You’ve probably seen Shannen Doherty’s most recent posts about her breast cancer. The actress has never shied away from telling it like it is. Taken during her 6-year breast cancer journey, Doherty shows herself in bed, bald, and with a bleeding nose.
Doherty, now 50, has stage IV breast cancer. In the 6 years since her 2015 diagnosis, she’s been unflinchingly honest about her cancer. And though the stark photos might have upset some of her fans, they tell an important story.
"It's an image that shows us that women diagnosed with breast cancer … may have good days and bad days," says Erin Roesch, MD, a breast medical oncologist at the Cleveland Clinic who was not involved in Doherty's treatment.
It may be blunter than we’re used to seeing from a star. But by showing both the good and the bad, Doherty opens a window on the reality behind the pink ribbons. Breast cancer treatment has come a long way. You may live longer and better than women who had the disease before you. But it’s still really hard.
Doherty first revealed her diagnosis in 2015. It was invasive breast cancer, meaning that it had gone beyond its starting point. But it hadn’t gone far. It had spread to one lymph node.
She had surgery to remove that breast (a single mastectomy).
Surgery is a key part of breast cancer treatment, Roesch says. Sometimes a lumpectomy -- surgery to remove the tumor but keep the rest of the breast -- is an option. But "If the breast cancer is more extensive, a woman has smaller breasts, or it is her desire, a mastectomy is another surgical option,” she says.
Doherty followed up surgery with chemotherapy and radiation therapy. Radiation lowers the odds that the cancer will return in the breast or lymph node. Chemotherapy gets rid of any microscopic cancer cells "so that they don't travel anywhere else and set up shop," Roesch says.
Falling Out in Clumps
During her chemo treatment in 2016, Doherty revealed that she'd tried cold capping to avoid losing her hair.
"When the cap is in place, the blood vessels in the scalp constrict, and this reduces the blood flow to hair follicles," Roesch explains.
Narrowing the blood vessels reduces the amount of chemotherapy drugs that can get into and damage cells in the hair follicles. But cold capping works better with some chemotherapy drugs than others, Roesch says.
The treatment didn't help Doherty.
"My hair was falling out in clumps when I washed it, I had bald spots and it became increasingly harder to cover those up. I finally made a decision to shave what was left of my hair," she wrote.
The loss of her signature dark locks hit her hard. "I loved my hair. It had defined me to a certain extent and provided me with a security blanket of sorts."
Doherty finished her treatments in February 2017. Two months later, she posted that she was in remission.
"I heard that word and have no idea how to react," she shared on Instagram. "Good news? YES. Overwhelming? YES." She was also blunt about the risk of it coming back. “The next five years is [sic] crucial. Reoccurrences happen all the time."
She also mentioned the need to make a decision about "taking a pill for the next five years that comes with its own set of problems and side effects."
Doherty was likely referring to anti-estrogen drugs like tamoxifen or aromatase inhibitors, which doctors sometimes prescribe for women with hormone-positive breast cancer. These hormone-blocking drugs are linked to a "substantial reduction in breast cancer recurrence and death," says Vered Stearns, MD, a professor of oncology at Johns Hopkins. She wasn't involved in Doherty's care.
"At the same time, many women, in particular young women who may also have received chemotherapy, report frequent bothersome side effects such as hot flashes. In these situations, we try to offer interventions to reduce the burden of side effects,” Stearns says.
It's not clear whether Doherty ever took one of these medications.
‘A Bitter Pill to Swallow’
In February 2020, Doherty announced that her cancer had returned, and it was stage IV -- the most advanced of the stages of cancer.
"I don't think I've processed it. It's a bitter pill to swallow in a lot of ways," she told ABC News's Amy Robach, who is herself a breast cancer survivor.
At stage IV, the cancer has spread beyond the breast and nearby lymph nodes to other parts of the body.
"In that case, the breast cancer is no longer curable. However, I advise my patients that it's certainly very treatable," Roesch says.
New treatments have helped women live longer with metastatic breast cancer. They can stay on treatment for many years and "have a very good quality of life," Roesch says.
Doherty says she's relied on humor to get her through "what seemed impossible." And she's used her social media platform (she has nearly 2 million followers) to urge others to be vigilant about their breast health.
"I hope I encourage people to get mammograms, to get regular checkups, to cut thru the fear and face whatever might be in front of you," she wrote.
"I love this message," Roesch says. "Mammography has been shown through rigorous studies to improve mortality, so it's a very effective screening tool. We can catch many of these cancers at an early stage and treat them for a cure."
Doherty's other key message is that, despite her diagnosis, she's kept working and stayed active. "Heading somewhere to do something," was the message she posted in early September, alongside a photo of herself and her mom, Rosa, in a car.
"Women can live very full lives with this diagnosis," Roesch says. "You might be on some form of treatment for your life, but you can still enjoy your life."