Photo by Madison Rosenbaum
When I was diagnosed with metastatic breast cancer, one of the first things someone said to me was, “Oh, you’re so young! At least you'll bounce back faster.” As if youth were a cancer repellent — SPF for rogue cells.
That phrase, “At least”, kept showing up, in every flavor — sympathy, awe, relief.
“At least it wasn’t worse!" As if stage IV wasn't the worst it could be before dying.
"At least it’ll grow back!" As if losing your hair (and your eyebrows, and your lashes) isn't a big deal.
“At least you have support!” As if I didn't watch people exit one-by-one from my life, unable to bear the emotional load of my illness.
“At least you’re alive!” As if I should send cancer a thank you card for not killing me … yet.
The thing about “at least” is, it’s intended as a life raft, a way to keep you afloat while cancer threatens to pull you under, a way to keep you from drowning in fear and uncertainty. More often, though, it feels like slapping a Post-it note over a gaping wound: "There! Fixed it!"
The “at leasts” pile up, and you start feeling like you’re expected to be the mascot of gratitude — always smiling and positive, just happy to be alive! Never mind that your body feels like a junk drawer full of broken parts, you put on the mask, say “Yes, thank you. At least there is that,” and hope no one notices the cracks in your grin.
The thing about masks is: you wear them too long, you suffocate.
Make no mistake! I am deeply, fiercely, desperately grateful to still be here. I feel it when I watch little birds eat the sunflowers in my front yard, when I bake endless loaves of focaccia for my friends, when I quench my skin in unexpected rain. But gratitude does not cancel out grief. It is not morphine. It does not ease the aching bones, or quell the hot flashes. It does not return my sovereignty over my body, or erase the surgery scars.
Gratitude does not change the dire truth: One day, this disease will likely kill me.
Sometimes gratitude is a mask I wear so the world doesn’t run screaming from my reality.
The reality of cancer is messy. It’s ugly-crying in the shower when you realize you’ll never breastfeed children you don’t even have. It’s joints creaking like a haunted farmhouse, at the ripe old age of 33. It’s choking down yet another chalky, despair-flavored pill and calling it ‘treatment’. It’s mapping your life around scan days and monthly blood draws, and being paralysed by anxiety for the following 24 hours waiting for results.
If I admit any of this out loud, I feel the silent judgment: Is she grateful enough? As if survival comes with a gratitude quota.
I am grateful, but I am also angry.
I am grateful, but I am also tired.
I am grateful, but I am also scared.
These things cohabit in my chest like roommates arguing over thermostat settings, and honestly, some days, the rage shouts louder than my gratitude. I’m angry at the time cancer has stolen from me, that my body most likely cannot give me children. I’m angry that my body is both a miracle of survival and a ticking time bomb. I’m angry that my vocabulary includes things like ‘neutropenia’ and ‘osteonecrosis of the jaw’ when I should be stumbling through the pronunciation of obscure wines on a bar menu.
However, rage may own the apartment, but life is not easy to evict.
The woman who screams in her car after a stomach injection also sings on the freeway home. The body that aches with side effects also dances barefoot in the kitchen. The heart which fears recurrence never stops wanting more, even when wanting feels dangerous.
The cruelest part of “at least” is the implication that those living with cancer should be content with survival; that we should not grieve what cancer took because we are, after all, still here.
But I do grieve. I will always grieve. And that grief does not cancel my gratitude.
This month, pink ribbons will adorn storefronts and social media posts, and the word “awareness” will scatter through the air like confetti. However, October 13, Metastatic Breast Cancer Awareness Day, doesn’t get the same spotlight, despite the fact that survivorship isn’t guaranteed. Stage IV isn’t the ‘bad luck’ exception. It’s the lived reality of too many of us — early detection saves some lives, but it doesn’t save every life.
Metastatic breast cancer is initially located in the breast before metastasizing (spreading) to other areas of the body. According to the Breast Cancer Research Foundation:
Metastasis occurs when breast cancer cells break away from the original tumor or nearby lymph nodes (found under the arm, inside the breast, and near the collarbone). The breast tumor cells then enter the bloodstream or lymphatic system, travel to other organs, and begin to grow. Doctors most commonly find metastatic breast cancer in the bones, lungs, liver, and / or brain.
Metastatic breast cancer is a paradox: treatable (for some) but incurable — somewhat survivable without survivorship. As of 2025, an estimated 200,000 women in the U.S. are living with metastatic breast cancer (JNCI Cancer Spectrum: Volume 5, Issue 4). The five-year survival rate is only 31.9%. Despite these numbers, only 3 – 5% of research funding is dedicated to understanding stage IV disease, how metastasis happens, and how to save the people living with it.
Even those numbers don’t fully explain the paradox of living with metastatic breast cancer, and here’s what I wish I could say out loud:
I wish cancer had never touched me.
I wish I didn’t know what it feels like to live in a body that betrayed me.
I wish I didn’t spend every scan day rehearsing how to hold my breath.
I wish I could say “everything happens for a reason” and believe it.
The truth is, sometimes, life is just fucked. My gratitude coexists with rage. My love coexists with grief. My hope coexists with fear. None of those things cancel each other out and no “at least” statement can make me pretend otherwise.
So if you hear me say, “I’m fine” or “I feel lucky” or “I’m grateful”, know that those words are true, but they’re not the whole story. Sometimes gratitude is a mask. Sometimes it’s armor. Sometimes it’s the thing I say to make both of us feel better.
Underneath it all, I am a woman learning to live in the paradox: thriving and grieving at the same time.
Madison Rosenbaum is a 33-year-old stage IV metastatic breast cancer thriver. You can follow her journey at madisonhatescancer.com or on Instagram: captainmadisonx
