancer patient at any stage, anywhere in the world. Parents can access customized conversation guidance by filling out a few questions, such as their children’s ages, the parent’s cancer stage, and whether the goal is to explain the treatment plan or to simply check in on the child’s well-being.
“Our team's hope is that parents all over the world will discover UNCFACT.org, and that they will go on, feel seen, and be able to have customized language and guidance that will give them the confidence and the encouragement to initiate honest, age-appropriate conversation with their children,” Yopp said. “I think a lot of parents want to do wonderfully with this, and if nothing else, this website might just give them a little bit of a nudge.”
Yopp added that open communication within families can help alleviate things like anxiety, depression, and stress for both the parents and their children.
“If children can know that their mother or their father are being straight with them and telling them what they need to know, that actually can reduce anxiety and can reduce the sense of having to figure out what's going on or listen through the bedroom door or even get on Google,” Yopp stated. “Building that trust as early as you can really goes a long way for that relationship, and for children's coping moving forward.”
For the Nichols family, the tool also helped explain Zakeya’s diagnosis to their children’s teachers.
“Had it not been for Yopp and the FACT website, there would have been so many questions that I would have been left with,” Zakeya Nichols said. “There was a sample letter to share with the teachers and staff about my diagnosis.
“That was helpful because I didn’t have to put the words together. There are different variations of it from if you just want to share the basic information, or if you’ve already spoken with your child, and whether you feel comfortable with teachers sharing that information with other members of the staff.”
Stories like the Nichols’ are becoming more common, as more young adults are diagnosed with cancer.