By: Josie Carstensen, 24, Non-Hodgkin’s Lymphoma 

Two weeks before I was supposed to walk across the graduation stage and receive my college diploma, I was diagnosed with Non-Hodgkins Lymphoma. A chest x-ray found the fast-growing tumor lodged between my heart and lung. The first thing I did when they told me was laugh; I recall startling the nurse and scaring my grandfather. 

As we got the details, I remember feeling wholly disconnected from my body. Rather, I was floating away and watching the whole scene play out in a life-size movie. Whether floating away or feeling trapped in it, my body and the relationship I had with it impacted my identity and confidence for the rest of my life. 

The various experiences, emotions, and opinions I had towards, with, and about my body were challenged. It challenged my faith in myself and in who I was in my core. I clearly remember the cognitive dissonance of being stuck in a body that constantly needed help, when I had always been the type to take care of myself. Some of my hardest-earned traits, ones I could proudly claim after years of hard work, now seemed shaky. How could I be the athletic person I remembered being when I couldn’t walk upstairs? How could I be the fiercely independent woman I wanted to be when I couldn’t even go to the bathroom by myself? The challenges I faced in my new weakened body were not only a hurdle for identity but also for my confidence. 

I had always taken pride in cleanliness and my appearance, but the simple act of taking a shower would easily knock me out for the day. Makeup influencers and hairstyle inspo videos felt like another universe. I felt separated from a world where others could choose how to look. While beauty wasn’t a defining characteristic of mine at all, being someone who expressed themself creatively through what they wore very much was. Being a try-hard in high school was how I discovered my love for self-expression through fashion. 

Choosing an outfit each day had become a puzzle of balancing shapes and contrasting aesthetics to fit my intentions for the day. Most days I was too exhausted to pick an outfit that was even remotely stylish, and much of my clothing also just stopped fitting me. I had never much struggled with body image before my diagnosis; I thank my mother for her undying effort while raising me. But that changed when my body suddenly changed. It finally took having a meltdown before our family picnic for my mother’s kind kick-in-the-rear to spur a shopping trip for clothes that actually fit me. 

As the weeks turned into months, I discovered ways to prioritize myself and feel confident. I started wearing fun colorful wigs to my chemo appointments, sometimes spending hours beforehand trying to style them as I kept having to take naps. Chloe Bean’s brand of Baldie Bean Beauty Temporary Eyebrow Tattoos also made a huge difference and helped me feel like I didn’t look so horribly sickly leaving the house. I found DIY face masks to do with my mom, fun designs for manicure nights with friends, and was able to add more and more self-care to my day as my health improved. Now officially one year in remission, I’ve got a tried-and-true skin care routine, eyebrows to pluck, morning meditation sessions, Sunday night bubble baths, and a rosemary hair mask schedule on Finch. 

Overall, the biggest hurdle with confidence and identity during my cancer experience was losing my hair. It’s interesting how connected we are to our hair as it truly becomes a part of us. How we style it or the crazy colors we dye it shape not only how we see ourselves, but also how the world sees us. I never realized, after years of being called a Barbie or airhead, how much having long blonde hair had wormed its way into my identity. 

After losing all the hair on my head, I never thought I might one day put a crown on it. But as my health and confidence returned, I knew I wanted to do something with the second chance it felt like I had been given. My Miss America journey has been a surprising and joyful ride from the very first day in January when I was crowned Miss Marion-Polk, 2025. It’s ironic that it’s never felt further from a beauty pageant. Perhaps it’s the type of perspective that only comes after hitting rock bottom and having to discover that somewhere, deep down in there, there is beauty. It’s trite and sour like lemons, but it’s true what they say: you are in control of what beauty is and it can be as shallow or sturdy as you make it. 

While sparkly gowns and winning scholarship dollars are amazing parts of the Miss America Opportunity, my main draw to the scholarship program was the outlet for activism. To me, it feels a bit like fighting back. Because while I can’t change what happened, I can be an active participant in what will. Advocating for others and the unique AYA cancer experience has become an even larger part of my life joining the program earlier this year. There is so much I wish someone could have told me about how my confidence and identity would evolve during treatment, which is why I chose to focus my work with the Miss America program on helping patients restore their self-image and passions outside their diagnosis. 

While cancer takes a whole lot from you, I feel like I finally took something from it. I took its power to define me. Its power over my identity and its power over my confidence. My whole definition of beauty at its core is more concrete and untarnishable now than I ever knew it could be. And while I’m grateful for that, I think I’m even more grateful for the equally concrete confidence I now have in my identity. And in a surprising turn of events, I got that from a diagnosis. 

Josie Carstensen currently serves as Miss Marion-Polk and will be headed to Miss Oregon this June to compete for the title of Miss Oregon, where once crowned, the winner will go on to compete for the national title of Miss America in Orlando, Florida on September 22nd.