At 31 years old, Jackie Garcia had surgery to remove a nearly 10kg tumour. Below, she shares her five-year journey to a cancer diagnosis she believes was delayed by medical bias and second-guessing — and a message for other plus-size women of colour. Here is her story, as told to Emilia Benton:
In 2017, when I was 26 years old, I started experiencing unusual symptoms, including cold and flu-like symptoms just about every month, as well as frequent, severe headaches and nausea. I would power through the workday and then take ibuprofen or paracetamol in the afternoons and evenings before passing out from exhaustion on the couch. Even with a supposedly “good night’s sleep,” I felt so fatigued and never woke up feeling refreshed. I would go on to feel this way for the next five years, during which time I struggled to get answers after visiting multiple doctors and other practitioners.
During that time, I also started to rapidly gain weight. I gained about 100 pounds within a year and a half, which was alarming, especially since my appetite had also waned and I could never seem to finish a full meal. This weight gain was an even bigger mystery to me because until then, I had always been very active, working out at least six days a week, running, weight training, and doing high-intensity interval training (HIIT) workouts. I also lived with my sister, who is a registered dietitian, and she would often cook healthy meals for us. So I just chalked up my symptoms to work-related stress.
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But as my symptoms worsened, my abdomen also hardened and expanded in size. I felt pressure in my pelvic floor, and my periods became painful and irregular, with intense cramping, nausea, and cold sweats. I was also getting rashes on my face and began having numbness in my legs when I would stand up. I figured this was all a result of the weight gain and thought maybe it was now my new “normal.” But I now understand none of these symptoms were normal at all, because I eventually learned I had a nearly 20-pound tumour that was pressing on my pelvic floor and spine, basically crushing my muscles and cutting off circulation to my organs.
Addressing underlying biases
For five years, I tried fruitlessly to get answers. I had always been good about going for my annual physical and well-woman exams and going to see my primary care doctor when I needed to. I brought up my symptoms to my GP and despite knowing how active I’d always been, she simply told me I needed to lose weight, walk more, and eat healthier snacks. I asked her to touch my hardened stomach, and she told me there was nothing there.
In 2022, I switched doctors, thinking perhaps if I saw a fellow woman of colour, she would better understand me. I suspected my original GP may have been stereotyping me, assuming that, as a Mexican American Latina, I was probably frequently indulging in things like tortillas, tacos and tamales, which I did occasionally but not at every meal. I had virtually the same experience with my new doctor, who told me to improve my diet and get more exercise, which left me feeling even more frustrated. I understand that due to common restrictions put in place by insurance companies, doctors are often limited in the tests and referrals they can make. But at this point, I felt like I’d been sounding the alarm on several very concerning symptoms, and, in hindsight, I wish I had pressed my doctors to do more.
As it turns out, many healthcare providers are aware of and are actively working to address these disparities, which are common experiences for people who look like me. At the same time, it’s important to know that even providers of colour are not immune to these unconscious biases, making it all the more important to advocate for yourself.
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“Research shows that women, people of colour and individuals with larger body size are more likely to have their symptoms minimised or misattributed, leading to delayed testing and referral,” says Lisa Diamond, an associate attending physician in immigrant health and cancer disparities service at Memorial Sloan Kettering Cancer Centre in New York City. “Cultural competence and humility mean not just awareness of differences but a commitment to understanding each patient’s lived experience and avoiding assumptions.”
Don’t second-guess getting multiple opinions
In 2020, I visited a new gynaecologist who I’d heard was good at diagnosing women who had been experiencing unusual symptoms like my pelvic and menstrual pain, and I suspected I might have polycystic ovary syndrome (PCOS). But he didn’t order an ultrasound or even examine me; he just took one look at me and declared I had PCOS. He prescribed phentermine, which is a weight loss drug, and also told me to walk more, just like the other doctors. I asked my brother-in-law, who is a pharmacist, about this drug, and he strongly cautioned me against taking it, so I didn’t. But I still felt pretty defeated and at a loss for answers.
I later saw that second GP again and relayed what the gynae said about my having PCOS and needing to lose weight, and she prescribed metformin, a drug that is commonly prescribed to type 2 diabetics who are overweight. Once again, my brother-in-law advised me not to take it since I wasn’t diabetic, so I didn’t. I felt like these doctors were trying to put a plaster on a root problem they hadn’t even found yet. But even though I was growing more frustrated, the experts I talked to agree that these symptoms are all worth looking into. “Any symptom that is new, persistent, worsening, or unexplained should be reevaluated,” Dr Diamond says. “These include any new lumps, swelling, or pain that doesn’t improve; unexplained weight gain or loss; fatigue that interferes with daily function; and changes in normal bowel, bladder, or menstrual patterns.”
I saw this GP for another year before I started looking elsewhere for solutions, seeing other providers like acupuncturists, Chinese medicine and holistic doctors – and paying about £2,000 total out of pocket for these services and the additional blood work they ordered. I even took Ozempic for about a month to see if it would help me lose weight, but it didn’t do anything for me, and I wasn’t feeling any relief from my other symptoms.
By 2023, none of my symptoms had improved. But I was young and still wanted to live my life, and I attended two back-to-back concerts in Los Angeles and New York. When I got to New York, though, my legs were completely numb, and I had a panic attack. After I returned home to Houston, my legs stayed numb for two weeks, which made it difficult to walk. I once again went back to my GP, who told me it was just my anxiety (I had been diagnosed with anxiety and depression years before all these other symptoms started) – and I left that appointment with new anxiety medications. In hindsight, I probably should have gone to A&E, but I trusted my GP when she said I just needed to rest.
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I also saw a new gynaecologist at this point. I told her I suspected I had PCOS, like the other gynaecologist had told me, noting that he never did an exam or ultrasound to confirm. She ordered one, but when they tried to do it, the ultrasound techs couldn’t find my ovaries. They assured me this was normal and sent me to another imaging centre, where they could still only see one ovary. I asked if this was because I was plus-size, and they said no; it was likely because I was “gassy,” which I knew was not the case. It also took three or four people to manoeuvre and position my body to perform the scan, and it was one of the first times I felt a lot of shame about my weight gain and condition.
When I later reviewed the imaging results with the doctor, she said the same thing, that it was normal for the ovaries to sometimes not show up and that I had PCOS. She prescribed me birth control pills, but I chose not to take them because I’d previously had bad experiences with hormonal birth control exacerbating my depression symptoms. However, I wish I had known that this was still not standard protocol for diagnosing someone with PCOS.
“While you do not need an ultrasound to diagnose PCOS and ultrasound alone should never be used to make a diagnosis, not seeing ovaries in a premenopausal patient should signal you to look further to make sure you see what is going on,” says Sameena A. Rahman, a gynaecologist at Northwestern Medicine in Chicago. “While ovaries can sometimes be difficult to visualise in patients with a higher BMI, an inability to see either ovary should never be dismissed as ‘normal,’ particularly for a premenopausal woman. In [this] case, the fact that a tumour was physically obstructing the view explains the finding — and highlights the missed opportunity for earlier detection.”
Additionally, according to Dr Rahman, a non-visualised ovary typically requires further evaluation, such as through a transvaginal ultrasound, repeat imaging or other modalities such as an MRI. She also noted that treatment plans for PCOS can include hormonal therapies or contraceptives, it should always be individualised. Medications like metformin may be appropriate when insulin resistance is documented (which, in my case, it was not). And while weight management can support a regular menstrual cycle, it is not a treatment for PCOS itself.
After that, I kind of gave up on trying to find answers for about six months. But I later started a new job that had a doctor’s office and pharmacy on-site, so I went in and once again described the symptoms I'd been experiencing for the last five years and asked her to touch my stomach. The first thing she asked me was if I’d ever had a CT scan, and she ordered one immediately after I said I hadn’t. When my results came back, the nurse called to tell me I had some kind of mass and would need to discuss the results in further detail with the doctor. I tried to analyse the results myself, which said further examination was needed to determine if it was a liposarcoma, which I learned from Googling is a rare soft tissue cancer.
The importance of advocating for yourself
Rather than waiting for a referral, I immediately sprang into action. I contacted the sarcoma department at the University of Texas Anderson Cancer Centre, a world-renowned cancer research hospital in Houston.
“Patients are often empowered to seek specialised evaluation on their own, particularly when facing rare or progressive conditions,” Dr Diamond says. “Patients should verify insurance requirements for self-referral, but they should know that it’s appropriate to seek speciality care if symptoms are worsening or unexplained.”
I was fortunate to be able to be seen within two weeks to have a sarcoma specialist review my results and do further testing, which confirmed I had a nearly 10kg tumour in my abdomen. The tumour had also attached to my colon and was wrapped around my ovaries and pushing on my spine, which explained my pelvic and menstrual pain, as well as the numbness I’d been experiencing in my legs.
While I was fortunate to not need any chemotherapy or radiation treatment, I had to have surgery to remove the tumour. My doctor warned that I should be prepared to lose an organ or two, such as my ovaries and uterus, as well as possibly a kidney and part of my colon, during the surgery. I looked into freezing my eggs, but my surgeon later determined it would be too risky because the tumour could be pierced during the egg extraction, causing cancer cells to spread further throughout my body. I ultimately didn’t have the choice to preserve my fertility, but I was at peace with that.
I feel so fortunate that I ended up being treated by one of the hospital’s top surgeons, who was able to remove the tumour without compromising any of my organs. My treatment team also set me up with resources like a social worker and mental health counsellor to help me process what I’d gone through.
At the same time, though, I’m still only 33 now and have lasting effects from living with such a large tumour and having major surgery to remove it. Recovery took about six months, and I wasn’t able to exercise for about a year. I now have to get scans four times a year to check for recurrence, and I’m currently going to physical therapy three times a week because I’m still trying to regain strength in my abdominal area and have been experiencing low back and muscle pain throughout my lower body. I’m aiming to walk the Houston Half Marathon in January, though I know I will likely need assistance, such as walking poles or a guide, to help me complete the race.
It’s now been two years since I had the surgery, and I’ve had a long time to reflect on what went wrong and how so many providers failed me. There are many instances where I wish I had pushed harder for more testing that could have led to a diagnosis much sooner. But I also believe my concerns were repeatedly dismissed because I was stereotyped as a plus-size woman of colour, and I think healthcare providers should receive regular training to be aware of and address unconscious biases. I wrote to my original GP telling her as much, and although she apologised to me, she was defensive about her actions. Still, I’m hopeful I at least got her to consider this and take a long, hard look within.
To fellow minorities who may be experiencing similar medical situations, I urge you to never stop asking for help. Listen to your gut and push harder if you don’t think you're getting sufficient answers. No one will ever be a better advocate for yourself than you. Don’t be afraid to fight for answers, because it could literally be life or death.
A version of this article originally appeared in SELF.
If you or someone you know is struggling with a cancer diagnosis, or any issues mentioned in the above story, you can receive free support at Macmillan Cancer Support (freephone: 0808 808 00 00 8am to 8pm, 7 days a week) and Cancer Support UK (freephone: 020 3983 7616), hello@cancersupportuk.org.
