Coping With Anxiety & Preventing Breast Cancer Recurrence
- Journalist Amy Robach, who previously had stage 2 invasive breast cancer, hasn’t gotten blood work done to check for cancer recurrence since August 2022—and it’s due to her fear, she admitted in a recent interview.
- It’s understandable how many cancer survivors have fears of recurrence, but it’s still necessary to stay on track with monitoring regimens.
- Julie Lange, M.D., a breast cancer specialist at Johns Hopkins, says “The risk of recurrence decreases as time goes on, but never gets down to zero.”
- The former “GMA” host was diagnosed with stage 2 breast cancer and underwent a bilateral mastectomy (removal of both breasts) and chemotherapy to treat it and reach remission.
- Dr. Marianna Strongin, a clinical psychologist and founder of Strong In Therapy, has been helping the SurvivorNet community by sharing coping mechanisms and a structured way to think about handling these issues.
It’s understandable how many cancer survivors have fears of recurrence, but it’s still necessary to stay on track with monitoring regimens, something Robach recognizes the importance of. Robach, who was declared “cancer free” in October 2013, may be many years out from battling the disease but it’s still necessary to get followup checkups when needed.
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She noted that her next blood test was supposed to be in February 2023, adding, “We were going through our hell and yes, it was the last thing on my mind.”
Robach also pointed out that “statistically speaking” her cancer is less likely to return do to the amount of time that has passed since beating cancer, but if she were to tell her doctor that she would likely be told to go get her blood test done.
As for why she’s continued putting off her blood work, she said, “I think anyone who has survived this knows that when you go in for the blood work, it’s very emotional, because you’re literally getting, they’re looking for tumor markers is what they’re looking for.”
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“So if the cancer were to come back in the places you don’t want it to with breast cancer, bones, liver, lungs, brain, you would think that you’d get a blood test that would show a tumor marker, which means that you would be facing then a terminal yet treatable, but ultimately a terminal cancer,” she explained.
“And so I think the fear of that, you get into this mindset, I don’t want to know. I’d rather not know.”
Robach continued, “It’s not going to make a difference anyway. You start to get in that head space and maybe it’s an excuse just not to have to go to the doctor again or go back to the NYU cancer center again or just to avoid something that’s uncomfortable and scary.”
Robach’s decision to hold off on getting her blood tests is, in the eyes of Holmes, “selfish,” something which Robach agreed.
Holmes said on the podcast, “And all I’m hearing is that this woman I’ve gone through all this with isn’t doing all she can to make sure we have as much time together as we can. Does that make sense?”
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Robach then admitted it isn’t the smartest to not get her blood test, but it truly makes her less stressed about the possibility of recurrence.
She added, “Do you know what’s interesting is I preach this or I have preached this to so many women who, this is what I’m saying right now is the same mentality a lot of women have about not getting mammograms because they don’t want to know. They don’t want to find the mass. They don’t want to know if they have cancer because that’s scary and that means it’s going to be difficult.”
“And so that ignorance is bliss mentality, as stupid as that is. And as illogical as that is somehow becomes this human trait that I’m now experiencing because I’ve put it off and once you keep putting it off, you’re like, ‘Oh, this feels so good to not have to make a phone call. This feels so good to not have go get a blood test. I feel normal. I feel like I never had cancer and that’s what I want to feel.’ And so then somehow I want to wish it into existence, but it’s illogical and dumb.”
Understanding Breast Cancer Recurrence
According to Julie Lange, M.D., a breast cancer specialist at Johns Hopkins, “At the Johns Hopkins Breast Center, our team of breast cancer specialists monitors patients who are at risk of recurrence. The follow-up schedule depends on the stage of cancer, what kind of treatment has been received and prognostic factors.
“The risk of recurrence decreases as time goes on, but never gets down to zero.”
Meanwhile a study published in the Journal of Clinical Oncology, titled “Annual Hazard Rates of Recurrence for Breast Cancer During 24 Years of Follow-Up,” concluded, “For the entire group, the annualized hazard of recurrence was highest during the first 5 years (10.4%), with a peak between years 1 and 2 (15.2%). During the first 5 years, patients with estrogen receptor (ER) – positive disease had a lower annualized hazard compared with those with ER-negative disease. However, beyond 5 years, patients with ER-positive disease had higher hazards.
“Among patients with ER-positive disease, annualized hazards of recurrence remained elevated and fairly stable beyond 10 years, even for those with no axillary involvement and for those with one to three positive nodes.”
The Susan G. Komen foundation also explains that that most local recurrence, (the return of cancer to the breast, chest wall or nearby lymph nodes after treatment), occurs within the first 5 years after diagnosis.”
And an earlier study from 2016, published in the World Journal of Surgical Oncology, concluded that, “ER+/PR+ and HER2− patients have higher risk of recurrence later than 5 years, especially in patients with high ER titer and low nuclear grade. Larger and node-positive tumors had higher risk of early recurrence.”
Amy Robach’s Breast Cancer Journey
Amy Robach’s cancer journey began after being encouraged by Robin Roberts during a segment on the morning show. Like Roberts, who also learned of her cancer diagnosis while undergoing a self-exam, Robach underwent a mammogram on the program to promote breast cancer awareness.
.@ABC News anchor @arobach opens up about the lessons she learned while battling breast cancer in 2013: "Realize how precious time is and no one is guaranteed a tomorrow." ? https://t.co/9BUBbAnKcD pic.twitter.com/aCkglXFn8p
— Good Morning America (@GMA) October 29, 2020
It was Robach’s cancer screening which led to her diagnosis of stage 2 invasive breast cancer. She also learned cancer had spread to her sentinel lymph nodes.
After her tumor was detected, she underwent a bilateral mastectomy (also called a double mastectomy), where both breasts were removed. Following the procedure, Robach underwent six months of chemotherapy. Luckily, her treatments helped her reach remission.
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Robach previously told SurvivorNet in an interview that her cancer diagnosis brought her closer to her ex husband, Melrose Place star Andrew Shue. Sometimes, a major health condition can strengthen relationships as both individuals find support and strength with each other. However, the opposite can also be true if the relationship is already struggling.
The former ABC News reporter also spoke about some of the trials and tribulations you undergo as you take on cancer.
Robach’s cancer journey strengthened her compassion for others. She says she developed a new kind of compassion that wasn’t possible before her experience with breast cancer.
TV Journalist Amy Robach Says Cancer Taught Her To Feel Other People’s Pain
“Cancer is something that has changed my life forever, something that I will always live with. There’s anger at first because you’ve lost security, and you’ve never had it to begin with. None of us have security, but you are grieving this loss of security because we all feel like there’s tomorrow,” Robach said.
“We all feel like there’s another day. When you get to something like this, you’re angry that you lost that. That’s been taken away from you. From that anger, I think, grew compassion and empathy.”
Robach considers that loss of security one of the gifts that cancer can bring. “You truly can feel other people’s pain in a way that you couldn’t have before.”
How To Manage Anxiety During High-Stress Times
Battling a mental health issue, cancer, or learning to move forward after treatment can be an extremely stressful time for so many people. How can you manage your anxiety andfear while dealing with so many other things?
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Dr. Marianna Strongin, a clinical psychologist and founder of Strong In Therapy, has been helping the SurvivorNet community by sharing coping mechanisms and a structured way to think about handling these issues.
“The way that I define anxiety is that it’s an internal question that we simply can’t find the answers to,” Dr. Strongin previously toldSurvivorNet.
Dr. Strongin says that one of the main causes of anxiety is uncertainty about life, and a cancer battle can fuel anxiety for individuals because of the lack of uncertainty about the future.
Many people will turn to media platforms for answers, but Dr. Strongin says that individuals often end up with more questions as a result which leads to more anxiety.
The first step for coping during stressful circumstances is understanding one’s anxiety. To do this, Dr. Strongin suggests checking in with oneself everyday to see where the anxiety is manifesting and what questions are causing the anxiety. From there, it’s important to answer those questions and reassure oneself with positivity.
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“The answers are our coping skills,” Dr. Strongin says. “Some people are really good at always giving themselves answers…other people don’t have the coping skills to answer their anxiety and as a result the anxiety increases. … We are all facing the same questions.”
She continues, “Some are facing them much more than others and some are better at answering those questions than others. What’s really important is to pay attention to is what those questions are, what the frequency of those questions are, and how you’re answering them.”
Anxiety In The United States
According to the Anxiety Depression Association of America (ADAA), anxiety disorders are the most common mental illnesses in the United States, affecting nearly 40 million adults (19.1% of population) 18 years and older. Anxiety can be developed through factors including genetics, personality, brain chemistry, and life circumstances. Despite being highly treatable, only 46.9% of people receive treatment for anxiety disorders.
Anxiety symptoms include feelings of irritability, fatigue, and nervousness. People struggling with anxiety also have trouble sleeping, difficulty concentrating, and rapid heart rate which leads to hyperventilation.
Therapy and medication are the two most recommended forms of treatment for individuals with anxiety, and treatments vary depending on the type of anxiety an individual has.
How To Reduce the Risk Of A Breast Cancer Recurrence
You beat breast cancer. like Amy Robach. You battled the beast and are healthy, strong and ready to tackle the rest of your life. But what about breast cancer recurrence?
As triumphant as breast cancer survivors can feel after learning they are cancer free, many worry about recurrence. What are their chances of the cancer returning and what, if anything, can they do to help prevent it from doing so?
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While the chance of recurrence varies based on the biology of the tumor, the stage it was when diagnosed and the treatment received, according to the Susan G. Komen organization, “Most people diagnosed with breast cancer will never have a recurrence.” That’s the good news.
“Once a patient has finished his or her active therapy for breast cancer, we will often refer to that time as breast cancer survivorship,” says Dr. Erica Mayer, a breast cancer medical oncologist at Dana Farber Cancer Institute.
“This is a time when patients are still being actively monitored by their treatment team, not only to ensure that they remain healthy and cancer-free in the years ahead, but also making sure that they have recovered from any side effects of their initial treatment, and that they are pursuing healthy behaviors for example, getting regular exercise, eating a healthy diet, and keeping up with all their other routine medical care.”
But recurrence does happen, so it’s important to do everything you can to reduce your risk. Here are some tips:
1. Follow Treatment Guidelines
“The best way to reduce your risk of recurrence with breast cancer is to follow treatment guidelines and complete the course of treatment that’s given,” says Dr. Elisa Port, a surgical oncologist specializing in breast cancer at Mount Sinai, recently sat down with SurvivorNet and offered the following advice.
For example, she says many women have breast cancer that’s hormonally driven, and there are treatments that they give, such as pills like Tamoxifen or aromatase inhibitors, to reduce the risk of these hormonally-driven cancers coming back. The issue is that the course of treatment may call for patients to take the pills for 5-10 years. While some have no side effects, others may experience a host of unpleasant side effects, even to the point where they’re severely debilitated and have no quality of life on these medications.
“So the challenge is to work with every individual person to make sure we give her the best chance of getting through these treatments and enjoying the benefits of these treatments, which is the lowest rate of cancer coming back,” Port says.
2. Maintain a Healthy Weight
Maintaining a healthy weight may also reduce the risk.
“We know that, uh, obesity or being overweight can increase the risk of cancer recurrence in breast cancer,” Port says.
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“And so I say, maintaining a healthy body weight, whatever that is for the individual… You know, we talk a lot about healthy body weight, and there’s a very big range of this, but there are certain numbers beyond which it does affect one’s health. So we try to keep people within a range of a healthy body weight.”
3. Limit Alcohol
Port says the other lifestyle factor that may increase one’s risk of breast cancer recurrence is heavy alcohol intake.
“We say alcohol in moderation is probably fine, which is defined as three to five drinks a week,” Port told SurvivorNet.
“More than that can also potentially increase the risk of recurrence. So the big lifestyle factors are healthy body weight and moderate alcohol intake.”
4. Eat a Healthy Diet
She says there’s no one dietary element that you can eat or consume to give you an edge against breast cancer recurrence. It’s not eating more broccoli or eating more blueberries or becoming a vegetarian. She says the fact that sugar feeds cancer is a big myth too. However, everything you eat does contribute to your overall health.
“These things are all really helpful in maintaining an overall healthy well-balanced diet and also to maintain healthy body weight. We know that diets that are heavy in sugar content are also usually unhealthy and can lead to weight issues. So it all really funnels back to maintaining a healthy body weight when it comes to lifestyle factors.”
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5. Exercise
This goes hand-in-hand with maintaining a healthy weight.
Exercise Can Lower Your Breast Cancer Risk
While exercise may reduce your risk, experts say it’s important to understand that if a recurrence happens, it’s not your fault, and there’s nothing you can do to guarantee that cancer won’t come back.
The best you can do is work with your health care providers to come up with a plan that best reduces your risk for recurrence while allowing you to embrace and enjoy your life in the present.
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What To Ask Your Doctor
- What is my prescribed regimen to help avoid a breast cancer recurrence?
- Are there steps I can take in my daily life to help avoid a breast cancer recurrence?
- Do you have recommendations for someone who doesn’t particularly enjoy exercise?
- Can you recommend a dietician who can help me with healthy eating tips and maintaining a healthy weight?
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Contributing: SurvivorNet Staff
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