Faith, Resilience, & Advocacy: Sarah McLean’s Story
Episode Summary
In this deeply personal episode of The Cancer Project podcast, host David Raubach sits down with Sarah McLean, a two-time breast cancer survivor and the founder and executive director of Project 31, a nonprofit organization based in Oklahoma City that provides peer support, community, and psychosocial resources to women navigating breast cancer treatment. Sarah was first diagnosed in 2003 at just 26 years old — only six months after she and her husband Steve had relocated from the Dallas area to Oklahoma City — and her candid account of being dismissed by her initial physician, ultimately advocating for her own mammogram referral, and proceeding through a lumpectomy, double mastectomy, and implant reconstruction offers a vivid picture of the systemic gaps patients routinely encounter.
Sarah describes arriving at the end of her first round of active treatment believing life would simply return to normal, only to find herself emotionally imploding in ways she could not name or articulate to her husband. It was Steve who persistently sought out a psychologist — herself a cancer survivor — and practically insisted Sarah attend. That appointment became transformative: hearing another woman describe the layered grief of a cancer journey validated everything Sarah had been silently carrying and simultaneously translated her emotional experience to Steve in ways she had been unable to do herself. That turning point planted the seed for Project 31, which she and Steve formally established as a 501(c)(3) in 2007 using personal savings.
Eight years after her first diagnosis, in August 2011 — the same month she launched her first peer support group at a local cancer center — Sarah discovered a suspicious spot during a self-exam on her reconstructed right side. An ultrasound confirmed cancer had returned. Sitting in her car in a Target parking lot after receiving the phone call, she recounts feeling a profound spiritual clarity: a sense that God was telling her this was not a hobby but a calling. She resigned from her full-time church position and committed entirely to Project 31. A subsequent latissimus dorsi flap reconstruction in 2014, followed by another reconstructive surgery in November 2024 to address severe capsular contracture and nerve impingement from prior radiation, illustrates the relentless, decades-long physical reality of survivorship that Sarah weaves throughout the conversation.
A recurring theme of the episode is the radical underinvestment in the psychosocial and relational dimensions of cancer care. Sarah speaks candidly about the toll breast cancer places on intimate relationships — the body-image grief of mastectomy, the vaginal atrophy caused by certain treatments, the emotional distance that accumulates when partners are excluded from the journey — and the practical wisdom she now passes on: get comfortable being naked in your own body, consider areola tattooing as a psychological restoration tool, invite your spouse to treatments, and give your children specific roles so they feel included rather than sidelined. Her daughter Tatum, who was five years old at the time of Sarah’s second diagnosis, managed the surgical drains and logged measurements daily — a small act of inclusion that gave a kindergartner agency during her mother’s surgery.
Sarah closes the conversation by discussing Project 31’s expanding advocacy work through the National Breast Cancer Coalition, including a legislative push to dramatically shorten the eligibility waiting period for Medicare and disability benefits for metastatic patients — currently a staggering five-month diagnosis wait plus a twenty-four-month application-to-services delay. She also shares her vision of Project 31 becoming a national organization, the care she takes in vetting peer support leaders (requiring them to complete their own healing journey before giving back), and her annual expo that brings education and community resources to women who would never attend a traditional support group. The episode ends with a reminder that Project 31 can be reached at project31.com and on Instagram and Facebook.
What You’ll Learn in This Episode
- Physician Dismissal of Young Patients: Sarah was turned away twice before receiving a mammogram referral at 26, underscoring how often young women must fight to be taken seriously when reporting a breast lump.
- The Pink Ribbon Roller Coaster: Sarah’s term for the survival-state tunnel vision that takes over during active treatment — doing whatever is necessary to remove the cancer — while emotional and psychosocial needs go entirely unaddressed.
- Layered Grief After Treatment: Why finishing active treatment can trigger an emotional implosion — patients grieve the loss of their pre-cancer body, identity, and relationship dynamics in ways that often surface only after the physical crisis has passed.
- Caretaker Trauma: Spouses and family members experience their own distinct trauma during a loved one’s cancer journey, yet receive almost no formal support — Project 31 intentionally includes husbands and families in its community.
- Capsular Contracture and Radiation Damage: When an implant is irradiated, radiation can destroy the surrounding blood supply and cause scar tissue to thicken and harden painfully over time, often requiring complex flap reconstruction years or decades later.
- Survivorship as Lifelong Wellness: Sarah defines survivorship not as the moment treatment ends but as an ongoing commitment to maintaining quality of life — monitoring vitamin and hormone levels, doing targeted physical therapy to manage scar tissue, and pursuing trauma-informed mental health care.
- Thrivers — Stage Four Language: Many women living with metastatic breast cancer prefer the word “thriver” over “survivor,” reflecting a daily choice to fight and find meaning even when prognosis is uncertain.
- Survivors’ Guilt: Women who are not stage four often grapple with guilt about outliving or out-recovering peers — a psychological burden Sarah addresses directly within Project 31’s communities.
- Peer Support vs. Therapy: Community-based peer support groups offer a specific level of healing — validation through shared experience — that individual therapy cannot replicate, and Sarah argues both are necessary components of a complete recovery.
- Metastatic Medicare Delay: Current federal policy requires metastatic cancer patients to be diagnosed for five months before applying for disability, then wait an additional twenty-four months before receiving Medicare benefits — a timeline that outlasts many patients’ lives.
- Areola Tattooing as Psychological Restoration: Sarah recommends post-mastectomy areola tattooing not because it restores sensation or appearance perfectly but because the visual illusion of normalcy in the mirror helps women emotionally embrace their reconstructed bodies.
- Faith as Anchor, Not Armor: Sarah candidly shares that her Christian faith initially made it harder to seek help — she felt pressure to handle suffering gracefully — but ultimately her belief that God orchestrates purpose through pain became the foundation of Project 31’s mission.
Sarah McLean’s story is a reminder that a cancer diagnosis does not end when treatment does — it reshapes identity, marriage, motherhood, and calling in ways that unfold over decades. From a dismissed lump at 26 to ushering a dying friend into heaven, from a personal savings account to a statewide network of over 10 hospital partnerships and a thousand-woman online community, Sarah has turned her most private pain into one of Oklahoma’s most effective cancer support organizations. If you or someone you love is navigating a breast cancer journey and wants to connect with Project 31’s peer support groups, care packages, or advocacy work, visit project31.com or find them on Instagram and Facebook.
Full Transcript
Read Full Transcript
David Raubach: Thank you so much for joining us on today’s episode of the Cancer Project podcast. We are really privileged and blessed to have a good friend of mine, Sarah McLean, on today. She’s a two-time breast cancer survivor and she’s also the executive director of Project 31, which is an amazing charity that operates here in Oklahoma and provides support services for women that are going through breast cancer treatment. So Sarah, thank you so much for joining us today.
Sarah McLean: Thanks for having me. I’m excited to be here.
David Raubach: For those who don’t know you well, tell us a little bit about yourself and your family. I know you have two kids — both off in college now, is that correct?
Sarah McLean: Yes. I have two kids. I was actually diagnosed when I was 26 years old. Steve, my husband, and I had just moved to Oklahoma City from the Dallas area. We unloaded the truck on our anniversary, went to dinner, and then six months later I was diagnosed. I had done self-exams since I was 18 years old — that’s just what the doctor had taught me to do. When we moved here I didn’t know any doctors, so a friend referred me to one. Like a lot of young women, I was turned away. I had noticed a lump and she told me it was probably a cyst, to stop drinking too much caffeine. So I believed her — she was my doctor. Six months later I noticed it was growing and tender to the touch.
Sarah McLean: I went back again. Being so young, insurance didn’t cover it, so I really had to advocate for myself just to get a mammogram. Steve went with me, and I felt like the doctor treated me as though I was being a hypochondriac. She finally gave me the referral, but I honestly waited even longer because I thought maybe I was overreacting. When I was finally diagnosed, we did catch it early — thankfully. At the time it was 2003 and there really wasn’t a lot of emphasis on the psychosocial needs of patients. We call it the pink ribbon roller coaster. You just get on and do what you have to do to get it out of your body.
Sarah McLean: We did a lumpectomy, we were going to have radiation, and I was going to move on with my life. But when they biopsied the surrounding tissue it had already started to spread through the cavity. So their recommendation was a double mastectomy. My mindset was just take them off — do whatever you have to do. Now, being in this world for so long, I realize that as a patient, you don’t know what you don’t know. It is so important to have community around you of people who’ve walked this walk.
Sarah McLean: Steve and I chose to go ahead with the double mastectomy in November 2003. I decided to do implant reconstruction — I didn’t really understand what that was going to entail. I got to the end of it and was so grateful to be cancer-free. I thought, let’s move on with life. Not realizing there is a new normal. I found myself imploding emotionally and I didn’t know how to put words to what I was feeling.
Sarah McLean: I’m more of an introvert by nature. My husband and I were still fighting over silly things — the toothpaste, the toilet paper. I didn’t know how to get out what I was feeling when I looked in the mirror. I wasn’t the same person. I didn’t even know how to relate to myself. And I’ll be vulnerable and say — as a Christian woman I think I had a lot of pride, too. I believed I should be able to handle things a certain way. I put a lot of pressure on myself, and yet my emotions felt really hard and I didn’t know how to reconcile that.
Sarah McLean: My husband was calling everywhere trying to find a resource for us — nobody had talked to me about the emotional side. The doctors did an excellent job diagnosing me and helping me have options, but beyond the physical part there was nothing. I am a full person — mind, body, spirit. Finally Steve found a psychologist who happened to be a survivor herself. He said we’re going, and I said no we’re not. I went kicking and screaming. The day we went into her office, she just started sharing her story with me and it was so eye-opening because everything she said was me. She was validating everything I had been going through. I’d been grieving and I didn’t know it. And she was interpreting to Steve everything I had been feeling that I didn’t know how to get out to him.
David Raubach: So he finally had the context to understand what was happening.
Sarah McLean: Exactly — he was like, oh, that’s what’s happening. Through our time with her I really felt a burden to come alongside other survivors and their families. Why is nobody talking about this? Why did nobody tell me this might be part of my journey? I got pregnant at the same time — I didn’t even know if I could have kids — and thankfully I had my son in 2004. When he was six months old I got pregnant again and had my daughter in 2006. So I was bopping through life, going to counseling, really getting some healing. But there was still something missing. I felt like there had to be so many people out there hurting and unaware of resources.
Sarah McLean: In 2007, Steve and I took money out of our savings and established Project 31 as a 501(c)(3). Initially I wanted to provide an opportunity for survivors and their families — this wasn’t just about me, it was about Steve too, and for other families it was also their kids. A whole family is impacted in their own unique way. Because of HIPAA I had to think creatively about how to meet patients, so I started creating care packages as a bridge — imaging centers and oncology offices would give the package to the survivor along with a release form so I could contact them. It was very organic, very slow. That was okay because I was still going through my own journey.
Sarah McLean: It really gave me purpose in my pain. Not everyone, but I think a lot of people need their suffering to mean something. You don’t go through this for nothing — and that’s what I needed. Fast forward to 2011 — a cancer center here in the city approached me and asked if I would consider leading a peer support group. Honestly, I said no. In my own mind I had really stereotyped support groups as negative, maybe even toxic. I wanted to create environments where people are educated, empowered, and given hope — regardless of stage, zero to four. But I felt like I was supposed to do it, so in May 2011 we showed up.
Sarah McLean: Over twenty ladies came that first night. I was like — wow. There are hurting people who want to talk about their story. As patients we hold a lot in; I know I was protecting my husband and children emotionally and didn’t want to share everything because I didn’t want to upset them. I needed a space to be vulnerable and honest but also gain comfort and encouragement. It was a great night and we kept going. Then that August of 2011 — I continued doing self-exams even though I’d had a double mastectomy, because I knew they couldn’t get every cell — I noticed something on my right side. I thought it was scar tissue.
Sarah McLean: I mentioned it at my scan. They said let’s ultrasound that before the MRI. Ironically I was in the same room I’d been in eight years before. She put the ultrasound wand on and I could tell by the look on her face she knew it was cancer. She said she’d be right back. I just laid there looking at the ceiling in disbelief. She came back and biopsied it. The next day I was in Target shopping for care packages when they called. “Sarah, I’m so sorry — it’s cancer again.” I was 34. I went to the car and sat there a while and talked to God. I really felt like He said to me, Sarah, this is not a hobby for you. This is a calling on your life.
Sarah McLean: I finished treatment, gave my notice at the church where I was working, and knew I was going to dedicate my life to this journey. From then until now, we collaborate with over ten hospitals across the state of Oklahoma, providing peer support through small groups and communities at each hospital. We have a leadership team of over twenty survivors. We do online communities now, including a group specifically for Thrivers — stage four patients. We had private Facebook communities of over a thousand women already when COVID hit, so going online was seamless. People needed more support than ever and we grew more than we ever had.
David Raubach: Going back to 2003 — one thing I know you talk a lot about with women in Project 31 is how to communicate with your spouse. What was it like talking to Steve? You’re in your mid-twenties, just married, excited about life, and then suddenly this massive interruption.
Sarah McLean: It’s a good question. We’re all unique so it’s different for everyone, and I’ve noticed a difference between younger patients and women who’ve been married a long time. However, across the board, whatever trauma you’ve experienced in your life prior to your diagnosis usually becomes a catalyst during that time. It can be very overwhelming because you have all this emotion that might not even be attached to the cancer — it might be all this other unprocessed stuff. For an introvert like me, I recommend finding a therapist to identify what you’re feeling and give it words. There is also a huge disservice to caretakers. They are going through their own trauma with virtually no attention given to them, still trying to take care of the family, still working and providing.
Sarah McLean: Grace for each other is essential because it is highly emotional and highly triggering. I see a lot of couples where it doesn’t work, and that’s why it’s important to me to bring awareness to it and to help people find tools. The second time around I knew that if I was having a hard day and taking it out on Steve, I could say, “I’m having a hard time right now.” He might take the kids to get ice cream and give me a moment, then come back. The first time I would just react. That all came from counseling and learning tools. Breast cancer is a little different too because of the way it affects your intimate relationship. I feel like it tries to steal every part of who God designed us to be as a woman — our hair, fertility, breast, intimacy, everything.
David Raubach: What are some things that you and Steve would recommend to spouses about navigating this? You mentioned taking the kids for ice cream to give some space. What else?
Sarah McLean: I’m laughing because I know exactly what he would say. He’d say just get naked. And it’s true — he would tell the groups that as soon as you get comfortable being naked in your own new body it helps your partner feel more comfortable too, because you’re both getting used to this new reality. Beyond that, he would say men tend to either try to fix it, control it, or disengage from it entirely. As partners, when there is something you want to fix, come into her space and appreciate her process, not your own. Ask her what she needs. Our home is a sanctuary — if she likes the dishes done a certain way, do it her way. She is the CEO of that house.
Sarah McLean: For survivors, it’s also really humbling to realize you can’t do everything you did before. I try to encourage women to get to a place where you allow people the opportunity to be a blessing to you because they want to help. With your kids — include them and give them jobs. My daughter Tatum managed my drains the second time. She would log the measurements every single day. She missed my first day of kindergarten — I was in surgery — but she had her role. Don’t take away opportunities for them to be the blessing. Invite your spouse to treatment. Reiterate: I need you. We are in this together.
David Raubach: What do you tell women who are thinking about going through treatment and just want to get through it and not really engage with these harder conversations?
Sarah McLean: That would have been me. But what I’ve realized over time is there is a certain level of healing that comes only through community. That’s why support groups are so important. The way we design our groups, it’s not just kumbaya — we have intentionality. You hear from an expert in a relevant subject, but through that time you start hearing stories, different perspectives, how people approach different things. You get validated and encouraged. I ideally want women engaged from the very beginning, because your body naturally goes into a survival state and you don’t process emotionally. If you learn these tools along the way you can process as you go. For me it blew up a year after treatment. But we meet people wherever they are.
David Raubach: Talk to me about the survivorship process. You were diagnosed and treated in 2003, it came back eight years later, and now you’re on this lifelong survivorship journey. What is it like living beyond treatment with that voice in the back of your head?
Sarah McLean: Survivorship to me is: what am I doing to maintain wellness and quality of life for the rest of my life? I was diagnosed in 2003 but this will affect me forever. Is it at the forefront of my mind every day? Not necessarily — but it’s a reminder every time I look in the mirror. I just had reconstruction in November. There are residual effects from the different treatments and surgeries. After my 2011 recurrence, when I irradiated a reconstructed breast, I knew I was high risk for capsular contracture. Radiation can cause the scar tissue around a foreign implant to thicken and harden over time, squeezing and becoming very painful.
Sarah McLean: In 2014 I went for a consultation thinking I’d go in, they’d swap the implant, and I’d be done. The surgeon told me that’s not how it works — radiation destroys the blood supply to the tissue, so a new implant would never heal. I had to do a latissimus dorsi flap: part of the lat muscle and tissue from my back, brought to the chest with all the blood vessels reconnected, then tissue expanders, the whole process again. Then eleven years later the nerve impingement became so severe — all those nerves got intertwined because I didn’t know I should have been doing physical therapy to break up the scar tissue all along. I literally couldn’t touch my skin without extreme nerve pain. So I went in and had that removed again just this past November.
Sarah McLean: Survivorship should include a baseline check once active treatment ends: B12 levels, D3, testosterone, integrative therapies to boost immunity and optimize your body’s healing environment. And then the trauma work — EMDR and other modalities are available now that many women don’t know about. The overall definition of survivorship is just really having that wellness and quality of life long term.
David Raubach: That segues into a term I think is really beautiful that you use to describe women living with metastatic disease — Thrivers. Talk about what a Thriver is and what your encouragement is for these women.
Sarah McLean: Thrivers are the women who are stage four who may have a different life expectancy than others. The majority of the ladies I know prefer that terminology rather than “survivor” because they have come to realize their life is going to look different, and they believe they are thriving every single day that they are alive. They are fighting and I respect that deeply. Being in that community is very humbling. I get on with our Thriver group and these are some of the most amazing people I have ever met in my life. I was just with a friend this week — a single mother, not even forty years old, stage four — and her tenacity, her resilience, her strength is extraordinary. She never complains and yet she is not in denial of her reality.
Sarah McLean: Hope is transcendent. Until the day we go to heaven we can still maintain hope, still trust that God knows every day that’s planned for us. And among those of us who aren’t Thrivers, there is a whole dimension called survivor’s guilt — why them and not me? We will never know the answer. But I can be present. I don’t have to have the words. I don’t have to have the answers. I can just show up, and that is what I try to do.
David Raubach: I’ve talked to you on some of the most difficult days — days where you are literally at the hospital with someone who may not have much time left, and you are there for them even when family members can no longer bear what is about to happen. I honestly don’t know how you do it.
Sarah McLean: I never want anyone to feel as alone as I felt in my journey. There was a woman — a good friend, someone I went to church with — who had been doing great after her initial diagnosis when the cancer metastasized. It was New Year’s Eve and she was on my heart. I reached out, she said she wasn’t doing great and asked if I could come pray for her. A board member and I went to her house. I could tell her body was shutting down. We visited, I prayed, and I felt like there was a letting go for her and her daughters. That night her older daughter called me: “My mom says she’s ready to go, but her grandparents are saying we’re here to fight.” I told her that was okay — her grandparents just weren’t there yet — and that she could tell her mom if she was ready, that was okay.
Sarah McLean: The next morning the daughter texted and asked if I could come up and pray in the afternoon. I got off the phone and I really felt like God was saying to me: I want you to usher her into heaven. I didn’t even know what that meant. I called Steve and said you’re coming with me. We walked into that hospital room — the family all thought I was probably crazy — and I went over and rubbed her little bald head and told her how beautiful she was. I felt like I was supposed to turn on worship music. The song that came on was “Come to Me.” I laid the phone by her head. The priest took the whole family into the hallway, so Steve and I were the only ones in the room with her. As soon as the song was over, the family gathered around, said the Lord’s Prayer, and as soon as they said amen, she passed.
David Raubach: Before we go — what are you hoping to see happen with Project 31 over the next couple of years? What is your big vision for 2026 and beyond?
Sarah McLean: My vision is for us to become a national organization. It has been a grassroots, organic, slow-growing process, and I’m okay with that because I think it’s been sustainable. I’m already seeing a few things on the horizon through the National Breast Cancer Coalition and other organizations learning about us. Because what we do is peer-to-peer, I am very selective about our leadership team. These women have to have completed their own healing journey — physically, emotionally, and spiritually — before they can give back. The vetting process is extensive and timely. I’m hopeful other partners will surface and we can expand in a way that honors the depth of what we do.
David Raubach: And the advocacy work — the legislation around metastatic patients and Medicare access?
Sarah McLean: Yes. Currently if a metastatic patient wants to apply for disability benefits, she has to be diagnosed for five months before she is even eligible to apply. Then once she applies, she waits another twenty-four months before she can receive Medicare services. We are working through the National Breast Cancer Coalition to shorten that window dramatically, because a lot of the women who need that aid may not be here by the time they’ve completed the eligibility timeframe. We are giving these women a voice — they can get on and share their personal stories to change this Medicaid bill. That is an amazing privilege and I am so honored to be a part of it.
David Raubach: Sarah, thank you so much for your time today and for sharing everything — your story, your journey, and what you’ve built with Project 31. You have been a true blessing to our patients at the Oklahoma Proton Center and to patients across Oklahoma. If someone wants to connect with Project 31, how do they find you?
Sarah McLean: They can go to project31.com. We’re also on Instagram and Facebook. Thank you so much for having me — I truly appreciate it.
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