Two weeks earlier she had finished chemo for HER2-positive breast cancer. The next morning she hiked Zion National Park. Then she hiked four more trails in Oregon, because resting was never the plan. As she put it, she had been resting through the entire stretch of treatment. By the end she was ready to go.

I did not flinch when she told me because I had done the same thing. E-bike six weeks after my mastectomy. Wakeboarding at three months. Weights all the way through chemo. The people who love us tell us to slow down, and they mean it kindly, and they are usually the reason we hesitate.

The instinct to move is more medical than the instinct to rest.

I never had the science to prove that. I just moved and trusted it. It turns out the research has been sitting there for decades, in journals oncologists were not reading.

In Episode 7, I sat down with Dr. Jay Harness, who spent his whole career cutting out breast cancer before he found it. What he discovered changed how I hear every “take it easy” a patient gets handed.

Behind the Paywall

In the full piece for subscribers, I get into what that research actually says, including:

• The trial that earned a standing ovation at the world’s biggest oncology conference last year.

• The line between brave and reckless that most people put in the wrong place.

Larissa did not ignore her doctor. She did something harder and smarter than that.

If you are in treatment, just out of it, or loving someone who is, this conversation is worth thirty minutes. Larissa is a yoga and mindfulness teacher who walked away from corporate law, and she talks about anger, fear, and the wall of wigs her three sons named like a woman who has decided exactly how to tell her story.

🎧 [Listen to the full episode here.]

Subscribers get the research, the citations, and the one question I think every patient should ask their oncologist.

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His whole voice changed. Vegas? What are you doing there? There are a lot of people there.

Two weeks earlier she had taken her last hard chemo infusion for HER2-positive breast cancer. Now she was about to drive to Zion to, in her words, hug a mountain.

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He looked at her chart, told her thyroid cancer wasn’t really “cancer-cancer,” and walked out.

She broke down crying. Alone in the room. Until his PA came back in and hugged her.

The Unseen Weight of a Second Cancer

This was the part that confused her. She’d done this before. Way harder the first time. Triple negative breast cancer, BRCA2, double mastectomy, chemo, hysterectomy, the works. This was supposed to be the smaller one. The easier one. It wasn’t.

She said it out loud while we were recording:

Why am I having this with thyroid cancer when I didn’t have it with chemo?

Most patients have felt some version of this and never had the language for it. The recurrence that hits harder than the original. The second time around that breaks you in a way the first time didn’t.

• Doctors call it: Anxiety.

• Survivors (and some therapists) call it: PTSD.

Both might be partly right. Erin’s experience pointed somewhere else, though. Somewhere specific. Somewhere that wasn’t about the cancer at all.

It was about a person she had the first time and lost the second time.

What We Are Exploring This Week

The deep piece this week is about what she had, what she lost, what the research says about the difference it makes, and what this means if you’re carrying a known mutation, navigating a recurrence, or staring down a fresh diagnosis from a system that hands you a list of doctors and a phone number.

If you’ve ever felt like the cancer itself was the easier part of cancer, this one is for you.

Listen and Subscribe

Erin’s full episode is live now: Kicking Cancer’s Ass: Erin Gray

The deep article on what she lost (and how to ask for it back) drops to paid subscribers this week.

→ Subscribe for the longer article, transcript, and more ways to Kick Cancer’s Ass.

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Connect with Erin:

• Erin’s counseling website: www.bewellwithincounseling.com

• Erin’s podcast website: www.wickedpsychotherapists.com

What the surgeon said next mattered more than the diagnosis. Not the news. The choreography. Here is your oncologist. Here is when you’ll meet her. Here is the doctor who will do your hysterectomy. Here is your plastic surgeon. Here is the order of things. Erin had been carrying a BRCA2 mutation for over a year. She’d known this was coming. The surgeon didn’t hand her a packet. She handed her a map.

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Eight years later, Erin sat in the same doctor’s office with a different diagnosis: papillary thyroid cancer. Not BRCA-related. Unrelated to the first. By every clinical measure, smaller. Less aggressive. Less surgery ahead. She should have been the most prepared patient on the schedule. She fell apart. The oncologist she’d known for years told her thyroid cancer wasn’t really “cancer-cancer,” shrugged, and walked out. The PA came back in and hugged her while she cried. Erin’s reaction surprised her: I didn’t have this with chemo. I didn’t have this with the mastectomy. Why now?

The Power of a Guide

The first time, Erin had a guide, and the second time, she didn’t. A guide is the person who, after the diagnosis, says these words: here is what happens next, and next, and next.

For Erin, the guide was her breast surgeon. When the second diagnosis fell outside that surgeon’s territory, the guide didn’t transfer. Erin had to assemble a team from scratch. The cancer wasn’t the destabilizing thing. Not having a map was.

What I’m describing might sound like emotional support. It isn’t. It’s a documented clinical intervention with thirty-five years of outcomes data.

• The Harlem Hospital Pilot (1990): The first patient navigation program in the United States started at Harlem Hospital in 1990, led by surgical oncologist Harold Freeman. His patients had been arriving with late-stage breast cancer at survival rates that were a national scandal. After he built a navigation program that walked patients from suspicious finding to resolution, five-year survival in that population went from 39% to 70%.

What the Data Shows

The intervening decades have produced more evidence than most oncologists know how to act on:

Study / SourceKey Finding

2023 Systematic Review

(CA: A Cancer Journal for Clinicians)

Patients with a navigator were two-and-a-half times more likely to adhere to treatment. (Source)

2024 Systematic Review

(Current Oncology Reports)

Navigation improved treatment initiation in 70% of studies and treatment adherence in 71%. (Source)

What Erin lost between cancer #1 and cancer #2 was not soft. It was the thing the data says moves outcomes.

A Systemic Gap

Erin had a guide the first time because her breast surgeon happened to be the kind of doctor who conducts. There is no system that requires it.

The American Cancer Society funded Freeman’s pilot in 1990, and there are still only about 2,500 certified genetic counselors in the entire United States (Source), roughly eight per million people. If you find out you carry BRCA1 or BRCA2 today, you are stepping into the same gap Erin stepped into before her first diagnosis.

Erika Stallings, whose mother had BRCA2 breast cancer, called for a genetic counseling appointment and was told the next opening was five months out. (Source)

That is not anomalous. That is the system working as designed.

I had a guide on my own genetic diagnosis without realizing how lucky I was. I was the third person in my immediate family to learn I was BRCA1 positive - and I had assumed it for years prior. My mother and sister were already on the map. The route was drawn in pencil before I was born. I had a geneticist talk with me before and after the DNA test and she share the map of my choices.

But when I was diagnosed with cancer, my hospital did not have (and still doesn’t have for breast cancer) a patient navigation team to guide me through the process. I was lucky because I’d been a caregiver so many times before that I knew the map. Most people don’t.

Finding Your Map

If you’re newly diagnosed, or carrying a known mutation, or supporting someone who is: who is your guide?

Not the doctor with the most letters after their name. The person who tells you the next three appointments, the next three weeks, the next three decisions. If your team has not named that person, name them yourself.

• Ask the oncology nurse navigator at your hospital.

• Ask the genetic counselor’s office.

• Ask one of your doctors which person on the team to call first when you don’t know what to do.

The PA who hugged Erin in the exam room wasn’t supposed to be the guide for the second cancer. Nothing in the system told her to be. She just was. Sometimes guides appear. The rest of the time, you have to ask.

Matthew Zachary (episode 37) is leading a national movement for a Cancer Patient’s Bill of Rights that would include a patient navigator for EVERY person diagnosed in the US. It’s called WethePatients.org and worth a look.

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[00:00:00] Hello. Welcome to Back to Kicking Cancer’s Ass. The podcast for people who’ve been recently diagnosed or suspect they’re about to be and want information, they want, hope, they wanna know, how do I do this? How do I kick cancer’s ass? And I am so lucky today to have my guest, Dr. Erin Gray. Erin is not just a psychotherapist.

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Abraham Williams, 37 years old, was just diagnosed with an extremely rare form of bone cancer. She didn’t share the type, and I’m not going to guess at it. What she did share is that he’s facing the fight of his life, and she needed to focus her time and energy on supporting him - something incompatible with her job as Director of National Intelligence.

Anyone who has loved someone through cancer understands how she felt.

Abraham, to Tulsi, to their family, we are all pulling for you.

But one number triggers me.

Thirty-seven.

The curveball is getting younger

I never got to believe the comforting story — that cancer is something that happens later, to older bodies, with more warning. My family didn’t let me. My mother was diagnosed at 36. My sister was 29. I grew up knowing in my bones that cancer comes for people in the prime of their working lives, and that it does not wait for a convenient decade.

So I did the thing the comforting story lets most people skip: I assumed the worst about my own odds and acted on it years before I had any proof. I changed how I lived. I nursed each of my kids for a full year, partly because I knew it lowered my risk. I didn’t get genetic confirmation until my early 30s after two of my three kids were born, but by then I’d been pushing back for years. I did nearly everything in my power short of a preventive mastectomy. When I finally decided to do that…I was in my 50s, and that’s when I was diagnosed. In my family, that made me the late one. The exception.

I can’t prove that acting early bought me those years. There’s no clean experiment for the cancer you didn’t get in your 30s. But I believe it did. The difference between my timeline and my mother’s and my sister’s wasn’t that I was healthier; it was luck. But the fact that my cancer was found very early and highly treatable - that wasn’t luck. That was vigilance informed by risk assessment.

That’s why a 37-year-old with bone cancer doesn’t land on me as rare bad luck. It lands as a pattern I’ve watched my whole life. Early-onset cancer — diagnosed in adults under 50 — is rising across many cancer types, not just one. People in their thirties and forties are getting diagnoses their grandparents wouldn’t have seen until their seventies, if at all. Abraham is 37. He is not the exception we want him to be.

And for some of those people, the risk was knowable. Not the diagnosis — the risk. The loaded dice they were carrying without ever being told.

What “knowing” actually buys you

I talk about agency constantly in coaching, in this podcast, and in my own treatment. It’s finding the levers that are yours and pulling them hard.

Genetic risk assessment is one of those levers, and most people don’t know it’s sitting right there.

A small but real number of cancers — including some of the rare and aggressive ones — trace back to inherited risk you can identify with a test combined with family history (if known) and a lifestyle inventory. Not a maybe. A known syndrome, a known gene, a known elevated risk.

Take the most studied example in bone cancer. People with a particular inherited syndrome that raises their risk of sarcomas and several other cancers can enroll in a surveillance protocol built specifically for them — annual whole-body MRI, regular imaging, bloodwork, the works. No radiation, because their bodies can’t tolerate it, which the protocol accounts for. And it works. In one analysis, that kind of imaging caught 41 of 46 of this type of bone cancer at an early, treatable stage. Survival improves when you screen the people who need screening.

This is the whole reason I do this work

I don’t know whether anything could have changed Abraham’s path. Neither do you. That’s not the point. The point is the thousands of people walking around right now carrying a risk they’ve never been told about, who could be in a surveillance program tomorrow, whose stage-1 catch is sitting in a test they’ve never taken.

I had that warning. Most people don’t. The WISDOM study tested 46,000 women and found that 30% of those carrying a high-risk gene had no family history of breast cancer at all. A third. Under today’s rules, no one would have offered them the test. They’d have found out the way too many of us did — after they already had cancer.

That’s what makes me want to change the whole system. Knowing your risk shouldn’t depend on having the “right” family history, or the money, or a doctor who happens to think to ask. Every adult should be able to get a genetic risk assessment — comprehensive, private, and free — and everyone who comes back high-risk should be walked straight into the screening and the support that catches things early.

So don’t wait to be told you qualify. Ask about genetic counseling. Ask what risk assessment is available to you. Ask while you’re healthy — that’s when the answer is worth the most.

We can’t stop every curveball. But we are getting better, every year, at seeing them coming. And seeing them coming is how you get to swing.

To Tulsi and Abraham: I wish you the best of luck. I hope the cancer responds to treatment and that you are surrounded by people who bring you joy.

I always ask: What’s your advice for someone who wants to kick cancer’s ass? Mine, today, is this — find out what your risk is, and if you have high risk, be vigilant about the right screening protocol, lifestyle changes, and staying up to date on prevention and detection research.

The distress didn’t peak during chemo and resolve. It built, year over year, fueled by recurrence fear and body changes and a social environment that had moved on. City of Hope (Emotional Health After Cancer Treatment) reports that more than 25% of long-term survivors experience clinical anxiety. Up to 25% experience clinical depression. Long after the bell has been rung.

This is the part of cancer your friends do not know exists. It isn’t in the brochures. It isn’t in the discharge instructions. There is no follow-up phone call about it.

The Illusion of “Done”

Three years ago this month, an oncology nurse called and used the words every cancer patient wants to hear: Pathologically complete response. No cancer in any of the tissue they removed. Done.

I smiled. Maybe I cheered. Then I hung up and looked at my calendar.

The word done was on the chart. It was not on the calendar.

Was I done? I was done with the tumor that could have killed me. I was not done with the appointments that the tumor created.

You learn the choreography. You say good at the dinner party because the real answer takes forty minutes and nobody wants to hear it. You stop mentioning the appointments because you can hear yourself sounding like a complainer. You can’t say I have cancer anymore. You can’t say I had cancer yet, either. You stand in the gap, and the people who love you look at you like you should be happier by now. They’re not wrong to want that. You want it, too. Most days, I was happy. Some days, I was not.

The Reality of the Care Gap

The Institute of Medicine recommended in 2005 that every cancer patient finishing treatment receive a written survivorship care plan. The document is supposed to outline what surveillance you need, what late effects to watch for, who is coordinating among your specialists, and what to do if something changes.

Twenty years later, the National Coalition for Cancer Survivorship’s 2024 survey of more than 2,100 patients (2024 State of Cancer Survivorship Survey) found that fewer than half receive one. For a recommendation old enough to vote.

The Burden of Endocrine Therapy

Then there’s the medication. Hormone-receptor-positive patients are looking at five to ten years of endocrine therapy after surgery.

• A 2025 study in The Breast Journal found that 87% of women on aromatase inhibitors experience side effects.

  • 86% have musculoskeletal symptoms.

  • 74.5% have hot flashes.

  • 74.4% have fatigue.

• Tamoxifen discontinuation rates run from 17% at two years to 49% at five, according to a population-based cohort study in the British Journal of Cancer.

Nearly half of women prescribed a drug to prevent their cancer from coming back stop taking it before the recommended course is up. Not because they’re careless. Because the side effects are debilitating and the support is inadequate.

Unseen Cardiovascular Risks

My cardiologist isn’t related to the chemo or the endocrine therapy. She’s there because I had my ovaries removed at 38 for genetic reasons.

A 2024 study in JACC: CardioOncology found that premenopausal women treated with aromatase inhibitors and ovarian suppression carry a two-fold higher risk of cardiovascular disease than those on tamoxifen alone. Within that same paper, data from the Nurses’ Health Study show that women who undergo bilateral oophorectomy without estrogen replacement carry a 2.35-fold higher risk of cardiovascular events.

The system that recommended my surgery at 38 didn’t add a cardiologist to my chart at the same time. It added one in my 50s, after it was too late to stop the problem and we were faced with containment options.

Standing in the In-Between

This is what done looks like from the inside. A drug that makes some women’s joints ache so badly they can’t keep taking it. The notification for the next surveillance scan. The new specialists you didn’t have before the diagnosis. The night the new sensation in your shoulder keeps you up because you’re not sure if it’s the pillow or the rest of your life.

Now scroll Reddit. You’ve read these threads. Maybe you’ve posted in them. The one I keep thinking about pulled 143 upvotes and 115 comments under the title “In a weird in-between. What do I say to people now?” No physician in the thread. Just survivors trading the answers their care teams never wrote down.

• What do I say when someone tells me yay, I’m done.

• How do I tell my husband I’m not the same person.

• When does the fear go away. Does it.

Every line is somebody trying to put words to a feeling they were told they shouldn’t be having. They’re not asking the question because they’re broken. They’re asking because the medical system declared them done while their calendars said otherwise, and nobody handed them the chapter they’re standing in. So they’re writing it. Comment by comment.

I had the resources to write my version. A husband who could travel. Financial stability. Friends who showed up. A family history that, perversely, had prepared me to navigate the system. Not everyone does. The 2 a.m. Reddit posts make that clear.

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Disruption, Not Destruction

What everyone has access to is the smallest version of the moves I made.

Halfway through chemo, when the tumor was responding, Neal and I sat down and asked each other what we could do that might be fun after active treatment. We planned it during treatment.

We took a six-week trip that summer, partly to watch our son play summer collegiate baseball in upstate New York, partly to visit friends in Corsica, partly to bike in France. I named the trip the Fuck Cancer World Tour. The naming was the point. I named the annual abdominal CT scan, too. I called myself the winner of it, because abdominal cancers are hard to detect, and I’m getting yearly imaging that most people don’t get which can catch a tumor when it’s small and treatable. Disruption, not destruction.

You don’t need a world tour. You need one thing on one day that you chose for yourself. A book that costs more than you’d normally spend. A call to someone you haven’t talked to in a year. Five seconds at the kitchen window watching a hummingbird. The act of marking a day as something other than a day you endured.

My grandmother was 66 when her cancer metastasized. Three years later she and my grandfather were approaching their 50th wedding anniversary, and she wanted the party they’d been planning. The whole family flew to Florida. She put on a dress and danced with my grandfather, who had been dancing with her since the 1940s. A few weeks later she sat us all down and gave us things she wanted us to have. She handed me her tennis racket. I said, “Grandma, you’re going to need this.” She said, “Jojo, if I can play tennis again, your grandfather will buy me a new racket.”

She died three weeks after that, at 69. It’s 2026. The racket is still in my house.

She didn’t wait until things were good enough to celebrate. She celebrated because celebrating was the point.

WHAT YOU CAN DO THIS WEEK:

1. Ask your oncologist for a survivorship care plan, by name. If they don’t offer one, the National Coalition for Cancer Survivorship has a template you can bring to the appointment. You should know what surveillance you need, when, and who is coordinating among your specialists. This is not optional information.

2. If you’re on hormone therapy and the side effects are affecting your life, ask for a medication review. There are multiple options inside the endocrine therapy class. Dosing adjustments (see Dr. Andrea De Censi’s episode) and side-effect management strategies exist. You don’t have to white-knuckle through five more years.

3. Name one thing this week you are marking, not enduring. A meal. A walk. A call. A purchase. The size doesn’t matter. The act of choosing it does.

The 115 commenters on that Reddit thread aren’t asking now what because they’re broken. They’re asking because somebody handed them a word and forgot to hand them the calendar that goes with it.

The calendar is yours. Write the chapter.

SOURCES CITED:

• National Coalition for Cancer Survivorship. 2024 State of Cancer Survivorship Survey. https://canceradvocacy.org/2024-state-of-cancer-survivorship-survey/

• Maass SWMC, et al. “Long-term psychological distress in breast cancer survivors and their matched controls.” BMC Cancer, 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8479978/

• Fabbri MA, et al. “Adherence to Aromatase Inhibitor Therapy in Breast Cancer.” The Breast Journal, 2025. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12721728/

• Hershman DL, et al. “Use of tamoxifen and aromatase inhibitors in a large population-based cohort.” British Journal of Cancer, 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101914/

• City of Hope. Dealing With Emotions After Cancer Treatment. https://www.cityofhope.org/patients/survivorship/emotional-health-after-cancer-treatment

• Cardiovascular Disease With Hormone Therapy and Ovarian Suppression in Premenopausal Breast Cancer Survivors. JACC: CardioOncology, 2024. https://www.jacc.org/doi/10.1016/j.jaccao.2024.08.006

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One version of the post pulled 143 upvotes and 115 comments on r/cancer. The title: “In a weird in-between. What do I say to people now?” Not a single physician answered. The thread is just survivors, trading the answers nobody ever wrote down for them.

Three years ago this month, an oncology nurse called and used the words I’d been hoping for. Pathologically complete response. No cancer in any of the tissue they removed. Done.

Except I wasn’t.

Immunotherapy ran another nine months. Revision surgery was on the books for July. They’d found something on my kidneys during the mastectomy, so I had a urologist. The prophylactic salpingo-oophorectomy I had at 38 had left its marks on my heart, so I had a cardiologist. The incidental lipomas in my abdomen meant I’d be the winner of an annual abdominal CT scan for the rest of my life.

The word done was on the chart. My calendar certainly didn’t look clear.

And I’m one of the easier cases.

Most women with hormone-receptor-positive breast cancer are looking at five to ten years on tamoxifen or an aromatase inhibitor after the tumor is gone.

• A 2025 study in The Breast Journal found that 87% of women on aromatase inhibitors experience side effects.

• 86% have musculoskeletal symptoms—joint pain bad enough that opening a jar feels like a workout.

• About half of them stop the drug before the recommended course is up, according to the British Journal of Cancer.

These are the women being told yay, you’re done. They learn to say good at the dinner party because the real answer takes forty minutes and nobody wants to hear it. They can’t say I have cancer anymore. They can’t say I had cancer yet, either. They stand in the gap and google the new ache at 2 a.m. They write the Reddit post at 2 a.m., too, because there’s nobody in their real life who still gets it.

Everyone moved on. They didn’t get to.

Living Inside the In-Between

I recorded a solo episode about the strange in-between that medicine has known about for twenty years and still does almost nothing to prepare patients for. The well-meaning friends. The fear of recurrence that lives in every new ache. And three specific moves I made that took a year I should have spent enduring and made it feel like the opposite.

The full episode is out now. The companion piece for subscribers goes into what cancer research has actually found about the post-treatment void, why your oncologist probably hasn’t given you a survivorship care plan, and the three moves I use to live inside the in-between instead of bracing through it.

If you know someone stuck in the gap, send this their way. Sometimes the thing that helps is knowing somebody else has been standing in that exact spot.

What she didn’t know at the time was that the lifts were doing more than building muscle. They were improving my odds on many dimensions.

A Friendship of Diagnostics

Jessica Rosenbaum is my best friend for 25 years. A licensed clinical psychologist. I met her in a parenting prep class twenty-some years ago, when we were both seven months pregnant with our first kids. We just clicked. We’ve been each other’s person ever since.

When I was diagnosed with triple-negative breast cancer, she didn’t ask what I needed. She claimed her role.

• She set up the meal coordination, but didn’t cook.

• She built the driver sign-up, but didn’t drive me to chemo.

• She set up the CaringBridge, but mostly laughed as I wrote about being the secret shopper at my cancer center.

She’d been watching me long enough to know the patient ends up doing logistics weather-watching for everyone else’s well-meaning help. So she became the air traffic controller. She kept her workout slot but adjusted the time and location to help me. The workouts, it turned out, were critical.

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I didn’t know she was watching me. Or rather, I knew, the way you know any friend who loves you keeps an eye on you. I didn’t know I was being read. The grip going slack would tell her. The setup rituals, shortening or lengthening, would tell her. The exact pace of the breath between reps. She was running diagnostics three mornings a week, and the cover story was that we were just getting our workouts in.

It took me about a year after treatment to fully understand what had happened. There’s something deeply tender about being known well enough that someone can read you under a heavy bar. There’s also something destabilizing about it. The protection of I’m fine was off the menu. You couldn’t perform fine for the person standing six feet away, watching your glutes.

The Research and the Reality

The research suggests this is a feature, not a bug.

• Social Support: The largest meta-analysis to date on social support and cancer outcomes, which summarized 87 studies by Pinquart and Duberstein, found that high levels of perceived social support were associated with a 25% reduction in mortality risk among cancer patients. Larger social networks contributed another 20%.

• Exercise: The 2019 ACSM consensus guidelines on exercise for cancer survivors, drawing on more than 2,500 randomized controlled trials, confirm that exercise during treatment is among the most evidence-based interventions a patient can use to manage side effects and improve outcomes.

My doctor cleared me to keep lifting. The lifting turned out to be therapy and surveillance in the same hour.

Cancer caregivers themselves bear measurable costs. The National Cancer Institute reports significant rates of chronic depressive symptoms among caregivers, and a recent survey found that more than 75% reported that caregiving had negatively affected their own well-being.

Jessica’s quiet response, before she ever said it out loud to me, was to gather her own people. She told her own friends (informed them, didn’t ask) that they were her people during this time. There was a network around me, and there was a network around her. She built both.

That’s the part of this kind of support I think most of us underestimate. The architecture has to include the architect.

Building Community Before You Need It

The conventional advice to ask what someone needs assumes the person in crisis is the right focus. They’re not. It’s the people with enduring relationships who can identify what is needed and when. A relationship that goes back 25 years has stored an enormous amount of information about what works, what doesn’t, what’s said, what isn’t, and where the soft spots are. Jessica wasn’t guessing when she chose the workout role or the logistics coordinator. She was deploying the dividend of two decades of paid attention.

By the time you need help, the relationships that will help you have already been mostly built or mostly not. That’s an uncomfortable implication because it pushes the work of being well supported earlier than we like to think about it. What does it actually take to be ready when a friend gets the call? Most of it happens before. Jessica’s own answer, when I asked her at the end of our conversation what she’d tell someone facing cancer or any other curveball, was straightforward: build community before you need it. From the get-go. Not because you might need help, but because it makes your life happier, healthier, and purposeful.

Pick someone you love. Not the obvious one. The second person you thought of. Do you know them well enough to design their role if they got the call? Do they know yours?

The Bye-Bye Boobies Party did happen, eventually. Four months later, the night before the same surgery, this time with a different prognosis. We wore T-shirts. We laughed. I was clinically cancer-free. The attendees were old and new friends. Build community before you need it and never stop building it.

I remember thinking that night that the party was almost beside the point. The point was that people showed up to laugh, support me, and be exactly what they knew I needed them to be.

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The party was a celebration of eliminating the risk that stalked me for 40 years. My preventative surgery was scheduled for the next morning, and since I’d decided that since my breasts had to go after a lifetime of good service, my sister suggested that they deserved a sendoff. We called it the Bye-Bye Boobies Party.

Then a routine pre-op scan showed something. More scans. A core needle biopsy. Then the call from my surgeon with bad news. Then, several hours of telling the right people in the right order while also seeking an oncologist. And somewhere in there, two hundred friends were still planning to show up that night for a party we couldn’t have.

The Order of Operations

So Jessica wrote the email. No explanation. Because the order of operations meant my husband had to know before my friends did, and I wanted to tell him in person. Any version of “why” could leak to the wrong place.

That email is the whole episode in miniature. The thing nobody tells you about being well-supported through a crisis is this:

The deepest support comes from someone who’s knows you well enough to do the impossible without instructions.

A Different Kind of Support

Jessica has been my best friend for 25 years. A licensed clinical psychologist. When I found out I had breast cancer, she assumed a role that only she could fill.

• The Commitment: Lifting weights with me, three mornings a week, in my home gym.

• The Reason: Not because we needed the workouts. Because she needed to see how I was actually doing.

• The Truth: The one place a person can’t fake an answer is under a heavy bar.

We talk about the cancelled party, the workouts, a THC-loopy walk through Burlingame that ended in bagels, and the surgeon Jessica described as “an artist” before I’d ever met her. And we get into something I think a lot of us have wrong about showing up for someone in trouble.

If you’ve ever wondered whether you’re doing it right when a friend is in crisis, or whether anyone’s doing it right for you, I think you’ll find something here.

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For paid subscribers: This week’s deep piece walks through Jessica’s actual playbook, and the research on why designed support correlates with measurably better outcomes.

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So she did what most patients don’t know they can do. While the optimal way for patients and research is to participate in a randomized clinical trial, she was not eligible for any trials. Her community oncologist could not order it due to limitations imposed by the health system's policies. Amy was able to get circulating tumor (ct) DNA tests through a researcher she works with. ctDNA is a blood test that may detect cancer recurrence months before imaging would show it.

She’s not the only patient who’s had to do that.

I’ve been getting questions from survivors for the past year about Signatera, Oncodetect, FoundationOne, and a wave of other new tests that hit the market faster than most community and even academic oncology practices can keep up with. At the cancer genomics conference at the University of Chicago last week, I saw the next wave coming. Science isn’t standing still.

For the record, I haven’t taken any of these tests. Three years out from triple-negative breast cancer, my statistical recurrence rate is genuinely low, and I have exams every six months. The immunotherapy I had as part of my treatment continues to do its work. That’s the right call for me.

It might be the wrong call for someone else.

That’s the whole argument of this week’s episode of Kicking Cancer’s Ass. Not whether ctDNA testing is good or bad; but whether the patient has the opportunity to decide.

Even the best oncologists in the US don’t offer ctDNA tests because they have not been validated for clinical utility in a clinical trial. That means that test results are not linked to a change in therapy that could prolong life. The patient may want the test anyway, but they need to be informed about what it might and might not provide. Many doctors are concerned that an ambiguous and non-actionable result will create more stress for their patient. Amy has a different perspective. She’d interviewed a fellow advocate who told her: we want to know everything we can know. Tell us straight, be transparent, and then let us decide.

Two things to take from this conversation:

The science around ctDNA is moving fast and it’s molecularly-specific. What’s true for one cancer type this year may not be true for another. Please ask your oncologist whether they stay current with the latest in the molecular basis of your disease. If you can’t get a clear answer, get a second opinion from someone who does - you may need to use Telehealth from a cancer center such as MD Anderson or Memorial Sloane Kettering.

The tests are imperfect, and that’s not a reason to withhold them — it’s a reason for honest informed consent. Not every tumor sheds DNA into the bloodstream. Some cancers are non-shedders, so a negative result might not mean what you think. A patient who knows all of that is in a better position than a patient who isn’t told the test exists.

The subscriber article this week goes deeper on the SERENA-6 trial — the phase 3 study that just changed what “clinical utility” means for ctDNA for metastatic disease and response to treatment — and on the questions to bring to your next oncology appointment.

🎧 New episode out now: Apple | Spotify | YouTube

📰 Subscriber article: link

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Some oncologists believe the average cancer patient can’t handle ambiguous information. They believe that when faced with a test result that says something is here but we’re not sure what it means or what to do about it, most patients will spiral. They’ll demand action when no action is warranted. They’ll lose sleep, lose function, lose perspective. The kind thing, the protective thing, is to not order the test in the first place.

I understand the impulse. Amy L. Delson, AIA, this week’s guest on Kicking Cancer’s Ass, knows it better than most. She’s been treated for cancer four times, and she’s in active treatment right now.

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But there is a gap in the argument, and Amy was the one who showed me where. She’d interviewed a fellow breast cancer advocate who told her: we want to know everything we can know. We have young children at home, we have our jobs, but you have to really explain it to us in a way we can understand. And then let us decide.

Your Blood Shows Cancer Is Back 8 Months Before a Scan Does (Episode #45): Apple | Spotify | YouTube | Everywhere

What ctDNA actually is, in plain terms

Circulating tumor DNA is exactly what it sounds like. Cancer cells release (shed) fragments of ctDNA into the blood stream. That DNA can be detected through a blood draw and matched against either a tumor sample or a panel of known cancer mutations. If the test finds tumor DNA in your blood, it is called “ctDNA positive.” If it doesn’t, it is called undectable ctDNA or “ctDNA negative.”

What is known is that persistent ctDNA positivity is prognostic for a poor outcome. However, personalized therapy interventions may improve outcomes, assuming we know what therapy to use. We know that persistent ctDNA+ is not good - but we don’t know what to do about it, yet. Tests market right now include Signatera, Oncodetect, Personalis, Guardant, and FoundationOne, with new entrants arriving regularly. At the cancer genomics conference at the University of Chicago in April 2026, I saw the next wave coming.

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Bachi is blind from cataracts now, a little deaf, otherwise fine. He’d been waiting all morning for his walk. Jeffrey was busy. Three projects, a Fitbit already past its goal, plenty of excuses to skip it.

Then he remembered something he’d thought about during the worst stretch of his hospital stay — when he wasn’t sure he was leaving the room he was in. The thing that broke him open wasn’t whether he’d see his wife or his brother again. He’d figured out how to say goodbye to them by phone. It was the dog. He realized he was never going to get to say goodbye to the dog.

So Jeffrey laced up and walked Bachi.

He used to walk a 16-to-18-minute mile. Post-treatment, on his own, he walks 21. With Bachi — blind, careful, prancing along on his little springy senior-dog steps — he walks at a 26-minute-and-40-second pace. Almost half an hour for under a mile.

Jeffrey told me it was one of the best things he’s ever done in his life.

He’s been to Rome, Zurich, Jerusalem, Istanbul. He wrote a New York Times bestseller. He took a company public. The walk with the dog is on the same list — maybe at the top of it.

Jeffrey has been diagnosed with cancer three times, including lymphoma that crossed the blood-brain barrier and put a tumor in his head that doctors initially refused to give him a prognosis on. He’s cancer-free now. We’ve known each other for years through mutual friends, and I had no idea any of this was happening until he reached out and asked to come on the podcast and tell the story. That’s what these conversations are for. Someone shares theirs, and somebody else who’s in the middle of their own hears that there’s a way through.

Two things to take from his story this week:

Ask the right question. When Jeffrey was scared in the hospital, he didn’t ask himself, “Will I die?” He asked, “What will I never see again? Who will I never see again?” That’s really what people are thinking when they’re facing their mortality. It’s the cancer filter that clarifies what’s really important.

Match someone else’s pace on purpose. Walk slower than you can. Notice what happens.

He looked at them and said: Why aren’t you?

He’d been thinking it for months — watching healthy people congratulate him for a perspective they assumed was reserved for the nearly-dead — and one afternoon he just said it back to them. You have grandkids. You have all of this. What makes our next minute different from yours?

One of the two friends came back to Jeffrey weeks later and said the question had rocked his world.

Jeffrey had given himself permission, after working with his therapist, to stop filtering. So here it is, on the record for the first time: a three-time cancer survivor saying that the well are the ones squandering their lives, and the cancer patients are not the ones who need to be told to appreciate what they have.

The research backs him up — but in a more uncomfortable way than most readers will expect.

What the data actually shows

Post-traumatic growth — the term researchers use for the lasting positive psychological changes that follow a crisis — isn’t rare in cancer survivors. A 2024 longitudinal study of 1,316 cancer survivors found growth was measurable four years after diagnosis across five dimensions: appreciation of life, relationships, personal strengths, new possibilities, and spiritual change. A 2025 meta-analysis of breast cancer survivors put it more strongly: post-traumatic growth is “almost ubiquitous” in this population.

The piece most healthy people miss: survivors aren’t growing despite the trauma. They’re growing through what researchers call meaning-making — actively reframing the experience, asking what it’s for, deciding what to do with the time. A 2024 scoping review in Psycho-Oncology found the survivors who actively engage in cognitive processing of their illness — deliberate rumination, positive reframing, finding meaning — show greater growth than those who don’t.

The flip side is the part that should bother the well: there’s a robust body of research on what’s called the hedonic treadmill. Healthy people adapt to good fortune within months. Lottery winners. Newlyweds. People who land the promotion. Within a year or two, baseline life satisfaction returns. Sonja Lyubomirsky’s Hedonic Adaptation Prevention model is built on the observation that the average person, untouched by crisis, will reliably take their good life for granted within months of acquiring it.

The structural picture: cancer patients are forced into the meaning-making cancer requires, and they grow. The well are not forced into anything, and they adapt. Jeffrey’s question to his friends wasn’t unfair. It was statistically accurate.

What Jeffrey did differently

He stopped ranking his life against other people’s highlight reels. Jeffrey wrote a New York Times bestseller during the same stretch his company was going through an IPO. The IPO didn’t go well. The bestseller call came from his agent the day before publication. He was on the road, exhausted, miserable. What should have been one of the best moments was not, he said. The walk with his blind 13-year-old dog, post-treatment, was. He stopped comparing his life to other people’s highlight reels and started comparing his Tuesday afternoon to his other Tuesday afternoons.

He understood his father from the inside. Jeffrey’s father had mantle cell lymphoma. Doctors gave him under six months. He lived six and a half years. Four or five years in, Jeffrey asked his father if he had any regrets. His father laughed. No. None. Jeffrey thought he understood it at the time. He didn’t. It took his own diagnosis to realize what his father was actually saying — that the Sabbath meal, the granddaughter on his lap, the ordinary afternoons were the life. The big things weren’t separate from the small ones. The big things were the small ones.

He asked the question backwards. When Jeffrey was scared in the hospital, he didn’t ask “will I die?” He asked “what will I never see again? Who will I never see again?” Same question with a different center of gravity. The first asks what’s worth fearing. The second asks what’s worth protecting. He landed on the dog. Then, months later, the dog laid his head on Jeffrey’s foot one afternoon, and Jeffrey understood what the question was for.

What to do with this

Three things, if you’re in treatment, post-treatment, or watching someone you love go through it:

1. Stop waiting for the perspective shift. It isn’t the cancer that creates it. It’s the meaning-making. You can start that process today, regardless of your diagnosis.

2. Ask the question backwards. Not “will I die?” Try “what will I never see again? Who will I never see again?” That’s the cancer filter — and it points at what’s actually worth protecting.

3. If healthy people in your life tell you how grateful you must be, you don’t have to perform it. You’re allowed to ask them the question Jeffrey asked. Most won’t be ready for it. One or two will come back to you weeks later and tell you it changed something.

Jeffrey said the gift — and he flinched at the word, because he knows how cynical it sounds — is that he learned, three cancers in, that his next minute and his friends’ next minute are identical. It’s just a choice.

He’s right. The literature is on his side. And he was kind enough — and brave enough — to say it out loud for the first time. Jeffrey and I had known each other for years before any of this happened. He didn’t tell me he was sick. He waited until he was through it, then reached out because he wanted his story somewhere it might help someone else find their way through. That’s why this podcast exists. One person’s story becomes a model for the next person who needs one.

Wait. Is that a hormone? I’m not supposed to take hormones.

Fair question. We should actually be asking: why is the word “hormone” doing so much work in cancer care, and why does nobody stop to explain that it means several completely different things?

Short answer on ulipristal acetate: No, it isn’t a hormone. It’s a blocker. It sits in the parking spot, so your own progesterone can’t park there. Your body keeps making progesterone at the levels it was always going to make. The drug just stops that progesterone from delivering its message to certain tissues. That’s a different category of medicine than “taking hormones”.

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I figured this out the hard way, as most of us do.

When I had my ovaries removed at 38 because of my BRCA1 mutation, I crashed into menopause on a Tuesday. I was immediately put on hormone replacement therapy — progesterone and testosterone, no estrogen, because the family history made estrogen too risky. That regimen was my norm for 14 years. Right up until the breast cancer diagnosis, when all of it stopped.

For two years of treatment and early recovery, I managed hot flashes with non-hormonal medication. As we approached year three, I started the conversation with my team about whether HRT could come back — not just for hot flashes, but for bone density, libido, and cardiovascular protection. That conversation is still open. It will be open for a while. And the reason it’s complicated is the same reason this whole topic is complicated: “hormone” isn’t a single category.

So here’s the framework I wish somebody had handed me on day one.

Supplements add. Traditional HRT, birth control pills, insulin, thyroid medication, testosterone — these give your body more of something it isn’t making enough of, or override what it is. When your doctor says “no hormones during treatment,” this is what they usually mean: don’t add estrogen to a body that just finished treating an estrogen-fed tumor.

GLP-1 drugs — Ozempic, Wegovy, Mounjaro — belong in this bucket too. They mimic a hormone your gut already makes. That’s worth knowing, because the conversation about GLP-1s and cancer risk is still being written, and survivors are making decisions about them right now with incomplete information. If your oncologist tells you to avoid hormones, ask specifically whether GLP-1s are included, because they are a hormone, even though nobody calls them that in the pharmacy.

Blockers subtract. Tamoxifen, aromatase inhibitors, ulipristal acetate — these don’t add anything. They either stop your body from making a hormone (aromatase inhibitors shut down estrogen production in post-menopausal tissue) or they occupy the receptor so the hormone can’t land (tamoxifen for estrogen, ulipristal for progesterone). Some do both in different tissues at the same time, which is why ulipristal is technically a modulator — blocker in the breast, partial stand-in elsewhere. Same molecule, different jobs depending on which tissue it shows up in.

Then there’s everything else your endocrine system does. Cortisol. Insulin. Thyroid. Oxytocin. Most of these have nothing to do with your cancer. But when a survivor hears the word “hormone” attached to any of them, the alarm goes off.

That alarm is not your fault. It’s the system’s fault for using one word to mean four or five things.

I’m not a doctor. I can’t tell you whether ulipristal acetate belongs in your prevention conversation (the research was just published in December, and it’s early days), whether a GLP-1 is right for your body, or what the HRT question looks like on the other side of your treatment. Those are conversations for your team.

What I can tell you is this: the next time somebody tells you a drug is or isn’t a hormone, ask them a better question. Does it add, block, or modulate? Which hormone? And in which tissue?

You have the right to a real answer.

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Here is what Dr. Sacha Howell told me at the Rise Up conference in San Francisco that I want every person with a daughter, niece, sister, wife, or female friend to know: the first genetic abnormalities that eventually lead to breast cancer appear in late adolescence. Not when the tumor shows up on a mammogram. Not in her thirties, when she finds the lump. In her teens. Quietly. Invisibly. Driven by the hormones that flood a young woman’s body every month from the time she gets her first period.

The cancer we diagnose at forty has, in a real sense, been twenty years in the making.

That changes what prevention has to mean. Prevention isn’t a middle-aged woman’s problem. It’s a life-course problem. And until very recently, the medicine for it has been stuck.

The estrogen orthodoxy — and the cancers it can’t touch

For four decades, breast cancer prevention has been organized around one hormone: estrogen.

• Tamoxifen, a selective estrogen receptor modulator, was approved as a preventive agent in 1998.

• Aromatase inhibitors, which block estrogen production itself, followed.

Both reduce estrogen’s effect on breast tissue. Both have been the only pharmacological prevention options available to high-risk women for an entire generation.

Here’s the catch: they only work on cancers that are driven by estrogen.

Triple-negative breast cancer (TNBC) isn’t. TNBC is the most aggressive subtype, the one most likely to recur in the first few years after diagnosis, and the one BRCA1 carriers are statistically most likely to develop at a younger age. For TNBC risk, tamoxifen does nothing. Aromatase inhibitors do nothing. The only options have been surgical — prophylactic mastectomy and oophorectomy — or active surveillance with no pharmacological intervention to actually lower the underlying risk.

Two-thirds of women who develop breast cancer have no family history. The Wisdom Study has shown that polygenic risk scoring can identify many of those women before cancer appears, opening the door to anti-estrogen prevention for those whose risk is hormone-receptor-driven. That’s real progress — and it’s still incomplete. For the women at risk is for triple-negative disease, no prevention drug has existed. Until now.

The Manchester Breast Centre’s discovery

Between 2016 and 2019, Dr. Howell’s team at the Manchester Breast Centre ran the Breast Cancer Anti-Progestin Prevention Study — BC-APPS1. Twenty-four premenopausal women with a strong family history of breast cancer took ulipristal acetate (UPA), 10 mg daily, for twelve weeks.

The results, published in Nature in November 2025 (Simões et al., DOI: 10.1038/s41586-025-09684-7), are the most rigorous evidence to date that anti-progestins can modify the precursor biology of breast cancer:

• Cellular: Ki67 staining (a standard proliferation marker) dropped significantly. Luminal progenitor cells — the putative cells of origin for triple-negative breast cancer — decreased in proportion, proliferation, and colony-forming capacity.

• Structural: Atomic force microscopy showed that the breast tissue became less stiff. Collagen VI, a key extracellular matrix protein associated with tumor-supportive architecture, was dramatically downregulated.

• Imaging: MRI showed reduced fibroglandular volume, which maps onto reduced breast density, one of the most consistent independent risk factors for breast cancer.

• Response profile: Women with dense breasts at baseline responded most strongly.

In plain English: three months of a drug already on U.S. pharmacy shelves made these women’s breasts measurably less hospitable to cancer — including the kind of cancer no other prevention drug has ever been shown to touch.

Why is this not front page news?

Ulipristal acetate has been prescribed to roughly one million women in Europe for uterine fibroid treatment. Five of those women developed liver failure — a serious outcome, but at a rate of one in 200,000.

The European Medicines Agency suspended the drug. That decision wasn’t unanimous. The agency’s own published assessment documents the internal disagreement: one committee wanted a full ban, another pushed back, and the drug was eventually reinstated for limited fibroid use in Europe. In the U.S., ulipristal acetate remains FDA-approved as Ella, prescribed regularly by OB/GYNs as emergency contraception.

Now compare that one-in-200,000 rate to drugs regulators have not pulled:

1. Statins (prescribed to roughly 40 million Americans) carry documented risks of liver injury and, rarely, rhabdomyolysis.

2. Combined hormonal contraceptives carry blood-clot risks well above the 1-in-200,000 threshold.

3. Baseline breast cancer mortality: In the UK, roughly 30 in 200,000 women in their forties die from breast cancer each year. Thirty times the UPA liver-injury rate.

A narrative review co-authored by Dr. Liberty and colleagues in Contraception in 2025 (Ebersole et al., PMID: 40044021) reached a blunt conclusion: the liver-injury signal was never confirmed, preclinical studies hadn’t predicted it, and access to UPA matters for conditions ranging from emergency contraception to fibroids to — now — breast cancer prevention.

What Dr. Howell hypothesizes next

He believes the path forward isn’t continuous lifelong use. It’s pulses — three-month courses of UPA, spaced across a woman’s reproductive life. Fifteen to twenty years of intermittent treatment could meaningfully reduce the cumulative number of luteal phases a woman experiences.

Fewer cycles means fewer cellular divisions, which means fewer chances for the mutations that begin in adolescence and accumulate, silently, until the day the mammogram catches what’s been growing for decades.

It’s a genuinely new model of prevention — one that treats breast cancer risk the way cardiologists treat cardiovascular risk: long-term, calibrated pharmacological management based on individual risk stratification.

What you can do

• If you’re high-risk (BRCA-positive, strong family history, or a polygenic risk score above threshold), bring the Nature paper to your OB/GYN. High-risk women without cancer don’t have oncologists. The conversation has to start in your gynecologist’s office.

• If you’re in the U.S. and 30 or older with no personal history of breast cancer, enroll in the Wisdom Study. Risk-stratified screening is the infrastructure that prevention drugs need.

• If you have a daughter, a niece, a wife, a friend, or a younger sister, this matters now. Not when she finds a lump. Now.

The mutations start in adolescence. The science is finally beginning to catch up to the biology — and the regulatory framework around it has to catch up too.

The science isn’t waiting. The regulators are.

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For forty years, the answer has been narrow. If you are at risk for estrogren receptive cancers - tamoxifen or aromatase inhibitors. For triple-negative - Prophylactic surgery. And for women at risk of triple-negative breast cancer — the most aggressive form, and the one BRCA1 carriers are most likely to develop young — there has been no pharmacological prevention option at all. Just surgery, or active screening and hope.

Dr. Howell’s team found another possibility.

In November, they published a study in Nature — yes, that Nature — showing that a drug called ulipristal acetate, taken for 12 weeks by 24 premenopausal women with a family history of breast cancer, produced measurable changes in their breast tissue that look a lot like cancer prevention working at the cellular level.

The drug reduced the proliferation of luminal progenitor cells — the cells that turn into aggressive triple-negative breast cancer. It reduced breast tissue density on MRI. It restructured the collagen architecture. It made the tissue less stiff. Every one of those measurements is a known marker of reduced cancer risk.

And here’s where it gets complicated.

Ulipristal acetate is the same active ingredient in Ella, which, as Dr. Abigail Liberty explained on the show last week, has been on U.S. pharmacy shelves for twenty years as emergency contraception.

Your OB/GYN has prescribed it. European regulators paused it two years ago after five women out of nearly a million on the drug developed liver failure.

Five in a million. That’s 0.0005%.

At the same age, the rate of women dying from breast cancer is thirty times higher.

Statins and hormonal contraceptives carry higher complication rates than ulipristal acetate does. Both remain widely prescribed. Nobody is pulling them. Ella is available in the USA.

When I asked Dr. Howell why European regulators applied a stricter standard to a drug that prevents cancer than they do to the drugs millions of women take every day, he didn’t dodge: “We don’t know. We all agree it doesn’t really make sense.”

Two things you can do this week:

1. Listen to the full episode with Dr. Sacha Howell. If you have a family history, if you’re BRCA-positive, or if you’re one of the two-thirds of women who develop breast cancer with no family history at all, this conversation is for you.

2. Bring the Nature paper to your OB/GYN (DOI: 10.1038/s41586-025-09684-7). High-risk women don’t have oncologists yet — that’s the whole point. Prevention lives in your gynecologist’s office, and most gynecologists haven’t seen this study.

The full subscriber article goes deeper — into why progesterone, not estrogen, may be the real driver of triple-negative breast cancer risk, and why anti-progestins may be the first real pharmacological prevention option for the women who have, until now, had none.

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An American oncologist stood up. “Why aren’t we doing this everywhere?”

Dr. Howell, politely, said: “Well, you don’t have this drug in America.”

Dr. Abigail Liberty, an OB/GYN at OHSU who had flown to Manchester from Portland, stood up next.

That moment — one specialist knowing something another specialist didn’t, across a gap that has nothing to do with science and everything to do with how we’ve sorted women’s health into acceptable and unacceptable categories — is what this episode is about.

The Gap Between Two Worlds

Ella is ulipristal acetate, 30mg. It’s been in U.S. pharmacies for twenty years. It works by blocking the progesterone receptor — the same mechanism Dr. Howell found protective against pre-cancerous breast changes in his research.

OB/GYNs know it well. Most oncologists have never encountered it, because it lives in a corner of medicine — emergency contraception, abortion-adjacent — that oncology doesn’t visit.

The reason it hasn’t crossed into breast cancer prevention isn’t safety. The data on liver risk pulled from European fibroid markets show the same statistical rate as common antibiotics that nobody has pulled.

The reason is that we hold medicines associated with women’s reproductive choices to a different standard than medicines associated with conditions we’ve decided are serious.

Fibroids are serious. Breast cancer risk is serious. The drug sitting in the pharmacy is serious.

What You Can Do Today

Ask your doctor — or your daughter’s doctor, or your sister’s doctor — for advanced provision of Ella. A prescription you have on hand before you need it. Studies show it doesn’t change how often people use condoms. It doesn’t change sexual behavior. The only thing it changes is the time between identifying a risk and taking action.

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Listen to the Episode

The full episode with Dr. Abigail Liberty is on Spotify, Apple Podcasts, and YouTube. Search Kicking Cancer’s Ass.

Subscribers: This week’s article goes into the biology — why progesterone may matter more than estrogen in breast cancer risk, what the luteal phase has to do with it, and the full three-layer case for why this drug hasn’t reached the women who need it.

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The science behind why progesterone — not estrogen — may be the overlooked driver of breast cancer risk. The research. The politics. And why the standard applied to this drug was different from the start. This week for subscribers.