Anxiety in Breast Cancer

Anxiety in Breast Cancer

Here’s the truth: the anxiety starts really early, well before you are even diagnosed. It starts
when you get the follow-up letter after a routine mammogram. Before that moment you’ve
never given your “routine” mammogram another thought. It was recommended that
additional mammographic views and possible breast ultrasound be performed. The letter
doesn’t seem to be too anxious, but you certainly are. Then your anxiety ratchets up when
you go back to the clinic and while you wait for the doctor who is looking at your
mammogram. When she doesn’t crack a joke with you but rather looks so earnest and
concerned about a mass that isn’t a shadow but an actual mass, the jig is up. Anxiety is
often triggered by the anticipation of future events, and all you can anticipate are bad things.

You have to make an appointment for a biopsy. This is the first thing you need to do,
before you see a surgeon, before you see an oncologist. The biopsy will identify what the
thing inside you is. Until the doctors know exactly what they are dealing with, they are no
good to you. Why can’t I do the biopsy now? Because there are orders and papers and
signatures and schedules that are not in sync with you and your anxiety. So you hurry up
and wait. While hours and days pass, the anxiety has run rampant. A mass that you might
not have even felt before is now giant; you don’t even have to press hard to feel it, and
every time you do feel it, it seems to get bigger. Then there is the interminable wait after
the biopsy to see if what you have actually is breast cancer. While you wait, your future life
rushes before your eyes, a life you think you will not be part of: your kids’ high school
graduations, weddings, births, travel to places you’d always wanted to visit.

Once you are diagnosed, the inevitability of treatment as well as the unknowability of
treatment stoke the anxiety that darkens your door. In my case, it was a mastectomy
followed by chemotherapy. As you await the day of surgery, a sly glance down at your
chest allows you to imagine what the new geography of your body is going to look like, and
as you wrap your head around the notion of breast removal (see “M Is for Mastectomy”),
this imagining is anxiety inducing. Anxiety grips you as you await the pathology results in
the days after they remove the breast and study the tumor. When you know you have to
have chemotherapy, you try to anticipate what your body will feel like after it has been
pumped full of poisons to cure you. Because there is nothing to prepare you for all of this,
your anxiety meter will be off the charts.

Anxiety is different from concern, even from worry or fear. You can be worried about
the state of the world or concerned about the ozone layer or scared of dogs or bees.
Anxiety is something altogether different. Fear is something all animals experience, but
anxiety is unique to humans. It is also part of living with cancer. It doesn’t define living
with cancer. Anxiety is more like your cancer companion; it is attached to you now,
sometimes in the background, sometimes front and center, but always there.

From the prosaic to the profound, I always found a reason to be anxious. Will I get a bed
or a recliner at the chemo infusion unit? Are they giving me the right drugs in the right
dosage? Are they sure I don’t need a prophylactic mastectomy? Anxiety stalks you as you
sit through countless doctor visits, hours and hours of tests, and days and days of waiting.

Anxiety actually sinks its tentacles in you and makes itself at home through bad news and
even when you get some good news. It lurks like an unwelcome visitor who never leaves,
because it never does. Anxiety is in your mind, yes, but it also manifests itself physically—
nausea, light-headedness, stomach upset, racing heartbeat.

Your challenge is to manage it. I’m pretty good at time management and, if I put my
mind to it, weight management too. Anxiety management is a completely different beast.

Anxiety is not neat or measurable. It is amorphous and stubborn and oh so resilient. It
cannot be compartmentalized or shoved aside or thrown out or vanquished. It actually must
be managed, and you have to figure out the best anxiety management techniques for you. It
can be drugs (see “D Is for Drugs”); it can be therapy of a wide variety of types (see “T Is
for Therapy”); it can be meditation or yoga or work or play or ice cream or movies. Coping
with anxiety is the part of your cancer treatment that may get short shrift from the medical
professionals. They are dealing with a big thing—your cancer—and thank goodness for
that. But anxiety is real and important, and you have to let people know that so you can get
all the help you need to manage it.

So why doesn’t it go away? Maybe you’ve gone through all the prescribed treatment and
your doctors feel good about your prognosis. So how come the anxiety is still there?

Because once you have cancer, all you can think about is, Will it come back? Every ache
and pain you have that might be a result of aging or strenuous activity or an accident, they
all could be your cancer coming back. At least that is what you think and that is what you
get anxious about.

The good news is that reality is never as dark as the places your mind can take you, and
unfortunately anxiety takes you to the darkest places imaginable. Maybe living with it
becomes a learned skill and the anxiety subsides; in the meantime, managing it seems to be
the only option.