Let’s start with the good news: Cancer deaths have declined by nearly a third since 1991, according to the American Cancer Society. Now for the bad news: Fear of cancer hasn’t diminished. In fact, experts say cancerphobia appears to be stronger than ever, even as mortality rates decline. Why?
Part of the reason, says Jessy Levin, a psychologist at Memorial Sloan Kettering Cancer Center, is that we’re much more open about all our illnesses, including cancer, these days. More openness means less stigma, which is a good thing, but the frequent stories of famous cases—including King Charles, Princess Catherine, and actress Olivia Munn—can add to the fear factor.
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When it comes to cancer, we have many fears: the treatment and its side effects, the pain and suffering, the radiation and recurrence, the impotence and infertility, and of course the biggest one, death. Some of these fears are now exaggerated or outdated thanks to advances in medicine. Yet there is a reason why oncologist and writer Siddhartha Mukherjee called cancer the “emperor of all diseases,” and why it tops the list of diseases we fear most, even though it is not the deadliest (that “honor” goes to cardiovascular disease). It is widely regarded as a “vicious, unpredictable, and indestructible enemy,” as one systematic study of attitudes put it.
Cancer used to be considered a death sentence, which was not an unreasonable fear before the development of modern treatment methods. For example, testicular cancer, which I was diagnosed with in 1984, now has a five-year survival rate of 95 percent, up from about 80 percent in 1975, according to the National Cancer Institute (NCI). The five-year survival rate for breast cancer is now 91 percent, up from 76 percent in 1975, according to the NCI.
For all cancers, the five-year survival rate is now more than 69 percent, up from about 50 percent in 1975, according to the NCI.
At the same time, some immunotherapies and other medications don’t have as many side effects as older therapies, which have common side effects like nausea, vomiting, and hair loss. That’s why experts and cancer survivors have repeatedly told me, “Learn about your cancer type,” which can go a long way toward alleviating fear.
David Ropeik, a retired journalist and author of the new book “Curing Cancerphobia: How Risk, Fear and Worry Mislead Us,” debunks other outdated anxieties. “Our fear of cancer has not kept pace with the advances in medicine” in recent decades, he says. “About two-thirds of the nearly 200 cancers can (now) be treated as chronic diseases or completely cured, but we don’t believe it.”
As a result, we see what Ropeik calls too many “fear-ectomies” — unnecessary surgeries such as prostatectomy and radiation therapy for slow-growing, asymptomatic prostate cancers and complete mastectomies for breast duct 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 sense of helplessness in the face of the disease only makes things worse. “If we can’t do anything, we become even more afraid,” he told me. Psychologist Levin agrees: “We want to be able to say, ‘I can do this and avoid that.’ Cancer sticks in our minds as one of those things we can’t control.”
But over the past two decades, science has shown that individuals can do much more to reduce their cancer risk, including:
Don’t smoke. Researchers recently reported that those who quit smoking had a 17% lower overall risk any of them Women who had smoked for more than 20 years were more likely to develop lung cancer than those who continued to smoke. They saw a 42% reduction in the risk of lung cancer, a 27% reduction in the risk of liver cancer, a 14% reduction in the risk of stomach cancer and a 20% reduction in the risk of colorectal cancer.
Eat healthy. Studies have shown that a healthy diet (less meat and processed foods, more vegetables, whole grains and fish), regular exercise, sun protection and preventive exams also reduce our risk of cancer, Levin said, but not to zero, “which is really hard for people to manage.”
Cancerophobia can lead to overscreening, diagnosis, and treatment by favoring the discovery of certain cancers that are considered unlikely to spread or cause symptoms. Overtreatment refers to the decision to choose more aggressive or even riskier treatments than medically necessary, such as the prostatectomies and mastectomies mentioned above.
So what can be done to reduce cancer-related anxiety? In addition to doing research to understand your condition, here are some strategies suggested by experts:
Mind-body interventions: These include cognitive behavioral therapy, mindfulness meditation, relaxation techniques, and creative arts (as a means of self-expression). A meta-analysis published in Psycho-Oncology concluded that “these interventions produced small to medium significant effects,” which were maintained at follow-up assessments up to two years. Some research has suggested that psilocybin, a psychotropic drug, may be helpful, although much research on this topic is ongoing.
Keep talking about what’s causing the anxiety. The fears we know are actually less scary than the hidden fears. 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 refer you to a therapist.
There’s nothing wrong with asking for help. In fact, it’s not only okay, it’s also 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 can come in many forms. These people include psychotherapists, social workers and religious leaders, nutrition experts, organized support groups, and, of course, friends and family. If you’re worried about the treatment process, find people who have been through it before. Worried about your finances? Seek out financial experts who can assess your situation.
Beth Rosenberg, a retired cardiologist in North Carolina, sums up perfectly how fear of cancer can hurt us as much, if not more, than a cancer diagnosis. “Unfortunately, I’ve treated too many patients (who feared) what might be discovered (and) waited until the pain or bleeding was no longer tolerable.”
She recalls a patient who delayed seeing a dermatologist because she feared a skin blemish was cancer, which it turned out to be. Or the woman who didn’t come in until her breast tumors were too large to ignore. Both died within a year. “The scarring and pain that resulted was far more intense than if they had been able to overcome their fear and come in earlier,” Rosenberg said.
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