You were diagnosed with breast cancer. You lived through the anxiety and fear of not understanding the disease or the treatments that your doctors recommended. You went through surgery, perhaps radiation therapy and maybe chemotherapy as well.  You then took medication for 5-10 years (maybe you’re still taking that daily pill).

Congratulations! You completed all of your treatment and can now get on with your life, just as your care team predicted. The entire breast cancer experience was just an interruption in the process of you achieving all of your life goals. Move on. Easy.  Right?

Not for every woman. Not for most women.

Fear of recurrence (FOR) is real. It can come and go. It can be mild or severe, and it can present differently at different times, in the same woman. Have you experienced it?

FOR is the fear or worry that cancer could return or progress in the place it originated or in another part of the body. That fear can pop up at any time: the day after your surgery or years after your treatments are complete. Women who were relatively young when they were diagnosed (under age 50) and women who have preexisting issues with depression and anxiety are among those most likely to experience FOR. But it can happen to every woman.

FOR can have significant consequences on a woman’s life. It can make psychological adjustment to life after treatment and other new situations very difficult. It can create emotional distress and anxiety. Women can have difficulty making future goals and plans if FOR is strong. Also, women with significant FOR often use more medical services: when symptoms or concerns arise, FOR can drive women to the emergency room or specialists for advice; they may also demand expensive tests for evaluation.  Most often, these pricey measures reveal no abnormalities and a woman’s FOR may not be satisfied for long.

There are things that you can do for yourself to deal with bouts of FOR:

1. Take a breath. When you feel the FOR rising inside, it is effective to immediately work on relaxation. There are many ways to do this: with a therapist or counselor, yoga, massage therapy or exercise. The fastest way to get a result is to stop what you are doing and simply breathe deeply a few times. The time you spend doing that breaks your train of fearful thoughts. You can then decide to focus on things that do NOT make you fearful and approach your anxiety from a more productive point of view.

2. Look on the bright side. The more optimistic a person is, the less likely she is to fear cancer recurrence. She is not in denial; she simply focuses upon what is actually happening and what is good in her life. When women adopt an attitude of optimism, their FOR diminishes.

3. Read a book. The less you know, the more fearful you may be. If you educate yourself about the breast cancer experience (reading brochures from your doctor, library books, other women’s blogs or memoirs), you can identify things that you have in common with others. This knowledge can combat FOR.

4. Review your medications. Is that new bodily symptom cancer recurrence? Before you jump to that conclusion, take a look over the medications you’re taking. Call the prescribing doctor to discuss the medications’ side effects. A side effect is not recurrence.

5. Take a look in the mirror. What else is going on with you? Are you experiencing stress from other people or situations? Are you just emerging from your chemotherapy? Have you gained weight? Are you going through menopause? Have you gone back to work/the gym? New life changes can create body changes.

6. Look inside. Mindfulness is moment-to-moment, present-centered, purposeful, nonjudgmental awareness of your thoughts and actions. Achieving mindfulness involves paying attention, setting intentions for your thoughts and actions before they happen, and adopting a non-judgmental attitude of yourself and others. Mindfulness increases your ability to be objective, and it ultimately alleviates anxiety and FOR. Mindfulness must be practiced on a regular basis, creating a new habit of thinking where FOR is not a dominant or significant thought. Often, mindfulness is learned with the help of a teacher or guide.

   Many women find that spirituality or religion is an effective coping mechanism against FOR.

7. Look outside. Ask for help! If you are not able to resolve your episodes of FOR, call your breast cancer doctor. S/he is always available to address your concerns, review your symptoms and medications, and examine you. Most of the time, that contact is what a woman needs to feel at ease. Do not be embarrassed to call and ask for help or advice.

You may also find help with therapy or counseling. Your breast cancer team can find a professional for you.  

Your care team may also direct you to support groups where you may find comfort from others who have shared some of your experiences.

References

1. Butow et al. CancerForum 39(2) July 2015

2. van Helmondt et al., BMC Cancer (2016) 16:527

3. Thewes et al. Support Care Cancer (2016) 24:2269-2276

4. Dawson et al. Clin J Oncol Nursing Dec 2016;20(6):E155-161