Coping with the diagnosis and treatment of breast cancer, as well as with the impact that it has on our lives, is a process that continues for many years, perhaps the rest of our lives. Just as there are stages of physical recovery from cancer and its treatment, so too are there stages of emotional recovery. Following are the stages people typically experience when coping with breast cancer, common reactions in each stage, and suggestions on ways that people can help themselves deal with each stage.

Stage 1
Suspicion
Whether the first hint of breast cancer is a suspicious lump, a questionable mammogram, or another symptom, the initial response is usually terror. You may respond to this emotion by denial and flight. People often grasp at any hope that the symptoms are benign, and you may postpone obtaining second opinions and appointments with surgeons. One woman, fearful of bad news, called a surgeon for an appointment. Told he was booked for two months, she happily said, “Fine, I’ll wait.” Inaction may be dangerous to your health! Keep in mind that most breast abnormalities are benign so the odds are that the news will be good. However, postponing a definitive diagnosis is risky. The earlier breast cancer is diagnosed, the better the prognosis and the easier the treatment process. Although watchful waiting is sometimes a good alternative, a biopsy is usually the best route. Of course, make any decisions in conjunction with a physician, but if waiting to see if a lump or other symptom changes is recommended, I would strongly encourage a second opinion. Avoiding fears may be very appealing, but they can only truly be resolved by obtaining a clear and accurate diagnosis. Action and acknowledgement of our feelings are the keys to dealing with stage 1.

Stage 2
Biopsy and Diagnosis
Improved surgical procedures have made biopsies of breast tissue relatively minor procedures. However, the emotional impact of the biopsy is usually major. This procedure will determine whether or not a life-threatening disease is present. For many, the period immediately before the biopsy and the time between biopsy and diagnosis are the most difficult of the entire cancer experience. The anxiety and uncertainty, as well as the continuing fear, can be enormous and immobilizing. One woman said that she “felt like she was going to jump out of her skin,” while another felt like “walking on hot coals,” trying but failing to avoid her emotional pain.

Engagement, self-nurturance, and assertiveness seem to be the keys to getting through this stage successfully. Taking care of ourselves, talking about our feelings, and seeking support from people we trust is essential. If a physician was not optimistic, this may be the time to begin gathering information and identifying sources of help from people coping with breast cancer. Avoiding feelings and acting like nothing is wrong is usually not helpful and will probably make you feel worse. Also, be assertive in asking for what you need, especially from your physician. The interval between biopsy and diagnosis should rarely be more than a few days. The shorter that interval, the less anxiety you will experience . Take steps to obtain the results of your biopsy as soon as possible.

Stage 3
Making Decisions and Beginning Treatment
Shock is often the first response to a diagnosis of breast cancer. “I feel fine; how can I have cancer?” Crying, screaming, even fainting are all reactions I have seen in response to the diagnosis of cancer. Rage, terror, grief, anxiety, depression and even denial are all normal and understandable reactions. You are also likely to feel overwhelmed by all the decisions you must quickly make.

Although you may feel like you are caught in a whirlwind, your prognosis usually will not be compromised if you take at least a few weeks to gather information, consider your options, and make a sound treatment choice. Of course, ask your physician when it is medically advisable for your treatment to begin.

Information, support, and acceptance are the keys to this stage. You will need both emotional support to help you with your upsetting feelings and practical support to assist you in gathering information. Organizations such as Y-ME, the American Cancer Society, and the National Coalition for Cancer Survivorship can provide both information and support. The Internet has chat rooms, bulletin boards, and many sources of information for breast cancer survivors. Ask your partner and good friends to help you on this journey, to organize a notebook with your questions, to set up folders with information and resources, and to help you deal with your work and family while you are in treatment. Assistance in organizing the many details and pieces of information during this stage can make a great difference. Finally, acceptance of yourself, however you are feeling and acting, and acceptance of your diagnosis are important.

Stage 4
Treatment
Treatments for breast cancer vary greatly, depending on the size and type of the tumor and whether it has spread to the lymph nodes or even to another organ. For most, surgery is the first treatment. That may be followed by chemotherapy, radiation, and hormone therapy, usually tamoxifen. During this stage, you will be coping with the physical side effects of treatment; your emotional reactions to pain, hair loss, nausea, negative effects of treatment; and to the threat of disease.

Greer and Watson identified five typical reactions following the diagnosis of cancer: hopelessness and helplessness, denial and avoidance, fatalism, anxiety and depression, and a fighting spirit. Although positive avoidance is sometimes useful, the fighting spirit generally seems to be the most successful way to cope with cancer. People with a fighting spirit fully accept their diagnosis but are optimistic, seek out information and resources, and are determined to combat their disease. This does not mean they are Pollyannas who never feel fear, worry or sadness. They are realistic and know they are dealing with a life-threatening illness. However, they have hope and are taking steps to take care of themselves.

Maintaining your fighting spirit, developing sound coping skills, and sharing feelings with others are the keys to negotiating this stage successfully. Coping strategies such as relaxation, visual imagery, gentle exercise, self-talk, and affirmations not only can help you to feel more optimistic and powerful, but they can also alleviate some of the physical side effects of treatment. If these coping skills are unfamiliar to you, cancer support groups or books written for cancer survivors can introduce you to them. Sharing your feelings with family and friends, as well as with other cancer survivors, can help you during this phase. Other people who have been through treatment can help you know what to expect and how to handle treatment. They can also reassure you that your experiences are normal. Your loved ones will also have feelings about your experience with cancer, and both you and they need to share feelings and support each other.

Stage 5
Immediate Post-treatment
Most people eagerly look forward to the end of treatment, especially if they have coped with the hair loss and other difficult side effects of chemotherapy. They expect to feel relieved and excited that treatment is over, however, their reactions when treatment ends are often surprising and different from what they expected.

While going through treatment, you are in close contact with your oncologist and know that action is being taken to destroy the cancer cells in your body and prevent their return. However, the end of treatment is like launching a boat into choppy waters. You are no longer anchored to the dock and have to rely more on yourself as you continue this journey. This can bring up renewed fears and anxieties, and it even leads some people to seek additional medical treatments. Keep in mind that this is an expected reaction. The keys to negotiating this stage include recognizing and accepting your fears, making sure you continue to get the medical care and reassurance you need, and beginning to rebuild your life. Your work, family responsibilities and leisure and social activities all may have been neglected as you focused your energy on treatments and recovery. Now is the time to reconnect with all those parts of your life that were important and rewarding to you before your diagnosis. Doing this will help you start to put cancer behind you, to begin to feel like yourself again, and to regain your energy and enthusiasm. Especially important is taking good care of your physical health through healthy eating, regular exercise, and appropriate medical check-ups. Even something as small as flossing your teeth on a regular basis may prolong your life. Also important is building into your life activities that help you feel strong and healthy and experiences to which you will look forward.

Taking a painting class and planning a trip to Europe, for example, can help you believe your life is moving forward again, and that you have a future.

Stage 6
Extended Survival
Most people will recover from their cancer treatments and go on to lead long and healthy lives. Although you will never forget your experience with breast cancer and may find your life has been forever changed by that experience, you can use cancer as a wake-up call. Our experience with cancer puts us in touch with our mortality. We always knew our lives would not go on indefinitely, but that realization becomes much more meaningful after cancer. Use that awareness to do those things that you have always wanted to do! Renovate your house, marry the man you have been living with, learn to water ski, take a course, and buy those great purple shoes that don’t match anything else in your wardrobe. You can look forward to buying a purple dress to go with them. Although your years of extended survival can be wonderful for you, you are also likely to have worrisome times. For most people who have had cancer, unexplained aches and pains cause fears about the return of the cancer. So can other reminders such as birthdays, anniversaries of your diagnosis, medical check-ups, and cancer diagnoses and deaths of others. Keys to helping you negotiate this phase include recognizing that these fears are predictable, getting the medical information you need to dispel those fears, and keeping your focus on the purple shoes and the matching dress, the joys you have in your life now and the many joys you will have in the future.