Famous for her years hosting Good Morning America, Joan Lunden was one of nearly 300,000 American women diagnosed with breast cancer in 2014. Opening up her heart, Had I Known - A Memoir of Survival, gives readers an intimate look into her journey navigating a breast cancer diagnosis and treatment, as well as personal family dynamics internal struggles, and the balancing of personal and public life.
How the Book is Organized:
The book feels like a journal in many ways, jumping from inner thoughts and fears to more factual content. It consists of 30 chapters and follows Joan’s personal narrative chronologically with some reflection on personal history. Messages of support from colleagues and fans are included throughout the book, highlighting how important it was for her to receive this love. Each chapter begins with an inspiring and motivational reflection by a different celebrity who has battled cancer in the past. There is also a rich and insightful collection of personal photos included in the middle of the book that illustrate Joan’s experience.
Introduction: A Daunting Diagnosis
Diving right into the harsh reality, Joan shares a first person account of what it was like for her to receive a Stage II breast cancer diagnosis. She describes all the thoughts that run through her head, her first question - “Will I lose my hair?” - and the feeling of holding her husband’s hands so tightly that they sweat together. She writes:
“The information was coming at me so fast, I could barely keep up. I felt as if I had just been shot out of a cannon at supersonic speed into the world of oncology. There were so many new terms. It was an avalanche of information. I didn’t want to be buried under this mountain of data I couldn’t comprehend. I had no knowledge of my disease or treatment. In an effort to dig my way out, I started assembling my search and rescue team” (pg 10).
Chapter 1: A normal doctor visit that wasn't so normal
Although she did not have a family history of breast cancer, every year Joan underwent an ultrasound after her 3D mammogram due to her dense and fibrous breast tissue. This was advice she had received from Dr. Susan Love during an interview years earlier. She shares the anxious uncertainty of having the ultrasound technician see something suspicious and the doctor wanting to do a needle biopsy. Due to a family event, she was able to put it off for the weekend and had to endure a couple days at home of acting like everything was normal - not a simple task at all.
Chapter 2: The Big C
“This news was against everything I thought about myself. I was a healthy and vibrant person! Wasn’t I? I felt an instant guilt that I was putting Jeff in this situation. I needed to be strong and healthy for him and for all of my children. I wanted time to stay frozen, but the cruel reality was about to be laid out by my doctor. I wasn’t ready to hear it. And yet time stands still for no one” (pg 26).
Facing the biopsy results, Joan shares the challenging and conflicting emotions, fears, doubts and thoughts that run through her head as she prepares to face a weekend waiting for the pathology report. She explains that she was familiar with sudden, untimely death because her late father, a cancer surgeon, died in a plane crash when she was just thirteen years old.
Chapter 3: I thought it could never happen to me
“I’ll admit I haven’t made perfect choices every single day - who among us has? That’s what makes each of us human. One thing I know for sure: I can’t dwell on what was. I have to place my focus on what is so that I can get to what will be” (pg 37).
Facing the reality of having a tumor, Joan questioned why this is her reality - what are the relevant risk factors for her? What did she do wrong? She did not have a family history of breast cancer, and she always had the mindset that since her father was a cancer surgeon, she was immune in some way! However, as she looked deeper, she discovered that only a small minority of breast cancer patients have a family history, and that risk factors such as growing older, dense breast tissue, consuming alcohol, lack of sleep, stress, and hormone therapy are all important to consider. With this, she started to really see her cancer as an opportunity to honor her father’s legacy by being a health educator through her own journey.
Chapter 4: Choosing the path of least regret
Upon learning that her breast cancer was triple negative, a type which accounts for only about 10% of all cases, Joan had to make some big decisions about her course of treatment. She also needed to start the process of finding the right wig that will make her feel like herself once her hair starts to thin and fall out. While Joan was fortunate enough to have access to wonderful doctors who were able to give her many supportive options, she reflects on the challenges patients face when needing to make these hard choices, especially when they need to be made quickly.
“The reality is, no one wants to make life-or-death choices out of fear or other duress. Although I didn’t like the way the situation made me feel, it definitely pushed me into becoming my own advocate really fast. At one point I realized that at each juncture you come to in the breast cancer journey, you just hope that you’re choosing the path of least regrets” (pg 46).
Chapter 5: Finding my "why"
As a public figure, Joan knew that she must go public with her breast cancer diagnosis at some point but really struggled with how to go about doing this since she saw herself as a health advocate that people look up to. Would she be considered a failure since she wasn’t able to keep herself healthy? In the end she understood that she could look at her disease as an opportunity!
“... there was something I deeply felt connected to for years - and that’s my desire to have lived a mindful life, fully engaged in self discovery and awake to the fact that, as I have lived, I have continued to evolve and grow, as a work in progress. In the end, as long as we live, that is a choice we all have! If I went public, put my journey out there, and shared my experiences with people, I could spread this message of hope and encouragement” (pg 66).
Chapter 6: Finding the courage to share
Once understanding that she needed to share her news, Joan told her extended family and arranged to go on Good Morning America to make her story public on her own terms. She writes, “... I didn’t want to feel like a victim or have people feel sorry for me. I wanted to be a warrior, to help motivate other women to get their checkups every year and protect themselves from getting cancer” (pg 70).
Chapter 7: The day I started chemo
While many breast cancer patients have a lumpectomy and then chemotherapy, Joan had her chemotherapy first to shrink the tumor. While beginning chemotherapy, Joan and her husband, Jeff, told their children about her diagnosis. They integrated advice from her doctor who says it is best to be honest rather than keeping the cancer a secret since “their imagined problem is usually worse than the truth” (pg 77). The family also prepared to go up to Maine for the summer at the camp that Jeff ran, and Joan tried to reconcile with the fact that, at least for the time being, she would not be the same independent person she had always known herself to be. It was time to open herself up and accept that there would be a new normal.
Chapter 8: Good Morning, America, I have cancer
“I wanted everyone to know that breast cancer is not something to be ashamed of or something that we should feel is taboo to discuss. If I stood tall and spoke about my cancer, it would help others speak about theirs” (pg 82).
After sending out a personal email to family, friends, and colleagues, Joan returned to Good Morning America as a guest and shared her news with the nation. As people start to offer their sympathy, she felt uncomfortable and did not want people to pity her.
Chapter 9: "TEAMJOAN: an unexpected outpouring of support
Following her public announcement on TV, Joan received a huge outpouring of support from fans, friends, and former co-workers, ending her previous anxiety. She was very touched by the love that she felt from all these messages, many of which are included in the chapter, and decided to keep a blog to document her journey moving forward.
Chapter 10: Going rogue: make me G.I. Joan
Joan decided to take control over her thinning hair underneath her wig and went “G.I. Joan” at the hairdresser’s, asking for a full, close shave of her head before the hair fell out on its own. She felt like a powerful warrior… and hoped to continue feeling that way!
Chapter 11: Creating my battle plan
Big reveal #2 happened as Dr. Sanjay Gupta on CNN shared with his viewers that Joan was wearing a wig during her interview… phew! She planned to stay at the camp for the summer where she would follow her doctor’s advice for beating the chemotherapy blues - stay physical; eat healthy; get enough sleep and rest; drink enough water; and have a strong support system.
Chapter 12: Cancer ain't for sissies
Given that she was going to stay in Maine for the summer, Joan makes arrangements to get care locally rather than travelling to New York City. As her treatments continued and side effects started to become more consistent, she understood how important it is to honestly share how you are feeling!
“I have a tendency to avoid highlighting any weird or uncomfortable side effects because that might make me appear - you got it - weak or less strong and less healthy. Are you seeing a pattern? I believe this is something a lot of people (especially women) do with their doctors, and it’s antithetical to getting the best care. NEWS FLASH: Your doctor needs to know what’s bothering you” (pg 121).
Chapter 13: Eat, pray, poop
To address her uncomfortable digestive side effects from the chemotherapy, Joan found a skilled nutritionist to help her create a healthy eating plan. A huge shift from simply counting calories, he advised her to start eating in a clean way, fully removing wheat, dairy, and sugar while integrating whole foods. He also gave her the advice of putting in a port for her chemo treatments to avoid long-term damage to her veins.
Chapter 14: Port of entry
Joan went through the procedure to put in her port. Following a personal email from a well-wisher, she revealed that her brother and mother have also passed away. She suddenly internalized in a new way that death is possible for her too, that she would leave behind her seven children and loving husband if she is unable to beat this cancer.
“Unable to shake the thought of what would happen should this cancer actually do me in, I began pondering what my family would find when and if they ever had to go through my things. Oh my God. They are all going to think I was a totally unorganized slob!” (pg 139).
She then proceeded to clean out drawers.
Chapter 15: You're never too sick to throw a party!
Joan continued with her chemotherapy treatments and, despite uncomfortable side effects, she made sure that she would be able to be there for her older daughters by throwing a baby shower and helping to move into a new apartment. She reflected on how her mother was able to stay positive for her and her brother after the death of their father and channeled that intention for her own children during these hard times.
“Living through that experience and watching my mom persevere through the toughest of times and still find a way to smile had taught me the importance and value of a positive outlook on life - something I have tried to instill in my children, too” (pg 149).
Chapter 16: Calling all campers
Despite bad blood counts, Joan did her best to prepare for the annual Camp Reveille, a woman’s retreat that she organizes. Along the way she was greatly challenged physically and had her first real emotional break down, realizing that she could not continue to go at the same intense pace she had been used to her whole life! The camp was a great success and she received great feedback from participants on what they learned.
“...they remind their friend [with breast cancer] to rest her body, remain positive, and continue to focus on her goals through courage and strength: inspiring words they heard from the ideals I shared with the group on the night I spoke from my heart. She called the ideals… ‘The Foundations of My Life.’ Wow. They should be the foundation of all of our lives” (pg 164).
Chapter 17: A surprise visit from Charlie Gibson
Joan started the transition from her life and care providers in Maine back to Connecticut and welcomed a visit from a dear friend. She found that using humor and wearing her cap around the house to cover her bald head helped to ease the awkwardness with her younger children.
“Change is hard, especially in the middle of something like chemotherapy. But as they say, the only thing that stays the same in life in change. You can count on it” (pg 166).
Chapter 18: Getting back to real life
Leaving the secluded and peaceful camp and getting back to regular life led Joan to reflect on how fortunate she had been and continues to be. She has access to such wonderful resources when so many women do not have the luxury to be able to take time away and engage in self-care at their own pace.
Chapter 19: A new baby brings new joy
Joan was not able to complete her chemotherapy treatment because of her low blood counts so she needed to have her white blood cells bolstered with a shot and take it easy - not an easy feat for her to do! Despite her very uncomfortable physical state, she was able to be present for the birth of her first granddaughter and celebrate life.
Chapter 20: A bold, bald move
In a bold move, People Magazine requested to interview Joan and publish a photo of her on the cover. They specifically want her to be bald in an effort to highlight to women everywhere that this is something normal that they can also do and be comfortable with. Of course, it is not something that Joan fully felt great about right away and she weighed the different options.
Chapter 21: No turning back now
On the day of the photoshoot, the People Magazine photo editor shared with Joan that her grandmother refused treatment for breast cancer because she was afraid to lose her hair. “As a result, she died. If she had seen a cover like the one I was contemplating, perhaps her outcome would have been different. That did it for me” (pg 189). Joan decided to go for it, and revealed her bald head for an empowering and invigorating photo shoot.
Chapter 22: The unexpected curveballs of cancer
Amazing news for Joan as the chemo made her lump very small and her doctor said that there was a possibility that soon she may not need any more chemotherapy! She received a blood transfusion to improve her blood counts and energy, a much-needed boost since she continued to have many great invitations to participate in different events. One such opportunity was The Today Show, who asked her to be a part of their new segment on breast cancer awareness, #PinkPower.
Chapter 23: One lump or two?
Joan proudly accepted the opportunity to emcee the Honoring the Promise Gala for the Susan G. Komen Foundation for the Cure at the Kennedy Center.
“There were moments every day that I appreciated a little more because I realized just how precious, if not fragile, life had become. Perhaps life had always been that way and I was just figuring it out. I don’t know, but I was really proud to be there at night - to willingly and boldly step out onto the stage and declare, “I have breast cancer, too,” especially if it meant raising more money, more awareness, and giving women more hope” (pg 203).
Chapter 24: The best birthday present ever!
Celebrating Joan’s birthday was an especially sweet day that year, honoring the struggle she was navigating and appreciating life. On that very day, Joan also received the proof of the bald cover photo from People Magazine and felt whole with her decision, though anxious for the world to see! Four days later, she underwent her lumpectomy and reflects on how wonderful it is that she has always been able to wake up from procedures surrounded by smiling and loving support.
“If you ever wanted to give the gift of your time, sit with someone going through chemo or radiation. Hold his or her hand, read aloud, perhaps take a home-cooked meal. I don’t know that I would have understood before my illness how important these acts are, but that surely speaks to the change in my outlook today. The smallest kindness or compassion means so much to someone facing a chronic illness. Even if you can’t give money to a cause, everyone has time to offer” (pg 212).
Chapter 25: The big bald reveal
The reveal finally occurred on the Today Show and the world saw the People Magazine cover with Joan’s picture. The response was very supportive and positive! On a personal front, Joan consulted with her doctors if it was wise to continue with a new kind of chemotherapy or stop that treatment. Throughout, her family and fans were always there, showing her love. She shares two important things that she learned over this journey - you need to be your own advocate on and your mental attitude matters - “an optimistic outlook, even when things look bleak, will help create a more positive outcome” (pg 226).
Chapter 26: Wrestling with cancer
Joan began a new round of chemotherapy and continued to be touched deeply by so many emails and letters of support. One especially poignant message was from a woman whose grandmother was treated for breast cancer by Joan’s father, making her feel the connection to him even more strongly as she maintained her healing and education journey around the disease. Despite less than ideal blood counts and energy, she continued to make her appearances on The Today Show around breast cancer awareness.
Chapter 27: My new normal
“While I had finally gotten used to seeing myself wearing wigs, I can’t honestly say that I would ever get used to looking in the mirror and seeing a woman with no hair, no eyebrows, and no eyelashes. It stopped me cold every time I caught a glimpse of that barely recognizable woman. It had been nearly nine months since I shaved my head, so in many ways, it had become my new normal, and yet there was nothing normal about it” (pg 248).
As Joan continued with chemotherapy, for the first time she started to experience “chemo brain,” where she kept forgetting things and not acting like herself, and mouth sores. Thankfully, she received news that she is scheduled to start radiation treatment and would be able to cease her chemotherapy. She had much to be grateful for around that Thanksgiving.
Chapter 28: The connection that changed me
As she reached her final chemotherapy treatment, Joan was surprised to see that she is more emotional than any other part of this journey! A mindful nurse shared that everyone acts differently on their last day of chemotherapy, and that there is no right or wrong response.
“That got me wondering: When is an ending not an ending… and would this journey ever really end? The more I thought about it, the more I recognized that I was coming to the end of doing something about the deadly cancer cells in my body, but I wasn’t done. Though I was coming to the end of chemo, I still had radiation to go through. I think they call this winning the battle but not the war” (pg 260).
As Joan celebrated with a Facebook post, she woke up to see that hundreds of thousands of people on social media had engaged with her message. This social media connection to so many who love her was really surprising and made a huge impact in her journey. She truly realized that she has been “moving toward a more meaningful and purposeful life that was inspiring others on a deeper level” (pg 266).
Chapter 29: Unbroken
Following a high fever and flu like symptoms for many challenging days, Joan got another blood transfusion, fluids, and white blood cell boosting shot. Thankfully, these did the trick and she was able to go on a much-needed vacation with her family for a couple of weeks. Upon her return, she finished her final radiation treatment. She felt finally cured.
Chapter 30: Had I known
After nine months, Joan was able to look at her breast cancer through the rearview mirror. She appreciated time and life in new ways, creating a bucket list to remember to live life to the fullest.
“In retrospect, had I known that breast cancer was going to have such a powerful and positive impact on me, would I have made some of these changes earlier in my life so I could have enjoyed the benefits of the outcome sooner? That’s the million-dollar question - one I support I’ll never know the answer to. But here’s what I do know. While I desperately want to put this ordeal behind me and live life as it was… before cancer, life when I didn’t worry about whether I would be around tomorrow - I don’t think that will ever be possible again. And in many ways, I am appreciative for that gift” (pg 279).
She continues to channel her efforts and energy into an online television channel, Alive with Joan, where she offers her reflections, shares interviews, tips, and brings the breast cancer community together. Additionally, Joan speaks to the importance of the patient/doctor relationship at conferences and events and is forever grateful for the advice to have an additional ultrasound due to her dense breast tissue and advocates for that information to continue to spread to every woman.
Had I Known is an engaging book due to Joan’s sincerity, dedication, positivity and approachability. Her narration provides a detailed and raw firsthand account of what it is like to go through breast cancer and it could be helpful for doctors, families, and patients to read. It is inspiring to read about how she navigates her journey in such a positive and strong way and sees herself as an advocate who can used her platform to come out publicly and actively work on educating the public and the medical sector. She did not have to navigate her disease in the way that she did - she could have been more private - but instead Joan made a point to continue to speak out, make a difference and become a powerful symbol for other women. Of course that status is very different than most women who navigate the disease and there are times in the book where the celebrity and generous means she had available to access support and seek care are just not very relatable to the average person. However, there are so many universal parts of her story and I would recommend it to others, especially those impacted by triple negative breast cancer.
The book is 299 pages.
Book reviewed by Helaine Alon, ZBC Communication Coordinator