Adverse Mental Health Outcomes in Breast Cancer Survivors


Key Points

  • Available evidence indicates that breast cancer survivors are at increased risk of anxiety, depression, and suicide.
  • Evidence indicates that they are also at increased risk of neurocognitive dysfunction, sexual dysfunction, and sleep disturbance.

In a systematic review of the literature reported in the Journal of the National Cancer Institute, Carreira et al found that most evidence strongly supports increased risk of anxiety, depression, neurocognitive dysfunction, and other forms of psychological issues in survivors of breast cancer.  

Study Details

The study involved a search of MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Social Sciences Citation Index to identify studies on adverse mental health outcomes in breast cancer survivors (≥ 1 year) compared with women with no history of cancer.

Evidence of Adverse Outcomes

A total of 60 studies were included in the analysis. Of 38 studies of depression, 33 found more depression in breast cancer survivors, with differences being statistically significant in 19 studies, including 6 of 7 in which depression was ascertained clinically (relative risk ranging from 1.06–2.04), 3 of 4 studies of antidepressant treatment (relative risk ranging from 1.16–2.06), and 13 of 31 that quantified depressive symptoms.

Of 21 studies of anxiety, 17 found more anxiety in breast cancer survivors, with differences being statistically significant in 11 studies, including 2 of 4 with clinical/prescription-based outcomes (relative risks = 1.06 and 2.00), and 8 of 17 that used scales for anxiety symptoms.

Breast cancer survivors had statistically significantly increased symptoms/frequency of neurocognitive dysfunction in 18 of 24 studies, sexual dysfunction in 5 of 6 studies, sleep disturbance in 5 of 5 studies, stress-related disorders/posttraumatic stress disorder in 2 of 3 studies, suicide in 2 of 2 studies (37% and 60% higher risk vs comparators), somatization in 2 of 2 studies, bipolar disorder in 1 of 1 study, and obsessive-compulsive disorder in 1 of 1 study.

The investigators noted that the studies were heterogeneous for participant characteristics, time since diagnosis, ascertainment of outcomes, and measures reported, and that approximately 50% of the studies were at high risk of selection bias and confounding by socioeconomic status.

The investigators concluded, “There is compelling evidence of an increased risk of anxiety, depression and suicide, and neurocognitive and sexual dysfunctions in breast cancer survivors compared with women with no prior cancer. This information can be used to support evidence-based prevention and management strategies. Further population-based and longitudinal research would help to better characterize these associations.”

The study was supported by the UK Medical Research Council (MRC) and the Clinical Practice Research Datalink (CPRD) at the Medicines and Healthcare products Regulatory Agency (MHRA), Bangerter Foundation, Swiss Academy of Medical Sciences, and Wellcome Trust and the Royal Society.

Helena Carreira, MSc, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, is the corresponding author for the Journal of the National Cancer Institute article.

Disclosure: See study authors’ full disclosures at

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.