Understanding Breast Cancer and PTSD

Breast cancer is the most common type of cancer in women. While survivorship is high, coping with breast cancer can be very difficult. Along with pain, fear, and cognitive impairment from treatment, mental health issues can also occur.

Following a breast cancer diagnosis, it is common for people to experience symptoms of post-traumatic stress disorder (PTSD). PTSD is a mental health disorder that involves difficulty recovering after witnessing or experiencing a traumatic situation.

Feelings are triggered and recur in the future, with symptoms that include nightmares, anxiety, disturbing memories, escalated reactions, and avoidance of situations that bring back memories of the trauma.

This article will discuss the connection between breast cancer and PTSD. It will explore the complications of both illnesses, as well as diagnostic procedures, treatment options, and ways to cope.

The Connection Between Breast Cancer and PTSD

Although a PTSD diagnosis occurs in only 2% to 9% of those with breast cancer, it is common for people to experience symptoms of PTSD after being diagnosed with breast cancer. The risk is highest right after receiving a breast cancer diagnosis and continues throughout treatment.

Risk Factors

Though a breast cancer diagnosis can be highly stressful, having breast cancer is usually not enough to cause PTSD alone. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a life-threatening illness is not considered a traumatic event unless the diagnosis is sudden and catastrophic.

However, a breast cancer diagnosis, along with other traumatic experiences, puts a person at increased risk of developing PTSD. Additional factors for incidence and prevalence include:

• Gender: Both breast cancer and PTSD are much more common in women than men.
• Race: In one study, people who were Asian and Black reported a higher incidence of PTSD than White people.
• Age: Those who are young when diagnosed with breast cancer are at a higher risk for PTSD.
• Past diagnosis: A previous cancer diagnosis within the family puts a person more at risk for PTSD.

Latest Research

Research shows that the impact of having breast cancer and PTSD can be highly detrimental (harmful). Developing PTSD while coping with breast cancer is connected to a lower quality of life. This can lead to less follow-through and compliance with treatment plans.

Some research has even found that those with PTSD have less effective immune systems. This can affect their body's ability to naturally kill cancer cells and support their recovery.

Complications of Breast Cancer and PTSD

Receiving a diagnosis and treatment plan early in the development of PTSD symptoms is crucial to the successful treatment of breast cancer. Leaving PTSD untreated can impact a person's ability to process information, solve problems, and make decisions, often leading to communication, relationship, and social issues.

Diagnosis of PTSD in Breast Cancer Patients

Only a mental health professional can provide a PTSD diagnosis. They can also help determine whether breast cancer or other experiences have contributed to symptoms.

The criteria for a PTSD diagnosis include:

• Exposure to death, the threat of death, actual or threatened serious injury, or actual or threatened sexual violence that can be direct, witnessed, or heard about
• A reexperiencing of the incident via upsetting memories, nightmares, flashbacks, or emotional or physical distress after reminders of the incident
• Avoiding thoughts, feelings, or reminders about the incident that began or worsened after the trauma
• New or increased arousal or reactivity after the incident, such as hypervigilance (overly alert), irritability, difficulty concentrating, or difficulty sleeping

These symptoms must be present for at least one month, create distress or impairment, and not be caused by substance use.

Self-Test for PTSD

Diagnosing PTSD requires a mental health professional, but the process can include information from self-screening tests.

Some evidence-based self-screening tests include:

• Trauma Assessment for Adults—Self-Report
• PTSD Checklist for DSM-5
• Post-Traumatic Diagnostic Scale for DSM-5
  

Treatment of Breast Cancer and PTSD

It's important to receive treatment for PTSD immediately upon receiving a diagnosis. Recovering from PTSD improves health outcomes and survivorship for those with breast cancer.

PTSD treatment usually involves mental health therapy and possibly medication. Breast cancer treatment usually includes a combination of chemotherapy, radiation, surgery (mastectomy or lumpectomy), and possible hormone treatment.

Medications

Some medications used to treat breast cancer can also impact a person's brain or mental health. These include:

• Nolvadex (tamoxifen), Evista (raloxifene), and Fareston (toremifene): These medications can increase depression and anxiety symptoms.
• Faslodex (fulvestrant), brilanestrant, and elacestrant: These medications can potentially reduce fear extinction. Fear extinction is important for people with PTSD as it helps to remove the learned fear response following a traumatic incident.
• Arimidex (anastrozole), Aromasin (exemestane), and Femara (letrozole): These medications can both increase depression and reduce fear extinction.

There are also medications used to treat PTSD that affect the brain and body. Common medications for PTSD include:

• Selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine) and Paxil (paroxetine)
• Combined antidepressants and nerve pain reducers, such as Effexor (venlafaxine) and Elavil (amitriptyline)
• Antidepressants, such as Remeron (mirtazapine) and Nardil (phenelzine)

When being treated for both breast cancer and PTSD, your entire healthcare team, including both physical health and mental health professionals, should be informed of both conditions and made aware of every medication prescribed.

Psychotherapy

Evidence-based psychotherapy interventions are often the most effective way to treat PTSD. These treatment options include:

• Cognitive behavioral therapy (CBT): A broad treatment method that examines faulty or negative thinking and how it relates to behavior. Specific types of CBT that are proven to help with trauma include prolonged exposure therapy (PET) and cognitive processing therapy (CPT)
• Somatic therapy: A treatment method that involves targeting areas within the body where the effects of trauma are "stuck" to help to release physical memories of the experience. Examples include eye movement desensitization and reprocessing (EMDR), sensorimotor psychotherapy, and tapping.
• Symptom-relieving therapies: Relaxation, stress inoculation training, and interpersonal therapy.

Though these treatment methods are specific to PTSD, relieving trauma-connected symptoms will also positively affect stress related to breast cancer.

Coping With Breast Cancer and PTSD

While treatment from a medical and mental health professional are both needed for someone with breast cancer and PTSD, lifestyle changes and peer support can positively impact a person's outcome. Work with a medical and mental health professional to develop an individualized treatment plan.

Lifestyle Changes

Increased stress is linked to higher levels of inflammation, which negatively affects the immune system. This makes it more difficult for the body to recover from illnesses. Since both breast cancer and PTSD can cause inflammation, having one condition can impact the other.

Here are some lifestyle changes that can contribute to better health outcomes for both PTSD and breast cancer:

• Eating a healthy diet
• Exercise
• Stress-reducing activities such as meditation, yoga, journaling, and reading
• Getting enough sleep

Support Groups

Support groups can be a way to find community, connection, and people who understand the difficult experience of having breast cancer and PTSD. To find a support group near you, ask your healthcare provider or visit the following organizations.

Summary

Receiving a breast cancer diagnosis can cause or worsen symptoms of PTSD. Incidence of breast cancer PTSD may be may be affected by a person's assigned sex, race, age, and previous cancer diagnosis. Because a combined diagnosis of breast cancer and PTSD can decrease quality of life and impact the treatment of both illnesses, speaking to your healthcare provider immediately is critical to successful treatment.

Treatment for PTSD usually includes a combination of psychotherapy and medication. A comprehensive treatment plan is essential, as some breast cancer medications can impact the brain and mood and worsen PTSD symptoms. Finding peer support and making lifestyle changes, such as exercising, eating a healthy diet, and reducing stress, can help you cope with breast cancer and PTSD.

A Word From Verywell

Coping with breast cancer or PTSD alone can be challenging. Being diagnosed with both conditions is likely to feel overwhelming and extremely stressful. It might feel isolating to have to navigate recovery, but finding a support group, getting a clear treatment plan, and doing things that bring you joy will help you get through the most challenging parts of these illnesses.