“The Bachelorette” star Katie Thurston, 34, revealed that she is on lifelong medication for stage 4 breast cancer, with monthly lab checks guiding dose adjustments to protect her liver and keep treatment on track. Her cancer’s spread to the liver has disappeared on scans, and she’s hopeful that upcoming tests will show no evidence of disease.
Thurston is preparing for a double mastectomy (removal of the breasts) scheduled for November, followed by possible radiation—marking a new chapter in her treatment journey as she continues to adapt and stay hopeful.
Stage 4, or metastatic, breast cancer occurs when cancer spreads beyond the breast to other parts of the body. While it is not curable, many treatment options are available to help manage the disease and extend quality of life.
A double mastectomy is a procedure that removes both breasts. Some women choose this procedure to reduce their risk of cancer, especially if they have a family history of cancer or possess the BRCA1 and BRCA2 gene mutation, which also increases their risk.
Katie Thurston, 34, known for her time on “The Bachelorette,” is facing one of the most challenging chapters of her life: a battle with stage 4 breast cancer. In a deeply personal update, she shared the realities of her ongoing treatment, the emotional toll of uncertainty, and her hope for healing.
“I will be on medication for life,” Katie revealed in an Instagram post.
“It’s kind of like a maintenance plan, which is great, but also can be scary… How many options do I have until I’ve exhausted all my options?”
Each month, Katie undergoes lab tests to monitor her progress. Recently, her results raised concerns, prompting her care team to adjust her medication dosage.
“We decided to lower it to two pills instead of three pills a day,” she explained. “That has worked for my liver enzymes, meaning I don’t need to pause my treatment. I can continue.”
Despite the challenges, there’s a glimmer of hope. A recent scan showed that the cancer that had spread to her liver has vanished.
Katie Thurston at the Breast Cancer Research Foundation event on May 13, 2025 (Photo by Stephanie Augello/Variety via Getty Images)
“It does not show up on a scan anymore,” she said. “If I’m being so honest and maybe a little delusional, but I don’t know, I predict, I hope, I pray that I will have no evidence of disease.”
Katie’s next big milestone is a double mastectomy scheduled for November—a step she describes as “a whole other chapter” she’s still learning about. Radiation may follow, but for now, she’s focused on what’s working.
A double mastectomy is a procedure that removes both breasts. Some women choose this procedure to reduce their risk of cancer, especially if they have a family history of cancer or possess the BRCA1 and BRCA2 gene mutation, which also increases their risk.
WATCH: Dr. Elisa Port explains what happens during a double mastectomy.
Making the decision to undergo a mastectomy can be an emotional experience for many women facing breast cancer. While the surgery itself may only take a few hours, the changes can be difficult to adjust to mentally.
“A double mastectomy typically takes about two hours for the cancer part of the operation, the removal of the tissue,” Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System, tells SurvivorNet. “The real length, the total length of the surgery, can often depend on what type of reconstruction [a patient] has.”
“I just want to live life,” she said. “I feel like I’m coming to the end. After surgery and radiation, it’s just medication. Every month it’s medication… So things are working so far, and we’re adjusting.”
What to Expect from a Mastectomy
When you’re faced with possibly getting a mastectomy, many factors go into the decision-making process, such as the size and features of the tumor and your family history. Some patients may opt for a lumpectomy instead, which is when doctors remove just the cancer and an area of healthy tissue around it rather than the entire breast or breasts.
Some women decide to have their breasts reconstructed after undergoing a mastectomy and have implants put in right away, while others don’t have reconstruction at all.
WATCH: Regaining your sense of self after reconstruction.
Dr. Port added that most women opt to have some sort of reconstruction. The length of these surgeries can vary greatly. When implants are used, the procedure can take two to three hours (so the total surgery time would be around five hours). There is also the option to take one’s own tissue (usually from the belly area) and transfer it into the breast area during reconstruction.
Thurston’s cancer is classified as hormone receptor-positive (HR+) and HER2-negative (HER2-), the most common subtype of breast cancer. According to Penn Medicine, about 70% of new breast cancer cases each year fall into this category.
Hormone receptors are proteins found on breast cells that respond to estrogen or progesterone. When cancer cells have these receptors, they can grow in response to these hormones—making them hormone receptor-positive. HER2, on the other hand, is a protein that can accelerate cancer cell growth. Tumors are labeled HER2-positive when they overexpress this protein, and HER2-negative when they don’t.
Traditionally, HER2 status has been viewed in binary terms—positive or negative—though many patients fall somewhere in between. These classifications are determined by how the tumor appears under a microscope and through additional testing by a pathologist.
(Instagram/@thekatiethurston)
Thurston’s current regimen includes three key medications:
Kisqali (ribociclib): Approved by the FDA in 2017, this targeted therapy is used in combination with endocrine therapy to treat HR+/HER2- breast cancer. It works by slowing the progression of cancer, offering a more tolerable alternative to traditional chemotherapy.
Lupron (leuprolide): A hormone therapy injection that lowers estrogen levels in the body, helping to prevent the cancer from growing.
Letrozole: An aromatase inhibitor that reduces the body’s estrogen production, commonly used in postmenopausal women with hormone-sensitive breast cancer.
Treatment Options for Advanced Breast Cancer
Metastatic breast cancer (also called stage 4) means cancer cells have spread from the breast to other parts of the body, which may include the bones, liver, lungs, brain, and beyond.
Breast cancer spreads through the bloodstream or lymphatic system. The blood carries cancer cells to different body parts, where they grow as new tumors.
As the cancer spreads to other body parts, patients may experience additional symptoms depending on where the cancer has spread. Examples include:
Bones: Severe bone pain or fractures
Lungs: Difficulty breathing, chest pain, new cough
Liver: Yellowing of the skin (jaundice), abdominal pain, nausea, and/or vomiting
Brain: Headaches, memory loss, changes in vision, seizures
WATCH: Treatment options for metastatic breast cancer.
Although stage 4 breast cancer is not curable, several treatment options exist that can extend the life of patients. Treatment options depend on the stage, type of primary breast cancer, and whether hormone receptors are positive.
Treatment can include a combination of:
Chemotherapy: Oral or IV medications that are toxic to tumor cells
Hormonal therapies: Drugs that lower estrogen levels or block estrogen receptors from allowing the cancer cells to grow
Targeted therapies: Drugs that target your tumor’s specific gene mutations
Immunotherapy: Medications that stimulate your immune system to recognize and attack cancer cells
Radiation: The use of high-energy rays to kill tumor cells and shrink tumors
Surgery: To remove a cancerous tumor or lymph nodes (uncommon with stage IV; more common in stages I, II, and III)
Clinical trials: Studies of new medications, treatments, and other therapies offer hope for better outcomes.
Questions to Ask Your Doctor
If you’re facing the option of having a mastectomy, here are some questions to consider asking your doctor:
What can I do to prepare for a double mastectomy?
What happens before and after the procedure?
For reconstruction, what are the benefits of using implants over my own tissue and vice versa?
