When it comes to cancer, we have many fears: about treatment and side effects, pain and suffering, radiation and recurrence, impotence and infertility, and of course the biggest one, dying. Some of these fears are now exaggerated or outdated, thanks to medical advances. Yet there’s a reason why oncologist and author Siddhartha Mukherjee called cancer the “emperor of all evils” and why it tops the list of diseases we fear most, even though it’s not the number one killer (that “honor” goes to heart disease). It’s widely regarded as a “malignant, unpredictable, and indestructible enemy,” as one systematic review of attitudes put it.
Cancer used to be seen as a death sentence, which was not an unreasonable fear before the development of modern treatments. For example, testicular cancer, which I was diagnosed with in 1984, now has a five-year survival rate of 95 percent, compared with about 80 percent in 1975, according to the National Cancer Institute (NCI). The five-year survival rate for breast cancer is now 91 percent, compared with 76 percent in 1975, the NCI reports.
According to the NCI, the five-year survival rate for all cancers is now over 69 percent, compared with about 50 percent in 1975.
At the same time, some immunotherapies and other medications don’t take the toll of older therapies, which often have nausea, vomiting, and hair loss as side effects. That’s why experts and cancer patients alike have repeatedly told me, “Get the facts about your type of cancer,” which can go a long way toward curbing anxiety.
David Ropeik, a retired journalist and author of the new book “Curing Cancerphobia: How Risk, Fear and Worry Mislead Us,” debunks other outdated fears. “Our fear of cancer has not kept pace with the advances that medicine has made in recent decades,” he says. “As many as two-thirds of the nearly 200 cancers can be cured 1720185796 “If chronic conditions are treated or cured directly, but we don’t believe that.”
As a result, there are what Ropeik calls too many “fear-ectomies” — medically unnecessary surgeries such as prostatectomies and radiation for asymptomatic, slow-growing prostate cancers, and full mastectomies for breast cancers that haven’t spread and often won’t. In both cases, experts say active surveillance with periodic follow-ups is a good approach.
Ropeik says our perceived lack of control or powerlessness over this disease makes matters worse. “If we can’t do anything about it, we’re more afraid,” he told me. Levin, the psychologist, agrees: “We want to be able to say, ‘I can do this and avoid that.’ Cancer sticks in your mind as one of those things ‘I can’t control.’”
But science over the past two decades has shown that people can do much more to reduce their risk of cancer, most importantly:
Do not smoke. Researchers recently reported that those who quit had a 17 percent lower overall risk of each cancer than those who continued to smoke. Specifically, they found a 42 percent lower risk of lung cancer, a 27 percent lower risk of liver cancer, a 14 percent lower risk of stomach cancer, and a 20 percent lower risk of colorectal cancer.
Eat right. Research has shown that a healthy diet (less meat and processed foods, more vegetables, whole grains and fish), regular exercise, sunscreen and preventive screenings also reduce our risk of cancer, Levin says, although not to zero, “which is really hard for people to deal with.”
Cancerphobia can lead to overscreening, overdiagnosis, and overtreatment by encouraging the discovery of certain cancers that are not thought to spread or cause symptoms. Overtreatment refers to a decision to choose more aggressive, even riskier treatments than medically necessary, such as the prostatectomies and mastectomies mentioned above.
So what can be done to curb cancer anxiety? In addition to doing research to understand your condition, here are a few strategies experts suggest:
Mind-body interventions: These include cognitive behavioral therapy, mindfulness meditation, relaxation techniques, and the use of creative arts (as a means of self-expression). A meta-analysis published in Psycho-Oncology concluded that “these interventions yielded significant, small-to-medium effects,” which were maintained for up to two years after follow-up assessments. Some research has suggested that the psychotropic drug psilocybin may be helpful, although much research on this topic is ongoing.
Keep talking about what is causing the fear. The fears we know are actually less scary than the fears that are hidden. Levin added that avoidance doesn’t reduce risk, but it can limit your options. Find a therapist who has dealt with these issues. Many cancer hospitals can make referrals.
It’s okay to ask for help. In fact, it’s not only okay, it’s a sign of strength to say, “I can’t do this alone.” Don’t be afraid to say you’re overwhelmed. Most people are; you don’t have to be the proverbial cancer warrior.
Help comes in many forms. These include psychotherapists, social workers and religious leaders, nutritionists, organized support groups, and of course friends and family. If you are concerned about the treatment process, find people who have been through it. Are you concerned about finances? Find financial experts who can assess your situation.
Beth Rosenberg, a retired cardiologist in North Carolina, summed up exactly how fear of cancer can harm us as much, if not more, than a cancer diagnosis. “Unfortunately, I have cared for too many patients [who feared] what could be found [and] waited until the pain, or bleeding, was no longer bearable.”
She recalled a patient who put off seeing a dermatologist because she was afraid a spot on her skin was cancer — which it turned out to be. Or the woman who didn’t come until her breast tumors were too big to ignore. Both died within a year. “The scarring and the pain that resulted was much worse than if they had overcome their fear and come earlier,” Rosenberg said.