The Emotional Side of Breast Cancer

Shaquita Estes recalls being in total disbelief when the doctor told her she may have breast cancer. “I absolutely lost it,” Estes says. “I remember falling to the floor just telling him that I heard what he was saying, that this could not be true.”

Estes, a 45-year-old pediatric nurse practitioner from Palmetto, GA, says she was caught off guard because she didn’t have any family history of cancer except for a grandfather with prostate cancer. While a family history of cancer is a risk factor, cancer can still happen if it doesn’t run in your family. Most women who get breast cancer don’t have a family history of the disease.
As a health care worker, Estes’ medical instincts pushed her to get what felt like a mastitis breast pain, clogged milk ducts that may happen when you breastfeed, checked out. “I knew that I didn’t have mastitis because I was not [breast]feeding.”
In September 2018, Estes was diagnosed with invasive ductal carcinoma, a common type of breast cancer that starts in the milk ducts. It makes up about 80% of all breast cancer cases.

A Range of Emotions

A life-changing diagnosis like breast cancer can dig up a lot of emotions. It’s not uncommon to have depression, anxiety, uncertainty, fear, loneliness, and body image issues, among others. In fact, about 1 in 4 people with any type of cancer may have major or clinical depression and benefit from its treatment. One day you’re just going about your life and the next minute, you’re scrambling to get tests and scans as you try to make sense of complex medical information and your fast-changing reality.
 

 
After getting the diagnosis, some women may feel “significant distress,” says Kathleen Ashton, a clinical health psychologist in the Breast Center, Digestive Disease, and Surgery Institute at Cleveland Clinic. “They may not know what the next steps are.”
The word “cancer” itself may be a source of worry for many women, Ashton says. The fears can include worries about treatment costs, anxiety, and uncertainty about how it will impact your life or even your mortality, how the cancer may change your physical body, and how it may affect your loved one’s lives.

Issues Related to Physical Changes

Breast cancer treatments like chemotherapy, radiation, or surgery may bring about a lot of physical changes. Depending on the type of treatment you have, surgical breast tissue removal or reconstruction may result in scars. You may lose hair through chemotherapy. Some people with breast cancer may also have weight gain and go through early menopause. These physical changes may bring about issues with self-image and confidence.
For Estes, losing her hair was a big point of worry. “In the African American culture … it’s really our crown, our strength. It’s who we are,” Estes says. “I had a lot of pride and joy in my hair.” Once Estes started to lose hair, she says she decided to embrace it. “I just went and got it shaved completely off.”

Snehal Ponde also had strong feelings about her hair. “The only thing I thought of was, ‘I don’t want to lose my hair.’ It’s like your hair, your breast — it’s a reflection of who we are as women.”
Ponde, a 37-year-old Indian expat living in Singapore, gave birth to her son in April 2020. Three months later, like Estes, she felt a lump that turned out to be stage IV cancer.
During chemo, she chose to try a cooling cap to reduce hair loss. The cap, which is worn before, during, and after each treatment, is designed to circulate a cooling liquid around your head. The cold temperature may stop the chemo from damaging your hair follicles.
“Right now, I almost have 60%-70% of my hair,” Ponde says. The research on cooling caps has been mixed, with better results from the newer types of these caps, some of which have FDA clearance. There are some theoretical questions about whether the cold temperatures might let some cancer cells stick around in the scalp, but no signals of safety problems in studies so far. If you’re thinking about adding a cooling cap, ask your doctor for their take on them and what to look for. And check on whether your insurance covers the cap’s cost.

Handling the Uncertainty

For Shayla Wishloff, the sudden sense of uncertainty was jarring. “I thought I had such control of my life. I’m always the girl who had the year planner. I planned my vacations 6 months down the road. I had a 5-year plan, and I was doing it.”

Wishloff, now 25, was 24 when she got her breast cancer diagnosis. She had just finished nursing school in Alberta, Canada and was talking about buying a home, getting married, and having kids. One day, while applying lotion after a shower, she felt a lump in her breast. “Having my nursing background, I was like, ‘Well, that’s not good.’”
Doctors assured her that it’s very rare for someone in their 20s to get breast cancer. Studies show that only 5% of all breast cancers are found in people younger than 40; breast cancer is most often diagnosed in women age 50 and older. But Wishloff’s biopsy led to a diagnosis of an aggressive form of stage II breast cancer. “I thought I could beat it,” Wishloff says.
After 6 months of chemotherapy that she says did not really work, Wishloff got surgery to remove both breasts — a double mastectomy — followed by reconstructive surgery. Wishloff also got radiation treatments to try to kill any remaining cancer cells. She recalls being told there was “no evidence of disease” afterward.
But a few months later, bad news came. Wishloff says that a follow-up CT scan showed multiple tumors in her lungs and breastbone. It was stage IV breast cancer, which can be treated but not cured. Wishloff says that in October 2020, her doctors estimated she had approximately a year to live. “It’s just such a shock. The only way to put is it feels like the whole world is crumbling on you,” she says.
 

 
It  took a while to come to terms with it all. “I don’t think so far into the future and get so anxious about it,” Wishloff says. “I realize now — today — I’m OK. Today, I’m happy. Today, I can live a good day.” 

Getting Support

Going through breast cancer and its treatment may exhaust you physically and emotionally. Having family and friends who act as a support system can be a comfort. 
Estes feels fortunate to have close family members nearby. But it’s her best friends who really help lift her up when she needs it. They call themselves the Ta Group.
“It’s five of my best friends,” she says. “We would just get together and pray. I’ll go into my prayer closet — I call it my war room. If I needed to talk, I would just talk to them in there.” 

Professional therapy may also help. Check with your health care team if you want a referral. “I think my counselor has really helped me go through everything, all my traumas … and deal with them,” Ponde says.
Talking and bonding with people who are going through breast cancer may help you feel understood and less alone. You can find support groups on social media sites like Facebook and you can join local organizations.
You can also speak to a social worker or your counselor for more resources. When you’re seeking a community, Ashton notes that hearing people’s stories or reading too many negative posts online may make you more anxious. Her advice: Notice what’s helping you.
“Women with breast cancer come into their diagnosis with many strengths, and it’s important to use those strengths along the way to help you in your journey,” Ashton says.

Self-Care and Relaxation Techniques

Breast cancer diagnosis and treatments demand a lot from you and your body. You owe it to yourself to take time — even a few moments every now and then — to unwind and take care of yourself.
Here are a few things you can do:

• 
  Yoga and meditation. These mindfulness practices can help to lower your fatigue and stress. Any kind of exercise is also a good outlet for stress.
• Go for walks. “It could be the worst day of my life, and then I go outside for a walk. That’s the only thing I can do that I know 100% will change my mood,” Wishloff says.
• Imagery. Many people with cancer find imagery exercises can help manage pain and stress. To get started, close your eyes and think of a happy image in your mind. You can also think of an activity you like and let your mind linger. This may make you feel calmer.