You've Been Diagnosed With Breast Cancer—Now What?

One year ago, the American Cancer Society published breast cancer statistics for 2022. They estimated that almost 290,000 new cases of invasive breast cancer and 51,000 cases of DCIS (the cells are malignant but remain contained within a milk duct) would be diagnosed. Of those cases, they predicted more than 40,000 women would succumb to their illness.

Diverse Responses Among Individuals

Discovering that you have a cancer diagnosis can be a traumatic event for most individuals, although, like variations in personality, the responses to this type of news can be diverse. For some people, the reactions can follow Elisabeth Kübler-Ross’s stages of grief. First proposed by Dr. Kübler-Ross, a Swiss-American psychiatrist and pioneer of studies on terminal patients, the stages were denial, anger, bargaining, depression, and acceptance. Not all people experience these stages, and the order can be variable.

Denial includes the sense of being overwhelmed by the prospect of a scary disease. Different responses can include “Why did this happen?”; “But I’m so young!”; “I have no family history.”; and “Are you sure they got the right biopsy?”

Breast cancer is not a rare diagnosis, especially among women (men can also be diagnosed with this disease). Except for skin cancer, breast cancer is the most common cancer in women in the United States, and it remains the second-leading cause of cancer death among women overall.

For some, the next stage is anger. This can occur at any time during or after your initial diagnosis. One of the causes of anger is feeling out of control of one’s body. In my practice, newly diagnosed women and I often discuss their feelings that their “protective armor” has been pierced, and they are now somehow vulnerable despite the fact they engage in good overall health practices such as maintaining a healthy diet, exercising, and drinking alcohol in moderation.

Bargaining is when you might say, “I should have had a mammogram sooner,” or “If only I had lost the 10 pounds I promised to lose, I would have decreased my risk factors.” Aside from totally ignoring your health or neglecting an obvious lump in your breast, you did nothing wrong that led to this diagnosis. As humans, we try and make sense of things that sometimes don’t make sense. Sometimes, things happen despite every attempt to offset known risk factors for this disease. The truth is most women diagnosed with breast cancer have no family history.

Sadness, despair, and sometimes depression are natural responses to the feeling of loss that can follow a diagnosis of breast cancer. At this stage, I often see patients referred by oncologists or breast surgeons in my office. Despite undeniable progress in the areas of prevention and early diagnosis, many patients still fear the worst possible scenarios, including pain, disfigurement, loss of sexual attractiveness, and possibly death. Nearly one-third of newly diagnosed breast cancer patients will develop some form of psychiatric symptoms, most often depression.

Acceptance does not mean you believe everything is OK. It means coming to terms with the fact that you will be living a “new normal.” Depending on your diagnosis, you may undergo surgery, radiation, chemotherapy, or a combination of these treatments. I generally tell my patients they should expect to invest a year toward getting well. Sometimes, arriving at the acceptance stage gives people a sense of hope and empowerment. Knowing that there are new and less-toxic treatment options can be encouraging and help to eliminate some of your fears. The good news is breast cancer death rates have been decreasing steadily since 1989.

It is crucial to treat psychiatric symptoms that may arise after your diagnosis or at some point during or even after treatment. A new study published in The American Cancer Society's journal looked at the influence of depression on breast cancer treatment and survival in a population-based study. The results showed that compared with patients with no history of depression, those who did have a depression diagnosis were less likely to receive guideline-recommended treatment and had worse survival rates.

Guidelines for Action After a Breast Cancer Diagnosis

Learning you have cancer can be overwhelming, and knowing where to start to receive the best care can feel like a full-time job. Here are some guidelines compiled from patient advocacy groups as well as The American Cancer Society, Johns Hopkins Medicine, and The National Breast Cancer Foundation:

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• Talk openly with the doctor who delivers your diagnosis.
• Never hesitate to get a second opinion.
• Learn as much as you can about your type of breast cancer. Remember, knowledge is power and will help you feel more in control.
• After you have been informed about your treatment options, carefully decide what feels right to you.
• Reach out to your support group. If you do not have one, there are many you can find online,

Once you have decided on your treatment team, consider asking these questions:

• What information do I need to help me decide on treatment?
• What are your goals for my treatment?
• What are the chances that I can be cured?
• What are my chances of a long-term response with a good quality of life?
• Are there clinical trials available to me?
• How will I feel during treatment? Will I be able to work?
• What help will I need to manage the side effects of treatment? When and for how long?
• Should I consider a second opinion regarding my diagnosis and treatment?
• Are there different approaches to treating my kind of cancer?

Remember, there is no “right way” to respond when learning you have a scary-sounding diagnosis. The good news is the prognosis for recovery from breast cancer has improved. Five-year survival rates are in the range of 90 percent, and 10-year survival is about 80 percent. Early and better screening has contributed to a 29-percent reduction in the number of women diagnosed with breast cancer that has metastasized, and innovative methods for understanding the biology of tumors have led to improved and less-toxic treatment options.