In September 2019, marathon swimmer Sarah Thomas did something that had never been done before: she swam the English Channel four times, non-stop. And she did this a year after completing treatment for stage II breast cancer.
Sarah started swimming lessons at age one and was on a year-round swim team by age 10. She swam on her high school team and in College at the University of Connecticut where she studied political science and journalism. She took a break from swimming while earning a master’s degree at the University of Denver, but joined a masters’ swim team after graduating.
In August 2017, Sarah swam 104.6 miles in Lake Champlain, the first current-neutral open water swim of more than 100 miles and the world record for the longest unassisted open water swim.
In November 2017, while planning her English Channel swim, she was diagnosed with breast cancer at age 35.
Listen to the podcast to hear Sarah talk about:
- how she found the breast lump and what she did after that
- how she talked to her doctors about treatments while she was planning her English Channel swim
- what she thought about and how she ate during the 54-hour swim
- how breast cancer has changed her
Running time: 22:12
Photo credit: James Musselwhite
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Show Full Transcript
Jamie DePolo: Hello! Thanks for listening to the Breastcancer.org podcast. Our guest is marathon swimmer Sarah Thomas, whom some of you may have heard about. In September of 2019, Sarah did something that had never been done before. She swam the English Channel four times nonstop, and she did this a year after completing treatment for stage II breast cancer. Sarah started swimming lessons at age 1 and was on a year-round swim team by age 10. She swam on her high school team and in college at the University of Connecticut where she studied political science and journalism.
She took a break from swimming while earning a master’s degree at the University of Denver, but joined a master’s swim team after graduating. In August 2017, Sarah swam 104.6 miles in Lake Champlain, the first current-neutral open water swim of more than 100 miles and the world record for the longest unassisted open water swim. In November 2017, while planning her English Channel swim, she was diagnosed with breast cancer at age 35.
Today we’re going to talk to Sarah about her journey through breast cancer and her English Channel swim. Sarah, welcome to the podcast.
Sarah Thomas: Hi. Thank you for having me.
Jamie DePolo: So in 2017, you’re at the top of your sport after finishing that Lake Champlain swim. Then you find a lump in your breast. Can you take us through how you found the lump and what you did after that?
Sarah Thomas: Sure. So I was just doing my routine monthly self-exam like they tell us our whole lives that we need to be doing, and I noticed a lump. And I ignored it for maybe longer than I should’ve, hoping that it might go away, seeing if it was going to change, or anything like that. It did not. I talked to my husband, and he said, “Sarah, quit being stupid. Make a doctor’s appointment now.” So I made a doctor’s appointment with my primary care physician and went in to see her. I was trying to be all casual about it like, “I have this it’s probably no big deal,” but I could tell pretty quickly that she was concerned about it. So she took my medical history. We have no family history of breast cancer in my family at all, I was only 35. But she said, “Sarah, you need a mammogram right away.”
So she gave me the referral, and she said, “Take the first appointment they have available, even if it’s not at a good location for you.” So I followed her directions, and it took maybe a couple of weeks to get in to see the doctor for a mammogram. They did the mammogram, they took me right back for an ultrasound, and then the doctor came in and said “You know, I don’t like what I’m seeing, I think we need to do a biopsy right now. But I’ve been doing this for a really long time, and I’m pretty sure that you have breast cancer.”
Jamie DePolo: Can you talk a little bit about the emotions that you felt? I mean, it’s got to be pretty shocking, you were 35, no family history.
Sarah Thomas: Yeah, it was definitely shocking. I went into the mammogram alone. My husband had offered to come with me, and I did not think that they would actually tell me anything definitive at that appointment. So I’m laying on my back with my arm over my head, and when the doctor came in and said those words, “I’m pretty sure you have breast cancer,” I was numb probably for the next hour or so trying to process that. She was really kind and answered questions and talked to me about next steps, but I think in that moment you’re just processing. And it wasn’t until I had to call my husband after I left the appointment and tell him that I really broke down. I was in the middle of downtown Denver on a November evening and it was dark out, it was rush hour, and I’m sitting in my truck trying to figure out how to tell him that it is what we thought and it was worse than we thought.
Jamie DePolo: And you did say you had no family history of breast cancer. Was there any cancer at all in your family?
Sarah Thomas: Nothing notable. One of my grandfathers had lung cancer, but he was a lifelong smoker. So when you go through your family history they always say, “oh, that one doesn’t count.” So no, no real history. It took me and my whole family by surprise.
Jamie DePolo: Okay. Now, if my understanding is correct, you were already planning your English Channel swim when you got this diagnosis. And so as you’re talking to your doctors about treatments, did you have to think about maybe how certain treatments or types of surgery might affect your ability to swim or your ability to swim very long distances, and did you modify any of your treatments because of that?
Sarah Thomas: We definitely talked about it quite a bit. I’m lucky that my oncologist, her husband has swum the English Channel.
Jamie DePolo: Oh wow.
Sarah Thomas: Yeah. So she understands my mentality and what it takes and all that. So really, really fortunate to have her as my oncologist and her understanding of what my body needed to be able to do. We did not change anything as far as my chemo treatments went. We followed the standard protocol of AC+T. We did that first.
When it came time to talk about my mastectomy, we really did have a lot of discussions with both my oncologist and with my surgeons about what was the best tactic to take for my swimming and to meet my medical needs. Everyone was pretty clear with me that I definitely needed a right-sided mastectomy, but they would not recommend a lumpectomy. I had two tumors in my right breast and one lymph node was impacted, so they really didn’t want to do a lumpectomy.
I had that really hard conversation with myself and with doctors about if I wanted to do just a right-sided mastectomy or both sides, and then what my options for reconstruction were. My husband was actually a big proponent of doing the mastectomy and then just leaving my right side flat so that we weren’t impacting any of my muscle groups with the reconstruction.
I had to do a lot of soul searching, and we ultimately decided to kind of follow a traditional reconstruction with an under-the-pec muscle tissue expander and then do an implant later on. Lots of discussion with my plastic surgeon about how that might impact my swimming down the road, and he didn’t know what to tell me. He’s obviously never had someone like me come through his doors, so it was kind of fun to see his face and try and get him to process exactly what I was asking of him. So he was really understanding and supportive, which it was nice to be able to have those honest discussions with him.
Jamie DePolo: Sure. And I guess, if you don’t mind discussing, did you think at all about autologous reconstruction, like using your own tissue? Because a lot of that involves transferring muscle, sometimes muscle and sometimes just tissue from other parts of the body, and it seems like that would also really affect your ability to swim or doing long distances.
Sarah Thomas: Yes. We definitely talked about that, and that was kind of discarded early on as not a really good option for me just as far as the length of recovery was going to be and the toll that it might take on my body in the long-term. So, yeah, we kind of discussed it and then moved on pretty quickly from that option.
Jamie DePolo: Okay. Okay. And as you’re going through the various, you know, the chemotherapy and then the surgery, the reconstruction, you were continuing to swim.
Sarah Thomas: Yeah, as much as I could. I swam, you know, probably on average between 3 to 4 times a week during chemo. It was a promise to myself that I would swim every morning before my chemo treatment. So my chemo was always on a Thursday, so I’d come into the doctor’s office and they’d be taking my vitals, like, “Sarah, you’re like sweating and your heart rate’s still kind of high.” And I’m like, I just got out of the pool, you know? And at first they were like what are you doing? And then as we went on they understood and the whole medical team and my oncologist’s office was really supportive of that.
I didn’t have a ton of issues during chemo. Obviously I was fatigued and tired and all of that fun stuff, but as we were going on they were kind of suggesting that they thought maybe my level of activity was helping me handle chemo a little bit better than it might’ve otherwise.
Jamie DePolo: That’s what I was wondering. There’s not a lot of research on that.
Sarah Thomas: Right.
Jamie DePolo: But it sort of intuitively makes sense when you think about it.
Sarah Thomas: Yes.
Jamie DePolo: Did you have to think at all about where you swam? It sounds like you were swimming in a pool, and I know that you’re mostly an outdoor swimmer, open water swimmer. Obviously, if you’re on chemo your immune system is suppressed and in some of that open water there could be bacteria and various things that can infect you. Did you talk about that at all or think about that?
Sarah Thomas: We did. My chemo started in December and ended May 1. So, maybe somewhat fortunately, most of my swimming during that time was just forced to be in the swimming pool.
Jamie DePolo: Okay.
Sarah Thomas: Just because we live in Denver and it’s a little cold outside in December and January for outdoor swimming. But I will say once we got into April I started talking to my doctor about, “Okay, spring swimming is coming, can I get in the lake?” And she didn’t really have any concerns about it. They wanted me to always wait 48 hours after a chemo treatment before I got wet just to make sure my port was all healed up.
Jamie DePolo: Okay.
Sarah Thomas: But otherwise, you know, I was mostly healthy. My white blood cell count was pretty consistent throughout all of it, and she said as long as I wasn’t, like, drinking the water she wasn’t too worried about what I was doing.
Jamie DePolo: Okay. Okay. Now as you’re going through treatment did you ever have any doubts that you might not be able to finish the four crossings of the English Channel that you had been planning?
Sarah Thomas: Yeah. I would say, you know, I finished treatment last September, and I had about a year to get ready for this swim. And I will say going through treatment and then trying to build my training back up over this last year I had a lot of doubts. You just don’t know what kind of training your body can handle. Structurally, my body was different, because now I have this big implant under my pec muscle, so I just didn’t know what was going to happen and how I would be able to handle it. My plastic surgeon kept saying, “Well, we’ll see what you can tolerate. We’ll just see how it goes.”
And I just kept pushing and kept trying and kept building slowly and working with my PT when I was having some shoulder issues. So we built up to it, I built up to it carefully and smart. I definitely found that I was needing more sleep over the last year then I maybe needed in the past. I’m definitely not quite as fast as I was prior to my cancer diagnosis, and that made me doubt a lot of my ability. But I built in some really big training swims throughout the last year just to kind of test myself and push myself, and those all went really well. So I went into it thinking I was as prepared as I could possibly be and we would just see what happened.
Jamie DePolo: I mean, that’s fair. You can’t really ask for more than that, right?
Sarah Thomas: Right. Exactly.
Jamie DePolo: Okay. Now I have some perhaps indelicate questions.
Sarah Thomas: Sure.
Jamie DePolo: The Channel swim took 54 hours, is that right around…?
Sarah Thomas: Yes.
Jamie DePolo: So, I’m not a marathon swimmer, and for those of us who aren’t, that’s a really long time to be by yourself in the water.
Sarah Thomas: Sure.
Jamie DePolo: So, like, what do you think about? How do you eat? How do you go to the bathroom? How do you stay awake? Like, how do you do all those things?
Sarah Thomas: Sure.
Jamie DePolo: And you know, I’m sure some of it — like you said, you were fatigued. Staying awake, was that harder, you think, because of you know having finished treatment?
Sarah Thomas: Sure. So part of when you’re doing a marathon swim, you do have a boat support next to you. So I had a boat that was following the GPS and guiding me. And on that boat is a team of people, so we had three people that were there just to drive the boat, and we had two people there who were the official observers to make sure that I was following all the rules and we didn’t cheat and all of that good stuff. And then I had five of my own teammates, and they kind of rotated in and out. They were sleeping, resting, and then looking after me kind of all at the same time during those 54 hours. So it is my team’s job to throw me nutrition. So we just have a water bottle.
Jamie DePolo: It sounds like they’re feeding a dolphin.
Sarah Thomas: Yes. It feels like that sometimes because, like, I’m just in the water, and I have a water bottle. It’s mostly liquids, and they toss it down to me and I drink it and then they pull it back up attached to the string. So I do, I feel like it’s feeding the fish. And you do you get, you know, you are so stuck in your head. I wear earplugs while I’m swimming, so I can hear them but not very well. Everything’s really muffled, and then you’ve got goggles on as well, and so you can see, but everything is a little bit distorted. So between the goggles and the earplugs you are really kind of in your own world. So you do, you know, you spend a lot of time with your thoughts and just reflecting on everything and anything. And a lot of times you’re thinking about absolutely nothing.
But you do kind of get to this like animal-like state almost where you’re just in the routine, your crew is feeding you, and all you do is just swim for hours and hours. I have become a master at peeing while I swim. When you first get into open water swimming, that’s what they tell you is you have to learn how to pee while you’re swimming, so you don’t have to stop and take a pee break. So I can just kind of pee on the go while I’m swimming. Yeah, you just kind of take care of business. If I need something I tell my crew what I need and they do their best to get it for me.
Jamie DePolo: And you don’t get any breaks or sleeping time, I mean, you’re awake for that whole 54 hours?
Sarah Thomas: Right. Yes.
Jamie DePolo: So do you, I guess, I don’t even know how to ask this question. Is it the adrenaline that keeps you going or you just know you have to stay awake for that long? And are you a little kind of hallucinatory when you get out when you finish?
Sarah Thomas: Yeah. I would say it’s a little bit of all of the above. Adrenaline definitely does keep you kind of on the move. Also the fear of drowning also keeps you alert. It’s not really ideal to try and take a nap while you’re face down in the water. And then I do consume a little bit of caffeine while I’m swimming, so usually somewhere between hour 30 and hour 36 is when I start to feel a little bit drowsy. And I don’t drink caffeine normally, so just like a little tiny bit, like the equivalent of a cup of tea every few hours, really perks me up quite a bit. So that definitely helps keep me alert and awake so that I’m not trying to take a nap when I’m swimming.
When I was very first looking into multi-day swims — this English Channel swim was the 3rd time I’ve been awake for more than a couple of days in a row — I did research and you do hallucinate. It’s what everyone said, you know, after a couple of days you’ll start to hallucinate, but fortunately I have never actually hallucinated. I’m usually pretty alert. I can have pretty coherent conversations with my team. They’re always kind of impressed, 3 days on I can tell them where we’re at and what’s going on and still be giving directions after 54 hours awake. So I don’t know if that’s just a genetic gift that I have or what, but it’s nice that isn’t a huge struggle for me.
Jamie DePolo: Yeah, that’s very impressive. So as you’re in the water and you’re doing this swim, was there a point when you said, “Yes, I know I’m going to finish this, I can do this”?
Sarah Thomas: You know, when I made the last turn in France I was pretty confident. I had had some rough points during the second and third laps, and we had kind of resolved those issues and I was actually feeling pretty strong. So when we headed into that last lap back to England I was feeling pretty confident that we weren’t going to have any issues, and we were going to be fine. But then the tide turned early on me and we went a little bit off course. And my first two laps, I think, took 11 and a half hours, 12 hours, and like 13 and a half hours. And so the last lap ended up taking around 17 hours just because the currents and tides were just really playing tricks with us. And so that whole last lap, especially starting into the evening until I actually landed, I wasn’t 100% sure that the tides were going to cooperate and let us get into shore.
Jamie DePolo: Well that had to be a little, I guess, unnerving, if that’s the right word.
Sarah Thomas: Yeah.
Jamie DePolo: And then did you kind of have an agreement with yourself, like, “If X, Y, and Z happens I’ll call it off”? Or you just kind of said, “Let’s see happens, I think I can do it we’ll stick it out”?
Sarah Thomas: Yeah. I mean my longest swim took me 67 hours.
Jamie DePolo: Oh, so this was a piece of cake then!
Sarah Thomas: Yeah, totally easy! But yeah, I knew that I still had a lot left in the tank. So really the agreement with my crew and my team was that as long as I was physically fine, we were going to keep swimming until we made it. Yeah, just knowing what my ability was, we were just going to go for it until we knew that it was either going to be impossible or I physically wasn’t able to continue.
Jamie DePolo: So do you think that breast cancer and then also this swim changed you in any way?
Sarah Thomas: I would say that breast cancer probably moreso than the swim changed me. You know, I’ve always been pretty driven and headstrong to start with, but now after going through cancer and treatment I feel like I have almost more of an obligation to live my best life and be outspoken to other people going through what I’m going [thought], that you don’t have give up hope. And I just think, I don’t know, that is a bigger part of me now moreso than it was prior to this. And before this I was really happy to just do my swims and call it a day and not talk about it a whole lot. They’re interesting and fun, but it’s just kind of a personal hobby. And now I feel like I have an obligation to other survivors out there to share my story and just make sure that they know that there’s life after cancer.
Jamie DePolo: Well, we certainly appreciate you sharing your story with us. Are you planning more swims perhaps longer, shorter? Anything big?
Sarah Thomas: So I honestly don’t have anything scheduled for the next year or so. This English Channel swim and just getting through the end of my treatment has been kind of my big focus for a really long time now, so I just wanted to get through this. But I will say in the wintertime I start to get a little antsy when I’m not able to get in the open water, so I am sure that come January or February I’ll have schemed up something else.
Jamie DePolo: Okay, that sounds good. And I guess for my last question, what do you want people to know about breast cancer?
Sarah Thomas: Breast cancer is a really real disease. And I think sometimes people get caught up in, “Oh it’s an easy cancer to have and the success rate is really high, so yeah it sucks that you have cancer, but you know it’s just breast cancer.” And that is just so false, and I hate that mentality because the treatment is brutal, it’s hard, women die from breast cancer. And just the more recognition that we can get out there that we still need support, we still need research funds. You know, there’s still a lot of advances in treatment that can help a lot of women, especially those with metastatic breast cancer. And people who have triple-negative breast cancer, like mine, we still need that support.
Jamie DePolo: Okay. Sarah, thank you so much. We really appreciate you sharing your time and your story.
Sarah Thomas: Yes, you are very welcome.
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