The Future
Questions about the longer-term effects of breast cancer can be very difficult for someone to ask.
Many of them are concerned with subjects who are rarely discussed – the possible recurrence of disease after treatment and living with incurable illness.
What are the chances of my breast cancer coming back?
The majority of people treated for breast cancer will never have any problems in the future. Some types of breast cancer are known to have a greater tendency to reappear later, either back in the breast or chest area or elsewhere in the body; other types are less likely to do this.
Even if the type of breast cancer you have had is one that is likely to recur, no one can tell you for certain when and how this might happen. And there will always be people who don’t get a recurrence of their breast cancer, even though statistically this was thought to be likely.
What do I do if cancer comes back?
When cancer comes back it can be devastating after all the treatment you have had before, and also the fact that you may have enjoyed a long time with no problems. A recurrence will mean different things depending on where in the body it has come back. Breast cancer that has come back or spread can still be treated, and some people are able to live with advanced breast cancer for several years.
I sometimes feel that there is no point planning for the future. Do other people who have breast cancer get like this?
Yes, this is a common feeling. In facing up to breast cancer many people find they have strengths they might never have known about, and discover things about themselves that they might never otherwise have had the chance to do. Having breast cancer can lead to people taking stock of their lives and making changes that they might never have dared to do.
That is not to underestimate the effects of breast cancer. For many people it is the worst and most devastating experience of their lives. Being forced to confront breast cancer is likely to cause some emotional distress, some psychological stress and could have physical implications that could never have been imagined. Yet often, as time goes on, the initial shock waves subside and the side effects of treatment pass, and people are able to think once more about things in their lives other than their breast cancer.
The cancer has caused lots of change in my life, most of which I would not have planned. I actually now feel like making major changes of my own free will! Is this a common thing?
For some people, the enforced break in their regular routine that comes through having breast cancer and treatment is like being given a chance to review things. It can help you to realize that change is long overdue. Having had the courage to face your illness you may find that other changes are much less daunting. Perhaps you finally decide to make changes in an unsuccessful relationship or unrewarding job, or in the balance of work and home life. Of course the cancer may make you realize that you like your life just as it is. Whatever the outcome of taking stock, many people come to view their breast cancer journey as a ‘wake up call’ that leads them to want to make the most of the future.
I really can’t stop thinking that my breast cancer will come back. Does this worry ever go away?
The fear of having a recurrence of their breast cancer is one that most people have. Often, the longer it is since you had the original cancer, the more the fear reduces, although it is unlikely ever to go away completely.
Some people say that the first thing they imagine whenever they have an ache or pain is that it is the breast cancer returning, even if deep down they know that this is unlikely. The other key time when people say they worry that their breast cancer might have recurred is when they are coming up to the time of a check-up with the surgeon or oncologist. Even if you are feeling fine, it is quite common to have anxieties about the check-up and wonder if something new will be found.
Some people don’t realize their raised anxiety level is connected to the appointment date, but if you notice your own stress levels rising without an obvious reason, you may find this is the link.
What all this means is that on some level, conscious or not, most people do fear recurrence from time to time. Sometimes a short course of counseling can be helpful to address this, reduce stress and develop some management strategies.
I think about the cancer coming back all the time. It even keeps me awake at night. What can I do to help myself?
One thing you can do is to share your thoughts with someone else. If you keep them bottled up inside, the worry can build up and get quite out of proportion. You might find that someone who has had breast cancer would be a good person to talk to as it is likely they will have had similar feelings from time to time.
This could be someone from a breast cancer support group or a professional counselor. A few sessions can make a big difference by helping you to find practical strategies to manage your worries.
If you are worried that a new cancer might be developing you can arrange to see the oncologist or surgeon, by bringing your regular check-up appointment forward if necessary.
Because I’ve had breast cancer, does this mean that I could get another type of cancer in the future?
No, this is not likely. The only exception is in women whose breast cancer is caused by an inherited faulty gene. They might have a higher risk of ovarian cancer but this will only affect very few people overall. Generally, you should have been told about this when you were first diagnosed.
I am determined to do all I can to stop the cancer coming back. What can I do to prevent getting a recurrence?
There is little anyone can do to guarantee that they do not get any recurrence. Your best plan is to improve your general health, by following the suggestions outlined in previous chapters about eating a balanced diet, limiting alcohol and taking regular exercise. Not only may this help reduce the chances of a recurrence, but your good health can also help you enjoy life to the full.
I have asked everyone on the team for their opinion about my future. No one seems able to give me a definite answer. Why can no one be certain about my future?
One thing that everyone who has had breast cancer wants to hear is that their cancer is cured and that it won’t come back. While this will actually be the case for the majority of people, it isn’t possible to predict this for each individual. Cancer does not always follow the ‘rules’ – so no one is really able to provide a cast-iron guarantee that their breast cancer won’t ever return.
When you ask about breast cancer being cured, why do people talk about five-year and ten-year survival figures?
Researchers quote survival statistics, usually referring to people being free of cancer five or ten years after it was diagnosed. These are only really of value for statistical purposes and to show possible trends in the population as a whole.
People who have breast cancer will often ask ‘what are my chances?’ but care should be taken when interpreting statistics. If you are told that you have a 90% chance of being cancer-free in five years, time, what does this mean for you as an individual? Do you focus on this and ignore the other 10% chance? Or, if you are told you have a 40% chance of being alive and well in five years’ time, will you feel sure you will be amongst the 40% and not the other 60%? Remember, statistics relate to whole populations, not to individuals.
What is known is that because breast cancer is so common in the ‘developed world’ there has been plenty of research, and there are now many different treatments which have much greater success in treating the disease. If, for example, you look at the statistics for a particular type of breast cancer 20 years ago, which then had a poor prognosis (outlook), the same type of breast cancer today is likely to be more effectively treated. So if you are looking at statistics, you need the most recent figures and to compare similar types of breast cancer and treatment regimens. Ask your breast care nurse, specialist, or a breast cancer charity where to find this information.
I’ve got plenty of good information from the Internet. There’s a lot there about ‘survivorship’: what does this mean?
Survivorship is a term that refers to quality of life after a cancer diagnosis. When it comes to breast cancer, there are many, many personal stories about being a survivor, about fighting cancer and about getting on with life. You will find them in articles, photographs, chartrooms forums and hospital or community-led support initiatives. You may or may not find it helpful to read some of these and perhaps to share in the forums.
Increasingly, as more and more people live and are well after breast cancer, there are conferences specifically for survivors held in different countries. It’s like being part of an exclusive club and for many people these conferences are affirming and confidence-boosting experiences.
There are times when I feel fine and then there are times when I am scared that I might die from my breast cancer. Is this common?
Yes, it is very common. Even several years after having breast cancer you may feel like this. It is something that relatives, friends, and health professionals tend not to realize, particularly if it is some time since your treatment has finished, and this can make it hard to talk about your worries. Many people will have put your breast cancer experience to the back of their minds and may be surprised to hear you mention it, unless perhaps you are just about to go for a check-up.
It is really important that you do find someone to talk to about your feelings. You are not alone and there are many people who could identify with you and with your experience, but these may not be relatives or close friends.
