Breast cancer and anxiety

Many people affected by breast cancer have anxiety at some point. Having anxiety means feeling worried, scared, or nervous about things that happen or may happen in life. It’s completely natural to feel anxious about a cancer diagnosis.

Cancer isn’t something anyone really expects, and it brings many new and uncertain experiences. Anxiety can be triggered at different times through diagnosis, treatment, and after treatment. It’s normal to worry about how life might change, and things you can’t control or predict. And family members and caregivers often feel anxiety, too.

When it comes to anxiety and breast cancer, here are some things to keep in mind:

• Anxiety can be acute, which means feelings may be strong and happen for short periods of time.
• Anxiety can also be chronic, or last for a longer period of time.
• It’s more likely to affect some people than others, depending on emotional, personal, and family history.
• Some experiences of anxiety can feel the same as side effects of some cancer treatments, such as fatigue or difficulty concentrating.
• Some cancer treatments, such as steroids given with chemotherapy, can trigger or heighten anxiety.

Anxiety can often be increased at certain points, including:

• A suspicious finding on a mammogram or somewhere else
• Waiting for test results, such as a pathology report after a biopsy
• Anticipating the start of treatment
• When treatment ends
• Follow-up appointments and scans

Research shows that more than 40% of people diagnosed with breast cancer experience anxiety. Even though anxiety can sometimes be challenging, it helps to remember that anxiety is very common — and very treatable.

What causes anxiety?

Some symptoms of anxiety are directly caused by breast cancer treatment. But there are other sources of anxiety that are not a result of treatment. Knowing the difference can be hard sometimes, but talking with your care team can help.

Sources of anxiety after a breast cancer diagnosis

If you’ve recently been diagnosed with breast cancer, it’s completely normal to worry about whether and how you’re going to get through it. Other common sources of anxiety after diagnosis are concerns about whether the diagnosis is accurate, and if the treatment plan is the most effective one for you. The good news is that you always have the option to seek a second opinion, which in many cases can ease anxiety and help you feel more confident in your plan.

Sources of anxiety during treatment

During treatment, it’s very common to experience anxiety due to:

• Worry about whether or not treatment will work or cause side effects
• Fear of having pain
• Fear that the cancer will recur or spread
• Fear of dying
• Worrying about the impact on family, friends, work, and overall functioning

Sources of anxiety after treatment

Some people experience anxiety after they have finished treatment. Anxiety at this time may result from:

• Returning to work and having co-workers ask questions
• Fear of follow-up exams
• Fear of recurrence — that cancer will come back
• Changes in body image and fertility, if you are concerned about being able to have children
• Post-traumatic stress

Breast cancer treatment involves considerable support from a team of medical professionals. When treatment ends, the loss of this regular support can be anxiety-producing. It’s not uncommon to have thoughts such as, “When I was being treated, I was doing something about the cancer. Now, I’ve stopped.”

With a breast cancer diagnosis, there can be lots of potential anxiety triggers. But there are also many ways to ease anxiety, including lifestyle strategies, support groups, counseling, and medicines. On this page, we’ll walk you risk factors, symptoms, and ways to ease and manage anxiety.

Risk factors for anxiety

People diagnosed with breast cancer are more likely to have anxiety if they have:

• A past diagnosis of anxiety or depression
• Anxiety or depression in the family
• Lack of a family or friend support network
• Financial challenges

What are the symptoms of anxiety?

Anxiety can affect your mind, your body, or both. Common symptoms include:

• Feeling as if you are worried all of the time
• Worries shifting from one problem to another
• Feeling restless, keyed up, or edgy
• Feeling fatigued or becoming tired easily
• Trouble concentrating
• Feeling irritable
• Trouble falling or staying asleep, or waking up feeling as if you have not slept well

Additional symptoms include:

• Changes in appetite
• Chest pain
• Abdominal pain
• Shortness of breath
• Sweating
• Dry mouth
• Shaking or trembling
• Tense or aching muscles
• Tingling sensation (pins and needles)
• Panic attacks (sudden, intense feelings of anxiety)

You don’t have to have all of these symptoms to be diagnosed with anxiety or to seek support and help.

How to manage anxiety

It’s important to remind yourself that a cancer diagnosis and having cancer treatments are stressful for anyone, and that’s normal. At times, you may feel scared, sad, angry, or even guilty. But if these feelings become constant and overwhelming, they can negatively affect different aspects of your life, including your work and your relationships.

There are many things you can do to help lessen or control anxiety. Some things you can do on your own, but it’s okay to ask for help from your care team, family members, friends, or other people who have been affected by breast cancer. Asking for help is a sign of strength.

Common ways to manage anxiety include things you can do right now in the day-to-day, such as getting enough sleep and exercise. Other ways to ease anxiety include support groups, psychotherapy (talk therapy), or medicine.

Managing anxiety through lifestyle and self-care

There are things you can do in your daily life to ease anxiety, including:

• Eating a healthy diet
• Exercising regularly
• Getting enough sleep
• Participating in hobbies
• Talking to loved ones
• Practicing yoga
• Meditating or doing deep breathing exercises
• Limiting alcohol and caffeine intake
• Maintaining daily routines as you’re able to, such as regular meal times, bed time, and daily activities; structure can relieve anxiety
• Journaling
• Learning more about your diagnosis and treatment to reduce feelings of uncertainty

Learn more strategies for taking care of yourself if you're feeling anxious.

Managing anxiety with support groups and counseling

Even if you’re not feeling anxious now, you may want to look for resources in case you need them at another time, especially if you’ve had anxiety in the past. There are different types of support groups and one-on-one therapy, available in person and online, that can help.

• Support groups: Many people diagnosed with breast cancer benefit from support groups. In a support group, you can connect with others who are living similar experiences and understand what you’re going through.
• One-on-one counseling: A licensed professional counselor or psychotherapist can provide ongoing support and anxiety-management tools during regular sessions. Sometimes these support sessions are called one-on-one counseling or talk therapy sessions. Ask your doctor or a hospital social worker to recommend a therapist who has experience helping people with cancer.
  • Many people being treated for cancer experience reduced anxiety with a type of counseling called cognitive behavioral therapy (CBT). With this kind of therapy, you are actively involved in treatment to help you understand and change how you think and respond to certain things. In CBT, a therapist can help a person recognize the thoughts that can lead to anxiety, and practice new skills to help manage it. For some people, these are skills that can be useful throughout treatment and in other areas of life.
• Mind-body approaches: Mind-body practices such as Mindfulness-Based Stress Reduction (MBSR), guided imagery, qi gong, and yoga, often called complementary therapies, can help ease anxiety. Ask your care team if programs are available at your cancer center. They often are. Visit Types of complementary therapy to learn more.

There is also evidence that hypnotherapy (hypnosis with a qualified professional therapist) can reduce anxiety in people who’ve been diagnosed with cancer. Hypnotherapy helps focus the mind through relaxation techniques and mental images that can counteract the effects of anxiety. It’s often considered to be a complementary therapy that can be used in addition to other anxiety-reduction strategies. If you’re interested in trying hypnotherapy for anxiety, ask your hospital social worker for referrals.

Managing anxiety using medicine

If anxiety becomes very hard to live with, a health professional can prescribe medicine to help. There are many different kinds of medicines used to treat anxiety. Talk to your doctor to decide if taking medicine is the right choice for you. If you and your doctor decide that medicine is a good option for you, your doctor will choose one based on your needs, possible side effects, other medicines you are taking, and your medical history.

It’s important to know that some medicines used to treat anxiety, called SSRIs, can interfere with tamoxifen, a hormonal therapy breast cancer treatment. There are other anti-anxiety medicines available if you cannot take SSRIs. Learn more on our Medicines for anxiety page.

There are shorter-acting medicines that work quickly for strong symptoms, and longer-acting medications for more chronic symptoms of anxiety, which often take several weeks to start working. Your doctor will be able to provide guidance about what’s right for you.

Managing panic attacks

Panic attacks can be a frightening and sudden symptom of anxiety. Common signs and symptoms of panic attacks include:

• Sense of impending danger
• Fear of loss of control or death
• Increased heart rate
• Trembling or shaking
• Shortness of breath

Panic attacks often reach their peak within 10 minutes. If panic attacks are frequent, or you’re often worried about having another if you’ve already had one, let your healthcare team know. They can help you find support with a licensed therapist and/or medicine.

Let your care team know how you’re feeling

At the beginning of doctor appointments, your healthcare team may ask you questions about how you’re feeling emotionally. This is a good time to share any of your concerns, especially if you’re struggling with anxiety. It may be hard, but it’s important to be open and honest with your team about your feelings. You can tell them what you’re afraid of, your physical symptoms, and the effect anxiety may be having on your life.

Keep in mind that you can let your doctor know if you would like to be referred to a social worker or counselor at any time.

Following up with your health care team

It’s important to check in with your doctors and other team members about your mental health. They can help you figure out what’s working or not working. For example, if you’ve been taking an anti-anxiety medicine that isn’t helping after several weeks, let your doctor know. If you think you would benefit from seeing a therapist in addition to taking medicine, discuss that with your doctor, too. If you’ve been meeting with a therapist who doesn’t feel like a good fit for you, ask your doctor or a social worker about trying another one.

Everyone feels things and responds to uncertainty differently. And, while there is no one-size-fits-all approach to managing anxiety, what has worked for you in the past may need to be changed at times. No matter what, remember that you’re not alone and there are many support resources available at any point along the way.