Facing the mental and emotional challenges of breast cancer as a Black woman

Editor's note: October is Breast Cancer Awareness Month.

By Taayoo Murray

"Are you sure?!"

That was the question Sharon Gill's husband kept asking the nurse who called to inform the couple about Sharon’s breast cancer diagnosis.

American women have an overall nearly 13% lifetime risk of developing breast cancer. And yet, like most women, Gill was surprised and mentally unprepared to hear the diagnosis in November 2012.

Though Black women are less likely to be diagnosed with breast cancer than white women, they are more likely to die of it. There is a 40% gap in the breast cancer death rate between Black women and white women. That gap is fueled by disparities in healthcare access and quality, economic stability, systemic discrimination, and social and community context.

Black women often experience common cultural differences that can exacerbate the emotional and mental challenges of breast cancer diagnosis and treatment.

Better understanding and support for these experiences and vulnerabilities is needed for these women to receive the best care.   

The mental and emotional challenges of breast cancer

"'I'm going to die.' I think the vast majority of people think just that," says Michele Y. Halyard, M.D., an emeritus professor of radiation oncology at Mayo Clinic College of Medicine and Science. "When you hear cancer, you think that's a death sentence. Particularly when you've just been given the diagnosis, and you don’t know what stage it is. You don’t know much about the biology. Your mortality flashes in front of your eyes."

"When you hear cancer, you think that's a death sentence. Particularly when you've just been given the diagnosis, and you don’t know what stage it is. You don’t know much about the biology. Your mortality flashes in front of your eyes."

Michele Y. Halyard, M.D.

For Gill, this fear was more pronounced because she was a wife, mother and grandmother. She recalled seeing the concern and unease in her husband’s eyes. 

Though this can be a terrifying experience, the infamous trope of the "strong Black woman" means some Black women are not comfortable displaying any signs of weakness. This is a major roadblock that prevents many Black women from being adequately prepared to use healthy measures to cope with a breast cancer diagnosis and treatment. 

There also is the instinctive response of some Black women hiding their diagnosis. This could be because they've been socialized to believe that illness should be kept private. Or they feel some amount of shame about being sick. Or, especially, it could be the reflexive need for Black women to be strong and protect everyone from the fallout of their illness.

But according to Eleshia J. Morrison, Ph.D., L.P., a Mayo Clinic clinical health psychologist specializing in cancer, this is not the time to tough it out on your own. Black women need to "recognize that when you’re going through that phase of screening, diagnosis, treatment, all of that naturally coincides with increases in psychological distress, specifically, depressive and anxiety symptoms," she says.

National guidelines emphasize the importance of addressing anxiety and depression symptoms in cancer survivors. A national sample of people newly diagnosed with breast cancer found that almost 28% experienced anxiety symptoms, and almost 22% reported symptoms of depression. Those with comorbid medical conditions were more likely to experience these symptoms.

"It is important to acknowledge that there continues to exist a level of stigma within Black communities, in terms of addressing mental health concerns," says Dr. Morrison. "So we may not necessarily always use the word 'depressed,' or 'anxious.' We might say, 'I'm tired.' 'I have a lot of pain.' 'I'm stressed.' It can be easier to say that you're stressed."

"It is important to acknowledge that there continues to exist a level of stigma within Black communities, in terms of addressing mental health concerns. So we may not necessarily always use the word 'depressed,' or 'anxious.' We might say, 'I'm tired.' 'I have a lot of pain.' 'I'm stressed.' It can be easier to say that you're stressed."

Eleshia J. Morrison, Ph.D., L.P.

Family members and friends need to recognize that the stress, anxiety, uncertainty and depression that may accompany cancer diagnosis and treatment can manifest in a lot of different ways. It could be not getting enough sleep. It could also be getting too much sleep or getting poor quality sleep. For Gill, the weight of the diagnosis bore heavily on her mind, leading to a series of tormented, sleepless nights, characterized by relentless, looping thoughts that often haunted her at 3 a.m.

There could be changes in eating behaviors. Some people may turn to comfort foods, while others may have a poor appetite. Stress and anxiety can manifest as difficulty concentrating because your mind is focused on your diagnosis. Extreme stress and anxiety also can result in tense shoulders, a clenched jaw, and muscle tension that can contribute to bodily aches and headaches.

Some people may even experience suicidal thoughts. If you're feeling overwhelmed by thoughts of not wanting to live or you're having urges to attempt suicide, get help now. In the U.S., call 911 or call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, seven days a week.

Getting the support you need from friends and family

Some people with breast cancer withdraw socially. Someone who used to be outgoing may want to stay at home more. Others may cancel plans with people they like to spend time with. While this may be a common coping mechanism for Black women, research shows that inadequate social support is associated with increased cancer-related mortality.

"Support needs to be driven by the survivor," explains Dr. Halyard, "and the survivor needs to feel free and empowered to either ask for or not ask for help."

"Support needs to be driven by the survivor, and the survivor needs to feel free and empowered to either ask for or not ask for help."

Michele Y. Halyard, M.D.

Turning to sources of social support can be really important, even when it's difficult to accept that sometimes you can't be the strong "super woman" that you were before cancer.

There are many ways women with breast cancer can ask for support. This could be physical support like getting help doing laundry or grocery shopping, or help preparing meals. It could be mental support, and simply saying "I'm depressed, I need somebody to talk to." It could be spiritual support, such as needing your pastor more. It could be financial support.

These needs change in the moment of the cancer diagnosis, during treatment and in the post-treatment phase.

"Survivors say, 'Just ask what I need, because it may not be the same every day. And it may not be what you think that I need, or what you can see that I need, but what I feel like I need,'" says Dr. Halyard.

Additionally, at the community level, leaders need to be more engaged in normalizing talking about medical issues including mental health.

When Gill reached out for support, she wanted to shield herself from the fearful thinking that well-meaning loved ones might inadvertently project onto her.

"Recognizing the profound impact that the attitudes of those around me could have on my mental state, I chose to confide in only seven individuals whom I considered to be the strongest prayer warriors in my life," says Gill.

The social and spiritual support she received made a big difference in her experience.

"During my cancer treatment, my faith played an integral role in guiding me through the journey towards recovery," says Gill.

"There’s an association between improvements in quality of life and practicing spiritual rituals with prayer, meditation, devotions, reaching out to others for fellowship and support, but therapy can come in the form of medical therapies and psychological therapies as well," explains Dr. Morrison.

"There’s an association between improvements in quality of life and practicing spiritual rituals with prayer, meditation, devotions, reaching out to others for fellowship and support, but therapy can come in the form of medical therapies and psychological therapies as well."

Eleshia J. Morrison, Ph.D., L.P.

Gill shared that she engaged in fasting, Bible study and long prayer walks. She said that the support of her faith, loved ones and medical professionals gradually changed her mindset.

"Instead of fixating on the end, I started envisioning a new beginning, a journey of healing and renewal. This shift in mindset, though challenging, proved to be a turning point in my mental health during treatment," says Gill.

Getting the support you need from the medical community

"Part of the challenge is there's a lot of medical mistrust in the Black community," says Dr. Morrison. "We need to change the healthcare environment, to make it more welcoming for Black women to come and talk about mental health struggles, medical struggles, screening for cancer, etc."

Some members of the Black community traditionally lean toward naturopathic remedies. This may be borne largely from a history of lack of access to traditional medicine and mistrust of doctors. Some Black people with breast cancer  have expressed interest in integrating naturopathic options in their treatment plans.

"I will always say this to patients: ‘If you have an interest in trying something naturopathic or integrative, absolutely make sure that you are talking with your oncologist about this.' They might be recommending a medication treatment, that if taken in combination with a supplement, can produce unwanted drug-to-drug interaction effects that may reduce the effectiveness of chemotherapy or be dangerous," says Dr. Morrison.

"I will always say this to patients: ‘If you have an interest in trying something naturopathic or integrative, absolutely make sure that you are talking with your oncologist about this.'

Eleshia J. Morrison, Ph.D., L.P.

You may be tempted to think "I'm not going to tell my doctor because I know they’re going to tell me not to do it." This can actually put you at risk. Dr. Morrison says that it's actually better to be forthright and say, "Here's what I’m considering," and get the doctor's take on it.

Your healthcare professional will help determine if it is an appropriate supplemental treatment, the purpose and function of the naturopathic treatment. Is it meant to be curative? Or is it meant to be more palliative in terms of just providing some comfort and some relief?

Dr. Morrison suggests that healthcare professionals need to also actively ask patients what their health beliefs are in terms of considering alternative and complementary interventions.

Reach out

It’s important to recognize that it's human to feel nervous, anxious and worried when you are diagnosed with breast cancer and going through the treatment process. It's not a weakness to acknowledge you need help and to reach out for support.

Learn more

Learn more about breast cancer and find a clinical trial at Mayo Clinic.

Join the Breast Cancer Support Group on Mayo Clinic Connect, an online community moderated by Mayo Clinic for patients and caregivers.

Also, read these articles:

• Cancer fatigue: A common cancer side effect that is different for everyone
• Emotional recovery after cancer treatment
• 4 things you can do to improve your quality of life after breast cancer
• Integrative oncology: Lifestyle medicine for people with cancer

A version of this article was originally published by Mayo Clinic Press.