Living with the Fear of Breast Cancer Recurrence

When you were first diagnosed with breast cancer, your fear began. This huge new reality blocked almost everything else from your attention. Over time, and particularly now that you've finished treatment, the fear is shrinking. But it never vanishes completely, and periodically, it looms large again, like the day before your follow-up mammogram. It shrinks again when you receive the all-clear. How can you learn to live with this fear? Look over the each of the feelings below and explore any that echo your own thoughts.

Is every twinge a return of the cancer?

Do you feel a little bit like a hypochondriac? Right after you complete treatment, you may still feel fatigue as well as some other side effects. Over time, your stamina should return, but it's sometimes hard to sort out what is a normal ache or pain, a symptom of menopause, or something more serious.

The following steps may help you as you manage and monitor your body so that you can be vigilant without being obsessed. Be patient: this is a balancing act that takes some practice.

1. Make an appointment with your oncologist to discuss the short- and long-term side effects you might expect. It will help lower your anxiety level if you know what's normal and what should be checked.

2. If there is a new discomfort that doesn't go away in a few days, make an appointment to see your primary care doctor. Try to contain your worry and wait to see what he or she says. Use your common sense. A headache is just a headache.

3. Take loving care of your body now. It's still recovering and needs your kindness. If you're not yet physically active, begin moderate activity to help your stamina return and keep your heart healthy.

How can I put my faith into imperfect medicine?

Most women feel more anxious about their future health after having cancer treatment. If you're feeling uneasy about relying on blood tests and mammograms to spot a recurrence, keep in mind that you do have some control over the process. Your job is to get the best quality health care you can and to be faithful in scheduling appointments and tests, especially as months, then years pass. You also can become an expert in listening to your body, with respect for both its strength and its fragility.

I can't trust my body ever again.

After the experience of breast cancer there may be a shift in your feeling of trust in your body. Perhaps you've taken good care of your body, yet you still developed breast cancer. Or maybe you just never had to think about your health and were floored by getting cancer. Most survivors have the challenge of developing a new relationship with their bodies following cancer. The confrontation with mortality can be an opportunity for appreciating your body's strength and resilience. Your breast may have developed cancer cells, but the rest of your body was doing its job. It may feel like a stretch to thank your body, but over time, you may feel better about all it does for you, every day.

I'm SO anxious!

Being told you have cancer is traumatic and leaves a lingering feeling of anxiety and nervousness. It might even feel like a mild case of post-traumatic stress disorder, with vivid flashbacks in which you relive some of the worst moments of your illness. The following actions may help you lower your anxiety:

• Consider counseling, especially if you're obsessively checking for signs and symptoms of recurrent cancer.

• Learn yoga, relaxation training, or tai chi to help you maintain a sense of calm.

• Keep your follow-up appointments with your oncologist, and follow up with your primary care doctor if a symptom doesn't go away.

• Fill your life with meaningful activities.

• Plan ahead for being particularly nervous when the time comes for a mammogram or follow-up doctor visits. Cut yourself some slack around the times of these appointments, but don't let the unpleasant feelings get in the way of having regular screenings.

I miss seeing my treatment team.

The period just after treatment ends is actually a very anxious time for many women. The regular contact with cancer treatment staff provides a community of healers to reinforce that you're doing everything you can to get rid of the cancer. Now that you're finished treatment, your next appointment is weeks or perhaps 3 months down the road. It's very common to feel sad. This is amplified when family and friends congratulate you on being done and hail your return to health.

Spend some time with some of the books that are written specifically for helping breast cancer survivors move on after treatment, such as:

• After Breast Cancer: A Common-Sense Guide to Life After Treatment by Hester Hill Schnipper (2003)

• Living Beyond Breast Cancer: A Survivor's Guide for When Treatment Ends and the Rest of your Life Begins by Marisa and Ellen Weiss (1998)

These books will help you realize that you are in a new phase of your life and that you're working toward a "new normal."

I want to hear "cured" instead of "in remission."

The language used by oncologists doesn't feel very reassuring. You may never have a return of breast cancer but no test can predict that definitively. Coping with the uncertainty may be the biggest challenge of becoming a survivor and moving forward with your life. It is normal to be worried or sad at times. Each time a follow-up test, like a mammogram, shows no evidence of disease, you are a little bit safer. Each year without a recurrence adds some confidence.

There are so many reminders of my cancer.

Sometimes it seems like breast cancer is everywhere, bringing up your anxiety level no matter how hard you try to focus on other things. And hearing about someone else's recurrence triggers worry for most survivors. Since each woman is so different, try not to confuse others' situations with your own, and try to be as supportive as you can.

Sometimes all it takes is an article about cancer in the paper or on the TV news to send your anxiety sky-high. It will be an ongoing challenge to cope with these cancer "triggers" because you cannot avoid all of them. One way to cope with October is to find a way to give something back and contribute to the anti-breast cancer cause. You could volunteer for the Race for the Cure in your area or walk or run the race. You can also limit your exposure to TV, magazines, and newspapers this month.