Skip to main content

Fear of Cancer Recurrence Among Breast Cancer Survivors

Abstract

Fear of cancer recurrence, a rational reaction to a future health threat, is often experienced by individuals who have undergone cancer treatment. In this manuscript we review recent research and clinical experience from the field of breast cancer, focusing on fear of recurrence with particular interest in the care process, both in terms of choices that patients make and how to intervene. We have included our own clinical observations arising from working with women who have received breast cancer treatment and are experiencing great fear of cancer recurrence. We found that younger women (pre-menopausal) are particularly vulnerable to such fear and may require special attention. This fear is also implicated in treatment decision-making, especially in selection of prophylactic mastectomy rather than breast conservation. Limited psychological intervention to help manage this fear is currently being investigated.

This is a preview of subscription content, access via your institution.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. International Agency for Research on Cancer. Breast Cancer: Estimated Incidence, Mortality and Prevalence Worldwide in 2012. 2012; Available from: http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx.

  2. American Cancer Society. 2014 [updated 31/1/201414/4/2014]; Available from: http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-key-statistics.

  3. Breast Cancer Campaign. [14/4/2014]; Available from: http://www.breastcancercampaign.org/about-breast-cancer/breast-cancerstatistics?gclid=CLql_qWc070CFfMQtAodFjMA7A.

  4. Simard S, Thewes B, Humphris G, et al. Fear of cancer recurrence in adult cancer survivors: a systematic review of quantitative studies. J Cancer Survivorship. 2013;7(3):300–22. This is a comprehensive review of fear of cancer recurrence for many types of cancer.

    Article  Google Scholar 

  5. Vickberg SM. The Concerns About Recurrence Scale (CARS): a systematic measure of women’s fears about the possibility of breast cancer recurrence. Ann Behav Med. 2003;25(1):16–24.

    PubMed  Article  Google Scholar 

  6. Koch L, Bertram H, Eberle A, et al. Fear of recurrence in long-term breast cancer survivors still an issue. Results on prevalence, determinants, and the association with quality of life and depression from the Cancer Survivorship-a multi-regional population-based study. Psychooncology. 2014;23(5):547–54.

    PubMed  Article  Google Scholar 

  7. van Londen GJ, Beckjord EB, Dew MA, et al. Associations between adjuvant endocrine therapy and onset of physical and emotional concerns among breast cancer survivors. Support Care Cancer. 2013. doi:10.1007/s00520-013-2041-y.

    PubMed  Google Scholar 

  8. Kanatas A, Rogers SN. Letter. Journal of Wound Care. In press;23(6).

  9. McGinty HL, Goldenberg JL, Jacobsen PB. Relationship of threat appraisal with coping appraisal to fear of cancer recurrence in breast cancer survivors. Psychooncology. 2012;21(2):203–10.

    PubMed  Article  Google Scholar 

  10. Ziner KW, Sledge GW, Bell CJ, et al. Predicting fear of breast cancer recurrence and self efficacy in survivors by age at diagnosis. Oncol Nurs Forum. 2012;39(3):287–95.

    PubMed  Article  Google Scholar 

  11. Liu Y, Perez M, Schootman M, et al. Correlates of fear of cancer recurrence in women with ductal carcinoma in situ and early invasive breast cancer. Breast Cancer Res Treat. 2011;130(1):165–73.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  12. Corter AL, Findlay M, Broom R, et al. Beliefs about medicine and illness are associated with fear of cancer recurrence in women taking adjuvant endocrine therapy for breast cancer. Br J Health Psychol. 2013;18(1):168–81.

    PubMed  Article  Google Scholar 

  13. Simard S, Savard J. Fear of Cancer Recurrence Inventory: development and initial validation of a multidimensional measure of fear of cancer recurrence. Support Care Cancer. 2009;17(3):241–51.

    PubMed  Article  Google Scholar 

  14. Thewes B, Bell ML, Butow P, et al. Psychological morbidity and stress but not social factors influence level of fear of cancer recurrence in young women with early breast cancer: results of a cross-sectional study. Psycho-Oncology. 2013;22:2797–806.

    CAS  PubMed  Article  Google Scholar 

  15. Thewes B, Butow P, Bell ML, et al. Fear of cancer recurrence in young women with a history of early-stage breast cancer: a cross-sectional study of prevalence and association with health behaviours. Support Care Cancer. 2012;20(11):2651–9.

    CAS  PubMed  Article  Google Scholar 

  16. Cserni G, Bezsenyi I, Marko L. Patients’ choice on axillary lymph node dissection following sentinel lymph node micrometastasis—first report on prospective use of a nomogram in very low risk patients. Pathol Oncol Res. 2013;19(2):211–6.

    PubMed  Article  Google Scholar 

  17. Goldhirsch A, Ingle JN, Gelber RD, et al. Thresholds for therapies: highlights of the St Gallen international expert consensus on the primary therapy of early breast cancer 2009. Ann Oncol. 2009;20(8):1319–29.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  18. Goldhirsch A, Wood WC, Coates AS, et al. Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St Gallen International expert consensus on the primary therapy of early breast cancer 2011. Ann Oncol. 2011;22(8):1736–47.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  19. Lyman GH, Temin S, Edge SB, et al. Sentinel lymph node biopsy for patients with early-stage breast cancer: American society of clinical oncology clinical practice guideline update. J Clin Oncol. 2014;24:2014.

    Google Scholar 

  20. Soran A, Ibrahim A, Kanbour M, et al. Decision Making and Factors Influencing Long-term Satisfaction With Prophylactic Mastectomy in Women With Breast Cancer. Am J Clin Oncol. 2013 May 2.

  21. Fisher CS, Martin-Dunlap T, Ruppel MB, et al. Fear of recurrence and perceived survival benefit are primary motivators for choosing mastectomy over breast-conservation therapy regardless of age. Ann Surg Oncol. 2012;19(10):3246–50. This study exemplifies the link between fear of recurrence and medical decision making.

    PubMed  Article  Google Scholar 

  22. Quinn G, Vadaparampil S, Gwede C, et al. Discussion of fertility preservation with newly diagnosed patients: oncologists’ views. J Cancer Survivorship. 2007;1(2):146–55.

    Article  Google Scholar 

  23. Oktem O, Oktay K. Fertility preservation for breast cancer patients. Semin Reprod Med. 2009;27(6):486–92.

    PubMed  Article  Google Scholar 

  24. Loren AW, Mangu PB, Beck LN, et al. Fertility preservation for patients with cancer: American society of clinical oncology clinical practice guideline update. J Clin Oncol. 2013;31(19):2500–10.

    PubMed  Article  Google Scholar 

  25. Adams E, McCann L, Armes J, et al. The experiences, needs and concerns of younger women with breast cancer: a meta-ethnography. Psychooncology. 2011;20(8):851–61.

    PubMed  Article  Google Scholar 

  26. Goncalves V, Sehovic I, Quinn G. Childbearing attitudes and decisions of young breast cancer survivors: a systematic review. Hum Reprod Update. 2014;20(2):279–92.

    PubMed Central  PubMed  Article  Google Scholar 

  27. Gelber S, Coates AS, Goldhirsch A, et al. Effect of pregnancy on overall survival after the diagnosis of early-stage breast cancer. J Clinical Oncol Off J Am Soc Clin Oncol. 2001;19(6):1671–5.

    CAS  Google Scholar 

  28. Blakely LJ, Buzdar AU, Lozada JA, et al. Effects of pregnancy after treatment for breast carcinoma on survival and risk of recurrence. Cancer. 2004;100(3):465–9.

    PubMed  Article  Google Scholar 

  29. Ives A, Saunders C, Bulsara M, et al. Pregnancy after breast cancer: population based study. BMJ. 2007; 00:00:00;334(7586):194.

  30. Azim Jr HA, Kroman N, Paesmans M, et al. Prognostic impact of pregnancy after breast cancer according to estrogen receptor status: a multicenter retrospective study. J Clin Oncol. 2013;31(1):73–9.

    PubMed Central  PubMed  Article  Google Scholar 

  31. Upponi SS, Ahmad F, Whitaker IS, et al. Pregnancy after breast cancer. Eur J Cancer. 2003;39(6):736–41.

    CAS  PubMed  Article  Google Scholar 

  32. van den Berg SW, Gielissen MF, Ottevanger PB, et al. Rationale of the BREAst cancer ehealTH [BREATH] multicentre randomised controlled trial: an internet-based self-management intervention to foster adjustment after curative breast cancer by decreasing distress and increasing empowerment. BMC Cancer. 2012;12:394. This is an example of intervention that will examine fear of cancer recurrence as a secondary outcome.

    PubMed Central  PubMed  Article  Google Scholar 

  33. Beck AT, Rush AJ, Shaw BF, et al. Cognitive therapy of depression. New York: Guilford Press; 1979.

    Google Scholar 

  34. Leventhal H, Halm E, Horowitz C, et al. Living with chronic illness: A contextualized, self-regulation approach. In: Sutton S, Johnston M, Baum A, editors. The Sage Handbook of Health Psychology: Sage Publications; 2005. p. 197–240.

  35. Butow PN, Bell ML, Smith AB, et al. Conquer fear: protocol of a randomised controlled trial of a psychological intervention to reduce fear of cancer recurrence. BMC Cancer. 2013;13(1):201. This theory-driven intervention will give us important information on how intensive intervention can affect fears of cancer recurrence.

    PubMed Central  PubMed  Article  Google Scholar 

  36. Humphris G, Ozakinci G, Philp J, et al. The development, implementation, dissemination of a psychological intervention for patients with recurrent fears: the AFTER intervention. Protocol NHS Fife Research and Development Innovation Grant. Queen Margaret’s Hospital Dunfermline Fife, UK: NHS Fife Research and Development; 2012.

  37. Humphris GM, Rogers SN. AFTER and beyond: cancer recurrence fears and test of an intervention in oropharyngeal patients. Soc Sci Dent. 2012;2(1):29–38.

    Google Scholar 

  38. Humphris G, Ozakinci G. The AFTER intervention: a structured psychological approach to reduce fears of recurrence in patients with head and neck cancer. Br J Health Psychol. 2008;13(2):223–30.

    PubMed  Article  Google Scholar 

  39. Horlick-Jones T. Understanding fear of cancer recurrence in terms of damage to ‘everyday health competence’. Sociol Health & Illness. 2011;33(6):884–98.

    Article  Google Scholar 

  40. Lee-Jones C, Humphris G, Dixon R, et al. Fear of cancer recurrence–a literature review and proposed cognitive formulation to explain exacerbation of recurrent fears. Psycho-Oncology. 1997;6(2):95–105.

    CAS  PubMed  Article  Google Scholar 

  41. Simard S, Savard J, Ivers H. Fear of cancer recurrence: specific profiles and nature of intrusive thoughts. J Canser Survivorship. 2010;4:361–71.

    Article  Google Scholar 

  42. Witte K. Putting the fear back into fear appeals: the extended parallel process model. Commun Monogr. 1992;59(4):329–49.

    Article  Google Scholar 

  43. Leventhal H. Findings and theory in the study of fear communications. In: Berkowitz L, editor. Advances in experimental social psychology. New York: Academic Press; 1970. p. 120–86.

    Google Scholar 

  44. Maddux JE, Rogers RW. Protection motivation and self-efficacy: a revised theory of fear appeals and attitude change. J Exp Soc Psychol. 1983;19(5):469–79.

    Article  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Gozde Ozakinci, Aleksandra Sobota, and Gerry Humphris declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gozde Ozakinci.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ozakinci, G., Sobota, A. & Humphris, G. Fear of Cancer Recurrence Among Breast Cancer Survivors. Curr Breast Cancer Rep 6, 219–225 (2014). https://doi.org/10.1007/s12609-014-0153-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12609-014-0153-0

Keywords

  • Fear of cancer recurrence
  • Psychological intervention
  • Decision making
  • Breast cancer treatment
  • Fertility concerns
  • Health-care use
  • Depression
  • Anxiety
  • Quality of life
  • Psychotherapy
  • Mastectomy