Felicia Mitchell, retired from college teaching, is a poet and writer who makes her home in southwestern Virginia. She is a survivor of stage 2b HER2-positive breast cancer diagnosed in 2010. Website: 

Felicia Mitchell

Felicia Mitchell is a survivor of stage 2b HER2-positive breast cancer diagnosed in 2010.

Catch up on all of Felicia's blogs here!

When I was undergoing treatment for breast cancer, hiking helped me. A month after my mastectomy, for example, I climbed Mt. Rogers, the highest mountain in Virginia, with a group of friends. I keep a photo of us in that autumn splendor on the mantel.

The hike to Mt. Rogers was feasible as I had begun hiking in earnest, solo and with friends, when I became my mother’s caregiver. Having time to myself helped me to juggle multiple roles. Just as much of my social life began to center around hiking, my interior life needed the trails for contemplative times in a natural setting.

After starting chemo, though, I knew I would have less energy to climb mountains. I made do with shorter hikes and casual walks. I also promised I would not walk alone and honored that promise until I finished the first phase of treatment. Since side effects of chemo included some neuropathy, fatigue and a crooked stride just after an infusion, walking through months of treatment took some getting used to mentally. Still, I continued to get outside as best I could.

My continued association with the natural world was bolstered by reassurance early on from my chemo oncologist. One of my favorite entries in my cancer journal not long after starting chemo says, “Met with Dr. D.: hiking is good. Blood work & kidney function good.” The journal otherwise contains meticulous notes about meetings with doctors, visits to the infusion center, or radiation. I wrote down advice such as “eat some red meat” or “let us know if you can’t get out of bed.” “Hiking is good” was in good company.

On the same day I wrote “hiking is good” in the cancer journal, I wrote this in my nightly journal: “Big chemo. Sort of wiped me out, but did go to Osaka’s with Guy [my son] and eat veg. sushi rolls and made baked chicken for supper. We had fun laughing. I was punchy and giggling again.” I could not walk in a straight line after chemo that day. The contrast between how I walked just sometimes and how I walked when I had enough energy to get out for a hike was dramatic. I needed that contrast to remind myself what I had in me.

In that nightly journal, where I continued to talk about hikes, I mention birds, including a beautiful hawk on a post. I describe a special afternoon at Fairy Stone State Park in Virginia. Comments on wildflowers and the camaraderie of the trail appear now and then. It was not always easy, but it was always beautiful, as I note in this entry: “Long walk off Blue Ridge Parkway. Not a lot of energy.” Energy waxed and waned. I especially love this entry about a good day: “Six-mile hike on AT — Bunny’s birthday! Made cardamom cake with rose petal buttercream frosting.”

I will be honest that I was emotionally and physically worn out at the end of treatment, a time when I was too often in tears. Just two days after I felt I had, according to my journal, “hit the bottom,” I tried a hike to cheer myself up. “Drove to Boone to Turchin Gallery and to hike but got tired and came home.” Fortunately, after the bottom fell out that week, I rallied with the help of friends, my son, and the great outdoors. My notes remind me: “Hiked at Backbone Rock while Guy ran — saw a Great Blue Heron on the way out.”

For some of us, there is nothing like being outdoors, infused by nature, while healing from cancer or the weight of the world. Hiking sustained me during 14 months of cancer treatment and continues to keep me happy.

This piece reflects the author’s personal experience and perspective. For medical advice, please consult your health care provider.

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Articles

Hiking played a crucial role in maintaining physical and emotional well-being during breast cancer treatment. Despite the challenges of chemotherapy, shorter hikes and walks provided a sense of normalcy and connection to nature. The support of friends, family, and healthcare professionals reinforced the positive impact of outdoor activities. Journaling captured the journey, highlighting the contrast between difficult days and moments of joy. Ultimately, the natural world offered solace and strength, helping to navigate the complexities of cancer treatment and recovery.

Hiking helped to sustain me through cancer treatment, with its emphasis on fresh air, natural wonders, and the companionship of friends. 

Hiking Through Breast Cancer Treatment

For years, I was curious about the smooth skin some friends have after surgery for breast cancer. I thought something was wrong with my body, specifically that it had not healed correctly after a modified radical mastectomy. What remains looks a little like a deflated breast with scar tissue instead of a nipple. Recently, organizing medical files, I found a notation about a “skin-sparing mastectomy” and looked that up online.

A skin-sparing mastectomy means that the surgeon, after removing the tumor(s) and related tissue, leaves some skin to facilitate reconstruction. Usually, this sort of procedure would be immediate, although I understand that a delayed reconstruction can be possible for women who opt for it many years later. I never wanted reconstruction, though, and was clear about that from the start of the conversations about treatment plans. Who knows how my choice fell through the cracks at the time?

I am okay with that. Still, upon learning that my right chest is primed for receiving an implant, I wondered if I should get one now, despite valid and rational reasons for never wanting to. I prefer to go au naturel, to be myself, which in this case means I am a one-breasted woman comfortable with asymmetry. Why, then, was I contemplating a hypothetical reconstruction just because my body was prepped for it? I guess just because I could. It is normal to imagine an alternate reality.

My current reality is fine. I am, in fact, approaching 70, used to the new normal. In the beginning, while I was working, I did dress to disguise my lopsided chest, with scarves or loose jackets and sweaters. I realized too that the color black is a great choice for camouflage. Eventually, it did not matter what I wore. I now go for complete comfort, except for the rare occasions I wear a prosthetic bra simply because sometimes it is fun to play dress-up and even just to blend in with a crowd.

The beanbag prosthesis, which shape-shifts, has always been more comfortable when I play-act. Now I know why my silicone prosthesis has never settled into my chest, even though it is a nice one (and will never wear out as I have only worn it a few times). I like the beanbag most and may buy another before I am 80 so I can have two bras at the ready (black, white). Finding out that there is a reason for my appearance also has helped me to stop comparing what I look like to what I once almost envied.

I do remain mystified that I ended up with a skin-sparing mastectomy rather than what is called, appropriately, an aesthetic flat closure. Perhaps during the days leading up to surgery I did not do enough research or make myself clear to my surgeon, whom I do not fault. In fact, my surgeon is my hero for going into what was first considered an in situ diagnosis and extricating two invasive tumors, lots of in situ tumors, and lymph nodes laden with cancer cells. She is my hero. My lesson for those considering mastectomies is to ask more questions in discussions leading up to surgery.

The extra tissue that remains now is aging with the rest of me. Sometimes my mastectomy site is uncomfortable. While a plastic surgeon could remedy the situation, I am not inclined to get cut on again unless I have to. I do think, because I wonder why this remaining tissue is not screened except in breast self-exams, I will follow up and ask my doctor at the annual breast check about the care and maintenance of any breast tissue that remains. Otherwise, I now accept what I look like and will stop comparing apples and oranges.

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The narrative reflects on the personal experience of living with the aftermath of a skin-sparing mastectomy, highlighting the initial confusion and eventual acceptance of the resulting asymmetry. The author discusses the decision against reconstruction, despite the body being prepared for it, and the comfort found in embracing a natural appearance. The importance of clear communication with healthcare providers and thorough research before surgery is emphasized. The author also contemplates the care of remaining breast tissue and the potential need for future medical consultations.

It took years to understand why my mastectomy site looked different. Knowing I healed correctly for my procedure helped me accept my new normal.

Body Positivity After a Mastectomy: An Ongoing Quest

Recently, an acquaintance who has not experienced cancer and I, a cancer survivor, had a disagreement about hope. Discussing how to move past despair over a horrific act shared widely in the media, I suggested (among other things) that we can hope. I was chastised, though, for invoking hope because my acquaintance believes that hope wastes energy on a belief in a nonexistent future. Such a philosophy may be helpful to some, but my experience as a cancer survivor leads me to have a different perspective.

Of course, to be fair, focusing on the present moment is not the worst path for cancer survivors. It can help us to avoid worrying about what comes next (a test, a scan, a metastasis, a death). Truly, we all know anybody on this earth does not know what tomorrow can bring, with or without cancer. As Matthew 6:34 observes, “Sufficient unto the day is the evil thereof.” At the same time, sometimes the present moment is so awful that it is realistic to hope for tomorrow, even as that hope is balanced by logic and evidence.

Hope makes me think of a week during treatment I felt too bad to go downstairs to get clean sheets out of the dryer for my bed. Living in the present moment, I could have wallowed in how I felt. Remaining hopeful that I would recover, that I could withstand treatment, I did not let circumstances overwhelm me. Instead, I treaded metaphorical water. It is more realistic to say that I assumed (rather than knew) that challenging days would pass. I would get better. Assuming is a lot like hoping. I am always hoping for the best, or better.

Hope reminds me, too, of my brother when he had terminal cancer, his imminent death a certainty. He struck a deal with an emotion straddling hope and despair, knowing his death was inevitable at the same time he hoped it would not happen. I think it is human to think like that. Navigating a sense of hopefulness while acknowledging the gravity of a disease can, for many of us, make it easier to wake up each morning and put one foot in front of another.

This week I am especially mindful of words shared by a friend’s mother in a public Facebook post on the passing of her mom, whom she cared for during her cancer journey, diagnosis through hospice: “A life well lived is a precious gift of hope, strength, and grace. My mom did just that!” Hope, strength, grace: these are traits cancer survivors can help each other to hold onto. One thing about hope especially is that it does not always have to have the expectation of a promise fulfilled. It can, paradoxically, be an emotion experienced only within a present moment.

The paradox of hope is that a person can hope against hope, which is to hope with no expectation that what is desired will come. That was my brother. A belief in a realistic sort of hope can allow a cancer survivor to work through a hard year or to anticipate death with a lighter spirit. There is also the advice to hope for the best and prepare for the worst. My parents imparted that advice to me from an early age.

Emily Dickinson’s line “Hope is the thing with feathers, that perches in the soul” is widely known. Truly, she reminds us that hope is light and airy, boundless yet contained within the soul or psyche. The poem’s ending is shared less, so I will repeat it here: “Yet never in extremity, it asked a crumb of me.” That is the thing about hope. Like love, hope can offer unconditional solace. I refuse to give it up.

Hope plays a crucial role in the lives of cancer survivors, offering a balance between acknowledging the present and aspiring for a better future. While some may view hope as futile, it provides emotional resilience and a way to navigate the uncertainties of cancer. Hope does not necessarily require the expectation of fulfillment but can exist as a comforting presence. It allows individuals to endure challenging times and face mortality with a lighter spirit. Ultimately, hope, like love, offers unconditional solace and strength to those facing adversity.

I share how hope, even when uncertain, helped me through cancer and honors its role in balancing realism, resilience and emotional survival.

A Reflection on Hope from a Cancer Survivor

My goal, like that of other cancer survivors, is not to look younger but to grow older with the ability to carry myself along on the wild ride of ageing. People may see me as a fit, active individual, but there is much more beneath the surface. I actively manage my blood sugar, monitor for signs of eye disease, cope with long-term effects of cancer treatment, and follow a lifestyle aimed at reducing the risk of recurrence. I also address challenges related to lymphedema and take steps to keep my bones from becoming too fragile. My infrastructure is age-appropriate, if not biologically older than it could be, even if my face may appear younger than my innards.

This relationship between how we look and what lies inside our bodies is why I was intrigued by a recent study on biological age versus chronological age reported in 

: “FaceAge, a deep learning system to estimate biological age from face photographs to improve prognostication: a model development and validation study.” In a nutshell, the authors hypothesized that biological age, in contrast with chronological age, might help doctors with “survival prediction.” In fact, “Looking older was correlated with worse overall survival …” Would I, a cancer survivor, want the AI tool used on me? Curious, I conducted my own informal research.

I downloaded a consumer-oriented app called Face Age, not to be confused with the scientific FaceAge program used in the study. Then I analyzed a photograph from just before I was diagnosed with cancer. The biological age noted was 47, seven years younger than I was. Blame genetics or lifestyle, but I have always looked a little younger than I am. Then, thinking of the study’s point that “on average, patients with cancer looked older than their chronological age,” I chose an image from two-thirds of the way through treatment when I was 55. Face Age, despite white fuzz on my head and a tired look in my eyes, estimated 51.

We all look different for our ages, so putting that difference aside, I could say that whatever my chronological age at the time, cancer made me look four years older biologically (according to AI) than I did before diagnosis. That is not a startling idea, though, not to cancer patients and survivors. Cancer and cancer treatment are hard. The effects show up in our skin, our smiles, and the wrinkles we acquire on our faces. Fatigue and chemo will age a person. I agree with that point of the AI study.

Next, to consider how my biological age might hypothetically affect decisions about my care or prognosis today, I let Face Age analyze me at 69. One image taken when I was feeling tired said I looked 72. Another taken the very next day at the same time of day when I was more rested and smiling for the camera, while wearing lipstick, said I looked 58. The difference made me wonder about how much a subtle difference in appearance shades information encoded by AI (and humans). Could a simple smile make us appear more likely to survive?

To test my own hypothesis about how a smile might affect the way AI perceives biological age, I compared two images taken another day, one after the other. In the first, I was not smiling (age estimated at 68, a year younger than I am, not a significant difference really). In the second image taken just after the first, I was smiling, my biological age estimated at 59. This assessment, that I must look younger when I smile, makes me wonder if smiling cheerfully could subliminally influence (a) a medical assessment and/or (b) an AI program making decisions about “survival prediction.”

 report to learn more about the actual study, which was scientific, unlike my simplistic experiment. Although I believe this study will play an important role as medical professionals explore the use of AI in cancer care, it remains essential that we continue to advocate for ourselves, especially as AI becomes increasingly involved in decision-making. And if a smile influences how we are perceived, then perhaps making the effort to smile more often is worthwhile.

For more news on cancer updates, research and education, don’t forget to 

subscribe to CURE®’s newsletters here.

Cancer survivors often focus on managing long-term treatment effects and reducing recurrence risks. A recent study in The Lancet explored the use of AI to estimate biological age from facial photographs, suggesting that looking older correlates with worse survival outcomes. The author conducted informal experiments using a consumer app, revealing that cancer and its treatment can make individuals appear biologically older. The study highlights the potential influence of appearance on AI assessments and underscores the importance of self-advocacy as AI becomes more integrated into cancer care.

When I saw a study about using AI facial recognition in cancer decision-making headlines, I decided to try my own informal, non-scientific experiment.

Felicia Mitchell

Hiking Through Breast Cancer Treatment

Body Positivity After a Mastectomy: An Ongoing Quest

A Reflection on Hope from a Cancer Survivor

Contemplating AI Assistance as a Cancer Survivor

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