‘On The Run’ Podcast Host Ali Feller Diagnosed With Stage 4 Breast Cancer At Age 40 After Suffering ‘Debilitating’ Pain, But She Remains Optimistic— Coping With Breast Cancer Recurrence

Aside from life with Crohn’s disease [a chronic disease that causes inflammation and irritation in the digestive tract, as the National Institute of Diabetes and Digestive and Kidney Diseases explains, which can cause diarrhea, cramping, and abdomen pain], Feller is now embarking on late-stage breast cancer.

She explained on Instagram, alongside a photo of her in the hospital, “This intense, debilitating, at times immobilizing pain came out of nowhere. It was mild at first. It was there in Boston. It was bad by London. The weekend of my birthday party, I was riding on adrenaline, but by the end of each night, I could barely move.

“My beloved surgeon was at my birthday party. I mentioned the pain, and the little bump I’d noticed near my sternum. She felt it. I winced. I had the best weekend ever. By 8 AM that Monday morning, her office was calling to start scheduling appointments for me. I knew that probably wasn’t good.”

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A post shared by Ali Feller — Ali on the Run (@aliontherun1)

She continued, “It has been a whirlwind month of ultrasounds, CT scans, bone scans, biopsies, MRIs, PET scans, second opinions, and, this Tuesday, a port placement procedure  … Dr. Rosenkranz knew. She felt the bump and saw the amount of pain I was trying to power through and push aside. She let me enjoy my party. She gave me a bit more time to keep riding the highest highs of my life.

“Because now I know. We all know. It is Stage 4 metastatic breast cancer that has spread to my bones. I am overwhelmed. I am up to my eyeballs in cancer admin. I am sad. I am scared. I am as delusionally optimistic as ever. I am angry.”

Feller also insisted she’s “convinced” she’ll be “an exception and not a statistic,” adding, “I am residing fully in the denial phase, with a commitment to start the fighter phase next week. I start chemotherapy — again, but more — June 10.”

The beloved podcaster, who previously was diagnosed with breast cancer in May 2023 and finished treatment in September 2024, which included a surgical removal of both her breasts, reconstruction, chemotherapy and immunotherapy, she continued, “I was so unafraid of recurrence.

“I thought my absence of fear was some kind of superpower, or at least an armor. And here we are. Metastatic. Incurable, by definition. Could I have prevented this? Should I have done something — a million things — differently? I was living my best, happiest life. I had the dreamiest spring. It crashed down so hard, so fast, so unexpectedly. It’s a lot. It’s too much. Soon you’ll get better, right? (Cause you have to…)”

Feller’s diagnosis news comes just one month after celebrating her 40th birthday

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A post shared by Ali Feller — Ali on the Run (@aliontherun1)

Recounting her first breast cancer diagnosis in another Instagram post, Feller explained that she had discovered two lumps in her left breast a few days before May 3, 2023, when she received her first diagnosis.

She wrote in the May 2024 post, “Historically, I would’ve pushed off getting them checked. ‘Too busy,’ blah blah blah. But my friend @lauramcgreen *always* goes to the doctor when something is concerning, and I decided to follow suit. (Seriously, Laura, I would not have gone to the doctor so immediately without you leading by example.)

“I called my OBGYN’s office and asked to be seen as soon as possible. They scheduled me with a nurse midwife, who did a quick feel and told me, ‘You’re young and healthy. It’s probably nothing. Come back in six months if the lumps are still there.’ That didn’t give me any reassurance or peace of mind. I asked for a mammogram and ultrasound, just to be sure.”

It turned out to be “stage 1 invasive ductal carcinoma with DCIS.”

She continued, “‘It’s probably nothing’ was, in fact, breast cancer. Advocating for yourself can be hard. And scary. I don’t want to pretend like I know more than the professionals. (My degree from Grey’s Academy can only get me so far. While I’m certain I could perform a running whip-stitch, a legitimate self-diagnosis is a bit above my 19-season pay grade.)

“People always say to ‘trust your gut,’ and I’ve always laughed off that notion with a light, self-deprecating joke about my gut being the leakiest, least trustworthy part of my body. Sure glad I went with it a year ago, though.”

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Metastatic Breast Cancer and How It’s Treated

Breast cancer spreads through the bloodstream or lymphatic system. The blood carries cancer cells to different body parts, where they grow as new tumors.

Once breast cancer spreads, the cells may continue to grow slowly or stop growing and stay at equilibrium.

“Metastatic breast cancer is a treatable disease,” explains Dr. Kenneth D. Miller, medical oncologist at the Alvin & Lois Lapidus Cancer Institute at Sinai Hospital of Baltimore.

“Fortunately, we have so many new treatments for women with recurrent breast cancer and for many women who look at this as a chronic disease that they can live with often for many years.”

When Breast Cancer Spreads to the Bones

Breast cancer is sometimes classified as either local, regional, or distant.

• Local: Cancer is located in the breast and has not spread
• Regional: Cancer spreads from the breast to nearby lymph nodes
• Distant: Cancer spreads to distant parts of the body, including bones, liver, lungs, and/or brain

Treatment for metastatic breast cancer focuses on decreasing the spread of cancer cells, as well as relieving symptoms and improving quality of life.

Women with HER2-positive breast cancer, meaning they have high levels of a protein called HER2 on the surface of their cancer cells, targeted treatments are available. The drugs trastuzumab (Herceptin) and pertuzumab (Perjeta) have transformed the outlook for some women with late-stage breast cancers. These therapies, which are often combined with chemo, are very effective at controlling breast cancer once it has spread.

Another notable treatment is for triple-negative breast cancer. This has historically been one of the most aggressive and most challenging to treat forms of the disease because it lacks any of the main drivers of breast cancer, the estrogen receptor, the progesterone receptor, and the HER2 receptor, and it doesn’t respond to treatments that target these receptors.

Now, in addition to chemotherapy, immunotherapy has been approved to treat triple-negative breast cancer.

The Outlook for Immunotherapy Treatment

Breast cancer that has spread to the bone – such was the case with Anderson’s mom – the cancer is often hormone receptor-positive, according to SurvivorNet experts. Women may think when this happens, they need aggressive chemotherapy. However, in most instances of hormone receptor-positive metastatic breast cancer to the bone, the first line of attack is hormone therapy.

Hormone therapies are often combined with other medications to improve their efficacy. For example, CD4/CD6 inhibitors are a type of oral medication that is sometimes combined with hormonal therapies to help shrink breast cancers.

Chemo Plus Immunotherapy for Metastatic Triple-Negative Breast Cancer

How To Reduce the Risk Of A Breast Cancer Recurrence

You beat breast cancer. You battled the beast and are healthy, strong and ready to tackle the rest of your life. But what about breast cancer recurrence?

As triumphant as breast cancer survivors can feel after learning they are cancer free, many worry about recurrence. What are their chances of the cancer returning and what, if anything, can they do to help prevent it from doing so?

While the chance of recurrence varies based on the biology of the tumor, the stage it was when diagnosed and the treatment received, according to the Susan G. Komen organization, “Most people diagnosed with breast cancer will never have a recurrence.” That’s the good news.

“Once a patient has finished his or her active therapy for breast cancer, we will often refer to that time as breast cancer survivorship,” says Dr. Erica Mayer, a breast cancer medical oncologist at Dana Farber Cancer Institute.

“This is a time when patients are still being actively monitored by their treatment team, not only to ensure that they remain healthy and cancer-free in the years ahead, but also making sure that they have recovered from any side effects of their initial treatment, and that they are pursuing healthy behaviors for example, getting regular exercise, eating a healthy diet, and keeping up with all their other routine medical care.”

But recurrence does happen, so it’s important to do everything you can to reduce your risk. Here are some tips:

1. Follow Treatment Guidelines

“The best way to reduce your risk of recurrence with breast cancer is to follow treatment guidelines and complete the course of treatment that’s given,” says Dr. Elisa Port, a surgical oncologist specializing in breast cancer at Mount Sinai, recently sat down with SurvivorNet and offered the following advice.

For example, she says many women have breast cancer that’s hormonally driven, and there are treatments that they give, such as pills like Tamoxifen or aromatase inhibitors, to reduce the risk of these hormonally-driven cancers coming back. The issue is that the course of treatment may call for patients to take the pills for 5-10 years. While some have no side effects, others may experience a host of unpleasant side effects, even to the point where they’re severely debilitated and have no quality of life on these medications.

“So the challenge is to work with every individual person to make sure we give her the best chance of getting through these treatments and enjoying the benefits of these treatments, which is the lowest rate of cancer coming back,” Port says.

2. Maintain a Healthy Weight

Maintaining a healthy weight may also reduce the risk.

“We know that obesity or being overweight can increase the risk of cancer recurrence in breast cancer,” Port says. “And so I say, maintaining a healthy body weight, whatever that is for the individual… You know, we talk a lot about healthy body weight, and there’s a very big range of this, but there are certain numbers beyond which, it does affect one’s health. So we try to keep people within a range of a healthy body weight.”

3. Limit Alcohol

Port says the other lifestyle factor that may increase one’s risk of breast cancer recurrence is heavy alcohol intake.

“We say alcohol in moderation is probably fine, which is defined as three to five drinks a week,” Port told SurvivorNet. “More than that can also potentially increase the risk of recurrence. So the big lifestyle factors are healthy body weight and moderate alcohol intake.”

4. Eat a Healthy Diet

She says there’s no one dietary element that you can eat or consume to give you an edge against breast cancer recurrence. It’s not eating more broccoli or eating more blueberries or becoming a vegetarian. She says the fact that sugar feeds cancer is a big myth too. However, everything you eat does contribute to your overall health.

“These things are all really helpful in maintaining an overall healthy well-balanced diet and also to maintain healthy body weight. We know that diets that are heavy in sugar content are also usually unhealthy and can lead to weight issues. So it all really funnels back to maintaining a healthy body weight when it comes to lifestyle factors.”

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5. Exercise

This goes hand-in-hand with maintaining a healthy weight. Dr. Erica Mayer, a breast cancer medical oncologist at Dana Farber Cancer Institute, previously told SurvivorNet, “Once a patient has finished his or her active therapy for breast cancer, we will often refer to that time as breast cancer survivorship.

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“This is a time when patients are still being actively monitored by their treatment team, not only to ensure that they remain healthy and cancer-free in the years ahead, but also making sure that they have recovered from any side effects of their initial treatment, and that they are pursuing healthy behaviors for example, getting regular exercise, eating a healthy diet, and keeping up with all their other routine medical care.”

CDK4/6 Inhibitors Can Help Reduce Chance of Breast Cancer Recurrence

In the breast cancer space, there are constant efforts from researchers and drug makers to develop therapies that can not only treat cancer better, but reduce the risk of it returning. And many promising advancements in breast cancer have arose in recent years.

For women with a common subtype of breast cancer — hormone-receptor-positive and HER2-negative (HR+ and HER2-) — a newer class of drugs called CDK4/6 inhibitors are showing promise.

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CDK4/6 inhibitors work to interrupt the growth of cancer cells. SurvivorNet sat down with Dr. Eleonora Teplinsky, Head of Breast Medical Oncology at Valley Health System, to discuss how a CDK4/6 inhibitor, Ribociclib (sold under brand names Kisqali and Kryxana), is being studied for women with this specific type of breast cancer.

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Referencing data obtained from the NATALEE phase III clinical trial, Dr. Teplinsky explained how breast cancer patients who received Ribociclib along with endocrine therapy (the current recommended treatment) had a 25% lower risk in recurrence or death.

Prior to the study, “Ribociclib was already approved for metastatic hormone receptor-positive breast cancer, but this study was looking to see if it has benefits in reducing recurrence in earlier stage breast cancer,” she explained.

The study looked at something called disease-free survival, which means patients are alive without their cancer recurring.

“In the group that received Ribociclib and endocrine therapy … at three years their disease-free survival was 90.4% compared to 87.1% in the group that received endocrine therapy alone,” Dr. Teplinsky said. This translates to a 3.3% “absolute improvement.”

It’s important to note that this therapy option is not currently FDA-approved.

The Importance of Breast Cancer Screening

Screening for breast cancer is normally done through a mammogram, which looks for lumps in the breast tissue and signs of cancer.

While there is some disagreement about the exact age a woman should start getting mammograms, doctors generally agree it should happen in their 40s.

The American Cancer Society (ACS) suggests women should begin annual mammogram screenings for breast cancer at age 45 if they are at average risk for breast cancer.

However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) now says that women should start getting mammograms every other year at the age of 40, suggesting that this lowered the age for breast cancer screening could save 19% more lives

WATCH: Mammograms are still the best tool for detecting breast cancer.

The ACS also advises:

• Women aged 40-44 have the option to start screening with a mammogram every year
• Women aged 55 and older can switch to a mammogram every other year
• Women aged 55 and older could also choose to continue yearly mammograms

For screening purposes, a woman is considered to be at average risk if she doesn’t have a personal history of breast cancer, a strong family history of breast cancer, a genetic mutation known to increase risk of breast cancer such as a BRCA gene mutation or a medical history including chest radiation therapy before the age of 30.

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Experiencing menstruation at an early age (before 12) or having dense breasts can also put you into a high-risk category. If you are at a higher risk for developing breast cancer, you should begin screening earlier.

Don’t delay speaking with your doctor to make sure you are staying on top of your breast health.

Understanding Provider Bias & Advocating for Your Health

While your doctor has undergone years of training and practice, she or he is ultimately still human and may come with their own set of biases that can impact how they treat patients.

To combat these biases and really the most out of your interactions with your doctor, you should provide her or him with plenty of information about your life and ask plenty of questions when things aren’t clear.

To better understand how you should approach conversations with your doctor, we spoke with Dr. Dana Chase, gynecologic oncologist at Arizona Oncology.

Avoiding Provider Bias – Is Your Doctor Understanding You?

According to Dr. Chase, physicians, like many of us, can be a bit biased when seeing patients. Dr. Chase makes clear that these biases are rarely sinister, but rather unconscious and more subtle. She says, “We have certain beliefs that we don’t know about. We might look, for example, at an older woman, and just by the way she looks we might make certain assumptions, and we might not even know that we’re making these assumptions.”

Sometimes, these assumptions can lead to differences in the care that doctors provide. That is the point at which you, the woman, should advocate for yourself and clear up any misconceptions the doctor may have, says Dr. Chase.

“Say things to your doctor like, ‘I may not seem healthy because I’m 92, but I want you to know that I play tennis three times a day,’” she explains.

This type of discourse can be really helpful when building a relationship with your physicians and even more important when it comes to creating a treatment plan.

“In order to avoid situations where potentially the doctor is making assumptions about you that you don’t even really know about, reminding yourself to tell the doctor who you are, to explain your life situation, I think is really important.”

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It’s equally as important that you’re understanding your doctor as much as you want them to understand you.

“It’s never a bad thing to ask for something to be repeated, or to ask the doctors to explain it in different terms,” Dr. Chase adds.

So next time you go to your physician, we think you should feel empowered to speak up, both so she or he understands you and you understand them.

Contributing: SurvivorNet Staff

Learn more about SurvivorNet's rigorous medical review process.

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