Breast Cancer and Depression

PJ Hamel Health Guide
  • I’ve just come from the warm embrace–literally, and figuratively–of a group of women I see on the first Friday of every month. We meet at a local watering hole, and take a big, deep breath… then let it out. We loosen our belts; we slip off our tight shoes. Whatever your favorite metaphor for relaxing, that’s what we do. Cancer survivors all, we connect on a level that non-cancer women don’t.

    We’ve been through hell.

    We see that in each other. Our bond is immediate, strong, and empowering.

    Today, the talk turned to a news story on the high incidence of depression and other emotional disorders in women newly diagnosed with breast cancer. A new study in the December 15, 2006 issue Cancer, a journal published on behalf of the American Cancer Society, was conducted right here in our own backyard: at our local cancer center and Dartmouth Medical School.
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    This wasn’t some nebulous, far-off study; this was about US–our girlfriends, our colleagues at work, the women we see at the supermarket. And it validates what all of us have experienced: the cancer diagnosis is a severe emotional blow. Cancer is as much an emotional challenge as a physical one.

    For years, breast cancer has been treated primarily as a physical disease. As one friend put it, “Having a lumpectomy felt like an orthopedic procedure. ‘We’ll just take this off and send you on your way.’ But it was so much more than that… SO much more.”

    Much attention has been paid to killing cancer: removing the tumor, destroying any errant cells, then healing the damage done to your body by treatment. But what about the damage done to your soul?

    If you’re at a good hospital or cancer center, there may have been a social worker with you when you received your diagnosis, someone who offered you a box of tissues, and advice about how to talk to your kids. But as the radiologist listed the various doctors you’d be seeing in the succeeding weeks, did you hear the name of a mental-health professional? Someone qualified to assess your emotional state, someone who would poke and prod your psyche, and offer treatment, just like the surgeon and oncologist would do for your body? Probably not.

    It’s not as though the health community doesn’t realize there’s an emotional element to cancer; it’s just that goal #1 is to keep you alive, and that means stopping cancer. As the all-out war rages, full attention is paid to your breast, your blood, your lymph system… every physical part of you involved in the battle. With all this effort centered around your body, there’s no time to think about YOU. And that’s why, for many of us, at the end of active cancer treatment the battle has been won, but the war is just beginning: the war to regain our emotional equilibrium.

    The study in Cancer cites some alarming statistics: 47% of women diagnosed with breast cancer experienced moderate to severe emotional distress BEFORE beginning treatment. Eleven percent of women were diagnosed with major depression, and another 10 percent with post-traumatic stress disorder.

  • Previous studies have shown that up to one-third of women with breast cancer will experience significant emotional stress for up to 20 years after treatment. What this new study shows is that this stress begins immediately, at the moment of diagnosis, and can build to alarming levels before treatment is started. In other words: cancer hits our minds fast and hard, much faster and harder than anyone previously believed.
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    What conclusions does this study draw? One of the lead researchers, Dr. Mark Hegel, writes, “First, we need to do a better job of getting the word out about how well we can treat breast cancer. These emotional disorders are almost certainly due in part to the fear and helplessness that continues to result from receiving a cancer diagnosis. Second, we need to assess for and provide adequate intervention for the women meeting criteria for these severe but very treatable psychiatric conditions."

    In other words, breast cancer is a war that needs to be fought on two fronts: physical, and emotional. Our bodies need healing, but just as importantly, starting on day #1, so do our hearts and minds.

Published On: December 18, 2006