St. Johnian Merlene Frett-Smith opted to remain at home in the USVI for her cancer care. Although the retired public health education professional has nothing against others seeking care off island, she knew that remaining in the Virgin Islands was the right choice for her. Photo courtesy of Merlene Frett-Smith.

As we commemorate Breast Cancer Awareness Month in October, we're sharing a two-part series featuring the stories of two Virgin Islands breast cancer survivors. While we celebrate these incredible warriors, we also take a moment to remember the mothers, grandmothers, wives, sisters, aunties, cousins, and friends who fought bravely and whose battles ended too soon. You’re always in our hearts, and your strength will never be forgotten. In Part II, I speak with St. Johnian Merlene Frett-Smith about her journey to healing right at home.

One of the first things patients are told at the start of their breast cancer journey is that everyone’s fight is different. And for St. Johnian Merlene Frett-Smith, her journey is as unique and inspiring as none other!

Merlene’s lively personality and plain-spoken way delighted me during our 58-minute phone interview. She took me through her breast cancer journey—one that she says she is still very much on—detailing what life has been like for her over the last 2-1/2 years. Hers is the kind of fearless attitude that meets cancer head on with the clear goal of winning.

The Diagnosis

The 67-year-old, who had no prior family history of breast cancer, was diagnosed with the disease in her left breast in March 2023 at age 65. She had completed her annual mammogram in December 2022, and the results, in fact, were normal.

But by January 2023, Merlene says she began experiencing an unusual sensation in her left breast. “I started having this excessive burning—no pain—but burning in my left breast and I couldn’t follow it,” she explains. “It radiated all the way through to my shoulder blade, and I knew something was wrong. It felt like I was on fire.”

Merlene’s severe discomfort caused her to return to her doctor’s office. Another mammogram was ordered, which also showed normal results. Then, from January through March 2023, she underwent a series of tests, including an ultrasound and five biopsies on the affected breast.

“In March, when [my doctor] called me in, they sat me down and they told me, ‘You have left-breast cancer’ and I was like, ‘What is that?’”, she says in that unmistakable Virgin Islands way, recalling her reaction to the news.

Merlene admits that her diagnosis came as a surprise, but it’s what she did next—and how she continues to approach her fight—that truly inspires.

Home Is Where The Heart Is

The retired public health education professional, who spent much of her career living and working in Florida and traversing some of the top health systems in the state, made the bold, and perhaps unpopular decision by some people’s standards, to undergo her cancer care at home in the U. S. Virgin Islands. During her years on the job, Merlene says she had seen too many patients from the Caribbean move stateside for treatment, only to end up not being welcomed by the very family and friends who initially invited them to come.

“I’m not going back to Florida, and my support system is here,” she says.

Merlene says she “went through her little emotions” following her diagnosis, pointing out that her doctors on St. Thomas had given her a tight deadline to decide where she would be treated. “I had three weeks to figure out what I was going to do,” she says.

From early on, Merlene knew she wanted to be treated at home in the Virgin Islands. One of her first phone calls was a consultation with doctors at St. Croix Cancer Specialists. Following that call, she felt comfortable moving forward with local care.

“I had the option of doing a mastectomy or lumpectomy,” she explains. ‘With the lumpectomy, I would have had to do radiation, and we don’t have a radiation facility here because Kimelman [Cancer Institute on St. Thomas] had been gone since Irma-Maria.”

She opted to have a mastectomy, the full removal of the breast tissue—a procedure she learned was regularly performed locally by a surgeon who previously treated her for a health matter unrelated to cancer. Following the mastectomy, Merlene would have to undergo chemotherapy, also offered locally through St. Croix Cancer Specialists, which had an office conveniently location on St. Thomas.

Everything seemed to be falling into place.

Breast Cancer Reveal Party

To inform her family and closest friends of her breast cancer diagnosis, as well as of her decision to have a mastectomy and her plan to undergo cancer care at home in the Virgin Islands, Merlene decided to host an intimate Breast Cancer Reveal Party at a friend’s villa on her native St. John.

“People that know me, know that I love to do catering, parties, and events, so when I sent out my little invitations, they thought they were coming to a party because they love to party. They thought they were coming to one of Merlene’s parties,” she chuckles.

As her guests arrived that Sunday afternoon, excited to be there, but unaware of what the gathering was about, Merlene remained in the bedroom while a few trusted friends whom she had already informed of her diagnosis welcomed attendees.

“When I came out of the bedroom and settled everyone down, my aunt started crying before she even heard me say anything. She kept saying, ‘Something wrong, something wrong.’

“I told them, ‘Well, this is a party, this is a gathering, and I guess I want you guys to know something, but I want you all to understand that whatever comes of it, it’s my decision. You all are here because I needed a support team that I’m comfortable with’,” she recalls.

Merlene remembers the room falling silent as she informed loved ones of her diagnosis. Some began to cry, and others exited the room. She allowed them to express their emotions for a moment but reminded them that she needed their strength to help her get through. It didn’t take long for questions to begin about where she would be treated—with many speculating she would be traveling to Cleavland Clinic in Ft. Lauderdale for treatment.

“That bothered me,” she says. While she has nothing against anyone opting for off-island travel to facilities like Cleaveland Clinic for treatment, Merlene says she knew the right decision for her was to be treated at home.

“To me, a lot of us don’t respect what we have here, and everything out of everybody’s mouth is ‘Cleveland Clinic,’ and that bothered me,” she says. “So, I had to calm them down and tell them that we are not going to have the discussion about Cleveland Clinic—they have good doctors, and we have good doctors, too.”

The Fight Begins

The St. Johnian says she never wavered in her decision to undergo her cancer treatment locally, but the journey hasn’t been easy. Taking the barge back and forth from St. John to St. Thomas for two surgeries and 12 weeks of chemotherapy was grueling.

“To come from St. John, it’s on a barge. That barge ride, sometimes, was not nice,” she recalls. She says her adult son, who relocated from Florida to be her caretaker, on the ride over from St. John would apply Novocain to numb the area where a port had been surgically inserted to administer her chemotherapy and other medications, as well as where medical staff could gain easy access to Merlene’s veins for labs.

“And after the chemo, that barge ride back to St. John, it was crazy,” she says. “I would be out of it, get in the house, crawl in my bed. When I wake up, I’d think it’s the same day, but it’s the next day. It was rough.”

Merlene says that although she successfully underwent surgery and completed chemotherapy and a year-long regimen of infusions, she still takes an oral cancer medication daily and stomach injections every six months.

The Fight Continues

“I applaud folks who talk about being cancer-free, but personally, and I don’t knock anybody, I feel that the little bit that I know about the medical field and public health, we all have some degree of cancer cells in our bodies,” she says. “It is when it manifests itself on a bigger scale that we have to go through this chemo and radiation.”

She continues, “I rang the bell last year at the end of my chemo, but I’m still doing infusions, taking tablets, and now doing the six-month injections. I guess all of that is to keep it from being full blown, as it was initially, but I feel I still have cancer in my body.”

Merlene says she still experiences a burning sensation at the site of her breast surgery. Her doctors say this results from the nerves that remain active, even after the breast tissue has been removed.

“I know I’m better, but I don’t feel cancer free if I’m still taking these different medications,” she says. “To me, I’m still fighting a battle.”

Merlene’s closeknit group of ‘breast friends’ rally around her, providing their support at fundraising events where they wear t-shirts showing their support for the St. John warrior. Photo courtesy of Merlene Frett-Smith.

And Merlene fights her battle courageously, thanks to the support of organizations like the St. John Cancer Fund and Cancer Support VI, as well as her tribe that rallies around her. But she wants well-meaning people to be mindful of one thing.

“I have an issue with people saying to me, ‘Oh, you don’t look like anyone that has cancer, you look good,’” she says. “I get flustered because I want to understand how do you look if you have cancer. Being diagnosed with cancer, nobody knows what’s going on inside of your body.”

Merlene encourages women to get their annual mammograms and to not hide their diagnosis from loved ones.

“Although my mammograms were clean, for someone else, that might be the key to whatever journey they’re on,” she says. “Remember, it’s a personal journey. You have to be the captain of your own ship. You have to decide for you.”

She adds, “Don’t hide from people. You don’t want to make a public, fly-by banner that you have cancer, but you don’t want to hide the issue from anyone. You shouldn’t. I know a lot of people who got diagnosed and they hid it. I don’t go into detail with everyone, but don’t hide. You never know who will be there to help you.”

Living Life on Her Terms

Merlene describes herself as a “free-spirted person” who loves to travel. She reminds anyone diagnosed with breast cancer or other illness to keep living and enjoying life, as long as they have the strength to do so. Because that’s exactly what she’s doing.

“Don’t let people put you in a vacuum,” she says. “Some people don’t think I should be out enjoying life, but I’m not dead,” she says.

The St. John Cancer Fund recently held its annual “Light Up the Night” fundraising event to benefit St. John cancer patients like Merlene. She has become involved with the fundraiser and attends the event every year since her diagnosis.

“People expected me [to be there], but they were really surprised to see me because I was recently hospitalized with pneumonia,” she says, adding, “but I’m a fighter.”

Merlene’s advice for other warriors like her is simple: “Don’t be afraid, don’t be ashamed, don’t skip your appointments. Do you, more than anything, and don’t let people discourage you from being you.”

If you wish to support local cancer patients during their time of need, consider making a financial donation to St. John Cancer Fund by visiting www.stjohncancercancerfund.org or to Cancer Support VI by visiting www.cancersupportvi.com.

PART II: MERLENE’S ‘BREAST CANCER REVEAL PARTY’ & HER WILL TO FIGHT ON HER OWN TERMS

PART I: DIAGNOSED AT 73; CANCER-FREE AT 74; CONTINUING TO THRIVE AT 75