Mary Piepmeier was 37 when excruciating back pain led to a Stage IV breast cancer diagnosis. Now 40, she wants people to understand what it really means to live with metastatic disease.

NEED TO KNOW

• Mary Piepmeier was diagnosed with Stage IV metastatic breast cancer at 37 after experiencing severe back pain
• She emphasizes that Stage IV cancer isn’t always a death sentence but requires ongoing treatment and energy management
• Piepmeier focuses on living intentionally, cherishing time with loved ones, and balancing optimism with life’s uncertainties

Mary Piepmeier thought she was dealing with a bad back.

In February 2024, the then-37-year-old New York City mom had just returned from a vacation in Cancun with her 7-year-old son when she found herself unable to get out of her airplane seat because of excruciating back pain.

She went straight to the emergency room and was told she likely had sciatica. But Piepmeier knew something was wrong. A pain specialist eventually ordered an MRI. The next day, she opened an email with the results: “Multiple lesions of the thoracic and lumbar spine. Seek oncologist.”

“I still remember the exact moment,” Piepmeier tells PEOPLE.

Additional scans revealed cancer in her spine, sacrum and pelvis, as well as her left breast, lymph nodes and brain. She was ultimately diagnosed with Stage IV ER-positive, PR-negative, HER2-positive metastatic breast cancer.

“I was forced to confront my own mortality,” she says. “One of the first thoughts that entered my mind was: Will I live to see 40?”

Three years later, Piepmeier is still here, receiving treatment at Yale Smilow Cancer Center. Her cancer below her neck has remained stable; tiny lesions have periodically appeared in her brain and have been treated with Gamma Knife radiosurgery.

Her experience has given her a message she wishes more people understood about metastatic breast cancer: “Stage IV cancer is not the death sentence that many people still assume it is,” she says.

Metastatic breast cancer is breast cancer that has spread to other parts of the body. Treatment is generally aimed at controlling the disease, and in some cases, people can live for years with the condition. But it remains a serious, life-threatening disease, and every person’s experience is different.

“Stable does not mean easy”

One of the hardest things for Piepmeier to explain is that looking healthy doesn’t necessarily mean feeling healthy.

“People assume that because I look healthy, I must be healthy — and if I’m living a relatively normal life, I must be ‘cured’ or ‘cancer-free,’” she says. “Neither is true.”

Piepmeier continues to experience side effects from treatment, including intense fatigue. Every three or four months, she also undergoes MRI and CT scans to monitor her disease. The days leading up to those scans can be some of the hardest.

“For those weeks, my future can feel like it is hanging on the interpretation of a few images on a screen,” she says.

Life between scans also looks different than it used to.

“I’ve had to learn to budget my energy the way someone might budget money,” she says. “I have a finite amount each day, and I have to decide where to spend it.”

This could mean canceling plans or choosing between two things she’d like to do — something that’s particularly difficult as a mom to a 10-year-old.

“At 40, I never imagined that I would have to think so carefully about whether I have enough energy to make it through the day,” she shares, adding that acknowledging her limits isn’t the same as giving up. “It’s learning how to take care of myself so that I can keep showing up for the people and the life that matter most to me.”

“Don’t stop inviting us into your life”

Piepmeier has been on medical leave from the Columbia School of Social Work, where she served as an adjunct lecturer, since her diagnosis. The intensity of treatment, appointments, physical limitations and side effects have made it impossible for her to return to teaching.

Being unable to work has been one of the hardest parts of the experience, she says. But she is still a mom, daughter, sister, co-parent and friend. She still wants to make plans, laugh, spend time with people she loves and be there for the ordinary moments of her son’s childhood.

That’s why one of her biggest requests for friends and family is surprisingly simple: “Don’t stop inviting us into your life.”

Supporting someone with metastatic breast cancer, Piepmeier says, isn’t necessarily about finding the perfect thing to say. Sometimes, it’s about being willing to listen without trying to fix what can’t be fixed.

“Validating the feelings … helps many people living with MBC feel less alienated and alone in their journey,” she says.

Less certainty, more clarity

Piepmeier says her diagnosis fundamentally changed the way she thinks about time. Before cancer, she had assumed there would always be more of it — another year to make a change, spend time with someone she loved or do something she’d been putting off. Now she’s more intentional about how she spends it. She calls it “active optimism.”

For Piepmeier, that doesn’t mean pretending everything will work out exactly the way she hopes. It means choosing how she wants to live today rather than allowing fear about the future to take over.

She’s reduced her son’s after-school schedule so she can pick him up more often. She journals and practices gratitude.

“I’m consciously choosing optimism not because I believe everything will necessarily work out exactly the way I want it to, but because I don’t see the value in surrendering my present to a future I cannot predict,” she says.

In some ways, she says, cancer has taken away her certainty but given her clarity. “I can’t control the future, but I can choose what I give my attention to today, who I spend my time with, and what kind of life I want to create in the midst of uncertainty,” she says.

And while cancer is now a significant part of Piepmeier’s life, she doesn’t want it to be the only thing people see. First and foremost, she’s Leo’s mom. She’s also a New Yorker, a lifelong learner, a yoga practitioner, a reader and someone who loves spending time at the beach.

Cancer is part of Piepmeier’s story. But it isn’t all of it.

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