When Janice Cowden hit the five-year mark after her early-stage triple negative breast cancer diagnosis, she thought she was walking into a routine appointment and a small victory lap.
Her oncologist was in that mood too. With triple negative breast cancer, the risk of recurrence tends to drop after those first few years. Five years can feel like a door closing.
But Janice had been dealing with bone and joint pain that didn’t feel like “getting older.” It was sharp. It was constant. It was changing how she moved through daily life. She assumed it was a medication side effect: she’d started Prolia, and she’d read that bone pain could come with it. Her plan that day was simple: tell her doctor she wanted to stop the drug.
Instead, her oncologist said: “Let’s do a PET scan. Just to make sure.”
A few days later, Janice got the call to come in and discuss the results.
In the exam room, her doctor rolled in close, knee-to-knee, took her hands, and told her he was sorry. The scan showed what they weren’t expecting: metastatic recurrence. Stage four. Triple negative.
And the moment that was supposed to be relief became the moment everything changed.
When “Good News” Isn’t Comforting
The part of Janice’s story that stops you isn’t only the diagnosis, it’s what happened next.
Her oncologist wanted to treat aggressively. At the time, there wasn’t targeted therapy for triple negative breast cancer. It was chemotherapy. Choose your weapon. They went with AC (Adriamycin + Cytoxan), then planned to follow with carboplatin.
After four rounds, Janice had a PET scan in November 2016.
No evidence of disease.
For most people, that’s the scene where the music swells. The tears are happy tears. The room celebrates.
But Janice didn’t feel safe.
Because the plan had been: chemo, then more chemo. And suddenly the message became: “There’s nothing to treat right now, so we’re not treating.”
To Janice, it sounded like losing a safety net.
She was watching the cancer community around her—people living with metastatic disease who stayed on treatment indefinitely, and she was being told to wait. Clean scan or not, she couldn’t shake the question: What if it comes back fast? What if we miss the window?
That discomfort wasn’t ingratitude. It was fear with a very logical backbone.
“I’m an Overachiever Like That”: Second Opinions and the Need to Know
Janice did what she does best: she researched.
And then she went further. she got four second opinions at NCI-designated cancer centers. Not because she didn’t trust her oncologist, but because she wasn’t willing to float in uncertainty without checking every angle.
She also needed confirmation of something that still didn’t feel real: that a tiny contralateral lymph node on the opposite side of her original cancer was enough to make her stage four.
Every opinion confirmed it: stage four. And every opinion also confirmed her treatment plan.
Janice’s case fit what’s often called oligometastatic disease: limited spread, low burden, one of the few contexts where aggressive treatment can sometimes lead to long-term NED. Her team added radiation after chemo. They scanned often at first, every two to three months.
Scan after scan came back NED.
Now, she’s eight years out from her metastatic diagnosis, still with no evidence of disease. That’s rare enough that her oncologists have told her she’s in a tiny percentage.
But she also refuses to romanticize it. She knows people can progress even a decade later. So she lives in the truth: grateful, vigilant, and grounded.
Knowledge Is Power: But It Comes With a Cost
Janice brings up something that many patients only learn after the fact: a significant portion of people diagnosed early-stage will later have a metastatic recurrence. It’s not a conversation most oncologists routinely lead with.
Janice understands why: fear can be paralyzing. But she also believes there’s a real knowledge gap. Some patients want every detail. Some don’t. The problem is when people never get the choice.
For Janice, learning became a lifeline.
Not because she had oncology training. She didn’t. She was a pediatric nurse. But she knew how to research. And eventually she discovered something that changed the shape of her life: the metastatic breast cancer community.
She found Living Beyond Breast Cancer (LBBC). She applied to their advocacy training program, Hear My Voice, and attended their metastatic conference walking into a ballroom filled with hundreds of people living with stage four disease.
It opened doors. It connected her. It gave her language. It gave her peers.
And it taught her a hard reality: if you’re going to love this community, you’re going to lose people.
Key Takeaways from Janice’s Story
- A “clean scan” doesn’t erase fear. Relief and anxiety can exist in the same breath especially when you’re living with metastatic disease.
- Get second opinions if you need them. Not as an insult to your doctor as a way to steady your decision-making.
- Learn the language at your own pace. You don’t need a medical background. Repetition + community + good resources = clarity.
- Find your people. The right community can teach you more than any pamphlet ever will.
- Grief is part of connection. Loving people in this space means risk. But isolation has a cost too.
- Turn pain into purpose in a way that’s honest. Advocacy doesn’t require perfection. It requires showing up.
About the Guest
Janice Cowden is a former pediatric nurse and patient advocate living with a rare long-term outcome after a metastatic triple negative breast cancer recurrence. Diagnosed early-stage in 2011, she was later diagnosed with stage four metastatic TNBC in 2016. After aggressive treatment and radiation, she reached no evidence of disease (NED) and remains NED eight years later.
Janice is deeply involved in metastatic breast cancer advocacy and education, including participation in scientific conferences and patient-led learning spaces. In the episode, she also discusses Metaviver, a nonprofit focused on funding research specifically for metastatic breast cancer, along with peer support and community programs.
