Natasha Carlson is a physician and breast cancer survivor.

Natasha Carlson

After I was diagnosed with breast cancer, I decided to reach out for support, which was surprisingly difficult to find, considering that I live in a large, metropolitan area.

I first reached out to my clinic, where I was informed that they knew of a local support group, but that since this group was made up of almost exclusively women who were metastatic, I probably wouldn’t fit in with them. It was more than a little disappointing when they didn’t have any other suggestions for me. Then after more research on my own, I attended various support groups that were made up of women who were decades older than I was, who had very different concerns than I did, and with whom I had very little in common.

Eventually I came across a local group of young breast cancer survivors, and this was a saving grace for me. Through my conversations with them, I found people who had similar challenges as I did, and who were in the same phase of life as I was. It was largely through this group of young survivors that I was able to start healing from my traumatic journey. Ultimately, I took over leadership of this local group, and so now I spend a good portion of my free time meeting with young survivors and supporting them in whatever ways are necessary.

It was in this role that I heard the same story time and time again. Women who were told by their doctors that they were “too young” for cancer. That the breast lump they were feeling was just a cyst, or a fibroadenoma, or a clogged milk duct if they happened to be pregnant or breastfeeding. They were told, “it can’t be cancer because cancer doesn’t hurt” when they pointed out a painful lump. They were dismissed or reassured that they couldn’t possibly have cancer. They were too young. And so consequently for far too many, they weren’t even (initially) offered the appropriate testing, such as a mammogram or ultrasound, which is standard of care for evaluation of breast abnormalities.

For more than a few of them, by the time they ultimately were diagnosed many months later, they already had late-stage disease. We all know the extreme importance of early detection, so it is difficult for anyone in this situation to not look back in retrospect and wonder, “would that have made a difference? Would I have been diagnosed earlier if I had been listened to and been offered an appropriate evaluation at the time that I raised a concern? Would that have impacted my chance at becoming cancer free/no evidence of disease? Would that maybe have given me more time with my family?”

I wish these stories were just anecdotes, but the statistics tell us that they are reflective of a growing reality. An even harsher reality is that when a young woman develops breast cancer, it is likely to be more aggressive when compared to older women, as well as diagnosed at a later stage.

So, it is really quite mystifying and maddeningly frustrating that women are too often told that their symptoms are “nothing to worry about” because they are “too young for cancer” before even a modicum of appropriate medical evaluation is performed.

Although it is certainly more unusual to develop breast cancer at a young age (under 40) compared to older women (median age of diagnosis is 62), it absolutely does happen, and in fact more younger women are being diagnosed than ever before. This could, in part, be due to better and more advanced screening methods. Additionally, the more widespread availability of genetic testing may mean that women are more aware that a family member has a genetic mutation which leads to a higher likelihood of cancer, and so they may be more cognizant that a breast issue may be more serious than it appears and may seek out evaluation earlier.

Many of the people I have met, both in person and virtually, who have experienced this heart-wrenching nightmare themselves have made it their mission to share their stories, to get the word out to both medical providers and to women (and men) in general that young people can and do develop cancer. There are any number of ways they can spread awareness: speaking at support groups and patient advocacy events, writing blogs or memoirs, participating in podcasts and TV interviews, just to name a few. But it is only by doing this, by being persistent, continuing to speak out, and eventually gaining enough momentum to transform the microphone into a megaphone that everyone will understand that there is no such thing as being too young for cancer.

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I’ve met too many people who were told that they were too young for cancer before being diagnosed.

Too Young for Cancer

If you spend much time talking with cancer survivors, there is a term which will eventually come up in conversation: scanxiety. This is the crippling anxiety that comes with each scan, imaging study or screening test. While undergoing treatment, it arose with a new test or scan, either because of new symptoms (therefore trying to ascertain if those symptoms are due to the known or worsening cancer), or perhaps to try to determine how well the treatment is working (hoping to see shrinking of tumors, presumably in response to current therapies).

For people who have cancer which is successfully treated, it is common that there are routine cancer screenings at regular intervals. In the case of breast cancer, I knew of the following options: if a person chooses a lumpectomy or a single mastectomy, she (or he) will still need mammograms on at least an annual basis, and sometimes additional screening tests are necessary as well, such as breast MRIs. For those with dense breast tissue, a common protocol is to have a mammogram and then a breast MRI six months later, each done annually, so there are two breast cancer screening tests per year. Once a person has a double mastectomy, they will no longer require regular mammograms or screening tests, as the breast tissue is now gone (or nearly completely gone, as much as current surgical techniques allow – there will always be SOME breast cells remaining).

I knew that this was the case when I opted for a single mastectomy. The idea that there would be NO screening tests going forward made me quite uncomfortable, and I felt that I wanted the reassurance that came with routine imaging studies.

Let me say that in general, I am a very logical, rational person. I am a physician – I spend my entire work life weighing risks and benefits. Of this test, of that treatment, of not taking specific action and instead just watching and waiting. I understand that there are no guarantees, and that having regular screening tests, even ones that are interpreted as normal by trained radiologists, does not provide 100% assurance that there is no cancer.

With all this in mind, I thought I wanted regular mammograms and breast MRIs on the remaining breast. I honestly thought I would feel better by having them. So, I was totally and completely unprepared for my own extremely powerful reaction when I had my first post-cancer screening breast MRI. To say I was a basket case would be the understatement of the century.

In the 24 hours between having the scan and receiving the results, I perseverated, ruminated and catastrophized about what I imagined the results would be. For 24 hours, my mind was completely consumed by fear, and no matter how hard I tried, I was absolutely unable to rationalize my way out of this primal panic response. I have never had a reaction anywhere close to that before.

This was my first introduction to scanxiety: the unrelenting dread, the slowing of the passage of time, the twisting of reality in my head… Experiencing this just once was too much for me.

Eventually, I opted to have three more surgeries in order to avoid going through this every six months with each screening test. I had a prophylactic mastectomy on the other side followed by two reconstructive surgeries. Certainly, there were other benefits that I gained by having the prophylactic procedure, but one of the biggest advantages in my mind was never having to go through that emotional spin cycle again.

I realize how fortunate I was that this was even an option available to me. There are so many people out there who are living with metastatic cancer who will always need to have scans and tests that can trigger debilitating scanxiety (at least temporarily). I have a massive amount of respect for those who must go through this regularly. Even for those cancer survivors who are not metastatic, each screening test can bring them right back to the beginning of that terrifying journey. There is absolutely a very real degree of PTSD that develops from this entire experience.

So the next time you are talking to someone with a history of cancer, keep in mind that cancer’s effects are quite far-reaching, even after treatment is over, and especially for those people who will be in treatment for the rest of their lives. Offer to lend a listening ear and an open mind – it can help to quell the rising tide of the powerful emotional aftermath of cancer.

After experiencing intense scanxiety after my single mastectomy, I decided to go back and have a prophylactic mastectomy. 

Scanxiety Made Me Change My Cancer Surgery Decision

Cancer is many things. It is sneaky. Relentless. Devastating. Heartbreaking. Painful. Terrifying. Traumatic. Frustrating. Exhausting. Destructive. Utterly unfair.

But cancer is also surprising. And above all, cancer is…clarifying.

After experiencing such a life-altering diagnosis and going through treatment, cancer shows us what is important. Frequently, cancer survivors will take the time to evaluate their lives and decide to make some changes. Maybe these changes are designed to benefit their physical well-being: committing to a healthier lifestyle, better diet and increasing physical activity might become a priority. Even something very simple such as drinking more water or getting better sleep can be a small change designed to make a big impact on their physical health.

Taking steps to reduce stress and improve emotional well-being is a common theme among cancer survivors. For some people, this might involve turning a critical eye on just about everything in their lives. Are they happy in their job? If not, are there steps that can be taken to improve satisfaction? Reducing hours, more flexibility, remote/hybrid work? Or is it time for something altogether different?

I have a friend who decided to use her experience with cancer to take a risk and try something that she had never done before, and now, she is a published author of several children’s books as well as a cancer memoir. Like so many of us, she learned that life is too short, and she never wanted to regret not doing something while she could. Taking this risk resulted in a very unexpected and welcome reward for her as she embarks on a new career, one she never envisioned prior to cancer.

Using time wisely and gaining more enjoyment out of life is a nearly universal goal among cancer survivors (well really, everyone). People want to devote more energy to doing what is most important to them — spending time with family and friends, or perhaps focusing on activities they enjoy or those that fill them with purpose. It is no accident that so many cancer support organizations are made up of cancer survivors themselves, or family members of those with cancer. Their shared experience provides an ocean of commonalities and understanding for those who find themselves seeking support during a very tumultuous period of their lives.

After experiencing the emotional, physical and sometimes existential or spiritual hurricane that is cancer, it is quite satisfying for people to discover the clarity and serenity that comes from a great deal of self-reflection and development of a laser focus on what is now important. Some people call this the gift of cancer. Others who refuse to believe that anything good comes of cancer still typically acknowledge that this newly discovered sense of purpose or what is worthy of their effort is, indeed, a positive development.

Cancer is a teacher. It shows us what we can do, and what we are capable of, sometimes despite seemingly insurmountable odds. It puts on display, right in front of everyone, how we must adapt and grow and better ourselves. Although the journey of self-discovery that is forced upon us by cancer has some common themes, each person’s path is unique. The amount of personal growth that occurs while working to heal from the trauma and widespread destruction of cancer is truly astounding.

All too often people talk about cancer’s side effects with a negative connotation, mostly deservedly so. But certainly in my own case, there is a forced transformation that is the result of cancer — a transformation that comes from grief, anger, despair, self-reflection, growth and ultimately evolution into a whole new person who has a very important and initially under-appreciated quality that my pre-cancer self did not have: perspective.

This summer, I will surpass my five-year cancer-free mark. I think back to the days of initial diagnosis and treatment, when I was so overwhelmed that I wasn’t even sure how I was going to make it to tomorrow, much less a five-year mark. Even after treatment was complete, the sometimes-all-consuming fear of recurrence blunted my appreciation for little milestones along the way.

Eventually, it dawned on me that fear was accomplishing nothing good, and serving to ruin the joys I did have, or should have had as my life went on. Because it DID go on, whether I was recognizing this or not. Maybe different than before, but it did keep ticking along.

I came to the conclusion that cancer had taken enough from me, and I wasn’t going to allow it to rob me of anything else, including my enjoyment of the present, and eager anticipation for what is yet to come.

Cancer brought me a forced transformation and gave me better a perspective on life. 

Cancer Is... 

When I began to speak publicly about cancer survivorship, I started by making a list of life lessons that cancer had taught me.

One of the many surprises that cancer had in store for me when I was diagnosed was the fact that I, like so many others, would be cancer “ghosted.”I had no idea that this happened at all, much less that it is so incredibly common.

This is the phenomenon of friends or family “ghosting” you or literally disappearing and cutting off all contact after a cancer diagnosis is revealed. In fact, one study found that 65% of respondents to a recent survey reported that they experienced cancer ghosting. This is quite counterintuitive — cancer should be a time when your friends and family band together to form a tight impenetrable cocoon of support. Why on earth would friends NOT support you in your time of need? But cancer is funny that way. It has a strange tendency to reveal who your true friends are, and unfortunately, who they are not.

Patients With Cancer, Survivors and Caregivers Open Up About Being ‘Cancer Ghosted’

In my case, I lost two friends during my cancer journey. They were the very last people I expected would literally abandon me at my most vulnerable point. One of those people I had considered to be a lifelong friend. We had a solid 22 years of friendship before I was diagnosed. We had been through good times and bad times together, as is typical with a friendship that spans decades. But after I shared my diagnosis, I was very surprised to find that all contact with me was cut off. No responses to emails, texts, phone calls. Even when I was reaching out because I was confused and hurt, this did not generate any sort of reciprocal response.

There certainly is the phenomenon of burnout among friends and family members of the person who is living with cancer. This occurs when the need for support becomes so intense in its depth or frequency that the friend/family member needs to take a respite from all things cancer in order to maintain a degree of emotional self-preservation. This is understandable. However, this was NOT the situation I found myself in when I was ghosted.

When I shared my diagnosis, it was very early on, and there were a lot of details I didn’t yet know, including stage, treatment, prognosis… After that first conversation where I revealed that I had cancer, I heard nothing from this friend for over a year. They literally had no idea whether I was going to be fine, whether I was going live with cancer, or perhaps, whether I was going to die of cancer.

Honestly, this was one of the most painful parts of the entire cancer experience for me. Losing my breasts was hard. Losing my close friend of 22 years…was not something that I had even remotely thought might happen. It was a bitter and painful lesson that I was forced to learn during a particularly vulnerable time in my life.

So why does this happen so frequently to patients with cancer? Well, I certainly have had enough time to ruminate on this thought and come up with all kinds of theories. Maybe they were going through something in their life that made it so that they couldn’t be there for me. But then why not reach back out once the rough patch for them was over? Shame? Embarrassment? Guilt? Maybe their own mental health at the time was not in the best of shape and they felt that taking on my crap was too much for them to handle.

I will never truly know why — and that is something I have had to come to terms with. I am still frustrated, hurt and angry that this happened, and because of how it happened, I still have not found closure. It is doubtful that I ever will.

But cancer has some other surprises too. Sometimes the people who show up for you are the people you would least expect. Maybe they hardly know you, but heard that you might need some help, so here they are. Cancer introduces you to a whole tribe of supporters, of fellow cancer patients, and a community that is like no other.

Lesson #8 on my list of life lessons that cancer taught me is: Invest your time and emotional bandwidth in people who will show up for you, no matter what. Make new friends. Form a new support network. You do not need the drama of having “friends” who will decide to excuse themselves from your life when things get challenging. If you find that this happens, even though it is SO painful, let them go. You deserve support from people who will go above and beyond to be there for you and whatever you need.

Losing my breasts was hard, but losing one of my best friends was even harder, and something I’ve had to come to terms with. 

'Cancer Ghosting' Is an Unfortunate Reality

Control.Ask any person who has been diagnosed with cancer, and many may tell you that the loss of control that comes along with being told this terrifying news is one of the worst parts of it all. Giving up (perceived) control of your health, your emotional stability, your ability to make plans, even just being able to commit to doing some of the little things that we all take for granted — that’s the truly devastating part of this.

During treatment, side effects, symptoms and complications will almost inevitably occur, and it is an all-too-frequent occurrence that someone may not be feeling up to having visitors or be able to go to their child’s school musical or basketball game. Even after active treatment is over, the effects of a cancer diagnosis and cancer treatment can stubbornly linger, and this can make the well-deserved and desperately longed for “return to normal” maddeningly fleeting at times.

But it doesn’t have to be this way. Although some degree of loss of control is inevitable, there is actually a lot that we can control, thereby helping to alleviate some of the frustration and feelings of hopelessness that can accompany a diagnosis.

Do your research. Ask questions. Talk to other people who have gone through a similar journey and learn from them. Have a very honest and frank discussion with your health care team about what to expect and when. Make an informed decision that works for you and your situation.

Learn your patterns and prepare for them. For example, if you find that you are at your lowest on days three and four after chemo, then plan for that.If you are working during treatment, take time off work those days, as you will need to rest and recover.

Perhaps schedule your chemo days so that you will have the weekend (or whatever your normal days off are) to help maximize the amount of time you have available to recuperate. Don’t plan to have visitors over during those most symptomatic days, unless it is for them to help you with whatever needs to be done (household chores, grocery shopping, picking up kids from daycare/school, etc). Maybe have some already-prepared frozen meals that you just have to quickly heat up for the family so the cooking is minimal.

For some people, they find that the day of chemo and the first day afterward are actually the days they tend to be very productive, thanks to the steroids that go along with the chemo. If that is the case for you, then try to deliberately plan to do some of the more energy-intensive tasks (such as laundry, errands, taking the kids to the park) on those days.

After cancer, many people find that they need to intentionally prioritize themselves and their own health, both emotional and physical. Part of this involves establishing boundaries with other people, especially with people who seem to have trouble respecting limits. This can also mean deliberately cutting out unhealthy relationships. Though initially this may seem like a daunting task, it truly is vital to preserve a sense of normalcy, and to avoid unnecessary drama and the draining of emotional bandwidth which you need to try to focus on your own well-being and healing.

As survivorship continues, be sure to pay attention to your physical health. If you’ve already been diagnosed with cancer once, research shows that you have a higher likelihood of having another cancer diagnosis in the future, relative to the general population.

We all know the extreme importance of early diagnosis. So keep up with your screenings! This means mammograms and Pap smears for women, and prostate exams for men. Colonoscopies, as unpleasant as the thought can be, are absolutely the best way to find problems early, before symptoms start, and it is very important to keep up with those screenings. Skin checks should also not be neglected. For current or former smokers, there are lung cancer screening protocols. If you have had cancer that is due to a genetic mutation, you will likely be advised to do additional screening tests for other cancers as well. Ask your oncologist about what you need to be mindful of for you and your medical history.

Make plans for the future. Go on that family trip, make the memories with the kids or grandkids. Start a memory book/journal for the next generation. Add to it for years to come — it will be a precious gift for loved ones to cherish.

Cancer is a thief; it tries to steal so many things from us, including our sense of control. Reclaiming some degree of that control is empowering and that can help us as we navigate our way through cancer treatment and survivorship.

Here are a few tips I’ve found that helped me regain a sense of control after being diagnosed with breast cancer.  

   How to Regain Control After a Cancer Diagnosis

When I was diagnosed with breast cancer, I was told that my cancer subtype was the “good” kind of cancer. At the time, I wasn’t sure what this meant.

I have since learned that in the world of breast cancer, they refer to the “good” kind of cancer as those that are hormone-positive, because there are long-term medications (hormone blockers) that can be taken to try to prevent this cancer from growing more or recurring in the future, which isn’t the case with hormone negative breast cancers.

While I certainly understood the point that was being made, I was sort of taken aback by the assertion that any cancer can be “good,” or the intimation that this piece of information was supposed to mean that I shouldn’t worry.

When I finished active treatment, people would tell me how fantastic that was, and how incredible it must feel to be done. I was told on many occasions how fortunate I was and how happy and grateful I should feel.

Yes, I most definitely recognized that being done with the multiple surgeries was a good thing, and I also knew that taking a medication that could block estrogen was a protective factor, one that not everyone had the option to utilize, depending on their specific cancer pathology. But I most definitely didn’t feel happy. I felt exhausted and angry. I was angry that this happened in the first place. I was upset about the loss of time and emotional security, and longer lasting physical effects that I had and still to this day continue to deal with because of treatment.

It is very common for people to try and provide cancer patients with positive thoughts and encouragement, and in doing so, they (perhaps albeit unintentionally) can demean the entire experience. This is part of the phenomenon of toxic positivity.

There are various definitions of this term, but this definition from 

 seems to resonate: “Toxic positivity occurs when positivity is used to cover up or silence the human experience.” These are the comments like “Look on the bright side!” and “You’re finished with treatment — you should feel fantastic!”

So what if I don’t feel that way? Does that mean that my experience is any less valid than someone else’s, simply because I feel angry, upset, frustrated, misunderstood or overwhelmed when people think that I “shouldn’t” feel that way? Am I not allowed to go through the spectrum of emotions to process this entire experience? Do I not deserve the opportunity to have a very human response to everything that comes along with a cancer diagnosis?

Comments like these can be interpreted as demeaning and dismissive to how the person who is dealing with cancer is feeling, and they can generate even greater feelings of isolation and distress. They also trivialize and oversimplify the human psyche. People are complex beings with a huge spectrum of emotions and reactions to things large and small, and sometimes these emotions are fluid and can morph into new ones or coexist simultaneously with other very strong feelings.

It is possible to feel gratitude AND fear at the same time. It is possible to feel relieved AND enraged simultaneously. It is possible, and even normal, to have completely incongruent emotions. Cancer does that.

In fact, experiencing all the emotions and being given space to convey them is critical to processing a cancer diagnosis. Not being allowed to do so or expecting someone to suppress how they are truly feeling or shame them for articulating an authentic emotion or mood is a setup for potentially serious future psychological issues. Cancer is difficult enough without inadvertently creating even more collateral damage that requires time, effort, cognitive recognition and emotional bandwidth to unpack and work through.

Perhaps through speaking out, sharing stories and offering examples of our lived experience, we can bring attention to this phenomenon of toxic positivity and challenge people to reconsider how their words, no matter how well-intentioned, can affect those living with cancer.

I was told I had the “good” type of breast cancer, but does such a thing even exist? I think not. 

Platitudes Can Be Toxic for People With Cancer

Cancer tends to throw people for a loop — it upends their worlds, introducing chaos and uncertainty. After a period of time, once all the shock and fear have subsided a bit, people tend to start talking about gratitude.What does this mean, and what does it look like?

For some people, they come to a place after cancer where they realize that stress is unhealthy and they purposely look for ways to de-stress, relax and unwind, physically and mentally.This might mean doing something like meditating, or it could mean establishing a gratitude practice of deliberately choosing to look for little things each day that can be enjoyed and appreciated: the sunset, the sound of children’s laughter, making memories with family — all those little moments that, collectively, comprise the whole greater package of “life”.

But this realization often happens later, after a lot of self-reflection and time has gone by. Immediately after a cancer diagnosis, it seems nearly impossible to be gratefulfor anything.

After my own diagnosis, I was acutely aware that this might happen, and I wanted to avoid this tendency.Instead of taking an abstract view of gratitude, I interpreted the idea of gratitude quite literally. What gratitude meant to me, at the time, while I was in the thick of it all and recovering from anesthesia and surgery, was that I needed to make a list of people to thank. Most people, if they are the type to write thank-you notes, probably remember to thank their doctors: the surgeon, the oncologist, and perhaps the nurses, especially the infusion room chemo nurses. Don’t get me wrong – these people absolutely deserve to be thanked.

However, I also wanted to bring attention to those team members who don’t typically get the same sort of respect and acknowledgement for their part in my care. I started with my primary care physician, without whom the idea of starting cancer screening would never have been on my radar. (Like a lot of people, I thought that I was “too young” for cancer!) I am SO incredibly grateful that she analyzed the many conflicting sets of cancer screening recommendations, and she chose the one that advised that I start mammograms at the earliest possible age of 40, as I was average risk, and I had no real family history of it (at the time). I wanted to be sure that she knew how very grateful I was that she pushed me to make that appointment and get that mammogram. Without her, I never would have found cancer early — I never would have even thought about it.

I wrote notes to the radiologist who initially read my mammogram, as well as the radiologist who performed the biopsy. These are members of the medical team who tend to be forgotten about since they are fairly removed from direct patient care.

I also wrote a thank you note to the mammography and ultrasound technicians, without whom the diagnosis could not have been made. Mammography techs typically don’t receive physical thank you letters from patients, as this type of nicety is generally reserved for the physicians and nurses (though it definitely shouldn’t be). However, I fully believe that this thank you note meant more to my mammography tech than the one I sent my surgeon (who has never mentioned it to me).

On the other hand, every time I am at the breast center and that mammography technician sees me, even if it isn’t for a scheduled appointment with her, she makes a specific point to seek me out and ask me how I’m doing and tell me that my thank you note is still hanging in her office, even years later, serving as a tangible memento and a daily reminder that she absolutely makes a difference in people’s lives.

Additionally, I wrote notes to the nurse navigator who held my hand during the biopsy and the surgery scheduler who coordinated two surgeons’ schedules to get me on the operating room schedule as soon as was humanly possible. I also thanked the pre-op and post-op nurses and the nurses on the surgical ward.

I repeated this process many times during my recoveries from eight total surgeries during my cancer journey. Ultimately, I wrote 15 thank you letters after that first surgery. They were, hopefully, beneficial to the letters’ recipients.

What I didn’t anticipate is how helpful the process would be for me. Having something very concrete to focus on during a very tumultuous period in my life was grounding for me, and it allowed me to feel that I had accomplished something worthwhile during a time when I desperately needed to feel productive — and grateful.