Sarah Ferguson, the Duchess of York, is getting candid about her initial reaction to being diagnosed with two different types of cancer in less than one year.

The British royal, 65, opened up about her experience in an essay for The Times of London published on Wednesday, April 23, saying that receiving her double cancer diagnoses felt “like a death sentence.”

“I was 63 when I was diagnosed with cancer for the first time and cancer at any age is traumatic,” she said while writing in support of the Teenage Cancer Trust’s campaign, #AndYoungPeople. “But as adults, we have maturity and life experience to help us advocate for ourselves and cope with challenges. We can seek help if we need it, and most importantly, our voices are, sadly, often taken more seriously.”

Sarah continued, “One group I feel is consistently neglected by those developing health plans and policies is teenagers and young people.”

Sarah, who is a patron of Teenage Cancer Trust, penned her contribution alongside an open letter from the charity to U.K. health secretary Wes Streeting. The charity’s campaign is asking the U.K. government to provide more support to teens and young adults with cancer. Additionally, they ask for more training for healthcare professionals in order to increase awareness of symptoms in younger people so that they can receive diagnoses faster.

Sarah was first diagnosed with breast cancer in June 2023 after she received a routine mammogram.

“She was advised she needed to undergo surgery, which has taken place successfully,” a rep for the author told Sky News at the time. “The duchess is receiving the best medical care, and her doctors have told her that the prognosis is good. She is now recuperating with her family.”

The rep continued, “The duchess wants to express her immense gratitude to all the medical staff who have supported her in recent days. She is also hugely thankful to the staff involved in the mammogram which identified her illness, which was otherwise symptom free, and believes her experience underlines the importance of regular screening.”

Sarah spoke about her diagnosis on her and Sarah Thomson‘s podcast, “Tea Talks with the Duchess and Sarah,” in July 2023.

“It’s really just extraordinary to come to terms with a new you,” she said. “You just cannot be complacent with yourself or life or just how lucky you are.”

Just over six months later, in January 2024, the ex-wife of Prince Andrew’s rep confirmed that Sarah had been diagnosed with skin cancer.

“Following her diagnosis with an early form of breast cancer this summer, Sarah, Duchess of York has now been diagnosed with malignant melanoma,” her spokesperson told E! News. “Her dermatologist asked that several moles were removed and analyzed at the same time as the Duchess was undergoing reconstructive surgery following her mastectomy, and one of these has been identified as cancerous.”

The rep continued, “She is undergoing further investigations to ensure that this has been caught in the early stages. Clearly, another diagnosis so soon after treatment for breast cancer has been distressing, but the Duchess remains in good spirits.”

Sarah admitted to The Times in January that getting diagnosed with cancer twice was “hard” on her mentally.

“I’m generally a positive person, but cancer is like a bomb going off in your life. One diagnosis is enough to deal with, but I had two in the space of a year. I don’t mind admitting that my mind went to some dark places, reflecting on my own mortality,” she explained.

“I’ve used meditation and mindfulness to help stay positive and balanced,” Sarah continued, adding that her family — which includes her and Andrew’s daughters, Princess Beatrice and Princess Eugenie — have been “an immense support.”