From the Cover: Sam Smith on Mental Health, Preventative Surgery, and Redefining Femininity

Banner photo by Hana Laurie

Sam Smith is 32 and describes herself as a work in progress, a phrase that feels earned rather than tentative. Originally from Somerset, she has lived all over the UK, gathering chapters rather than settling into a single narrative. Her life, like her body, carries the marks of survival, choice, fear, courage and recovery, all of which now sit alongside a growing sense of purpose.

At 19, while living in Merseyside, Sam was diagnosed with Hodgkin’s lymphoma. The treatment was aggressive and necessary: six months of chemotherapy followed by three weeks of radiotherapy to her chest. She survived, but survival came with consequences that would not fully reveal themselves until much later. The radiotherapy placed her at a significantly increased risk of developing breast cancer, a fact that lingered quietly until she reached the five-year all-clear mark and began receiving annual MRI invitations.

Those letters became a trigger. Each year, from the moment the envelope landed on the doormat to the eventual results, Sam entered a three-month stretch she barely recognises in hindsight. She describes becoming a shell of herself, consumed by health anxiety and overwhelmed by a sense of dread that blended painfully with seasonal depression. Although she had been diagnosed with anxiety and depression shortly after her original cancer treatment, the annual scans intensified everything. Her mental health, already fragile, fluctuated throughout her twenties, with periods on and off antidepressants and a constant background fear that she might once again hear the words she never wanted to hear again: “you have cancer”.

Alongside this fear, Sam kept moving. A few years ago, after a couple of beers and an impulsive decision, she signed up for the London Marathon and secured a place. She loved the experience, even when her Garmin died mid-run, and she raised a substantial amount for a children’s cancer charity. The challenges continued in the years that followed, acts of physical endurance that coexisted with a quiet, relentless anxiety about breast cancer that never fully left her.

By 2024, her mental health reached what she now describes as rock bottom. It is a place she does not like to revisit, but one she acknowledges with a strange gratitude, because it forced her to rebuild rather than simply cope. During an initial conversation with a surgeon, Sam asked the question that had haunted her for years: how high is my risk? After consultations, the answer came back stark and clarifying. Her risk level was comparable to that of someone with BRCA gene mutations. In that moment, she knew she could not continue living as she had been, governed by fear and anticipation. She did not want to be a slave to her own anxiety any longer.

She was presented with three options. Medication, which carried the possibility of early menopause and other side effects. Risk-reduction surgery with reconstruction, involving longer recovery and additional complications. Or a double mastectomy without reconstruction. Sam chose the latter, after careful consideration and repeated reassurance from her surgical team that she could change her mind right up until the moment of surgery. She never did.

In April 2025, on the drive to the hospital, she sat in the car blasting “Overcome” by Nothing But Thieves at the top of her lungs. She later said she had never been so certain of anything since marrying her wife. When she woke up after surgery, her shoulders dropped. The feeling was not grief, but relief. She felt free.

Before the operation, Sam had imagined doing something bold with what came next. She wanted to take on big challenges with her scars visible, to raise awareness around cancer in young people, body confidence, and flat closure. When she first tried running topless, she shared a small update online. It was reshared beyond her immediate circle and drew an overwhelming amount of support. Messages poured in celebrating her strength and visibility, but there was also hate. Some comments were transphobic, arriving at a time when wider legislative changes around gender made the climate feel especially hostile. Others claimed her parents would be disappointed, a suggestion that stung deeply despite knowing how proud they actually are. Those messages knocked her back toward the frightened version of herself from the winters marked by scan letters and waiting rooms.

Rebuilding confidence has been slow. Running topless still scares her, but she understands there is something larger at stake. She wants to raise money for Coppafeel!, a charity that encourages people to check their chests, and to show that flat closure is valid, strong and worthy of pride. Her story has also reached a wider audience through coverage by BBC, where her words have contributed to broader conversations about preventative surgery, mental health, and how survival does not always look the way people expect.

Sam does not frame herself as finished or fearless. She is clear that she is still learning how to exist in her body and in public, scars and all. What has changed is that she is no longer at rock bottom. She is still here, deeply grateful for that fact, and determined to do something meaningful with the time and strength she has reclaimed.