The young survivors, fighting on

Tiffany Nardella was engaged to be married, living in South Philadelphia, and loving life when she was diagnosed with stage 3 breast cancer at 35 in 2010.

The cancer stuck around, but the boyfriend didn't - gone after the second chemo treatment.

"My experience with the breakup, cancer, chemo, and trying to work, pay my mortgage, take care of my house and myself while living alone was daunting and overwhelming," Tiffany said. "I went through a bad period of depression and feeling worthless."

Breast cancer strikes 232,000 American women a year, but only 13,000 under 40.

For younger women, the cancer is often much more aggressive, and they have issues that older women often do not - dating, fertility, breast reconstruction.

Searching the Web for help, Tiffany found the Young Survival Coalition (YSC). Online and in person, she had an instant sisterhood. These women understood. They taught her so many tricks, that dark polish, for instance, helps preserve fingernails longer. (They fall off from chemo.)

The sisterhood helped her deal with the endless rudeness a young bald women encounters in public. When a moron asked, "Are you a lesbian?" Tiffany was grateful to have survivors with whom she could vent.

"Otherwise, I'm sure I would have slapped someone," she said.

The coalition "was there for her in ways we couldn't be," said Tiffany's best friend, Jackie Raszeja. "It saved her sanity."

Tiffany also heard about the coalition's annual ride, Tour de Pink, and soon after her diagnosis, the organization donated a road bike for her to begin training.

She cycled through nine months of chemo, and two weeks after her last treatment, she rode in her first Tour de Pink, in September 2010. It was three days, 200 miles, from Hershey to Washington.

She walked every hill, and often wept. The ride was so hard.

But the strength of the other women, their stories and support, inspired her.

Tiffany rode in 2011 and 2012, stronger each time.

She had breast reconstruction, six surgeries in three years, riding through them all.

In 2011, after her last radiation treatment, no evidence of cancer in her body, Tiffany got a tattoo on her left arm - an elephant, rabbit, and bird all riding one bike. She wanted to depict a celebration.

Tiffany took 2013 off from Tour de Pink because she was a newlywed. She wanted to focus that summer on her husband, not cancer.

Tiffany met Mike Nardella on an online dating site, OKCupid.com. She had started dating during chemo. "I knew life was short and didn't want to miss out," she said. Even though she was bald, overweight from treatment, with one breast after mastectomy, she found most men were happy to date as long as she was honest.

She never expected to meet her future husband online, but, "I knew right away."

"We often feel ugly, unlovable, and with our medical history that no one would want us, but it's not true and you don't know until you try."

After missing last year, Tiffany looked forward to this fall's Tour de Pink.

The local chapter of the Young Survival Coalition has its own cycling group, the Fighting Phillies, which trains for Tour de Pink. Tiffany took over the group, reinvigorated it.

This summer, she led Sunday rides to Doylestown, Ambler, and Valley Forge, 60- and 70-milers. She encouraged many survivors to join, even as they underwent treatment, and to ride in this year's Tour.

She put in 900 miles this summer, the best shape of her life.

But then came her August checkup.

Doctors felt enlarged lymph nodes under her arm, and sent her for an ultrasound, into the same room where she was diagnosed in 2010.

"I immediately went into PTSD," she said.

All these women live with the knowledge their cancer could return.

"It's horrible," Tiffany said. "It's scary."

Doctors suspected cancer was back and had metastasized. They ran a series of tests - weeks of uncertainty. They told Tiffany they wanted to run one final test, a PET scan, the Monday after Tour de Pink.

Many of the 53 survivors and 168 supporters who planned to ride arrived at the hotel Thursday night.

It was a hugfest.

This year's Tour de Pink was Sept. 19 to 21, Friday through Sunday. It started in Frazer, Chester County, and would go 200 miles, ending on the beach at Assateague Island, Md.

Tiffany raised $5,000. The ride netted $1 million. She pedaled out of the parking lot in front, positive, loving life. The weather that Friday was glorious, sunny, high of 72.

She was cruising, chatting as she rode, catching up with old friends and making new ones.

"I don't have any more worry left in me," she said a few miles in. "I'm just going to tell myself it is clean."

After 22 miles and many, many hills, Tiffany crossed Brandywine Creek. A monster hill loomed. She could see a string of riders before her, many walking, as she had done years ago.

She turned Tour de Pink into Tour de France.

Up she flew. She takes the hills personally. She crested the top.

"The hills on this ride are really similar to the battle with cancer," Tiffany explained, pedaling on. "You have to go up. You have no choice. You have to make it through it, with your people."

On another hill that first day, Kelly Bratic, a member of the Fighting Phillies, wanted to walk. But didn't.

"I know Tiffany would be so disappointed in me," she said, pumping hard.

One Fighting Phillie, Kara Guzzetti, 32, has stage 4 metastatic breast cancer that had spread to her liver. She had been dosed up on heavy chemo most of August and into September, and feared she wouldn't be able to ride at all.

She rode 11 miles the first day, and told Tiffany at a rest stop, "I should have gone to the doctor yesterday. I need platelets."

She rode 33 miles Day 2.

On Sunday, the last day, 14 Fighting Phillies including Tiffany formed a circle around Guzzetti, a windshield with their bodies and bicycles so she could ride with as little resistance as possible. They carried her along in this cocoon for 58 miles, until they reached the Atlantic Ocean.

 Tiffany plunged into the sea, then swigged a well-deserved beer handed to her by her husband.

"I could cry at how happy I am," she said. "I am a little delirious."

"Whatever faces me, I can handle it," she said. "I am with all these people, who've been through so much."

Sunday night, before bed, she posted on Facebook: "Hashtags are all I have. #love #courage #fierceness #hope #strength #family #neveralone #ysctdp #family #joy #200+miles #soregirlstuff #sunburn #bellyfullofgel #achingback #wildhorses #roadkill #awesomeroadcrew #bestteamever #fightingphillies #noeffingcoffee? As always, I fell in love with the world again."

She had her PET scan Monday.

Cancer had returned to lymph nodes under her arm, and traces were seen in bones.

She has a form of breast cancer, ER/PR positive, that feeds off estrogen. She had been taking a hormone to prevent estrogen from spreading the cancer though her body and it seemed to work for four years.

But no longer.

The news devastated her. She told friends it was even worse than finding out she had cancer the first time. But with each passing day, her spirits improved.

"My plan is to treat this like any lifelong disease," she posted on Facebook. "Remember there isn't a cure and I had four good years of zero signs of cancer. With the right treatment and some luck, I can get back to that or at least very close to that."

Doctors on Monday removed her ovaries in outpatient surgery. The hope is that with no ovaries, no estrogen, the cancer can be contained for as long as five years.

By then, with the swift pace of research, Tiffany hopes there will be another remedy.

On Tuesday, the day after her surgery, her mind was on life, not death. "I will be on the bike soon," she texted. "Thinking doing some version of the covered bridge ride that's coming up."