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Kate Middleton's cancer announcement following abdominal surgery has quelled rumors but sparked more questions. Most are none of our business, but from my position as a surgeon, one burns bright: "How long has she known?" I'm not concerned with how long the princess waited to publicize her shocking news. I'm curious how long she wondered in the back of her mind if something was wrong. Did she continue appearing in public while brushing off vague abdominal discomfort? Did she think to herself, "It's probably just that time of the month"?

If she did disregard her symptoms even as they mounted, she is not alone. Many types of abdominal cancer — appearing in ever-younger patients — deliver only vague warning signs, like persistent pain or bloating, as they grow. I have unfortunately seen the end of this story all too often. It begins when a young person, the picture of health, strides into a physicians' office with pain that is downplayed — sometimes by all parties — and attributed to more benign causes. While optimism in these settings is reasonably well-founded, too frequently it dissuades medical providers from beginning an investigation. Furthermore, studies show that women and people of color are less likely than white men to be taken seriously when they surface concerns to their physicians. When physicians turn a deaf ear or downplay what's happening, the result can be fatal.

Knowing that even famous women often struggle to be heard or taken seriously, I wonder if Middleton, the Princess of Wales, sought care promptly or if she instead confided in her support network? When she ultimately did seek medical attention, did her physicians listen and respond appropriately, or did they pat her shoulder and tell her "It's probably just stress"? I worry that her diagnosis and treatment — like those of so many women and people of color — are worse than they had to be because she walked alone for too long.

While medical systems certainly bear some of the blame for delayed diagnoses, research shows that our best chances of cancer survival are seized not between diagnosis and treatment, but in the time from symptom onset to seeking care and starting a diagnostic workup. In a world where women are taught not to trust their own experiences, or worse, to bury their physical or mental anguish in service of motherhood, work, marriage or the thankless task of smiling in public, vague abdominal discomfort and other symptoms are too often ignored.

To be sure, some bodies use anxiety as fuel for physical maladies. In those instances, calming the mind might be a good way to alleviate physical discomfort. However, in our present age of mind-numbing social media, gut-numbing hyper-processed foods and soul-numbing politics, one wonders how our ability to feel or know anything could remain intact — let alone our gut-brain axis. Indeed, studies show that stress, hyper-processed diets and even increased screen time can negatively affect the gut microbiome, increasing the likelihood of chronic diseases. What's more, when our gut microbiome is non-diverse, we can suffer from a condition called dysbiosis, which itself can cause abdominal pain and bloating. When we live with such chronic discomfort, it can be very hard to recognize signs and symptoms of life-threatening cancers.

For those of us who are so overwhelmed in our daily lives that acts of self-care include simply using the restroom when nature calls, I hope that we can learn to listen to our bodies and share our concerns with others. In the meantime, if a friend or loved one confides that they are experiencing physical discomfort, instead of telling them "It's probably just stress," how about asking, "Have you considered seeking medical care?" If they have sought care and have been brushed off, encouragement to persist and seek testing may be the only validating voice in a crowd of internal and external deniers. Without such validation, the only question left to ask might be "How long has she known?"

Dr. Susanne Warner is an associate professor of surgery at the Mayo Clinic. Her opinions are her own and do not speak for her employer.