The Psychological Impact of Breast Cancer: Informing Without Frightening

The psychological impact of breast cancer can emerge before a diagnosis. It makes itself felt when a woman is invited for a routine mammogram and fear of the result leads her to put the test off, and it can stay with her throughout treatment, down to the way she comes to recognise herself in the mirror again. Much depends on the words used to talk about the disease and on the support of the people around her.

Breast Cancer Awareness Month, which every October brings campaigns and initiatives focused on breast cancer prevention, is an opportunity to explore the subject with Prof. Valentina Di Mattei, Full Professor of Dynamic Psychology at Vita-Salute San Raffaele University, President of the Lombardy Order of Psychologists and Coordinator of the Clinical and Health Psychology Service at IRCCS San Raffaele Hospital, where she also heads the “Health in the Mirror” programme.

Choosing Words With Care

The metaphor of battle comes up often when people talk about cancer. Patients are described as battling, fighting, winning or losing. The metaphor can convey energy and determination, yet it also carries an implicit judgement: if recovery equals victory, a negative outcome risks looking like the result of insufficient effort.

«The words we use are not neutral. The metaphor of the “fight” can be motivating for some people, but for others it can become a burden: if cancer is a battle, then those who do not recover implicitly risk being perceived, or perceiving themselves, as someone who did not fight hard enough», Professor Di Mattei says.

Absolute reassurances can also have a different effect from the one intended. Saying “everything will be fine” avoids naming the fear, but it leaves the uncertainty intact. For someone facing a test, a diagnosis or treatment, that promise can sound unconvincing and make it harder to share what they are feeling.

Responsible communication refrains from predicting an outcome that no one can guarantee. Its task is to help the person understand what is happening and face uncertainty without feeling alone. «Reassuring someone does not mean promising that everything will be fine, but acknowledging their fears, offering clear information and letting them know that, whatever the outcome, they will be supported throughout», Di Mattei adds.

Why Knowing About a Risk is Not Enough

A prevention campaign can be medically sound and still fall short. Information is interpreted through emotions, past experiences, risk perception and personal expectations. A highly threatening message, for example, does not necessarily prompt action: in some people it can lead to avoidance, the tendency to move away from whatever causes fear, or to rejection of the message itself.

The step from information to behaviour is precisely what psychology studies. Knowing that screening is useful does not automatically lead someone to book it. In 2024, mammography screening coverage in Italy stood at 50% of eligible women, with 62% in the North and 34% in the South, according to the report I numeri del cancro in Italia 2025 by AIOM, the Italian Association of Medical Oncology. «Knowing that a behaviour is good for your health does not automatically mean putting it into practice», Di Mattei says of the figure.

Between knowledge and action, several factors can get in the way: fear of the result, financial difficulties, family caregiving responsibilities, logistical difficulties and cultural barriers. Health literacy also plays a part, meaning the ability to find, understand and use the information needed to make decisions about one’s own health.

Presenting prevention as a simple individual duty overlooks these obstacles and can end up blaming those who have put off a check-up. Personal responsibility still matters, but it needs conditions that allow people to exercise it: access to programmes, clear guidance, schedules compatible with everyday life and communication people can understand. «So it is not enough to inform people or tell them what they should do: we need to understand what makes it easier or harder to turn that information into concrete behaviour», Di Mattei stresses.

Anxiety While Waiting for Test Results: When to Seek Help

The time between a clinical test and its result can bring anxiety. Fear of a diagnosis is only part of it: waiting temporarily reduces the sense of control and leaves several possibilities open, which the mind tends to explore, sometimes over and over again.

The way a result is communicated shapes this experience. Reading a document alone in an electronic health record, perhaps written in technical language, is different from discussing it with a doctor. Timing, channels and procedures vary with the test and the clinical situation; when further investigations or prompt care are needed, specific ways of contacting the patient may be in place. This is why, Di Mattei points out, «communicating the result is an essential part of the care pathway», especially when the outcome is unexpected.

Some worry while waiting is understandable and should not automatically be treated as a disorder. A few practical steps can help: keeping to one’s usual routines as far as possible, avoiding compulsive online searches and talking to people who can listen without playing things down. Knowing when the report will arrive, how it will be communicated and whom to contact with questions also reduces uncertainty.

Psychological support becomes advisable when anxiety persists or grows intense enough to disrupt sleep, work, relationships and daily activities. It can also help when waiting brings back previous experiences of illness or situations of vulnerability.

The Psychological Impact of a Diagnosis Varies From Person to Person

There is no universal psychological reaction to cancer. The same diagnosis can take on different meanings depending on age, stage of life, relationships, cultural background and personal experience. The characteristics of the disease and of its treatment matter too.

For a young woman, fertility, sexuality and plans for her relationships or career may become central. Between 15% and 25% of breast cancer patients are premenopausal at diagnosis, and around half of younger patients wish to become pregnant later on, as a literature review co-authored by Di Mattei and Gaia Perego points out. Other concerns emerge at other stages of life. Culture and family dynamics shape how the illness is named, how a diagnosis is communicated and how people ask for help.

Tailoring psychological care starts from this diversity. «We cannot deal with the diagnosis alone: we need to understand what that diagnosis means for that specific person at that particular moment in their life», Di Mattei explains. Avoiding rigid models makes it possible to recognise needs that a purely clinical reading might leave in the background.

Breast Cancer and Body Image

In breast cancer, the effects of treatment can alter body image and the relationship with intimacy. In the early stages, treatment and survival understandably take centre stage. Scars, hair loss, weight changes and other side effects, however, affect how a person recognises herself and presents herself to others.

The breast may be associated with femininity, sexuality or motherhood, but these meanings differ from woman to woman and should not be taken for granted. The same goes for the distress caused by physical changes: what is marginal for one person may matter a great deal to another.

The Health in the Mirror programme, which Prof. Di Mattei heads, grew out of the need to support women during treatment by caring for their psychological well-being, their self-image and their relationship with their body. Calling these aspects “aesthetic” does not mean regarding them as superficial. They can affect self-esteem, relationships and quality of life.

Sexuality, too, often remains on the margins of public discussion, and at times of conversations with healthcare professionals, even though it can affect both individual and couple life. «Treating patients means looking after more than the disease: it means looking after the person who must return to living in her own body and her own life», Di Mattei observes.

How to Support Someone With Cancer

Family, partners and friends can offer crucial support, as long as closeness does not turn into an emotional prescription. Telling someone “you have to be strong” or “you have to think positive” often comes from a wish to encourage. Yet it can imply that fear, sadness and anger are inappropriate reactions, to be kept hidden.

Listening means allowing the person to express themselves without deciding in advance how they should face the illness. A simple question, such as “What do you need?”, often draws concrete and honest answers. At some moments talking may help; at others, being accompanied to an appointment, getting help with everyday tasks or spending time together without focusing on the diagnosis all the time.

Illness also involves the wider circle of loved ones. Fear, fatigue and a sense of helplessness can affect caregivers too. Supporting family members protects their well-being and, indirectly, strengthens their ability to stay close to the person who is ill. A study of 40 couples published in 2026 in the Journal of Psychosocial Oncology Research and Practice by a team led by researchers at Università Cattolica del Sacro Cuore found that the more symptoms of anxiety and depression a partner shows, the less the patient is able to adapt the way she copes with the illness. How a woman experiences her body image also appears linked to how her partner perceives her.

Talking About Prevention With Young People

Among young people, physical health can feel like a remote concern, something for later in life. Psychology shows that a risk set far off in time tends to weigh less on present decisions. Simply evoking a possible future illness, then, is unlikely to be enough.

To bring prevention closer to everyday experience, those who communicate it can connect it with knowing one’s own body, with well-being in the present and with the possibility of making informed choices. Schools and universities are well suited to developing this skill before prevention comes to be associated only with symptoms or with getting older.

«Taking care of your health does not mean being afraid of getting ill», Di Mattei concludes. The aim is neither to keep people in a constant state of alert nor to play down the risk artificially. A useful message makes clear which actions can be taken and strengthens people’s sense that they can act concretely on their own health, without blaming those who face difficulties.

References

AIOM, AIRTUM, Fondazione AIOM, ONS, PASSI, PASSI d’Argento, SIAPeC-IAP. (2025). I numeri del cancro in Italia 2025 (15th ed.). Rome.

Di Mattei, V. E., Perego, G., Taranto, P., Mazzetti, M., Ferrari, F., Derna, N., Peccatori, F. A., Mangili, G., & Candiani, M. (2023). Psychological issues in breast cancer survivors confronted with motherhood: Literature review and a call to action. Frontiers in Psychology, 14, 1133204. DOI: 10.3389/fpsyg.2023.1133204

Vagnini, D., Acquati, C., & Saita, E. (2026). Body image concerns in breast cancer: An exploratory study on the role of partners’ perceptions and well-being. Journal of Psychosocial Oncology Research and Practice, 8(2). DOI: 10.1097/OR9.0000000000000191