“Do you feel guilty for looking normal while having stage 4 breast cancer?”
It’s the question former Bachelorette star Katie Thurston was queried on her Instagram channel, Boobie Broadcast. She created the space after being diagnosed with metastatic breast cancer in March, and it now has more than 60,000 members—survivors, thrivers, medical professionals, and supporters—talking openly about what it means to live with a disease that so often hides in plain sight.
Thurston’s response stopped me mid scroll, mid breath: “I’m tired all the time, my body aches continuously, my hair is thinning, my hormones are suppressed, my memory is shit, my vagina is dry, my hands and feet feel tight, I had to freeze my eggs so that I could maybe find a way to pay $100K for surrogacy just to have a baby, I am removing my breasts, and eventually my ovaries, but in the meantime, I get a shot every month in my ass while taking medication every day for the rest of my life. So no. I don’t feel guilty for looking normal. And I hope those of you who ‘look normal’ never feel guilty too.”
Her words felt like holding up a mirror to my own life. I, too, have metastatic breast cancer. I, too, look normal. And I, too, do not feel guilty.
Metastatic breast cancer—stage 4, when cancer spreads beyond the breast to other parts of the body—is sometimes an invisible illness. You carry it quietly, like a secret, sometimes masked behind a smile. Time keeps ticking; you keep moving. The world doesn’t stop, and neither can you.
The diagnosis is devastating—defining, even—but life continues. “The first thing to remember,” says Devika Gajria, MD, a breast medical oncologist at Memorial Sloan Kettering Cancer Center, “is that the experience varies greatly depending on the biology of the cancer itself.” For some, treatment means weekly chemotherapy; for others, monthly injections. And the course of treatment can change in an instant. No two journeys look the same, and, as Dr. Gajria says, “One should never feel guilty for how well they’re doing in their journey.”
What is increasingly common is the number of young women receiving a stage 4 diagnosis. As of 2024, an estimated 200,000 women are living with metastatic breast cancer in the US, according to the Breast Cancer Research Foundation (BCRF). In recent years, women between the ages of 20 and 39 years have had the steepest rise in metastatic breast cancer diagnoses, up nearly 3% annually.
And yet there is more hope than ever. “There are many more lines of therapy and offerings for a patient,” says Dr. Gajria. “We’ve come a long way, even in the decade and a half that I’ve been practicing, with multiple therapeutics, better delivery of those medications, and improved tolerability of the medications, which optimizes side effects and makes it easier, even if there is a profile of toxicity or side effects that are challenging. [There is an opportunity] to make it more of a chronic disease than a life-threatening one right out of the gate for some patients.”
More novel therapies have been approved in the last 10 years than in the three decades prior, BCRF confirms, and survival rates have improved accordingly. Because of these treatments, maintaining some sense of normalcy is now a possibility for more patients than ever before.
“Some days I forget I have cancer,” Thurston tells me as we chat on the phone. “But there’s never a finish line. There are a lot of big decisions you have to make: Am I removing my ovaries? My breasts?”
That’s the quiet heartbreak of metastatic disease: the loss of control. “When our health is hijacked by a malignancy—one that needs persistent management, treatment, and follow-up—it changes the narrative of our lives,” says Dr. Gajria. “There’s a known understanding that this disease is here and maybe it’s quiet right now, but one day it could and will become more aggressive. There’s a destabilization that happens with something that will be with us forever.”
Uncertainty is the common thread. No one is promised tomorrow, but with a metastatic diagnosis, that truth hums louder in the background of everything. And what’s visible on the outside rarely tells the story.
I’ve had a bilateral mastectomy; a metal rod is screwed into my right femur, where my cancer spread four years ago. My body bears a map of survival: scars, radiation tattoos, numbness, reminders. I’m grieving the loss of being able to carry my own child, perhaps the greatest heartbreak of all for me. Still, I live with profound hope.
“It’s hard not to have people appreciate what you may be experiencing because it’s not worn on your face or skin or hair,” says Dr. Gajria. “We think of a cancer patient coming in looking gaunt with hair loss.” And countless patients are experiencing that version of this diagnosis, but some, simply, are on a different journey—but still fighting.
“I give it to people straight,” says Thurston. “Healing isn’t linear. You’re going to have some high highs and some low lows.”
Metastatic breast cancer is a lesson in perspective. A constant reminder of the fragility of life. Every day becomes an act of presence—a tenderness for the ordinary, a reverence for time. What it takes away, it also gives back: clarity, gratitude, the urgency to love, to live, to celebrate.
“Cancer just makes you a better version of yourself,” says Thurston. “I’ve embraced my body. I am so thankful to be alive. Who cares about cellulite, who cares about a roll? I’m just happy to just be, to have a body. I look at wrinkles like, Wow, how blessed are you to be aging?“
The night before our call for this story, I saw Thurston at The Pink Agenda’s annual gala—an evening to raise money for breast cancer research—radiant in a blush gown. We chat briefly, and not about cancer.
With the two of us, you’d never know. And that’s the point.
You never know what someone is carrying—what pain, what fear, what private storm.
Less than 24 hours later, we speak of her scanxiety (anxiety before a medical scan like an MRI) ahead of her six-month checkup. It’s the roller coaster we’re on together. This oscillation between hope and fear, between living fully and waiting quietly.
“A lot of times people view stage 4 as the end, and so they kind of just mourn and move on,” says Thurston. “But it’s like, no, we’re here and we’re active members of society—but we need support. We need funding.”
Metastatic breast cancer may be invisible for some, but those living with it are not. We are here. Moving through time. Alive.