By Brookshire McDonald COMMUNITY | POETRY Be your own advocate You must do. Healthcare workers are great But overworked, too. Don’t accept “no news is good news” ‘Cause that’s not always so. You need to receive an answer “From the get go.” Life expectancy has increased Causing more older folks on earth, And referrals to specialists Has increased since birth. Appointments are taken For doctors galore Making the wait time A month or more. Adding your name to a call list Is sometimes a thing; But don’t hold your breath For a possible ring. Make the call yourself Every day or two To check on cancellations To find room for you. Make your case By saying you feel worse; But don’t jinx yourself By calling the hearse. Some offices get tired Of your calling so much; So by magic they have an opening Right before lunch! Don’t forget a second opinion Is always a good thing Even tho’ it’s another office You must continue to ring. It’s your body, So show it good care. It means more to you Than others anywhere! To be counted in the life expectancy numbers this year Be your own advocate To release all fear!! Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story Connect with SurvivingBreastCancer.org Podcast Weekly Meetup Free Events

By Beth Krasemann COMMUNITY | BREAST CANCER STORIES In May 2023, I went on a run and a dog bit me! I went to a doctor to have it checked out and I asked for an order for a mammogram, as I had not had one since before Covid. The mammogram revealed a fairly large tumor–I was in shock as I had no symptoms, pain, or indication that a 8 centimeter tumor was embedded in my left breast. A needle biopsy and pathology analysis revealed I had triple positive breast cancer; I had positive receptors for estrogen, progesterone, and HER2. The cancer had spread to lymph nodes, so a treatment plan was crafted. Later studies put me at stage 2. As I navigated those frightening opening days and weeks, I made a decision I would not stop moving. I ran, hiked, swam, mountain biked, road biked, gravel biked, skied uphill, skied downhill, Nordic skied, kayaked, windsurfed, sailed, climbed mountains, wrote a book, taught high school history, coached ski mountaineering, traveled, and raced in many different events through 18 months of breast cancer treatment—20 rounds of chemo, 28 rounds of radiation, and a mastectomy. I used movement as medicine; I exercised on average 900 minutes a week, far above the 150 minutes recommended by the American Heart Association. I believe movement is the fourth pillar of cancer treatment. In the middle of treatment, I completed one of the most challenging ski mountaineering races in the United States: the Power of Four in Aspen, Colorado, with my son Daniel by my side. My answer to the absurdity of the diagnosis and treatment was to move. I grew up with three older brothers and very active parents who instilled in the family a passion for movement. We spent vacations skiing or backpacking in the mountains and all four of us played a range of sports growing up. After competing as a college soccer and track runner, I continued to pursue physical fitness as a runner and biker in my adult life. So when the cancer diagnosis arrived, I made a deliberate decision to not stop moving. I would not let cancer steal my love of fitness and adventure. It did not matter the pace or how; I simply needed to move my body, every day. The “red devil chemo” (doxorubicin) made running really hard, but I kept at it. I turned to skiing in the winter months as my main focus of movement. After my mastectomy, I skied using only one arm! In the spring, summer and fall, I turned to the trails to run and bike. When I was outside moving, I did not feel like a cancer patient. I felt like a healthy and normal athlete. I wrote about my experience in my book 900 Minutes: Movement as Medicine. It recounts the ups and downs of anyone fighting cancer—or any other trauma. It demonstrates how exercise—in all its forms—serves, sustains, and nurtures us all. I dedicate my book to exercise, in all forms, and to the resilience of my body. I pushed it so hard and she always responded and made my fight through the treatment manageable. To truly mark the end of my treatment and on to what I call Beth 2.0, my husband and I climbed Mt. Kilimanjaro in June 2026. My story serves as a model of what is possible during breast cancer treatment. Now, let’s get moving! About the author: Beth Krasemann is the author of 900 Minutes: Movement as Medicine. More information: https://900minutes.com/ Read More: The Role of Hormones in Breast Cancer What is Breast Cancer Rehab? Exercise and Breast Cancer Lymphedema is a Chronic Condition & Why I Love Swimming On the Podcast: Breast Cancer Conversations Episode 214: The Benefits of Pilates for Breast Cancer Recovery Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story Connect with SurvivingBreastCancer.org Podcast Weekly Meetup Free Events

By Elisa Herrera We walk through a hallway of mirrors, the same day repeating in each one— yet never looking the same. In one, the light is soft, the weight of things barely touches me. I pass through the moment as if it means nothing. In another, the glass darkens— the same scene bends inward, presses against my chest until I can hardly breathe. Nothing has changed— the room, the words, the silence— yet the mirror turns it heavy, turns it into something I cannot carry. I move from reflection to reflection, not realizing I’ve stepped into a different one. One tells me I’m okay. Another whispers: this is too much. And somewhere in between, there must be a mirror that shows things as they are— not softer, not crueler—just true. But until I find it, I keep walking this corridor, living the same life in a thousand different ways. Share your poetry: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetups Free Events

PIK3CA. AKT1. PTEN. mTOR. What the PI3K/AKT/mTOR pathway means for breast cancer treatment — and the questions worth bringing to your next appointment. SurvivingBreastCancer.org. Editorial EDUCATION | BIOMARKERS Breast cancer treatment is becoming increasingly personalized, but that progress comes with an entirely new vocabulary. PIK3CA. AKT1. PTEN. mTOR. These terms may appear on a biomarker report or come up when an oncologist is discussing why a treatment stopped working, or what treatment might come next. Together, they are part of the PI3K/AKT/mTOR pathway, often shortened to the PAM pathway. Understanding this pathway will not tell you exactly how your cancer will behave, but it may help explain what is driving it, why biomarker testing matters, and whether a targeted treatment could be an option. For some people with breast cancer, changes within the PAM pathway can help cancer cells grow, survive, or become less responsive to treatment. Finding those changes through biomarker testing may help your care team identify a treatment designed to target what is driving the cancer. Key Takeaways The PI3K/AKT/mTOR, or PAM, pathway helps regulate how cells grow, use energy, and survive. Changes involving genes such as PIK3CA, AKT1, or PTEN can allow cancer cells to continue receiving growth signals. PAM pathway alterations are especially relevant in hormone receptor-positive, HER2-negative advanced or metastatic breast cancer. Biomarker testing may identify an alteration that helps guide treatment, but blood and tissue tests do not always provide the same information. A negative liquid biopsy does not necessarily rule out a mutation. In some cases, testing tumor tissue may provide additional answers. Having an alteration does not guarantee that a targeted treatment will work. Treatment decisions also depend on previous therapies, overall health, side-effect risks, and personal priorities. Side-effect prevention and early management, particularly for high blood sugar, rash, diarrhea, and mouth sores, are an important part of treatment. What is the PAM pathway? The PAM pathway is one of the communication systems cells use to control growth, division, energy use, and survival. In a healthy cell, the pathway switches on when it is needed and quiets down when the job is complete. In some breast cancers, however, a mutation or another molecular change disrupts this process. The pathway may continue sending growth and survival signals even when it should stop. Several genes and proteins play important roles: PI3K helps begin and pass along signals that tell a cell to grow. PIK3CA is the gene that provides instructions for making one part of the PI3K protein. AKT carries growth and survival messages farther into the cell. mTOR helps regulate cell growth, metabolism, and protein production. PTEN helps slow the pathway down and acts as one of its natural brakes. When PIK3CA or AKT becomes overly active, or when PTEN no longer functions properly, the cancer cell may gain another way to grow and survive. WHY IT MATTERS Why does this pathway matter in breast cancer? Changes in the PAM pathway are found across different breast cancer subtypes, but they have become especially important in the treatment of hormone receptor-positive, HER2-negative advanced or metastatic breast cancer. One of the most commonly discussed changes is a mutation in PIK3CA. A PIK3CA mutation can cause the PI3K protein to remain overly active, sending ongoing signals that encourage the cancer cell to grow. Alterations involving AKT1 or a loss of normal PTEN function can have a similar effect by activating other parts of the pathway or removing the signals that would normally slow it down. The PAM pathway may also play a role in treatment resistance. For example, a hormone receptor-positive breast cancer may initially rely heavily on estrogen to grow and respond well to endocrine therapy (also referred to as hormonal therapy). Over time, some cancer cells may begin using another signaling system such as the PAM pathway to continue growing despite treatment. Cancer cells can change over time and develop new ways to survive. That is one reason biomarker testing may need to be revisited when cancer returns or progresses. TESTING What is biomarker testing, and why is it important? Biomarker testing is different from testing for inherited cancer risk. A hereditary genetic test usually looks for changes you were born with such as certain mutations in BRCA1, BRCA2, or PALB2, among many others, that may be present throughout the body and passed through families. Tumor biomarker testing looks primarily for changes that developed inside the cancer cells. These are called somatic alterations. Most PIK3CA mutations found in breast cancer are somatic. This means they developed in the tumor and were not necessarily inherited from a parent or passed on to a child. Some people benefit from both hereditary genetic testing and tumor biomarker testing because the tests answer different questions. How is the PAM pathway tested? Testing may be performed using tissue from the tumor, from a blood sample, or both. A laboratory may test tissue collected during a biopsy or surgery. In some cases, previously collected tissue can be used, although a newer sample may provide a more current picture of the cancer. A liquid biopsy uses a blood sample to look for small pieces of tumor DNA circulating in the bloodstream. This is known as circulating tumor DNA, or ctDNA. Liquid biopsies are less invasive than tissue biopsies and may detect information released by cancer in different parts of the body. However, not every cancer releases enough DNA into the blood to be detected. A negative liquid biopsy does not always mean that an alteration is absent. If your liquid biopsy comes back negative, an important question to raise with your oncology team would be: “My blood test did not find a mutation. Could testing tumor tissue give us additional information?” TREATMENT What could a PAM pathway alteration mean for treatment? Finding a PAM pathway alteration does not automatically determine your next treatment. It does, however, provide another piece of information your oncology team can use when comparing options. Several medications target different parts of the pathway. Their FDA-approved uses currently focus primarily on specific groups of people with HR-positive, HER2-negative locally advanced or metastatic breast cancer. These medications are not interchangeable. Eligibility depends on the exact alteration, previous treatments, timing of recurrence or profession, one’s overall health, and other individual factors. Does having a mutation mean the treatment will work? No biomarker can guarantee that a medication will work. A biomarker may tell your care team that a treatment is more likely to help a particular group of patients. But every cancer is complex. A tumor may have several alterations and use more than one pathway to grow. The presence of a mutation also does not tell us exactly how long a treatment will work for one individual. Your care team will consider: The exact alteration identified Your breast cancer subtype Previous treatments How long earlier treatments controlled the cancer Where the cancer is located How quickly it is progressing Your overall health Diabetes, prediabetes, or other medical conditions Possible medication interactions Side effects and quality-of-life priorities Available clinical trials Biomarker testing can help personalize treatment, but it is one part of a much larger conversation. SIDE EFFECTS What side effects should patients know about? The PAM pathway is involved in normal functions throughout the body, including blood sugar regulation, cell growth, and metabolism. Blocking the pathway can therefore affect healthy cells as well as cancer cells. Side effects vary by medication, dose, treatment combination, and individual health. High blood sugar PI3K and AKT inhibitors can raise blood sugar, sometimes significantly. Before beginning treatment, your care team may check: Fasting blood glucose Hemoglobin A1C Current diabetes medications Personal or family history of diabetes Other factors that could increase your risk Blood sugar may need to be monitored closely after treatment begins. Contact your care team if you experience: Increased thirst Frequent urination Unusual hunger Blurred vision Headaches Weakness or extreme fatigue Confusion Having diabetes or prediabetes does not always mean that a pathway inhibitor cannot be used. It may mean that additional planning, monitoring, or support from an endocrinologist is needed. Mouth sores Mouth soreness or ulcers, sometimes called stomatitis, can occur with several pathway inhibitors. Depending on the medication, your team may recommend a specific mouth rinse or other preventive strategy. Do not assume that all mouthwashes are appropriate, since products containing alcohol may worsen irritation. Diarrhea Diarrhea can lead to dehydration and electrolyte changes if it is not controlled. Ask your team: When should I start an antidiarrheal medication? How many episodes should prompt a call? What should I drink or eat? When is diarrhea considered urgent? Rash Rash can occur with some PI3K and AKT inhibitors. Reporting it early gives your care team the opportunity to intervene before it becomes more severe. Contact your team about new itching, redness, pain, blistering, peeling, or sores involving the skin, mouth, eyes, or genital area. Other side effects Depending on the treatment, additional effects may include: Fatigue Nausea Decreased appetite Changes in blood counts Increased risk of infection Changes in liver or kidney laboratory results Inflammation involving the lungs Changes affecting the eyes This does not mean that every patient will experience every side effect. It means that having a clear monitoring and management plan matters. Managing side effects is part of treatment Side-effect management is not an afterthought. It is part of receiving cancer treatment safely. Addressing symptoms early may help prevent complications, reduce interruptions, and make it easier to remain on treatment when the medication is helping. Before starting a PAM pathway inhibitor, consider asking: What side effects are most common with this exact medication? Which symptoms require an immediate call? How often will my blood sugar and laboratory results be checked? Will I need to monitor my blood sugar at home? Should I meet with an endocrinologist before treatment? Will you recommend medications to help prevent rash or mouth sores? Are there foods, supplements, or medications I should avoid? Who should I contact during evenings or weekends? Does the PAM pathway matter in early-stage breast cancer? The pathway can be present and biologically important in early-stage breast cancer, but most established PAM-targeted treatment uses in breast cancer currently apply to locally advanced or metastatic disease. Finding a PIK3CA, AKT1, or PTEN alteration in an early-stage tumor does not automatically mean that a PAM pathway inhibitor should be added to treatment. Researchers continue to study whether these medicines could help prevent recurrence or improve outcomes in earlier-stage disease. Clinical trials are necessary to determine whether a treatment is both safe and beneficial in a new setting. What about triple-negative or HER2-positive breast cancer? PAM pathway alterations can also occur in triple-negative and HER2-positive breast cancers. However, finding an alteration does not necessarily mean that one of the currently approved PAM-targeted treatments is appropriate. Researchers are studying pathway inhibitors in different breast cancer subtypes and in combination with: Chemotherapy HER2-targeted therapies Endocrine therapy Immunotherapy Other targeted treatments A clinical trial may be an option for some patients whose tumor has a pathway alteration but who do not meet the criteria for an existing FDA-approved treatment. How might targeting the pathway improve outcomes? Biomarker testing may reveal a specific alteration that can be targeted with an available medication. Blocking the PAM pathway may help interrupt one of the routes cancer cells use to continue growing despite endocrine therapy. For some patients, combining endocrine therapy with a targeted treatment may help control cancer longer than endocrine therapy alone. Questions to ask your care team Consider bringing these questions to your next appointment: Has my cancer been tested for PIK3CA, AKT1, PTEN, and other actionable biomarkers? Was the testing performed on blood, tumor tissue, or both? Which genes were included in the test? If my liquid biopsy was negative, should tumor tissue also be tested? Could my cancer’s biomarkers have changed since my original diagnosis? Does my result make me eligible for an FDA-approved treatment? How does this option compare with the other treatments available to me? What benefit was seen in clinical trials for patients whose situation was similar to mine? What side effects should I expect, and what can we do to prevent or manage them? Will I need blood sugar monitoring or support from an endocrinologist? Is there a clinical trial targeting this pathway that may be appropriate for me? Can I have a copy of my biomarker-testing report? What This Means for Patients The science behind the PAM pathway is complex, but its relevance to patients is much more practical: it may help explain why a cancer is growing, why a previous treatment is no longer working, and whether another treatment could target a specific feature of the tumor. Most importantly, you deserve more than a list of unfamiliar letters on a laboratory report. Ask your oncology team to walk you through what was found, what was not found, and whether the results change your options.. Understanding the science does not mean carrying the responsibility for making these decisions alone. It means having the information you need to participate meaningfully in your care. ________ This article is intended for educational purposes and is not a substitute for personalized medical advice. Treatment approvals, guidelines, and research continue to evolve. Always discuss biomarker testing, medications, side effects, and treatment decisions with your oncology team. Funding from Celcuity helps SurvivingBreastCancer.org provide free, evidence-informed education to people affected by breast cancer. Sponsorship does not constitute an endorsement of any product, treatment, or company.

By Kia Lee I was 38 years old when I was diagnosed with stage III ER+/HER2- invasive ductal carcinoma. At the time, I was doing everything “right.” I exercised daily, maintained a healthy weight, ate well, rarely drank alcohol, and had no known genetic mutations associated with breast cancer. Cancer was not something I expected to hear. Yet on October 10, 2023, my life changed. Treatment moved quickly. I underwent dose-dense AC chemotherapy followed by Taxol and Abraxane, a unilateral mastectomy with lymph node removal, proton radiation, reconstruction, ovarian suppression, and hormone therapy. Like many patients, I focused on getting through the next appointment, the next scan, the next treatment. Survival became the goal. And eventually, I survived. What I didn’t expect was that the hardest part would begin after treatment ended. People celebrate when treatment is over. They tell you how strong you are. They tell you how happy you must be. Everyone wants the story to end there. But survivorship is not the end of the story. For me, survivorship felt like standing in the middle of a life I no longer fully recognized. Before cancer, much of my identity was built around achievement, productivity, being dependable, helping others, and always moving forward. Looking back, much of my self-worth was tied to what I could accomplish and how useful I could be to everyone around me. Then cancer stripped away the ability to measure myself by any of those things. Treatment forced me to slow down. It challenged my relationship with control, perfectionism, work, appearance, femininity, and certainty. When treatment ended, I expected to return to my old life. Instead, I discovered that parts of my old life no longer fit. My priorities had changed. The pace I once lived at no longer felt sustainable. Some of the goals I had spent years pursuing no longer felt aligned. I wasn’t trying to become who I was before cancer. I was becoming someone new. That realization was both painful and liberating. For a long time, I thought healing meant getting back to normal. Now I understand that healing often means creating a new normal, one that honors who you have become because of what you’ve lived through. One of the greatest gifts of survivorship has been discovering purpose in sharing my story. Today, I write, advocate, and support other women navigating life beyond diagnosis and treatment. I have learned that many survivors quietly struggle with identity shifts, fear of recurrence, changing relationships, body image, career transitions, and the pressure to “move on” before they’ve had a chance to process what happened. If there is one thing I wish every newly diagnosed person knew, it is this: Your life is not over. Your future may not look exactly as you imagined, but there is still joy, purpose, love, meaning, and possibility ahead. You are allowed to grieve what was lost. You are allowed to change. And you do not have to become the person you were before. Surviving cancer is not about returning to your old life. It’s about creating a life that feels even more true than the one you left behind. About the Author: Kia Lee is a breast cancer survivor, author, advocate, and speaker dedicated to helping women navigate the often-overlooked realities of survivorship. Diagnosed with stage III breast cancer at age 38, Kia understands firsthand that completing treatment is not the end of the journey—it is often the beginning of a new one. Through her writing, speaking, and advocacy, she explores the emotional, physical, relational, and identity shifts that can occur after a cancer diagnosis and treatment. Kia is the author of Lighthouse: The Path Through Cancer, the Power of Becoming and a contributor to survivorship publications and patient advocacy initiatives. Her work focuses on creating honest conversations around healing, rebuilding confidence, navigating uncertainty, and finding meaning beyond survival. As a member of the survivorship community, Kia believes that while cancer changes us, it does not define us. She is passionate about helping others reconnect with themselves, rediscover joy, and create lives that feel aligned after treatment. Read More: Addressing the Unique Challenges of Breast Cancer in People Under 40 Different Types of Breast Cancer Understanding the Different Stages of Breast Cancer Survivorship Care Plans: Life After Breast Cancer Treatment On the Podcast: Breast Cancer Conversations Breast Cancer Survivorship: Exercise, Nutrition, Sleep, and Support That Actually Matter Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Podcast Weekly Meetup Free Events

By Sierra Hendren Content warning: death and dying Just days before my graduation, my family was celebrating what we believed would be one of the happiest moments of our lives. After two years of hard work, sacrifice, sleepless nights, clinical rotations, and balancing motherhood alongside school, I was preparing to graduate with honors and a 4.0 GPA from the Cardiovascular Sonography program at Caldwell Community College and Technical Institute. My pinning ceremony was scheduled for May 5, 2026, followed by graduation on May 8. But behind that celebration was a story much deeper than academic achievement. Just two months into my sonography program, my mother was diagnosed with metastatic breast cancer while she was already battling sarcoidosis. Overnight, our lives became filled with doctor appointments, treatments, hospital visits, and the emotional weight of watching someone you love fight for their life. Recently, we received the devastating news that the cancer had spread to her brain. As her only daughter, I stepped into the role of caregiver while continuing my education, raising my two young children, and trying to hold my family together through one of the hardest seasons of our lives. Still, through every setback and every heartbreaking moment, my mother kept fighting — because she wanted to see me graduate. And somehow, despite everything, she made it there. But on the drive to my pinning ceremony, my mother suddenly lost her vision completely. What should have been one of the proudest days of our lives instantly became filled with fear and uncertainty. The woman who had fought so hard to be there could not even see the moment she had been holding on for. Over the following days, her condition worsened rapidly. Her memory began fading in and out, confusion increased, and our family suddenly found ourselves discussing palliative and hospice care instead of simply celebrating graduation. One moment, we were taking graduation photos together. The next, we were preparing ourselves for the possibility of losing her. Then everything changed again. Just recently, we rushed my mother to the emergency room because her oxygen saturation had dropped to 74% and her feeding tube needed to be evaluated. Around 2:00 AM, we were told she would be admitted and reassured that it would be okay for us to go home and rest. Then at 3:57 AM, I received a phone call from the ER doctor that completely shattered me. He explained that my mother’s lungs were failing and could no longer support her body. He told me I had two choices: To allow her to pass naturally, which he explained would happen very quickly in the condition she was in. Or to make the decision to place her into a medically induced coma and put her on a ventilator, knowing there was a very real possibility she may never wake up from it. No daughter should ever have to make a decision like that for her mother. She is now in the ICU fighting for her life. We went from trying to celebrate my graduation… to fighting for more time with my mom almost overnight. At the same time, my nine-year-old son, who is globally developmentally delayed, has also been overcoming challenges of his own. Despite everything happening around him, he pushed through academically this year, began making A/B Honor Roll, and is now approaching grade level — something we are unbelievably proud of. My son and my mother share an incredibly special bond. They have been together nearly every single day since the day he was born, and years ago, he was actually the one who helped her discover the first lump in her breast when she first battled breast cancer. This story is about so much more than graduation. It is about caregiving. Motherhood. Family. Faith. Resilience. Heartbreak. Hope. And what it truly means to continue showing up for the people you love even when your world feels like it is falling apart. Read More: Metastatic Breast Cancer: Understanding the Significance of Stage IV Expecting the Unexpected: Anticipatory Grief and Breast Cancer How To Be Helpful When A Loved One Is Sick On the Podcast: Breast Cancer Conversations Palliative Care Is Not Giving Up: Patients Living With MBC Share What It Really Means Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Podcast Weekly Meetup Free Events

Imagine hearing the words: "You have Stage 0 breast cancer." Within days, you're faced with decisions that may affect your body, your future, and your quality of life. Should you have radiation? Can it safely be avoided? Is your risk of recurrence low or high? These aren't easy questions—and they deserve thoughtful, individualized answers. That's why recent news surrounding Medicare coverage for genomic testing in ductal carcinoma in situ (DCIS), also known as Stage 0 breast cancer, deserves our attention. A proposed Medicare coverage change could limit access to certain genomic tests that help estimate an individual's risk of recurrence and whether radiation therapy is likely to provide meaningful benefit. While the proposal directly affects Medicare beneficiaries in jurisdictions covered by the MolDX program, coverage decisions like these often extend far beyond Medicare. Private insurers frequently look to Medicare policies when determining what they will cover, meaning the ripple effects could impact patients of all ages. First, What Is DCIS? Ductal Carcinoma In Situ (DCIS) is often referred to as Stage 0 breast cancer, but that label doesn't capture the complexity of the diagnosis. DCIS develops when abnormal cells are found inside the milk ducts of the breast. Unlike invasive breast cancer, these cells have not broken through the duct wall or spread into the surrounding breast tissue. Because the abnormal cells remain confined to the ducts, DCIS is considered non-invasive. Today, DCIS accounts for approximately one in every five new breast cancer diagnoses in the United States, largely because routine mammograms are able to detect these early changes before they become invasive. While DCIS is highly treatable and carries an excellent prognosis, it is not one disease. Some DCIS lesions are unlikely to ever progress or return after surgery, while others have a higher risk of recurring or developing into invasive breast cancer over time. That is what makes treatment decisions so challenging. There is no universal "right" answer for every patient. Treatment recommendations may include lumpectomy alone, lumpectomy followed by radiation therapy, hormone therapy for some hormone receptor-positive tumors, or mastectomy in select situations. These recommendations are based on many factors, including the size and grade of the DCIS, surgical margins, hormone-receptor status, age, family history, personal preferences and values, and in some cases genomic or biomarker testing. The goal is to understand the biology of the tumor well enough to recommend the treatment that is most appropriate for that person. What Is Genomic (Biomarker) Testing? This is where many patients become confused. Genomic testing does not tell you whether you have cancer. It also does not replace your pathology report. Instead, these tests analyze the biology of the tumor itself to better understand how that specific DCIS may behave. In certain cases, these tests can provide additional information about the likelihood of recurrence and whether radiation therapy is likely to provide meaningful benefit after breast-conserving surgery. The current Medicare Local Coverage Determination itself acknowledges that traditional clinical and pathologic features do not always reliably predict recurrence risk and that validated biomarkers may provide additional prognostic information to help distinguish patients who may benefit from more treatment from those who may benefit from less. This is the very definition of precision medicine. Information Empowers Patients. At SurvivingBreastCancer.org, we believe that informed patients make better decisions not because they choose one treatment over another, but because they understand why a treatment is being recommended for them. Genomic testing is not a replacement for conversations with your surgeon, radiation oncologist, or medical oncologist. It is another piece of information, another data point, another tool that can help patients and physicians weigh risks, benefits, and personal preferences together. Access to information should never depend on a person's financial resources. If a validated test can help someone better understand their individual risk and make a more informed treatment decision, patients deserve the opportunity to discuss that option with their care team. Why This Matters Beyond Medicare Many people assume Medicare policy affects only older adults. Unfortunately, that's often not the case. Medicare coverage decisions frequently influence private insurance policies, employer-sponsored plans, and future payer decisions. While there is no guarantee private insurers will mirror this proposal, history suggests they often consider Medicare coverage when developing their own policies. That means today's Medicare decision could shape tomorrow's access for women diagnosed with DCIS across the country. What Can We Do? One of the questions I kept asking myself while researching this issue was: "What can we actually do?" The good news is that patients and advocates do have a voice. Here are a few meaningful ways to get involved: Learn about the proposed policy from reliable sources before sharing information. Contact your members of Congress and let them know that access to evidence-based, personalized cancer care matters to you. If public comment opportunities are open during Medicare contractor review periods, submit your perspective as a patient, caregiver, clinician, or advocate. Share your story. Real patient experiences help policymakers understand that these decisions affect people, not just policies. Talk with your healthcare team. If you've benefited from genomic testing, ask whether they're participating in professional advocacy efforts through their medical societies. Our Commitment At SurvivingBreastCancer.org, we don't advocate for one company or one test. We advocate for those impacted by breast cancer. We advocate for access to high-quality information. And we advocate for a future where treatment decisions are driven by science, evidence, and the unique circumstances of each individual, not simply by whether a diagnostic tool happens to be covered. Because every person diagnosed with breast cancer deserves the opportunity to make informed decisions with their healthcare team. Learn More If you're newly diagnosed with DCIS and want to better understand your options, we invite you to listen to our Breast Cancer Conversations episode: DCIS Isn't 'Nothing': Stage 0 Breast Cancer and the Decisions No One Explains. In this conversation, we explore why DCIS treatment is often more nuanced than people realize, what genomic testing can and cannot tell us, and why personalized decision-making matters.

By Jill Siegal Chalsty Bay of Islands, New Zealand – learning about and becoming inspired by the resilience of the Maori people I’m the founder of Overcoming Obstacles, a nonprofit organization that provides the world’s educators with free life skills curricula to teach in their classrooms. I had devoted decades to helping ensure young people learn the communication, decision making, and goal setting skills they need to lead healthy and prosperous lives. But my journey with cancer taught me that I hadn’t been practicing those same skills myself. On October 5, 2022, I left my home for twenty-four hours that would change my life forever. I had been followed for years as someone at high risk of breast cancer and then my incredible surgeon and her team at Moffitt Cancer Center stepped in when cancer was found. Leaving home for a double mastectomy would have been difficult for anyone, but I had become the full-time caregiver for my husband, John. He had been my source of strength for decades but was now entering the final stages of mixed dementia. I headed to Moffitt alone. During my time in recovery post-surgery, I didn’t have the television on. Nor did I have visitors. I lay in my bed, reliving moments of my past. I thought about a trip John and I had taken to a small island off Fiji, one of the most beautiful places we had ever visited. The sun bounced off the turquoise water. Ripe coconuts fell from the trees. That had become my happy place. Other memories surfaced too, reminding me that I was raised to be a warrior. Delivering a "packet of hope" in Mauritius My parents were fighters. My father had served with the Marines during the Korean War and taught my brother, sister, and me things that helped him make it through the most difficult times, including crossing the Han River during the Inchon Invasion and making it back to shore alive. Dad had favorite quotes that became huge in our lives. One from George W. Cecil that we were instructed to memorize was on the wall of his home office: “On the plains of hesitation bleach the bones of countless millions who at the dawn of victory, sat down to rest, and resting died.” The quote became a way of life for me. “Never hesitate! Jump on things right away!” I did that through childhood, into adulthood, in preparing for surgery, and in caring for myself and my husband as I recovered. But growing up, no one talked to us about “balance.” We all need to have balance in our lives, otherwise we’ll be stressed and burn out. And the link from stress to cancer is well documented in studies. What’s more, no one spoke to us about getting a good night’s sleep or the diet necessary to be healthy. Not even well-intentioned and caring parents were able to teach the skills I needed to stay healthy. A warrior spirit and sayings got me through the twenty-four hours away from John but weren’t going to be enough to win my battle against cancer. Fifteen months after the double mastectomy, I was diagnosed with two primary lung cancers in my left lung. I had the upper half of my left lung removed for the larger of the two cancers and then lasted only a few rounds of chemo before my kidneys cried, “Enough!” The cancer in the lower left lung is being monitored by CT scans. I’m living my life now in chunks of months. This new timetable has become the calendar for planning my life. With each report of “Stable” I move forward. During my recovery, I began writing my memoir, Packets of Hope and with that spent hours re-reading the Overcoming Obstacles curriculum. I engaged with the lessons and, best of all, connected with former students to hear how the life skills they learned in school saved their lives. Now, unlike the person who walked through the doors of Moffitt Cancer Center in 2022, I’m practicing what Overcoming Obstacles educators teach. I’m setting small goals to reach larger ones, making healthy choices, and surrounding myself with positive people. These lessons aren’t just for students. They’re lessons for us all. About the author: Jill Siegal Chalsty is the author of Packets of Hope: A Journey of Healing and Rediscovery. Read More: The Psychological Impact of Breast Cancer: Strategies for Coping A Disabled Clinical Psychologist’s 6 Tips for Living Well with Breast Cancer Grit and Grace 20 Sleep Hacks For A Better Night's Rest On the Podcast: Breast Cancer Conversations The Messy Middle of Breast Cancer: Chemo, Surgery, Side Effects, and Survivorship Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Podcast Weekly Meetup Free Events

By Lisa Johnson I first heard the words “you have breast cancer” in November 2014 while lying in bed praying. As I turned onto my right side, I felt a sudden pain in my breast and asked God, “What is this pain, and where did it come from?” In my spirit, I heard Him say, “You have breast cancer, but fear not, for I am with you.” Those words echoed in my heart like a broken record as I moved through the holidays carrying thoughts I had not yet shared with anyone. I waited until January to schedule a mammogram, when my new health insurance became active. By February 2015, the journey had begun, and it moved quickly. A mammogram, ultrasound, and biopsy confirmed my diagnosis: breast cancer, ER/PR-positive, HER2-negative. That single year brought overwhelming change: marital separation, moving, job loss, a mastectomy, reconstruction, chemotherapy that nearly took my life, infections requiring hospitalization, and ultimately a divorce, all while preparing my only child, who also became my caregiver, for his senior year of high school. I survived by entering what I call “lock and load mode,” pressing forward one step at a time. I trusted God, believing this season was temporary, and I declared with faith, “I am healed. I shall live and not die.” By the end of that year, treatment was complete, cancer was in remission, I had a new job, and life finally felt stable again. Although I thought I would magically snap back to “normal,” I soon realized I was so wrong. I needed to embrace this new body, new person and found myself grieving the woman I was prior to breast cancer. I faithfully followed my oncology care, took tamoxifen for a few years, and looked forward to my five-year cancer-free milestone. Then on May 25, 2020, during what I thought would be my victory oncology appointment, everything changed. A lingering cough and abnormal blood work led to scans that confirmed breast cancer had returned, this time as stage 4 metastatic breast cancer, spreading to my lungs and bones. Those words took my breath away. Fear came rushing in, I was faced with my mortality much sooner than I ever thought I would be, but I knew I had a choice. I had to declare yet again, “I shall live and not die!” Rather than shrinking back in fear, I chose to continue to have faith in God, grab life by the horns and live, now. Treatment began immediately. After one chemotherapy treatment caused a medical emergency and revealed a single brain tumor, I underwent CyberKnife radiation, noninvasive and successful. Chemotherapy was stopped, and I transitioned to a treatment plan of fulvestrant (Faslodex) injections and ribociclib (Kisqali). That decision changed everything. Today, I have been boldly living with metastatic breast cancer for five years and grateful to have been NED for about the past three and a half years. I enjoy a great quality of life with manageable side effects, work full-time and feel like myself most days. I am not merely surviving, I am learning, leading, teaching, advocating and truly thriving. My journey with metastatic breast cancer has become my mission and purpose. I am committed to learning all I can about MBC and using my voice to share my story, encouraging and educating others on what metastatic breast cancer truly is, ensuring its ribbon is recognized, and advocating for stronger resources, better legislation, and increased research funding. I am not just an MBC patient: I am a peer support and advocate. I am living proof that purpose is more powerful than prognosis. Read More: Metastatic Breast Cancer: Understanding the Significance of Stage IV The Role of Hormones in Breast Cancer Early Warning Signs of Breast Cancer On the Podcast: Breast Cancer Conversations The Hidden Trauma of Breast Cancer: PTSD, Fear, Triggers, and Healing Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Podcast Weekly Meetup Free Events

By Summer Owens I was forty-six when my world shifted with four words no one ever wants to hear. You have breast cancer. And the surprising part is that I did not panic. My very first thought was the same phrase that has carried me through so many of life’s hardest seasons. S.O. What!. Not as in this does not matter, but rather I can face this. Then came the next question that always follows for me. S.O. NOW what? That mindset became the foundation for everything that happened next. My diagnosis was ductal carcinoma in situ (DCIS), stage 0, found during a routine ultrasound and confirmed by biopsy. I felt no lump. No pain. No warning. Just a quiet discovery that changed everything. I am grateful it was caught early, but hearing the word cancer still takes your breath in a different way. In September, I had a partial mastectomy. I didn’t have to have lymph nodes removed, and I’m grateful I didn’t have to have chemotherapy. A blessing I do not take lightly. The scar reminded me of my C section years ago. Another physical reminder of something that changed my life and made me stronger. Radiation brought its own surprises. Twenty sessions later, my breast is so dark now that I cannot even see the scar anymore. And even in that, I found gratitude. I was still here. Still healing. Still moving forward. Fatigue, brain fog, and emotional swings showed up too. Although I like to blame menopause for most of that and keep it light when I can. There were hard days, but there was also humor, honesty, and grace. I am self-employed, which helped me schedule treatment around work, but it also means insurance and costs have been a challenge. My son is grown and out of the house, so I walked much of this alone. It was peaceful at times and painful at others. Still, I am grateful. So grateful. I looked forward to seeing my friends who are also fighting cancer when I went to my daily radiation appointments because their appointment times were close to mine. We shared stories, shared life experiences, and laughed and encouraged each other a lot. What helped me with expectations were the friends who had been diagnosed with DCIS before me. They gave me real, honest expectations, and because of them, nothing felt as terrifying as the unknown usually does. And then there was the support I received from people who surprised me. Individuals who had no idea how much their kindness meant or how deeply their messages touched me. At the same time, I had to navigate the quiet heartbreak of realizing that some people I thought would check on me never called at all. That part was hard, but even in that, I found clarity, strength, and a deeper appreciation for the people who truly showed up. Perhaps the most meaningful part of this journey has been turning pain into purpose. A few years ago, I helped my mother pass out one hundred pink crochet caps at Race for the Cure. I had no idea that breast cancer awareness would one day become personal. This year, I created my own breast cancer awareness hoodie brand to honor this chapter, bring awareness to early detection, and share the mindset that carried me through. I gave my surgical oncologist a hoodie, and she even made a video about breast cancer surgery in it! I share my story because I remember searching for stories just like this when I was first diagnosed. Stories that told the truth. Stories that offered hope. Stories that said you can get through this too. If you are in the fight, just beginning, or supporting someone you love, I am praying for you. I see you. And I believe in what you still have the strength to overcome. My journey was not what I expected, but it reminded me once again that obstacles are not the end of the story. With faith, gratitude, and the right mindset, they become the beginning of a new purpose. S.O. What!. Now, what will you do with your next challenge? Connect with Summer: www.summerowens.com https://www.youtube.com/@SummerOwensSOwhat instagram.com/summero_sowhat facebook.com/SummerO.SOwhat linkedin.com/in/summer-owens-10846625 https://www.thesowhatfoundation.org/ https://summerowens.com/product/the-s-o-what-breast-cancer-awareness-hoodie/ Read More: Ductal Carcinoma in Situ (“Stage Zero” Breast Cancer) The Impact of Breast Cancer on Self-Image Managing Fatigue During Breast Cancer Treatment The Cost of Breast Cancer On the Podcast: Breast Cancer Conversations DCIS Isn’t “Nothing”: Stage Zero Breast Cancer and the Decisions No One Explains Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Podcast Weekly Meetup Free Events

By Shantana Watkins Greetings, my name is Shatana Watkins. I am from Indianapolis, Indiana. I am divorced with no children. I am a 46-year-old African American woman living with stage IV advanced-stage hormone receptor-positive (HR-positive), HER2-negative breast cancer. I did recognize some of the initial signs of my cancer in my breast years before I was able to address it. I made the discovery by self exam in 2010. I was eventually diagnosed in April 2021. Since then I have learned of the advancement of my cancer. The cancer has metastasized to my right lung, rib cage area, as well as a small mass in the right side of my brain. The result of the one round of radiation to my brain has been necrosis found in that area. I have had ten rounds of radiation to my breasts, along with a mastectomy. I continue my chemotherapy treatments with various medications including everolimus, abemaciclib, tamoxifen, and letrozole. I also have a port for easier access for blood draws and chemotherapy treatments. At this time, I continue my routine health care plan as prescribed by my oncologist. I have spent the majority of my time taking care of my mother, who struggled with her own health issues, which in turn caused me to neglect my own health. I was my mother’s primary care provider from August 2006 until she passed away in December 2020, during the Covid-19 pandemic. I lost my father in 2013; he was not aware of my condition. I did not want to neglect the care of my mother as I am an only child. I did not share any of my health information with my mother; I never wanted her to worry about me and I continued to place all my focus on her wellbeing until she passed. I also did not share my diagnosis with my closest friends or the rest of my family, until I could no longer care for myself, and needed additional support. I did not want to place any worry or stress on them as they have their own lives to live. In 2014 I obtained my Associate’s degree in business and in 2016 I obtained my Bachelor’s degree in management from Indiana Wesleyan University. My father instilled in me that education is very important, so I made certain to obtain my education and to continue to learn as often and as much information as I am able to. Living with metastatic breast cancer has caused me great physical, mental and financial toxicity. The mental and physical stress of worrying about finances has taken its toll. I am struggling to make ends meet as the cost of living is steadily increasing. I have attempted to find various resources to help fill the gap in what I am lacking, but most do not assist with daily costs of living and other financial obligations that most adults have. I have worked all of my adult life and I currently receive monthly disability payments. While I am thankful for the amount I receive, I can barely afford to meet my other financial obligations. When employed, I have been without health insurance through my employer for cancer treatments as it was unaffordable. I also had to toggle between missing work or neglecting my chemotherapy treatments so I would not miss any work days. For the weekdays that were missed, I made up for it on weekends. Women with financial hardships can furthermore face challenges in completing comprehensive multidisciplinary breast cancer management, because the frequency of treatment visits will generate costs related to transportation, childcare, and time away from work. The level of care should also be a focus for those in assisted living facilities and should also be investigated more often than what I have seen in my recent experience. Those who reside in such places may not have a voice in their care or they may not have a family member to voice their concerns. In some cases, residents may be taken advantage of mentally, physically and financially. In 2023, I had to move to another city in Indiana (Kokomo), as I was no longer able to live alone. I lived with a close friend for two years until she was no longer able to assist in care for me due to her full-time workload and parenting two children. After a recent hospital stay, my friend decided it was in my best interest to seek a nursing facility in the area. I stayed at this facility from January 2025 to August 2025. I did not select this facility, this was decided by my friend. During this time, there were issues in coverage between Medicaid and Medicare. The coverage between the two can be difficult to understand. During my stay at this facility, I experienced many issues with communication, accommodations, care plan management, social services, nutrition, and more. As I was trying to find a different assisted facility closer to my family, there were issues with locating a place that would accept me due to my age. I have learned that most assisted facilities are mainly geared to those who are 55+. I have also learned that the majority of assisted living coverage and acceptance is focused on that of 55 or older. I wanted to share my experiences as I would like to find more information on funding for those of us who are under the age of 55, but also have major health issues. Medicare is not an option for me because of my age, but I do have a terminal health diagnosis that should qualify myself and others who may face the same struggles. Many individuals fall into a gap where they cannot afford private health insurance, yet their income levels via disability payments are too high to qualify for government-supported insurance. No human being should have to decide on whether or not to seek medical care or to suffer in silence over the concern of unknown expectations, treatments, or just general care. I have spent these past years trying to not only deal with my health, but being constantly hounded to pay for treatment “not covered” with funds I do not have. The last thing a patient wants to hear when seeking treatment or waiting for test results is “You have a current balance of…” I understand that some costs will apply in some cases, but at the same time, how can a person who already has a limited income be expected to take care of their other needs on top of making countless doctor visits that will ultimately result in another financial obligation? It is a vicious, never-ending cycle. Most younger adults have financial obligations such as car and car insurance payments, credit card payments, cell phone payments etc. I am also having issues in locating housing and financially setting myself up to transition to a different location outside of an assisted facility situation because of the lack of my own “income” I am allowed to have. I find myself feeling stuck in an assisted living place for the remainder of my days. This has taken a mental and social toll on my overall well-being, in addition to living with my breast cancer diagnosis. I am currently in a position in which I have completed physical therapy expectations and am hoping to be discharged from the healthcare facility I am currently in. The biggest issue I have faced in trying to transfer to another assisted living facility is the denial from many facilities due to my age. There is a need for a healthcare program for those younger than 55. There is a desperate need for facilities that can and will accept and assist those who might not be ready to the normal standard of assisted living, but need the additional support with whatever severe illness they are facing. Another concern I have faced is challenges in attempting to regain full financial independence due to my entire disability income being already directed to a healthcare facility. An ongoing issue I am facing is the ability to leave the healthcare facility, as I am unable to financially do so. It is important to add that I am fully able to care for myself at this time, and have only received assistance with meals and medication distributions, which are things I can handle and control myself. I do not require assistance with bathing, dressing, or taking care of my room with cleaning and upkeep. The current facility does not provide transportation as often as I need it, which has resulted in me dealing directly with my patient navigator in setting up transportation for future appointments. While trying to depend on the help for the healthcare facility I am currently in, I have been asked to reschedule my chemotherapy appointments as there was a lack of communication between the chemotherapy office and the healthcare facility. In turn, I have had to mediate and correct the lack of communication to insure I would not miss any appointments going forward. Breast cancer, as well as other cancers impacting both men and women, can occur at any age, regardless of race. Being under the age of 55 does not mean those individuals cannot face any major health concerns such as cancer. How can the gap of coverage between Medicaid and Medicare meet to where the recipient can keep more of their monthly benefit that they have spent most of their life working for? How can more assistance be offered through grants regardless of race or gender? Where can those who are under the age of 55 find residency for support and care? I have found there are a lot of disparities in the care received between African American women and those of other races. I have researched grants specifically for African Americans in general and did not receive many results. The American Cancer Society states that breast cancer is the leading cause of cancer death in the U.S. for African American women. They are more likely than white women to have inadequate health insurance or access to health care facilities, which may affect screening, follow-up care, and completion of therapy. Compared to other racial/ethnic groups, Black women are more likely to be diagnosed with breast cancer at a young age (under 45) and at later stages of the disease, when it is more difficult to treat. Black women continue to die of breast cancer at an alarming rate of more than 40% as compared to white women. Unemployment rates are higher in the African American community compared with the White American community; this disparity persists during times of economic strength and is magnified in the setting of financial stresses. Socioeconomic disparities undoubtedly contribute to the 40% higher breast cancer mortality rates seen in African American women by causing delays in diagnosis and more advanced-stage distribution compared with White American women. Increased access to free or low-cost mammograms can help close the gap and ensure more Black women get timely breast cancer screening. I want to be very candid with my care, as had it not been for the care of my patient navigator, nurses and aides at St. Vincent Hospitals as well as Dr. Deng Zhang with the Hematology Oncology of Indiana over the years, this journey would have a completely different ending. While I have had many good experiences with these providers, I still feel there is a lack of empathy from some. We are seen as only patients and not as human beings. There is a need for a reminder to those who serve to be kind, we all have a battle that others know nothing about. I want to share positivity and a small token of hope. I have continued to survive with this illness due to their care and my faith in God. As I am today, at first glance, someone who does not know me personally, would have no idea what I have experienced and what I continue to face on a daily basis while still surviving this disease. I still remain as active as I can by spending time with family and friends. I also enjoy bowling as I have done so for over ten years. I would like to return to a sense of normalcy, in spite of my breast cancer. I would like to live outside of an assisted living facility as I am primarily a resident to participate in physical therapy. With the exception of receiving my medication, I am fully able to perform self-care needs. I have seen the success stories of those facing a health crisis and receiving so much support and an excellent level of care, but what type of resources are there for those who don’t know what is available? While I am happy to see the stories of those who are in remission, and those who have beat cancer altogether; where are the stories of those who still face their battles on a daily basis? What about those who don’t meet a certain demographic to even receive such support? Should it matter what stage of illness or what type of illness one is facing? I would like to be the voice for those who may face a similar situation in which they may be afraid to seek medical care or unable to due to other obligations. A person facing any serious medical condition should not have to face it alone. They should not be uninformed, nor turned away from care due to insurance paperwork. My experiences over the years since my diagnosis have been more stressful financially, physically and mentally than dealing with my terminal illness. I am certain there are individuals my age (or a range of ages 18-55) that have been or are going through a similar situation. There has to be a better solution for those who really need more support than what is provided so those with any sort of illness can focus on the importance of their care and have a better quality of life. This is not just about policies on paper; this is about human lives. Read More: Metastatic Breast Cancer: Understanding the Significance of Stage IV The Cost of Breast Cancer The Role of Hormones in Breast Cancer Understanding Breast Cancer in Young Adults Understanding the Different Stages of Breast Cancer MBC Programs: Expressive Writing for MBC Thursday Night Thrivers: MBC Support Group Video Library: MBC Webinar Series On the Podcast: Breast Cancer Conversations Insurance Denied My Cancer Treatment: What Every Cancer Patient Should Know About Medical Bills Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Podcast Weekly Meetup Free Events

By Jayant (JP) Parthasarathy Listen to JP on the SBC podcast, Breast Cancer Conversations: Revolutionizing Breast Cancer Detection with JP Parthasarathy, founder and CEO of Astrin Biosciences Updates from the SBC Team as of June 2026: In September 2024, the FDA updated mammography guidelines to include an overall assessment of breast density as part of a mammography report. In March 2025, the National Comprehensive Cancer Network updated its screening guidelines to recommend that patients with extremely dense breasts receive breast MRIs with and without contrast starting at age 50, but may start at age 40. “Do you have a family history of cancer?” is a standard question doctors ask all their new patients. It’s a crucial indicator of when, how often, and for which cancers a person should be screened. But there’s another question that both doctors and patients should consider when it comes to breast cancer: “Do you have dense tissue?” If you’re not sure what that means, or how you can find out if you have dense breasts, don’t worry. This article will tell you what you need to know about dense tissue and why this information is important for breast cancer detection. Breast density describes the type and amount of tissue someone has. While some women have almost all fatty tissue, others can have more or entirely fibrous tissue, making their breasts more dense. Breast density is not something that can be felt; it’s only determined during a woman’s first mammogram. While it’s incredibly common – over half of women over 40 have dense breasts – it can multiply someone’s chances of developing breast cancer by up to six times – more than family history. For those with fatty tissue, a typical mammogram will clearly reveal any existing tumors as white marks. For those with dense tissue, however, the fibers also appear white, obscuring doctors’ view of any tumors. In women with extremely dense breasts, the whole breast may appear white. Today, doctors use ultrasounds and MRIs as supplemental screening for people with dense breasts since they provide higher sensitivity and clarity than mammograms, but this is a band-aid on a bigger problem. Women with dense breasts need a more effective and sustainable screening option. How to Screen Dense Breast Tissue for Cancer Detecting and treating breast cancer as early as possible is one of the best ways to save lives. The American Cancer Society (ACS) reports that nearly 100 percent of women diagnosed with localized breast cancer survive five years past their diagnosis, compared to 32 percent for those diagnosed with distant spread. Screening is a powerful early detection tool, and the ACS recommends that most women start annual mammograms after they turn 40. Once they’re eligible, all women should get a mammogram – not only for early cancer detection, but also to learn whether they have dense breasts. From there, most women with dense breasts need supplemental screening. Unfortunately, this isn’t as seamless a solution as it should be. Most people with dense breasts are referred for a breast ultrasound, which can search through dense tissue to identify tumors using high-frequency sound waves. An ultrasound may find two to three more cancers per 1,000 women than mammograms, but can still miss several cases. Additionally, while ultrasounds are low-risk, painless, and usually covered by insurance, they lead to false positives more than 90 percent of the time. This can cause unnecessary distress for patients. A smaller portion of women may be referred for a breast MRI, which uses magnets and radio waves to create an image of the breast. These are even more sensitive than mammograms; however, they’re also more invasive, more expensive, more likely to yield false positives and less likely to be covered by insurance. Beyond the individual-level impact, our healthcare infrastructure and the shortage of radiologists isn’t prepared to schedule, perform, and pay for the 40 million women who would need them each year. How Blood Tests Can Improve Breast Cancer Outcomes While mammograms and ultrasounds remain the go-to standard of care for women with dense breasts, innovation in cancer screening is essential. Advances in cancer science and technology are creating new opportunities to catch breast cancer earlier than ever. Rather than waiting for a tumor to form to find it via imaging, highly sensitive blood tests can identify cancer at stage 0 by analyzing a small blood sample before any signs or symptoms are felt. While researchers have attempted to detect cancer through blood tests in the past, breast cancer has specifically been one of the most difficult to uncover. Unlike lung or colorectal cancers, experts estimate that detecting breast cancer in the blood would require technology 10 times more sensitive than what is currently available. Now, thanks to breakthroughs in machine learning, catching breast cancer through blood tests may now be made a reality through proteomics – the proteins that breast cancer cells use to communicate with one another. Proteins are the functional units of cells, meaning they reveal what cells are doing in real time. If cells are acting in a way that indicates cancer, proteins will be the first signals. Using artificial intelligence (AI), scientists have been able to sort through signals that are now 1,000 times more sensitive than previously possible to find the ones relevant to cancer, then inform the next best steps in a care plan. For women who have dense breasts, and even those who don’t, highly specific blood tests can be a revelation, increasing access to the early detection they need for better breast cancer outcomes. More accessible and less invasive than today’s screening options, highly sensitive blood tests could be the missing piece of the breast cancer detection puzzle. These innovative testing technologies are currently in development and will become more widely available to oncologists and patients over the next few years. In the meantime, it’s important to continue to advocate for better screening options for women with dense breasts. Understanding breast density and available screening options is a great place to start; then you can take those learnings to your next doctor’s appointment. Ask your doctor about your breast cancer screening options and eligibility. If you’re eligible for a mammogram, it’s time to schedule one. Whether or not you have dense breasts, talk to your doctor about blood test options that may work well for you. Note: This article offers general information and does not replace professional medical advice. Make sure to discuss your options with your healthcare provider. About the Author: Jayant (JP) Parthasarathy is the founder of Astrin Biosciences, a St. Paul, Minneapolis-based cancer intelligence company transforming detection and treatment via deep proteomics and AI. Motivated by his father’s cancer diagnosis and passion for research, he left his role as deputy chief science officer at UnitedHealth Group to launch Astrin in 2021. JP serves on the board at the Hennepin Healthcare Research Institute and holds a Ph.D. in Brain Machine Interfaces from the University of Minnesota. Read More: What Are Dense Breasts Addressing the Unique Challenges of Breast Cancer in People Under 40 Unleashing the Potential of AI in Breast Cancer Screening, Diagnosis, and Treatment Understanding Your Pathology Report: A Comprehensive Step-By-Step Guide On the Podcast: Breast Cancer Conversations Revolutionizing Breast Cancer Detection with JP Parthasarathy, founder and CEO of Astrin Biosciences Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetups Free Events

By Cara Lockwood After I was diagnosed with HER+ breast cancer in 2023, I knew the journey forward would change me — but I never imagined how much. My therapist told me I’d have a choice between becoming a victim or being a survivor. That road to survivor was hard, involved lots of crying in the shower and pleading with the universe, and also required learning some hard truths about myself. Like nearly every woman I know, I play a loop of negative thoughts that runs in my brain at any given time. I’m an award-winning USA Today bestseller of more than 35 romance novels published by Simon and Schuster, Harlequin, St. Martin’s Press, and Hachette over the last 25 years — and yet I suffer imposter syndrome all the time. Terrible, awful thoughts like: No one is going to read your new book. Sure, your first book was made into a movie, but did anyone even see it? No one wants your stories. You’re not good enough. This playlist ran alongside other ones, like: You aren’t pretty enough. You’re not skinny enough. You’re not sexy enough. You’re not… enough. I let these mean thoughts, fueled by insecurity, run unchecked through my head. They’re constantly in the background, like hold music on a customer service line. But when cancer hit, a new round of negativity began to play: Everyone says you’ve got this, but you 100% do not have this. You’re not strong enough for this. You’re not brave enough. You’re not going to make it. And on, and on, and… on. And I just let it play. Researchers say we can actually talk to ourselves at a speed equivalent to 4,000 words a minute in our heads, and I’ll be honest: Most of those words in my head were negative. Passive aggressive. Critical. Even under the barrage of criticism, I worked hard to get ready for my double mastectomy. I began eating right. Exercising more. I channeled my anxiety about the surgery into being more active. I went to a therapist. I did some hard mental and emotional work on her couch. I did all the hard things to prepare for the scariest thing I’ve ever done in my life. And… you know what? I came out of that surgery with flying colors. I had a complication-free recovery. I made it. And, in the days after that surgery, I gave myself a genuine compliment. I told myself: “You did a good job. You were brave. You did the hard work and it paid off.” I gave myself an honest pat on the back. No caveats, no snide side comments. No buts. No exceptions. Just a good job. Period. And I immediately began crying. Big ol’ shoulder-wracking sobs. Because I realized up until that point in my life, I don’t think I’d ever given myself a genuine compliment. Backhanded ones? Sure. Like, Congrats on making the USA Today bestseller list. It’s not the New York Times, but whatever. Or Oh? You gave birth. Twice? Good for you. Except you have no idea how to soothe this crying baby. You’re useless! There was always a snide side comment to every compliment I ever gave myself. Every. Single. Time. It was then that I realized how mean I’d been to myself my entire life. Cruel, even. Unfair. I’d never say these things in my head out loud to anyone ever. I’d never be that mean to a living soul. But I was regularly that horrible to myself. I’d been living in an emotionally abusive relationship with myself and never even knew it. I read that before a big mission, Navy SEALs train themselves to keep a constant stream of positive-self talk going because they know that when times get tough, the last enemy they want to be fighting on the battlefield is themselves. They put their lives on the line in dangerous missions all the time, where they’re tested mentally and physically, and they know how important positive thinking is. How dangerous negative self-talk can be. And this made me realize that up until my double mastectomy, I’d been fighting cancer all wrong. I’d been a house divided against itself. There’d been a civil war raging in my head about whether or not I’d actually beat cancer. I’d looked for any reason I could to blame myself for the cancer. I’d gained weight. I’d not eaten right. I liked wine too much. I was a little late getting that mammogram. I never gave up Red Dye 40 because I can’t quit Twizzlers or Doritos. The treatments the doctors prescribed probably wouldn’t work on me, I told myself. The odds wouldn’t be in my favor, even when doctors said they would be. I challenged everything because I thought this was how I could motivate myself. That if I criticized myself I’d work harder. Be better. But I wasn’t motivating myself at all. I was beating myself down faster than the cancer could. So I decided to challenge that negative playlist in my head anytime it started to play. No longer would I Iet it auto repeat. I decided, genuinely, to show myself the kindness I so often showed others in my life. And I think this helped me kick cancer. I went into remission in 2024. And positive self-talk is still paying dividends in my life as a survivor, too. Studies show that you can reap all kinds of benefits from positive self-talk. Positivity may lead to longer life spans, less stress, and even better cardiovascular health. I give myself genuine compliments all the time now, and it feels amazing. I don’t kick myself when I’m down. I allow myself some grace when I’m a messy human who makes mistakes. I believe it’s made all the difference, both in my fight to end cancer and in the life I live afterward. Because being a survivor doesn’t just mean to live. It means to thrive. And that’s what I plan to do from here on out. Read More: Scheduling Worry Time: A Technique to Control Your Anxious Mind Grit and Grace How Cancer Trauma Can Impact Your Life and Ways to Move Forward On the Podcast: Breast Cancer Conversations How Breast Cancer Changes the Way You See Yourself Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Podcast Weekly Meetup Free Events

New research on Ozempic, Wegovy, and other GLP-1 medications is raising questions about breast cancer risk, treatment outcomes, and survivorship. Here’s what patients need to know. SurvivingBreastCancer.org | By Laura Carfang GLP-1 medications like Ozempic, Wegovy, Mounjaro, and Zepbound are best known for helping people lose weight and improve blood sugar control. Now, researchers are asking a bigger question: could these medications also influence breast cancer risk, treatment tolerance, or long-term outcomes? Early studies presented at ASCO in 2026 and research at the San Antonio Breast Cancer Symposium in 2025 suggest the answer may be promising, but the science is still developing. For people living with breast cancer or navigating survivorship, this is an important topic. Weight, metabolism, hormone therapy, and inflammation can all affect health after a breast cancer diagnosis, which is why GLP-1 medications are drawing so much attention. What are GLP-1 medications? GLP-1 receptor agonists are prescription medicines originally developed to treat type 2 diabetes, and several are now also approved for weight management. They mimic a natural gut hormone called GLP-1, which is released after eating and helps coordinate metabolism in several ways: they slow how quickly food leaves the stomach, increase feelings of fullness in the brain, reduce appetite, and help the pancreas release insulin when blood sugar rises while also lowering glucagon, a hormone that tells the liver to release stored sugar. Together, these effects help improve blood sugar control and reduce calorie intake, which can lead to weight loss over time. Common GLP-1 medications include semaglutide, tirzepatide, and liraglutide, sold under brand names such as Ozempic, Wegovy, Mounjaro, Zepbound, Victoza, and Saxenda. Why breast cancer researchers are paying attention Weight and metabolic health matter in breast cancer because excess body fat is linked to higher risk of developing breast cancer after menopause, and it may also affect recurrence, treatment tolerance, and long-term outcomes. That is one reason researchers are watching GLP-1 drugs so closely: if they help people lose weight safely and sustain that loss, they may improve more than just body mass. Scientists are also looking beyond weight loss. GLP-1 medications may influence inflammation, insulin signaling, and other biologic pathways that could matter for cancer development and progression. Because obesity can drive chronic inflammation, raise insulin levels, and alter the metabolic environment around tumors, researchers are now asking whether GLP-1 drugs may help change those conditions in ways that could affect cancer risk or outcomes, not just body weight. GLP-1s and hormone receptors Hormone receptor status is central to breast cancer care because many breast cancers are driven by estrogen or progesterone signals. That is why endocrine therapies such as tamoxifen and aromatase inhibitors are so important for hormone receptor-positive disease. The current research does not show that GLP-1 drugs directly target estrogen receptors, progesterone receptors, or HER2. Instead, the interest is mostly indirect: GLP-1s may help with weight, insulin resistance, and inflammation, which can shape the metabolic environment in which hormone receptor-positive breast cancers develop or recur. In other words, GLP-1 medications are not being studied as hormone therapy; they are being studied as metabolic medications that may affect outcomes in hormone-sensitive disease. This is especially relevant for people with hormone receptor-positive breast cancer who are taking endocrine therapy. BreastCancer.org highlighted research suggesting GLP-1 use may help some patients on hormonal therapy lose weight, even though that weight loss may be slower or less dramatic than in the general population. At the same time, the available studies are still early, so GLP-1s should not be viewed as a breast cancer treatment outside a clinical trial. What the newest studies suggest At the 2026 ASCO Annual Meeting, Penn researchers reported that women ages 45 to 80 who used GLP-1 medications were about 30% less likely to develop breast cancer than women who did not use them. That result is encouraging, but it was observational, so it shows an association rather than proof of prevention. Other ASCO-presented research found that people with stage I, II, or III lung, breast, colorectal, or liver cancer who took a GLP-1 drug were less likely to progress to stage IV disease than those who did not take one. It is important to note that some cancer treatments, including certain chemotherapy drugs and targeted therapies, may not be a good match with GLP-1 medications. Because these drugs can affect how treatment is tolerated and how well it works, your care team will weigh the potential risks and benefits before deciding whether to pause or continue a GLP-1 during cancer treatment. What we know about weight loss One of the most familiar effects of GLP-1 medications is weight loss, and that may matter for some people with breast cancer. For patients who are gaining weight during treatment, or who are struggling with weight after treatment, these medications may offer another option to support overall health and wellbeing. Researchers are still studying how this may affect breast cancer outcomes, but for many patients, the most immediate benefits may be feeling more in control of weight, energy, and day-to-day health during and after treatment. What this does not mean These findings do not mean that GLP-1 drugs should be used outside of a clinical trial to treat or prevent breast cancer. The current evidence is mostly observational, and people with prior cancer were often excluded from the large trials that led to GLP-1 approvals. It also does not mean that GLP-1 medications are right for everyone with breast cancer. The best choice depends on cancer subtype, current treatment, medical history, weight goals, diabetes status, side effects, and insurance coverage. Questions to ask your care team If you are considering a GLP-1 medication, these questions can help guide a conversation with your care team: Is a GLP-1 medication appropriate for my situation? Could it help me if I am struggling with weight gain during or after treatment? Are there any concerns with my cancer subtype or current therapy? What side effects should I watch for? How will we know whether the benefits outweigh the risks for me? Why this story matters now Even though evidence is still early and more research is needed, GLP-1 medications are now part of a broader conversation about cancer prevention, survivorship, treatment tolerance, and long-term health after breast cancer. For those navigating a breast cancer diagnosis, there is hope but also caution—especially until larger studies can confirm which patients may benefit most and when these medications are safest to use. Note: This article offers general information and does not replace professional medical advice. Make sure to discuss your options with your healthcare provider. Read More: SABCS 2025: What the Science Is Saying Breast Cancer Risk Factors Exercise and Breast Cancer Recovery On the Podcast: Breast Cancer Conversations The Prehab Plan Surgeons Wish You’d Start

By Jill Rackham “You have oestrogen-positive breast cancer,” the sympathetically eyed consultant said. “Your three tumours have been fuelled by oestrogen so we need to do all we can to stop any spread.” I was aged forty-three so needed a monthly injection to send my ovaries to sleep. It was a huge needle and painful but this was the plan I had to keep. Then came medication to reduce the oestrogen in my body even more. This was all new to me, I was in a clinical menopause, something I hadn’t ever considered before. In time my ovaries were removed, so the monthly injection was not needed. Now I was in a surgical menopause, in abolishing you oestrogen - I’ve succeeded! But throughout all this my body was suffering so much more. The cancer had been taken but now it was time for menopausal symptoms galore. Hot flushes, joint pain, brain fog, dry skin to name but a few. Followed by itchy skin, hair thinning, fatigue, brittle nails and a feeling of not knowing what to do. For me the menopause happened all of a sudden instead of taking several years. It took time to get used to and accept my new normal, it did make me shed a few tears. Cancer treatments leading to an early menopause I never knew that would be. But here I am living and owning it and all that it entails for me. So well done ladies if a cancer diagnosis brought a medically induced menopause to your door. You are doing amazing - let’s all support each other to lessen the intensity a little more. Share your poetry: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetups Free Events

Control your mind with the worry time technique. Schedule worry time daily: a therapeutic approach to reducing the time you spend worrying. SurvivingBreastCancer.org | By Lisa Kalner Williams As a breast cancer survivor, I rarely go a day without a worry or two. Or fifty. Or more. Here’s the tiniest slice of my worries this week as a node-positive survivor seven months out of active treatment: How will I survive this summer heat while layered in lymphedema compression garments? If I start Kisqali, will it give me lifelong side effects? Should I have had my treatment and care team at one of the big cancer centers in Boston? What’s that spot on my back? I’ve learned that when worry follows me around all day, it drains my already low energy (thanks, cancer treatments!) and takes my focus away from getting better and living my best life. If your mind is flooded with worries, consider scheduling worry time to keep these thoughts under control so you can enjoy the most out of survivorship. What is worry time? Worry time is a technique where you schedule a specific time to express your worries. Outside that window, you postpone anxious thoughts to their designated time. Worry time, also called worry postponement, has roots in cognitive behavioral therapy (CBT). Instead of letting constant worries disrupt your day, CBT therapists suggest briefly acknowledging your thoughts. Then you write down your thoughts and choose to address them during your scheduled worry time. This trains your brain to regain control of your focus. Worry time is also similar to the “passengers on the bus” idea of acceptance and commitment therapy (ACT). In this model, the passengers on the bus represent your worries, and you’re the bus driver who controls the passengers’ actions. In ACT, you’re encouraged to tell your passengers to sit down because it’s not worry time – or, in bus speak, it’s not their stop yet. With this model, you’re not ignoring your worries, but you’re also not letting them steal your attention. If you’re into Keanu Reeves movies, imagine you’re him behind the wheel in Speed, keeping Dennis Hopper in check. How to build worry time in your busy schedule At first, you might think, “Another thing to put in my schedule?” You had a life before cancer. That was busy enough. Now, you’re adding blood draws, doctor visits, physical therapy appointments, and pharmacy runs to your day-to-day. But by sticking with a consistent worry time, you’ll be in a better mindset to handle all the extra things that have been thrown your way since your diagnosis. Here’s how to get started. Create a consistent block of time in your schedule. Start with a daily cadence of about 15 minutes. If any worries come to mind before your next worry time block, write those thoughts down in a physical notebook or a note-taking app. When it’s worry time, review the thoughts you’ve jotted down. For each thought, ask yourself, “Do I still have this worry?” If not, great! Cross it off your list. For any thought that remains, decide which of the following two buckets it belongs to. Is it: Something out of your control? Something you can solve? If the worry is out of your control, accept that fact and cross it off the list. If the worry is something you can solve, make an action plan to address it. At the end of the fifteen minutes, conclude with something grounding – stretches, deep breathing, or perhaps a meditation. If you still have worries that you weren’t able to address during this session, add them to the following worry time’s agenda. After all, you have other things to do, and you don’t want worries to take over your days. (That’s why you’ve set up worry time in the first place, right?) Ready to schedule your worries? Want to practice worry time with other people in the breast cancer community? Join SurvivingBreastCancer.org for an online Worry Time session on Tuesday, June 16 at 5:30 pm EDT! Read More: The Psychological Impact of Breast Cancer: Strategies for Coping What Is Lymphedema? Causes, Stages, and How to Live Comfortably Why a Second Opinion Matters for Breast Cancer Managing Fatigue During Breast Cancer Treatment SurvivingBreastCancer.org meditation library On the Podcast: Breast Cancer Conversations Breast Cancer Stopped My Life— Music and Meditation Helped Me Breathe Again Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetups Free Events

By Latanya Bispham-Robinson Yep, I called you a Survivor. Your treatment may not be over… In fact, you may be at the beginning of your journey… I still call you a Survivor. You’ve made progress. From the date of your diagnosis up to this very moment, you have made progress. You should be proud, you are fighting in your own unique way, you are a Survivor, a Warrior, a Champion. Oftentimes it’s hard to think of a victorious end when we feel like we haven't even started yet. But what if we did? What if we began planning the victory celebration at the start of the fight? I can imagine you must be thinking, “What is she talking about?!” Celebrating is probably not on your mind at present. And believe me, I totally get it! Nonetheless… What if instead of only focusing on the treatment, we envisage our victorious completion? What if we planned how we are going to celebrate completing surgery before we have the surgery? What if we planned how we are going to celebrate completing chemo before we start chemo? What if we planned how we are going to celebrate completing radiation before we start radiation? The mental part of the battle of cancer treatment can be intense, to put it mildly. From the onset of my diagnosis through surgery and chemo and even now, I often wonder: “When will this be OVER?!” When I completed chemo, oh my goodness… happy is an understatement. I felt so proud of myself, on a natural high. You did that, GIRL!!! I celebrated by taking myself on a mini shopping spree. It was the day after chemo and I was in the mall?! I couldn’t believe my energy level; it was on HIGH and I decided to go right along with it. I had a BALL! When I got tired, I would sit for a few minutes all the while smiling from ear to ear under my mask. It felt like I was having my own private party. I decided not to ring the bell until I completed both chemo and radiation. I knew I was going to celebrate, but I wondered how. I wondered if I would even have the energy to do anything this time. My oncology social worker, Samantha, told me about an organization called For 3 Sisters and their pink fire truck. For 3 Sisters was started in 2011 by retired Montgomery County, Maryland career firefighter Marshall Moneymaker and his wife Shannon after he lost three older sisters, Vicky, Penny and Valessa, to breast cancer. Samantha explained that Marshall and Shannon would come to the hospital with their big pink firetruck and drive me all the way home. I began to feel joyful in my heart…WOW, a pink firetruck will come pick ME up! I wanted that experience to be a part of my celebration! I knew I wanted that memory to be mine forever. Beauty for Ashes. I decided I would find a nice pink dress to mark the occasion! Here are some additional celebratory ideas you can consider: Have an intimate celebratory gathering with close family and/or close friend(s). When it is safe to do so, treat yourself to a celebratory spa day, manicure and/or pedicure. Choose a new color, not your norm, o mark the celebratory occasion. Take a weekend getaway in nature to celebrate; some place easy to get to and a short distance away. Take a gentle celebratory hike with a supportive friend and/or family member; bring a beverage to toast this special occasion. Have a picnic with fruit and beverages for toasting. When you’re up to it, have a meal at your favorite restaurant. Chew slowly and savor each bite. Don’t forget to toast this special occasion. I hope these ideas will help spark your imagination to create the most special celebration perfect for you. Do something that makes you happy. Please celebrate yourself. Please also remember to be kind to yourself, be patient with yourself and most of all love yourself through each part of your journey. I’m cheering for you and sending hugs!! Read More: Navigating Cancer and Treatments with Honesty and Humor Questions to Ask Your Doctor After a Breast Cancer Diagnosis After Your Breast Cancer Diagnosis: Planning Your Next Steps More Breast Cancer Stories from Our Community On the Podcast: Breast Cancer Conversations From Chemo to Curtain Calls, Radiation to Regattas: This Is Survivorship Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Podcast Weekly Meetup Free Events

If you’ve had cancer treatment and find yourself searching for words, losing your train of thought, or feeling less sharp, you’re not alone, and you’re not imagining it. For many, cancer treatment can cause mental fog. That experience, often called “chemo brain,” is a common and recognized effect of cancer care. Understanding what’s happening is the first step toward regaining clarity and confidence. What Is Chemo Brain? “Chemo brain” is a common term for cognitive changes that can occur during or after cancer treatment. Clinically known as cancer-related cognitive impairment (CRCI), it affects how people think, remember, and focus — often showing up as forgetfulness, word-finding trouble, or mental fog. Many notice they’re not as sharp as they used to be. Cancer and its treatments — along with inflammation, stress, and emotional strain — drive these changes, not chemotherapy alone. For some people, these effects can disrupt daily life, work, and relationships. How Common Is Chemo Brain? The statistics confirm that you’re not alone if you’re dealing with chemo brain. Breast cancer survivors have been the most studied group, and for good reason; breast cancer represents 22% of all cancer survivors in the United States. Studies show that breast cancer survivors may report cognitive difficulties for 5 to 10 years following treatment with chemotherapy and/or radiation therapy. Research published in Cancer Medicine in 2025 found that up to 75% of cancer patients experience cognitive impairment during treatment, with approximately 35% reporting persistent symptoms months or even years after treatment ends. A 2024 review published in Frontiers in Oncology confirmed a similarly wide range, reporting CRCI incidence after chemotherapy ranging from 17% to over 70%, depending on cancer type, drugs used, and the method of cognitive function assessment. Common Symptoms of Chemo Brain Chemo brain doesn’t look the same in everyone. Symptoms range from subtle to significant, and they can shift over time. For many people, these symptoms don’t announce themselves dramatically; they creep in gradually, making them easy to dismiss or attribute to stress or aging. The most commonly reported experiences include: Memory lapses: Forgetting names, appointments, or recent conversations Difficulty concentrating: Losing focus quickly, needing to re-read the same paragraph multiple times Trouble finding words: Knowing what you mean but not being able to retrieve the right word Slowed processing speed: Feeling as though your brain takes longer to respond or compute Mental fatigue: Ordinary cognitive tasks require far more effort than they used to Difficulty multitasking: Struggling to juggle several things at once Confusion or disorientation: Experiencing brief episodes of mental cloudiness What Causes Chemo Brain? Scientists haven’t identified a single cause of chemo brain. Most evidence points to a mix of biological and treatment-related factors: Brain inflammation: Chemotherapy can trigger inflammatory responses, oxidative stress, and changes in brain cells that affect memory and focus. Blood-brain barrier changes: Some drugs may compromise this protective barrier, allowing harmful substances to enter the brain. Reduced neurogenesis: Treatment may slow the brain’s ability to create new neurons, impacting learning and memory. Structural brain changes: Imaging studies show shifts in gray matter, connectivity, and brain activity in some survivors. Not just chemotherapy: Cognitive changes can begin before treatment. Cancer itself, along with radiation, hormone therapy, and immunotherapy, can contribute. Other contributing factors: Fatigue, sleep disruption, anxiety, depression, anemia, hormonal changes, and genetics can all make chemo brain symptoms worse. How Long Does Chemo Brain Last? For some people, chemo brain symptoms can resolve within months of finishing treatment. Still, the American Cancer Society notes that some people experience long-term or delayed cognitive changes that can persist well beyond treatment’s end. Can Acupuncture Help With Chemo Brain? Strategies such as cognitive exercises, sleep, and physical activity can help manage chemo brain, but no single solution has stood out. New research suggests acupuncture may offer meaningful benefits. A trial led by researchers at Memorial Sloan Kettering Cancer Center and presented at the 2025 San Antonio Breast Cancer Symposium studied 260 breast cancer survivors with cognitive symptoms. Participants received either real acupuncture, sham acupuncture (not using actual therapeutic techniques), or standard care (without acupuncture) over 10 weeks. Key findings: Both acupuncture groups reported perceived cognitive improvement Only real acupuncture improved objective cognitive performance (memory and learning) Participants sustained benefits for months after treatment Researchers believe acupuncture may stimulate brain regions involved in memory and attention. Earlier studies from MSK show similar promise across different cancer types, and ongoing trials are exploring its effects in older adults. Bottom line: Acupuncture isn’t a cure for chemo brain, but it may be a helpful, low-risk option for improving both how patients feel and how they think. Tips for Managing Chemo Brain Stay organized: Keep a planner for appointments and tasks Exercise your brain: Try puzzles, reading, or memory games Prioritize sleep: A consistent bedtime routine supports recovery Stick to routines: Keep essentials in the same place to reduce mental strain Count on Us for Information, Resources, and Support Chemo brain is real, common, and often more complex than many people expect. Managing chemo brain takes patience. While symptoms can feel frustrating or even unsettling, understanding what’s happening and knowing you’re not alone can make a meaningful difference. If chemo brain symptoms affect your daily life, talk with your care team about supportive options such as acupuncture. Whether you’re newly diagnosed with breast cancer, navigating survivorship, or supporting someone you love, SurvivingBreastCancer.org offers virtual support groups and programs, as well as trusted educational resources on symptoms, testing, treatment options, surgery, and more, plus podcasts featuring professionals, advocates, and caregivers. Your support helps SurvivingBreastCancer.org continue providing knowledge, connection, and community to those impacted by breast cancer, every day, all year long. Note: This article offers general information and does not replace professional medical advice. Make sure to discuss your options with your healthcare provider. Read More: 7 Ways to Prioritize Your Health After Breast Cancer Treatment A Disabled Clinical Psychologist’s 6 Tips for Living Well with Breast Cancer Chemo Brain Fog 11 Tips to Manage Chemotherapy Side Effects On the Podcast: Breast Cancer Conversations Two Years on Verzenio: Side Effects, Brain Fog, and Why I'm Glad I Did It Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetups Free Events

On the suspicious mammogram that led to my diagnosis By Ashley Muspratt Diagnosed with breast cancer at 46 I resented you when you told me It was over the phone A doctor’s work is in person but mine was out sick So you were a voice on speaker phone A land line, actually, one with a long coiled black cord – a relic of bygone technology in this state-of-the-art institution Without pretext, or context, or fanfare, you announced, from a hospital 100 miles away, that there was an “asymmetry” in my mammogram To be fair, this wasn’t a complete surprise You’d directed a return trip to the mammogram machine and two trips to the ultrasound table over the course of this visit But isn’t it funny, the human audacity to hold out hope? Hope is fragile and fleeting though, and you’d barely gotten the words out before my eyes welled over and I’d already concluded that I had cancer Rendered speechless by tears I went silent And so did you During that pregnant pause, I pictured you thumbing your own desk phone’s cord, unsure what to say And I resented you The nurse, signaling her assistant to pass me a tissue, moved the conversation to next steps The two of you discussed the biopsy equipment available at our community hospital I stared at the mauve vinyl covering on my yellow oak chair, resenting the designer who chose to doll up this ugly institutional furniture with faux soothing colors I heard you briefly debate the merits of an MRI, but that would “light up” given the density of my breasts So it was settled: a stereotactic biopsy for me I could read all about it in the tri-fold pamphlet slipped into my hand “Do you have any questions?” came your voice through the speaker, inviting me back into the conversation I managed a stifled, “What does this mean?” “We have a low threshold for biopsies,” was all the comfort you offered And I resented you Too distraught to speak, I quietly dissected your passive prose I waited for, I yearned for, you to tell me that everything would likely be fine For you to tell me that I was at the low threshold and that you almost decided to forgo this step But you didn’t And I resented you more And now I’m on the other side of a double mastectomy and I have nothing but gratitude for you You, who got me diagnosed You, the only doctor who hasn’t gambled with reality to put a temporary stop to my tears Who didn’t tell me not to fear the worst Who didn’t tell me that most biopsies come back negative, and that surely my lymph nodes would be clear, and that this would all be a blip I resent you no more Share your poetry: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetups Free Events

By Jen Fernandez Listen to Jen on the SBC podcast, Breast Cancer Conversations: The Truth About Cold Capping During Chemo I was getting out of the shower one day in January 2023 when I noticed what looked like a shadow on my left breast. When I looked a little closer, it was a dimple. When I pressed, I felt a lump. I tried not to panic. I told myself that it may be scar tissue, but deep down I think I knew my cancer was back. Just a few weeks earlier, in December 2022, a breast exam at my gynecologist’s office was clear! I was originally diagnosed in January 2020 with stage 2a HER2 positive, hormone negative breast cancer in the left breast. I had chemo (weekly Taxol) and lost my hair, all while Covid took over and shut the country down. I had a lumpectomy the week that “elective” surgeries were allowed to resume, followed by radiation. I completed Herceptin and Perjeta in February 2021. Like most breast cancer survivors, it was hard not to live in fear of recurrence, but as more time passed, that fear lessened. After noticing these breast changes in January 2023, I found out my cancer was back. It was the same pathology as before. Luckily, after a bone scan/CT scan, it was determined to be a local recurrence (stage 2a) that was caught early. Because I had a recurrence, I was given a more aggressive chemotherapy regimen. My oncologist asked if I was interested in cold capping to preserve my hair. Dana Farber now had the Paxman cold capping system, which was not available there in 2020. Since I had already lost my hair the first time, and it was emotionally very difficult for me, I decided that I wanted to give it a try. I made an appointment with a nurse at Dana Farber to be fitted for my Paxman cap. The nurse gave me the Paxman website to view videos and useful tips. I had to call and pay for the cap plus the cost of treatment for my 6 chemotherapy cycles of TCHP (Taxotere, Carboplatin, Herceptin, Perjeta) every 3 weeks. It was expensive (I can’t remember the exact cost, but it was over $1,500) and unfortunately it wasn’t covered by my insurance. I decided to watch all of the videos including how to put the cap on at my appointment, and how to brush and care for my hair while going through chemo. I joined the Paxman Facebook community group to read about others’ experiences. I received my Paxman kit within a couple of days, which included shampoo, conditioner, and a small brush. The blue cap that is applied directly to the scalp has a long hose that attaches to the Paxman machine. The second cap goes over this piece and is tightened to keep the blue cap close to the scalp. I practiced at home a few times and decided I was ready. The night before my first chemo, I took a long hot shower and washed my hair. I knew it would be a while before I was able to really scrub my scalp with hot water. At the first chemo appointment, I brought the entire Paxman kit with me. I put a decent amount of conditioner on my hair and scalp, which helps prevent hair from sticking (freezing) to the blue cap. On Facebook, others recommended putting a pantyliner or gauze pads at the hairline to prevent the forehead from getting cold, so I stuck a pantyliner to my forehead. The nurses then helped make sure the cap was nice and tight. I was given a dose of Ativan and 15 minutes later we were good to go. I was definitely not at all prepared when the machine was first turned on. Honestly, it was so brutally cold that it was almost painful. After about 15 minutes, it was almost like my scalp got used to the cold and became a little numb. Either way, the intense cold/pain wasn’t as bad. I was given warm blankets that I would wrap around my shoulders. The nurses would come by often and replace the blankets to keep me warm. I had to wear the cap for 4 hours (starting 60 minutes before chemo and continuing until 90 minutes after chemo was finished). I remember taking the cap off and having a headache, likely because the outer cap was on so tight. It was a long 4 hours! Getting home, I made sure to follow the Paxman recommendations. My routine was washing my hair the day after chemo and then once a week. This was best since I put conditioner in my hair when the cap was applied and my hair always felt greasy after. I used the Paxman shampoo and conditioner with cool/cold water. When washing, I used my fingertips to gently rub the shampoo onto my hair. I left my hair under the running water just enough to rinse. When brushing, I would hold the hair by the root and brush down very gently using the Paxman supplied hairbrush, to prevent pulling. I bought silk scrunchies from Amazon and would put my hair in a low, loose braid to prevent tangles and keep my hair off my face. While receiving treatment, I knew that I would shed more hair than usual, even using the cold cap. My hair started to shed a decent amount after my second cycle of chemo. I could definitely tell there was more hair on the brush, which was a little discouraging. But my hair looked great, and people couldn’t see any difference. I can’t lie, I dreaded every chemo appointment, and using the cold cap. But I also knew that each appointment was getting me closer to the finish line. Every time, I thought I only needed to do this a few more times. I dreamt of the day when I could wash my hair with hot water and put my hair in a real ponytail! My last chemo finally came. I did it! It was such a great feeling to be done with the hard part. I had read that the shedding of the hair would continue for a while after stopping chemo. I needed to continue to “baby” my hair until shedding returned to the normal amount. I had no eyebrows or hair anywhere except the top of my head, so I knew that the cold capping had worked! Overall, I kept around 80% of my hair. I only had one small bald spot on the very top of my head by my part. My hair continued to shed for around 4 months after my last chemo, which seemed like it took forever. I gradually was able to wash my hair more frequently and increase the temperature of the water. When I went to my hairdresser for my first haircut about 8 months after stopping chemo, she was amazed at how healthy my hair looked. I hadn’t done anything harsh to my hair, including using a hairdryer, since the start of chemo. I am very grateful that I had the option to use a cold cap. I didn’t look like a typical cancer patient, which was important to me for many reasons, including my children. I am confident that I was successful because I followed all the recommendations listed by Paxman. It was a commitment, but necessary to be successful. I would do it again in a heartbeat! Wishing all of you luck in your breast cancer journey! Read More: Cold Capping for Breast Cancer Treatment: Benefits, Risks, and Results My Three-Time Survivor Story The Role of Hormones in Breast Cancer On the Podcast: Breast Cancer Conversations The Truth About Cold Capping During Chemo Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Podcast Weekly Meetup Free Events

By Sara Kandler Manhattan 2003 another specialist heavy hitter on Park Ave dim lights low hum warm ooze semi-circles over her stomach almost soothing Not seeing much he declares then a hmph we are pretty backed up though a higher voice pipes up yes siree and they share a two-toned chuckle champagne glasses clinking by a crackling fire mom’s eyes fixed hard on the monitor white ghosts like swelling balloons as their chatter sinks in shame washes over her naked body butt of their joke No need to fret he assures (is that even a word) bleeding is quite common she knows a blood filled toilet bowl is not common tries to explain this dismissed he turns up the lights pats her shoulder gentle whack of a rolled newspaper obscuring the bad news Providence 2025 the man in a worn tee pushing a wide rag mop down long hallways across classrooms catching gum wrappers under lab tables a used vape by a toilet and that crumpled paper tossed behind a door dark arrows aimed at a stick figure he’d noticed a guy lurking peering through doorways washing his hands slowly in the bathroom stuck out like a sore thumb in his light pants a week before Christmas thin fabric billowing like a balloon out in the frigid wind pacing the streets nearby elegant victorians quartered for students the janitor decides to tell the uniformed guards at their large desk in the lobby see there’s this guy something’s up with him I’m sure of it they smile jab his shoulder and say don’t worry yourself Joe you just do your job and we’ll do ours (as if he could do ours) and he lumbers off head bent dismissed the guards head out for coffee puzzled by the loud sirens and flashing lights speeding their way Interstate 87 Honey just try to stay within about 5 miles of the speed limit okay I’m just gonna close my eyes for ten minutes or so I’m so sleepy but sweetie seriously I’d appreciate it if you could pleas Share your poetry: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetups Free Events

By Shannon Malburg Today Margie walked in the door, Saw me and said: “You’re still alive!” (We hadn’t seen each other in over a year) She came toward me, all embodied surprise and joy The biggest smile (Everyone should be smiled at like that) Held my shoulders out from her in a pre-hug And beamed at me “I’m so glad” she said “Good job” (The words were a hug As much as her arms were) But it wasn’t until later How this hit me I felt proud of myself Of my being-aliveness In a way I hadn’t Maybe Ever? But certainly not since cancer When every intuition-steeped choice Still yielded mixed results Less than hoped outcomes It’s back It’s spread Inching closer and closer to un-aliveness Disappointment Disillusionment Failure Failure Failure Despair But Yes! Here I am Still alive Good job intuition Good job body Good job invisible forces What a grace to feel proud of us Even if it’s fleeting A respite from the judgement And shame Of not healing right Share your poetry: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetups Free Events

Cancer brings with it a particular kind of loneliness that is difficult to describe to anyone who hasn’t felt it, and difficult to forget for anyone who has. SurvivingBreastCancer.org  |  By William Laferriere I just read this heart-wrenching meme on social media and it spoke to me as an epiphany (I apologize for failing to capture the meme’s author name before it disappeared). There is a variety store somewhere — the kind with fluorescent lights that never quite commit to brightness, where the refrigeration units hum a low, tuneless note all night, and the hours between 2am and 5am move like water through sand. A clerk works the late shift there. She has, most nights, almost no one to talk to. One night, a customer came in at an hour when almost no one does. They bought something small — it doesn’t matter what. And before leaving, they asked the clerk if she would write something on the receipt. Not a coupon code, not a return policy reminder. Something human. Anything at all. She did. Maybe it was a few words about the night sky. Maybe it was something she'd been thinking about and hadn’t had anyone to say it to. The receipt was thermal paper, the kind that fades, the kind nobody keeps. She handed it over and the customer left. Then another customer came in. Word had spread, the way quiet things sometimes do — not virally, not loudly, but person to person, in the particular telegraph of people who are awake when the rest of the world is not. They asked for the same thing. She wrote again. And then another person came, and another. The late-night store became, without anyone planning it, a gathering place for the people who live in the margins of the social day — the ones who work odd hours, who can’t sleep, who have nowhere else to be, who simply needed someone to acknowledge that they existed. One handwritten note on thermal paper, and somehow a community had formed around it. Most of us know that feeling — of needing someone to just notice we’re here. The loneliness that doesn’t have a name. Cancer brings with it a particular kind of loneliness that is difficult to describe to anyone who hasn’t felt it, and difficult to forget for anyone who has. It is not the ordinary loneliness of a quiet weekend or an empty apartment. It is something more layered and more specific. There is the loneliness of sitting in an infusion chair surrounded by other patients, all of you tethered to your poles and your drip bags, each person sealed inside their own private reckoning — and not being able to say a word to any of them, because what is there to say, and where would you even begin. There is the loneliness of coming home the night of your diagnosis and watching the people who love you most suddenly go quiet, searching for something helpful to say and finding nothing, their silence not unkind but vast, a new distance that opened without warning. They love you and cannot reach you. There is the loneliness of being finished with treatment while still feeling broken in ways that don’t show. The world, which has been watching and worrying, begins to exhale and drift back to ordinary life. People say you must be so relieved. And you are, partly — but you are also frightened in a way that doesn’t diminish when the IV comes out, and grateful that the hard part is over while also grieving that it happened at all, and unsure who you are now on the other side of it. The world expects celebration. You are standing in your kitchen at noon, still in yesterday’s clothes, not sure how to explain any of this. And then there is the 3am loneliness — the one that belongs entirely to darkness. The fear that arrives when the house is quiet and there is no distraction left and the mind turns, as it always does at that hour, toward the hardest questions. That loneliness has no audience. You don’t want to wake anyone. You’re not even sure what you would say. So you just sit with it, alone, in the way that so many people with cancer have sat with it — this particular 3am silence that has no good answer, only the long wait for morning. There is also, and this one is perhaps the loneliest of all, the loneliness of feeling like a burden. Of watching the people who love you rearrange their lives and wear their worry quietly and not wanting to add one more phone call, one more request, one more difficult conversation to the weight they’re already carrying. So you say you’re fine. You say you’re managing. You carry as much as you can alone, and the aloneness compounds. What the research knows, and what it costs It turns out that loneliness is not merely painful — it is physiologically costly. Social isolation is associated with increased inflammation, suppressed immune function, and worse outcomes across a range of serious illnesses, including cancer. Patients who lack strong social support are significantly more likely to experience depression and anxiety during treatment. And in survivorship, perceived social connection is one of the most powerful predictors of quality of life — not the number of friends, not the frequency of social events, but the felt sense that someone, somewhere, knows what you’re going through and is present with you in it. This is not a minor footnote. It means that connection is not a comfort measure. It is a health measure. The loneliness that cancer patients carry is not weakness or self-pity. It is a real and serious condition, with real and serious effects — and it deserves to be taken as seriously as the physical protocols of treatment. What the clerk understood The store clerk didn’t design a program. She didn’t convene a task force or launch a campaign. She just looked at another person who needed to be seen, and she wrote something true on a piece of thermal paper. That was all. And it was enough to change the quality of someone’s night — and then another person’s night, and then another. What SurvivingBreastCancer.org does is not so different, at its core. The support groups, the community programs, the spaces where people with breast cancer can find each other — they exist because someone understood that patients deserved a place where another person would write something human on the receipt. Not a pamphlet. Not a list of resources. A real acknowledgment, from one person to another, that says: this is hard, you are not invisible, and you do not have to carry this part alone. The formats are different from a late-night variety store. But the impulse is the same. The door is open If you have been sitting with your loneliness quietly — not wanting to explain it, not sure it’s bad enough to warrant attention, not wanting to be a burden even to people whose entire purpose is to be present for this — you don’t have to explain anything.  You can just come in. SBC’s support groups and community programs ask very little of you at the door. You don’t have to be articulate about what you're feeling, or ready to share, or certain that what you’re going through qualifies as hard enough. You just have to show up at the hour when you need someone to write something human on the receipt. That’s what we are here for. Read More: Living Well with Breast Cancer How Cancer Trauma Can Impact Your Life and Ways to Move Forward The Psychological Impact of Breast Cancer: Strategies for Coping On the Podcast: Breast Cancer Conversations The Hidden Trauma of Breast Cancer: PTSD, Fear, Triggers, and Healing Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast  Weekly Meetups Free Events

A daily pill has helped transform outcomes for hormone receptor-positive breast cancer, but navigating its side effects takes real-world know-how. Debbie Ciak's story shows why listening to your body and speaking up can make all the difference. SurvivingBreastCancer.org | Breast Cancer Conversations | By Laura Carfang Debbie Ciak, 75, lives outside Pittsburgh. She was diagnosed in early 2023 with stage 2B ER-positive, HER2-negative breast cancer after noticing an indentation in her breast one morning after a shower. Debbie's Ki-67 score was 57%, indicating an unusually fast-growing tumor. She underwent a single mastectomy and radiation. When her oncologist strongly recommended Verzenio to reduce her high risk of recurrence, Debbie didn’t hesitate. It was her second month on Verzenio when Debbie first noticed something was off. She’s a walker, and she began noticing that climbing hills was harder than it used to be. Then came the stairs. “I started to notice going up steps... just a little bit of shortness of breath,” she recalls. She reported it at her next appointment. Nothing was done. What followed was a months-long medical odyssey that would take Debbie through an ER visit on the day before Thanksgiving, three different pulmonologists, a bronchoscopy with ten biopsies, and a diagnosis of drug-induced pneumonitis (permanent lung scarring) that her pulmonologist now describes as feeling like “a straight jacket” around her lung. She will never be able to take a fully deep breath again. Debbie tells her story not to frighten anyone, but because she believes deeply that if she had known what to watch for, things might have gone differently. “You’ve got to listen to your body,” she says. “When something’s telling you it’s not right, don’t just let it go. You’ve got to pursue it until you get some answers.” Extra protection from Verzenio Verzenio (abemaciclib) belongs to a class of drugs called CDK4/6 inhibitors. By blocking proteins that cancer cells depend on to divide and replicate, these therapies can meaningfully slow or stop tumor growth in ways that hormone therapy alone cannot. For patients with HR-positive, HER2-negative breast cancer at high risk of recurrence, like Debbie, whose Ki-67 score came back at 57%, signaling an exceptionally fast-growing tumor, Verzenio can represent a crucial extra layer of protection. As Debbie understood it, Verzenio was her best extra line of defense against recurrence. The drug carries known side effect risks, but she was “willing to take that risk,” she says. “I want to continue to live my long, full life.” But she also walked into treatment without a full picture of what the drug could do, and she believes that gap cost her. For many patients, Verzenio is a pill taken every day for years. What it does to the body day-to-day matters enormously. The side effect everyone talks about — and how bad it can actually get Ask anyone on Verzenio about side effects and the conversation starts in the same place: diarrhea. Debbie is no exception. “The diarrhea was terrible — three or four times a day, no warning. I literally almost could not leave my house.” She became severely dehydrated, her kidney function became elevated, and her hemoglobin dropped. She needed five hospital infusions for dehydration in the first month alone. All the while, her weekly check-in calls from the nurse practitioner came back marked “normal, normal, normal.” GI symptoms are real and, for some patients, genuinely disabling in the early weeks. There are strategies that help (careful hydration, anti-diarrheal medications started proactively, smaller meals, easy-to-digest foods) and for many patients, symptoms do ease as the body adjusts. But Debbie’s experience is also a reminder that “common” doesn’t mean “minor,” and that patients shouldn’t have to white-knuckle through symptoms alone. Practical strategies to manage GI side effects Ask your oncology team about anti-diarrheal medications before symptoms start Stay well hydrated throughout the day; consider using electrolyte drinks Eat smaller, more frequent meals rather than large ones Focus on low-fiber, easy-to-digest foods during flare-ups Track symptoms carefully: timing, frequency, and triggers to help your team respond faster One note worth flagging: Debbie had been prescribed Verzenio at the highest starting dose of 150mg. She had questioned this at the time, but was told the logic was that if problems arose, the dose could be reduced. Since then, she says, protocols have shifted — many providers now start patients at lower doses and titrate up. If you’re starting Verzenio, it’s worth asking your oncologist about current dosing approach and what flexibility exists. The side effect that changed everything: ILD Among Verzenio’s less common but more serious potential side effects is interstitial lung disease (ILD), also called pneumonitis. In plain language, this is inflammation in the lung tissue that can reduce its flexibility and make breathing feel more labored. The FDA issued a warning about this risk in 2019. It appears in the drug’s prescribing information. It is mentioned, in small print, at the bottom of Verzenio advertisements. Debbie had sat through a mandatory hour-and-a-half session with a pharmacist and nurse practitioner before starting the drug. She does not remember anyone discussing shortness of breath as a serious warning sign. When she arrived at the ER with respiratory symptoms two months into treatment — at the same hospital system where her oncologist practiced, with access to her full medication record — the clinical team checked for a pulmonary embolism, ruled it out, and sent her home with an antibiotic. Nobody called a pulmonologist. Nobody flagged the drug she was taking. “I think there was a total unawareness of the possibility of what the drug I was taking might have been doing to my lungs.” — Debbie Ciak It was Debbie herself who, over that Thanksgiving weekend, searched “FDA alert Verzenio” and found the 2019 warning. When she called her oncologist Monday morning and shared what she’d found, she remembers “total silence on the other end of the phone.” Her oncologist told her not to take the drug again. By the time Debbie reached the third pulmonologist — the first two either didn’t know about CDK4/6 inhibitor-related pneumonitis or treated it generically — the damage was done. Steroids that might have helped were too late. She now has pulmonary fibrosis and has completed 12 weeks of pulmonary rehabilitation. She has undergone regular pulmonary function tests ever since. “Now it's in my chart,” she says. “Nobody will ever prescribe anything like that to me.” Tell your care team right away if you notice new or gradually worsening shortness of breath, especially with activity that felt easy before; a dry cough that’s new or persistent; chest tightness or a sensation of not being able to take a full breath; noticeably reduced stamina on walks, stairs, or daily tasks. These symptoms have many possible causes, but they require prompt evaluation, not a wait-and-see approach. What Debbie wishes the system had done differently Debbie is measured and thoughtful when she talks about this. She isn’t angry. But she is clear about the gaps she experienced: a care system where specialists operated in silos, where an ER team looked for the one thing they were asked to rule out and stopped there, where a known FDA-listed drug side effect wasn’t on anyone's radar in the room. “Everybody’s in their own little silo and only looking at one thing,” she says. “The nurses at a different hospital would have been more on top of what was going on. It’s a big lack of education piece.” She later participated in a medical webinar on ILD and CDK4/6 inhibitors, as the patient voice alongside an ER physician, a radiologist, and a medical oncologist. All three agreed: this is a significant and underrecognized issue, and clinicians need better awareness of what to look for when imaging a patient on these drugs. Movement as medicine: Debbie’s path forward Here’s the part of Debbie’s story that matters just as much as the warning: she didn’t stop living. Despite permanent lung limitations, she walks. She practices restorative yoga. She does Pilates. She is enrolled in a cancer and exercise research study through Colorado State University. She credits the SurvivingBreastCancer.org virtual exercise program and a local Pittsburgh organization called Cancer Bridges with being central to her recovery. “Exercise has been very important to me in my recovery — which is the one big positive change since having cancer, because I was not an exerciser before,” she shares. Her pulmonologist put it bluntly: “You can’t be sedentary. It would only make it worse. You have to keep active.” She schedules her classes the way she schedules medical appointments, because that’s what it takes. “I’m one that’s had to put it on the calendar.” For anyone who struggles with motivation during treatment, that framing alone is worth something. Questions for your next appointment Ask your oncologist before or during Verzenio treatment What starting dose is recommended for me, and what’s the reasoning? What respiratory symptoms should I watch for, and how urgently should I report them? If I go to an urgent care or ER, what should I tell them I’m taking? Are there supportive medications I should have on hand from day one? What is my bloodwork monitoring schedule, and what are you watching for? Should I be tracking symptoms between visits? How detailed should those notes be? The bottom line Verzenio is an important drug. For patients at high risk of recurrence, it may be the difference that matters. Debbie knew that going in — and still believes she made the right choice in trying it, even knowing how it ended for her. What she wants other patients to have is what she didn’t: a full picture, a care team that communicates across specialties, and the confidence to keep pushing when something feels wrong. “Keep asking those questions,” she says, “and don’t stop until you get the answers.“ Survivorship is not passive recovery. It is active navigation. Debbie Ciak is proof of that. Listen to the full episode: Debbie Ciak tells her complete story — including her diagnosis, treatment, the Thanksgiving ER visit, and what she’s learned about advocacy — on Breast Cancer Conversations, the SurvivingBreastCancer.org podcast. Listen below, or wherever you listen to podcasts. This article is for informational purposes only and does not constitute medical advice. Always consult your oncology team regarding treatment decisions and symptom management.

# Navigating the Waiting Game: Coping with Cancer Test Results By Laura Carfang Waiting for medical test results can feel like living in suspended animation. Time stretches endlessly. Thoughts spiral out of control. You check your phone more often than you realize. You refresh the patient portal, even though you know nothing has changed. Your body remains tense, as if something significant is about to happen. For many impacted by cancer, the waiting can be just as distressing as the diagnosis itself. And sometimes, something unexpected occurs. You prepare yourself for the worst. Let’s talk about why. Preparing for the Worst as a Coping Strategy There’s a psychological concept called defensive pessimism . It describes what happens when someone anticipates a high-stakes outcome—like cancer test results—and mentally assumes the worst on purpose . This isn’t because people want bad news. It’s because certainty, even painful certainty, can feel safer than hope. By imagining the worst-case scenario, the mind tries to: Reduce the shock if bad news arrives. Regain a sense of control. Emotionally “pre-grieve” what might come. For those diagnosed with cancer, waiting on test results and frantically refreshing the screen of your medical portal, this strategy is incredibly common. The challenge? When the results are good, your mind has already rehearsed catastrophe—and relief doesn’t land. When Your Body Thinks Waiting = Danger If you’ve been diagnosed with cancer, your brain has learned something powerful: Waiting for results once changed everything. That memory doesn’t just live in our thoughts; it resides in our nervous system. Psychologists call this anticipatory anxiety or medical PTSD . It means your stress response activates before danger is confirmed. When this happens: Your body stays in fight-or-flight mode. You scan for threats, even after reassurance. Good news feels unreal, fragile, or temporary. You might think: “They must have missed something.” “This can’t be right.” “I’ll believe it when more time passes.” This isn’t disbelief; it’s your brain prioritizing safety over celebration. The Whiplash of Good News There’s also something called cognitive dissonance at play. If you’ve spent days or weeks organizing your life around the assumption that something is seriously wrong, your mind has already adapted. Then suddenly, you’re told: “Everything looks okay.” Your brain needs time to undo what it prepared for. Disbelief is often not denial—it’s lag time between threat and safety. Hypervigilance Is Not Pessimism — It’s Protection Many people feel guilty for not feeling relieved right away. They wonder: “Why can’t I just be happy?” “What’s wrong with me?” “Other people would be grateful—why am I still scared?” Here’s the truth: Hypervigilance is a form of self-protection. Believing good news can feel like lowering your guard—and after a cancer diagnosis, that can feel dangerous. Your mind may be saying: “If I don’t fully trust this, I won’t be crushed if it changes.” How Relief Actually Arrives (Hint: It’s Not All at Once) For many cancer survivors, relief doesn’t come as a wave of joy. It arrives quietly: Sleeping a little better. Taking a deeper breath without realizing it. Thinking about the future for a few seconds longer. Relief often comes in increments, not declarations. You don’t have to force yourself to believe good news fully. You can let it be true for today. Here is a mantra to stay grounded in the present moment: “The results are good right now, and that’s enough.” If you’re struggling to trust good medical news: You are not broken. You are not pessimistic. You are not doing survivorship “wrong.” Your body remembers how real the danger once was. And it is slowly—at its own pace—learning that this moment is different. You don’t have to rush relief. You don’t have to perform gratitude. You don’t have to explain yourself. If this resonates with you, please know: you are not alone in this experience. At SurvivingBreastCancer.org , we believe survivorship includes the emotional aftermath of waiting, fear, and uncertainty. Healing isn’t just about test results; it’s about giving yourself permission to feel exactly where you are. The Importance of Community Support Navigating the emotional landscape of waiting for test results can be overwhelming. It's essential to connect with others who understand your journey. Sharing experiences can lighten the load. Whether through support groups, online forums, or one-on-one conversations, community support can provide comfort and reassurance. Finding Your Tribe Consider reaching out to local organizations or online platforms dedicated to breast cancer support. These communities often host events, workshops, and discussions that can help you feel less isolated. Engaging with others can foster a sense of belonging and understanding. Sharing Your Story If you feel comfortable, share your story. Writing about your experiences can be therapeutic. It allows you to process your feelings and connect with others who may be going through similar challenges. You can submit your story, poetry, or art at SurvivingBreastCancer.org . Self-Care Strategies During the Wait While waiting for results, it's crucial to prioritize self-care. Here are some strategies to help you cope: Practice Mindfulness: Engage in mindfulness exercises. Focus on your breath and the present moment. This can help reduce anxiety and promote relaxation. Stay Active: Physical activity can boost your mood. Even a short walk can help clear your mind and reduce stress. Limit Information Overload: While it’s tempting to research every detail, too much information can increase anxiety. Set boundaries on how much you consume. Connect with Loved Ones: Reach out to friends or family members. Talking about your feelings can provide relief and support. Conclusion: Embracing the Journey The journey through cancer and its uncertainties is deeply personal. Each person's experience is unique. Embrace your feelings, whatever they may be. Allow yourself to feel the weight of waiting, the fear of the unknown, and the hope for good news. Remember, you are not alone. Many have walked this path and emerged stronger. At SurvivingBreastCancer.org , we’re here to support you every step of the way. Read More: Permission to Feel: 10 Tips for Navigating Cancer and Treatments with Honesty and Humor No Pink Here: What October Really Feels Like for Breast Cancer Survivors The Transformative Power of Art Therapy in Cancer Survivorship On the Podcast: Breast Cancer Conversations Understanding and Coping with Medical PTSD in Cancer Care with Emily Parks Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Podcast Weekly Meetup Free Events