Sometimes mental scars can take the longest to heal

Ann Kent on the emotional turmoil breast cancer brings

Most of us can empathise with the shock and grief caused by a cancer diagnosis. But once the treatment is over, we expect the mental scars will heal as quickly as the physical scars. This is not the case.

Many patients are too shocked to consider properly what has happened until weeks after their diagnosis. As their appointments become less frequent, they may feel the medical staff have lost interest. Meanwhile, their loved ones, who have also suffered, want to forget the cancer happened.

A lonely conspiracy of silence can result in all parties refraining from discussing their future fears.

Disbelief, grief and anger are all part of the recovery process. But some people get stuck in these emotions and are unable to move to the next stage, which is acceptance of what has happened, followed by an ability to put the whole experience on the back burner. Becoming preoccupied with anger at medical staff, no matter how justified, delays recovery. One woman told me she thought constantly about the surgeon who had failed to inform her she could have a breast reconstruction operation nine months earlier. Even the offer of surgery by another specialist could not assuage her anger.

Women know they are recovering mentally when they realise they have not thought about their cancer for half a day. Although it is normal to be depressed by a cancer diagnosis, treatment is needed if the person with cancer becomes so demoralised she cannot get herself out of bed. While anti-depressant drugs will not take the cancer away, they restore equilibrium.

False alarms, in which digestive upsets or odd joint pains are suspected of signalling a recurrence of the cancer, are common.

There is great variation in the effects of breast cancer on sexual relationships and self-esteem. Many women are amazed at how upset they are by hair loss, even though they know it will probably grow back. Some women grieve deeply over a lost breast, while others request a mastectomy even if it is not necessary. For them, the diseased breast symbolises their cancer and must be cut away. Breast care nurses encourage husbands to see the mastectomy scar as soon as possible. Reality is seldom as bad as what we imagine.

Ann Kent is author of Life After Cancer (Ward Lock, pounds 8.99). Cancer Research Campaign helps patients cope with breast cancer - Education Department, 10 Cambridge Terrace, London NW1 4JL.