In 2018, Hil Moss was lounging around casually watching television, when she touched her chest and felt a lump. She was 28 at the time and had no family history of breast cancer, so her doctor reassured her that she had nothing to worry about. But after a few more appointments, Moss was diagnosed with stage 2 breast cancer.
She underwent a 14-month treatment plan, which included three months of chemotherapy, a double mastectomy, and a tissue-based reconstruction, later followed by hormone therapy. More than five years later, Moss is both a breast cancer survivor and the cofounder and CEO of OncoveryCare, an organization focused on offering support to other survivors.
Soon after she was diagnosed, Moss says she expected the most difficult part of her experience to be the treatment, but a fellow survivor warned her that it would actually be the months after treatment ended that would be the hardest. Sure enough, Moss found the first six months of her recovery period more mentally challenging than anything she had physically gone through — including the amputation of both her breasts.
“That just seems impossible to believe. You’re in chemo, you feel horrible, how could it possibly be worse? But it kind of is,” Moss says. “When you’re actively in treatment, you at least have this sense of what your day-to-day is, and sometimes that can feel like a safety blanket. When you are removed from that, you are forced to essentially reckon with what’s happened. You have to come to terms with your own mortality.”
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More People Are Surviving Breast Cancer
“Survivorship” can either refer to a person having no signs of cancer following treatment or as “living with, through, and beyond cancer,” the latter recognizing that survivorship starts at diagnosis and continues for the rest of your life. But some who reach the “beyond cancer” stage say they hadn’t anticipated the toll that this experience would take on their mental health.
“I’ve been an oncologist for a long time, and early on we were just happy that people survived. We didn’t really look at what their quality of life after survivorship was,” Dr. Meyers says. “I always like to say that the cancer treatment may be over, but the cancer experience is far from over.”
While not every breast cancer survivor will experience psychological issues — such as anxiety or depression — experts say that there are some people who may struggle with mental health after receiving cancer treatment. “There’s anxiety about what the next steps are, how they’re going to feel, how long it’s going to take for them to get better,” Meyers says. “The reality is, while you can give somebody an estimate, it’s impossible to predict.”
Though mental health may certainly be affected after cancer treatment, Moss says that the lasting impacts can be present in every aspect of a survivor’s life.
“What does it mean to continue working or to return to work? If I have an interview, should I disclose what I’ve been through? What does it mean to date with scars? What about the impact that hormone therapy or my [other] treatments have had on my sexual health and my ability to have a fulfilling sex life?” Moss says. “It’s kind of amazing how survivorship can really permeate every facet of your life — whether it is work life, sex life, personal life, or family life.”
Fear of Recurrence Has an Impact on Mental Health
Some who have been diagnosed with breast cancer say that the anxiety they feel stems from the fear that their cancer might come back. “Scanxiety” is described as the anxiety some people experience when going through imaging scans after cancer treatment.
Moss says that when she feels any type of pain in her body, she wonders if her cancer has returned. And when she enters the Dana-Farber Cancer Institute for a checkup with her doctor and smells the building in which she previously underwent 24 infusions, she instantly feels nauseated.
“If you underwent treatment in a particular location, there is a Pavlovian response when you walk in that building,” Moss says. “Feeling a random pain and wondering if it’s a recurrence or having blood drawn and flashing back to sitting in that chemo chair: Some of those things just won’t go away.”
Depression and Other Lasting Effects of Cancer Treatment
Your mental health and mood may also be affected by the drugs used in many treatments, according to experts. Hormone therapy, for example, is one method of treatment that may lead people to experience depression, but its impact on psychological health is often overlooked, Meyers says.
One study published in January 2021 in PLoS Medicine found that survivors of breast cancer were more likely to experience a variety of psychological issues — including depression, fatigue, and sleep problems — than women who have not been diagnosed with cancer.
“I truly believe that the one thing that is not discussed enough is the commonality of chemical treatment that’s given to you and what it does to the mental stability of your mind,” Ayers-Cluff says. “By the end of the journey, the depression was set into me for months.”
When Ayers-Cluff was diagnosed with metastatic breast cancer in 2018, she says she decided she wasn’t going to let her depression build back up to where it had been after her first diagnosis a decade before.
“I just told myself I was going to do all I could for my mental health this time,” Ayers-Cluff says.
Adjusting as You Enter Survivorship
Experts and people who have been diagnosed with breast cancer say that many people are able to manage their mental health with the help of exercise, mindfulness and meditation practices, art, and therapy, among other outlets.
“The No. 1 piece of advice that I give to folks navigating a cancer diagnosis is, if at all possible and if you have access to this, line up a therapist as soon as you can,” Moss says.
You may also find that making certain social and lifestyle changes after completing treatment can have a positive impact, regardless of whether or not you find yourself running into mental health challenges post-treatment.
Some survivors choose to pivot in their careers to something they find more fulfilling. Others may decide to spend more time doing advocacy work and offering support to others with the disease, something that cancer survivors can be particularly helpful with.
And for some, reestablishing connections and having an open dialogue about your experience and needs with friends and family can help both you and your loved ones adjust to survivorship.
The Takeaway
Some breast cancer survivors find they struggle with their mental health once treatment has ended, with many survivors experiencing anxiety over whether their cancer will return. Survivors may find that lifestyle changes, such as changing careers or becoming a cancer advocate, have a positive impact on their life after treatment ends.
Lisa Curcio, MD, is a board-certified general surgeon and a fellowship-trained surgical oncologist. She is currently the medical director of breast surgery at Northern Dutchess Hospital in Rhinebeck, New York. Dr. Curcio attended George Washington University Medical School in Washington, D.C., where she also completed a residency in general surgery. She was invited to fellowship training in cancer surgery at City of Hope National Medical Center in Duarte, California. She was the recipient of the competitive U.S. Air Force Health Professions Scholarship Program. During her military commitment, Dr. Curcio served in the military as chief surgical oncologist at Keesler Medical Center in Biloxi, Mississippi.
From 2003 to 2004, she served as program director for Susan G. Komen in Orange County and remains involved with Komen outreach efforts. She was on the board of Kids Konnected, a nonprofit that helps children of cancer patients deal with the emotional fallout of a cancer diagnosis. Currently, she is on the board at Miles of Hope Breast Cancer Foundation, an organization dedicated to providing support services for people affected by breast cancer in New York's Hudson Valley. Dr. Curcio also has a strong background in breast cancer research, having contributed to dozens of peer-reviewed articles. She is currently a member of the Alpha Investigational Review Board.
Her practice includes benign and malignant breast diagnoses. Dr. Curcio was diagnosed with breast cancer at the age of 37. Although her fellowship training was in surgical oncology, this experience motivated her to provide compassionate, high level breast care and to focus on breast surgery.
Dr. Curcio is passionate about treating the patient and individualizing the care plan to their specific needs. Dr. Curcio strongly believes that cancer care must include lifestyle changes to focus on healthier habits to reduce future events. Her practice also focuses on breast cancer risk reduction, education, and access to genetic testing for patients with a family history of breast cancer.
Leona Vaughn was born and raised in Seattle, where she also completed her undergraduate degree in journalism at the University of Washington (UW). During her time at UW, she worked as a freelance writer for her school newspaper, The Daily UW, where she wrote stories about mental health and wellness. Vaughn was also an editorial intern for The Seattle Globalist, a local news outlet, where she focused most of her writing on issues of race and diversity.
Toward the end of her undergraduate career, Vaughn tried her hand at political reporting and covered the legislative session in Olympia, Washington, where she continued to pursue mental health within the realm of politics.
At the end of 2020 — in the middle of the COVID-19 pandemic — Vaughn moved to New York City to continue her education at Columbia University. She earned her master's degree in journalism in 2021.
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Custers JAE et al. The Patient Perspective in the Era of Personalized Medicine: What About Scanxiety? Cancer Medicine. May 2021.
Carreira H et al. Associations Between Breast Cancer Survivorship and Adverse Mental Health Outcomes: A Matched Population-Based Cohort Study in the United Kingdom. PLoS Medicine. January 7, 2021.
What’s Next: Cancer as Inspiration for Career Changes. Cancer and Careers. 2022.
Relationships After Cancer Treatment. City of Hope.
