Breast Cancer

There are more than 3 million breast cancer survivors, with an estimated 268,600 new cases of invasive cancer in the United States in 2019. A significant mortality disparity exists between white and black women diagnosed with breast cancer, especially for young black women. Advances in the understanding of the biology of breast cancer and newer therapeutic approaches have increased the complexity of the experience for all women. Anxiety, uncertainty, and inadequate information can result in significant distress during the decision-making process for primary treatment (breast conservation surgery with radiotherapy, mastectomy with or without reconstruction, prophylactic mastectomy), adjuvant therapy, and metastatic disease. Predictors of psychological distress include younger age, prior psychological problems, chemotherapy, non-Caucasian ethnicity, limited social support, lower socioeconomic status, increase in the subtype of triple-negative breast cancer, and moderate to severe physical symptom distress. Some level of psychological distress occurs in all women and permeates time spent in treatment as well as the transition to survivorship, when women attempt to integrate the entire breast cancer experience into their life. As providers personalize therapies based on biologic characteristics, we need to personalize psychosocial interventions based on the unique psychosocial experience of the individual woman.