Miss You Already (2015): Breast Cancer and Friendship

Milly and Jess have been inseparable since childhood in London. Milly is the glamorous, chaotic one. Jess is steadier, and quietly trying to conceive.

Milly has been putting off a check-up. She is told a breast lump is malignant and begins chemotherapy. Jess sits through it with her, while concealing that her own IVF has worked. The results push the surgical plan from lumpectomy to a double mastectomy. Milly's marriage and her sense of herself come apart. She starts an affair and pushes Jess away.

Their friendship ruptures on the Yorkshire moors. The two are still estranged when Milly's headaches turn out to be the cancer having reached her brain. She loses much of her sight and moves into a hospice, with one goal: to be there when Jess gives birth. She makes it, meets the baby, and dies shortly afterward.

Spoilers throughout. This page says how Miss You Already ends.

The film is precise. The error is in the summaries written about it.

On screen, a consultant explains that the plan is moving from lumpectomy and radiation to mastectomy. The reasons given are that the cancer is triple negative, and Milly's genetic testing results. Later an MRI confirms the cancer has reached her brain, and Milly repeats the phrase "metastatic brain tumors" back at her friend. Both facts are stated, not inferred.

What is not in the film is remission. The word never appears. One formulation has circulated widely: that her breast cancer was in remission while she also had fatal brain tumors. It originates in a plot summary and has been copied into derivative sites. It is internally contradictory on its own terms.

The film shows a continuous progression instead. A malignant lump, chemotherapy, escalated surgery, a reconstruction she never becomes well enough to have. Then the headaches, an MRI, and the news.

One more thing is worth flagging. A character does say "you had brain cancer" at one point. That is Jess, a lay friend, speaking loosely. It is characterization, not the film's diagnosis.

NCI defines triple-negative breast cancer as the absence of staining for estrogen receptor, progesterone receptor and HER2.

That is a statement about what is missing. It matters because several of the most effective breast cancer treatments are aimed at exactly those three targets. NCI says so directly: triple-negative disease is insensitive to HER2-directed therapy such as trastuzumab, and to endocrine therapy such as tamoxifen or aromatase inhibitors.

So the label is not a severity score. It is a list of doors that are closed, which is why the remaining plan looks different. See what triple negative means for how the result reads on a pathology report.

Preoperative treatment is common here. NCI notes that neoadjuvant therapy is particularly favored in triple-negative and HER2-positive disease, because the response seen at surgery then guides what is given afterward.

Two lines of evidence shape the current approach:

• Carboplatin added to an anthracycline and taxane backbone. In GeparSixto, the pathological complete response rate rose from 36.9% to 53.2% with carboplatin. In CALGB 40603, it was 54% with carboplatin against 41% without.
• Pembrolizumab added to chemotherapy. In KEYNOTE-522, people with stage II or III disease received paclitaxel and carboplatin, then doxorubicin and cyclophosphamide, with pembrolizumab or placebo. Pathological complete response was 64.8% against 51.2%. At a median 39 months, event-free survival at 3 years was 84.5% against 76.8%.

The trade is real. Serious treatment-related adverse events occurred in 32.5% of the pembrolizumab group and 19.5% of the placebo group.

This is the confusion the film gets right and its own characters get wrong.

When breast cancer spreads to the brain, the tumors there are made of breast cancer cells. The disease is still breast cancer. It is treated according to breast cancer biology, not according to a cancer that started in brain tissue. That general rule is covered in a cancer keeps the name of where it started, and what it means day to day is in brain metastases.

It also has practical consequences the film has no room for. Many trials exclude people with brain metastases outright. The ASCENT trial of sacituzumab govitecan in metastatic triple-negative disease enrolled 468 women without brain metastases, treated on days 1 and 8 of each 21-day cycle. Milly, at that point in the story, would not have qualified.

The social wreckage, rather than the illness. The friend who is exhausted and resentful and cannot say so. The husband who cannot look at his wife's body. The children who ask whether their mother is dead.

Milly is written as difficult, vain and often unkind while dying. That is a rare refusal of the noble-patient template. The physical detail is specific rather than tasteful: the post-op bra, the wig, the reconstruction always one hurdle away, then the cane and the lost sight.

The disease moves at the speed of the friendship plot. Estrangement, reconciliation and terminal news arrive in a sequence built so that Milly's decline and Jess's pregnancy peak in the same week. The late loss of vision is deployed mainly for visual poetry. The hospice admission is compressed and well lit. The childbirth crosscut is a construction, not an observation.

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Miss You Already gets the medicine right and has been summarized wrong. There is no remission in it. What there is, unusually, is a dying woman allowed to be selfish and awful, and a friendship that survives her being it.

• NCI — Breast Cancer Treatment (PDQ®), Health Professional Version

This page discusses Miss You Already for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email corrections@cancerexplained.org.