Sex and the City (1998) and Breast Cancer

Sex and the City follows four friends in New York. Samantha Jones is the one built entirely on appetite and confidence. For five seasons that is her whole argument with the world.

In the sixth and final season she is diagnosed with breast cancer. By then she is in her first real relationship, with a young actor, Smith Jerrod, who is also her client. He stays. She has chemotherapy, loses her hair, and works through a wardrobe of wigs, hats and scarves rather than hide.

The scene everyone remembers is a cancer benefit. She drops the polished speech and says out loud that she is having hot flushes, because treatment has pushed her into menopause. Then she pulls off her wig. Women in the audience take theirs off too. Smith shaves his head.

Spoilers throughout. Samantha's storyline is discussed here from diagnosis to the later films.

For 2003 television this was brave. The hair loss is right. The improvised headwear is right. The hot flushes are right, and they are the part almost nobody dramatises.

Chemotherapy can stop the ovaries working. In a woman in her forties that can bring menopause on within weeks rather than years. What follows is not only heat and sweating. It is broken sleep, vaginal dryness and a loss of desire. Patients report these as among the hardest effects to live with and the hardest to raise in a ten-minute appointment.

Putting that in Samantha's mouth is the smartest choice the show makes. Treatment can change how you see yourself as a sexual person as much as it changes your body. Saying so at a podium is the whole point of the scene.

Everything before the wig. There is no account of how the cancer was found, no stage, no tumour type, no receptor status and almost no surgery. A viewer learns nothing about why this treatment rather than another.

The side effects shown are mostly the visible ones. Fatigue, mouth ulcers, infection risk and the long stretches of simply feeling unwell barely register. Samantha keeps her firm, her friends and her sex life running at full speed.

The later films then hand her a clean survivorship. No tablets. No scans. No fear of it coming back.

Receptor status is the missing piece. It is a test done on the tumour that shows whether hormones drive its growth. If they do, treatment usually continues after chemotherapy as a daily tablet, often for five to ten years.

That is a long tail the show never shows. It is also the answer to a question worth asking early: after chemotherapy ends, what else am I taking, and for how long?

Below screening age, most breast cancers are found because somebody notices something. The CDC lists these:

• A new lump in the breast or underarm.
• Thickening or swelling of part of the breast.
• Irritation or dimpling of the skin.
• Redness or flaky skin on the nipple or the breast.
• The nipple pulling in, or nipple pain.
• Discharge other than breast milk, including blood.
• A change in the size or shape of the breast.
• Pain anywhere in the breast.

Most turn out not to be cancer. The CDC also notes that some people have no symptoms at all.

The US Preventive Services Task Force recommends a mammogram every two years for women aged 40 to 74. That is a grade B recommendation. For women 75 and over, and for extra scans in women with dense breasts, the Task Force says the evidence is not strong enough to judge.

Samantha is written as a woman in her forties, so she sits inside that window. Plenty of viewers do not. Anyone with a strong family history, or a known BRCA1 or BRCA2 gene change, should ask whether screening ought to start earlier and whether MRI should be added. That is a specialist decision, not a routine one.

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Sex and the City stayed a comedy about clothes and men, and the cancer story is thinner than it looks. What it did well, it did better than almost anything since. It said out loud that treatment can take your sense of yourself as a sexual person, and that this is worth talking about.

The practical part is duller. Know the changes that need an appointment. Ask what your receptor status is, and what it means for the years after chemotherapy.

• https://www.cdc.gov/breast-cancer/symptoms/index.html
• https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening

This page discusses Sex and the City for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email [email protected].