Sammye Johnson’s surgeon told her not to worry too much about her breast cancer. “It’s just DCIS,” he said. And, while Johnson, 61, understood the statistics intellectually—ductal carcinoma in situ has a low risk of recurrence ranging from 1 to 10 percent—dealing with the diagnosis emotionally was another matter.

“Cancer is cancer,” says Johnson, a communications professor at Trinity University in San Antonio, Texas, who has also collaborated on writing projects with this author. “I still worry it will return. In my heart, I had the same risk as any other woman with breast cancer.”

Johnson is far from alone; the anxiety that follows a cancer diagnosis can make patients jump to dire conclusions. According to a recent study published in the Journal of the National Cancer Institute, women who had been treated for DCIS overestimated their risk of recurrence, lumping DCIS in with other, far more aggressive, forms of cancer. Of those who thought they were at least moderately likely to have a recurrence, 54 percent expected that to happen within five years of diagnosis. The women who were the most convinced their cancer would return were those who also had the highest anxiety levels.

Why are we so anxious? And can this anxiety affect how we deal with breast cancer?

AN ANCIENT INSTINCT

Sammye Johnson
Despite an excellent prognosis,
she was still terrified.

Anxiety is even older than the human race, and its roots lie in self-preservation. To avoid poisonous plants and dangerous wild beasts, our primate ancestors developed a sense of fear in the presence of possible threats. These same instincts guide us today. Faced with a stressful situation—a test, a first date, a fender-bender, or something more serious—our bodies automatically go into “fight-or-flight” mode, preparing us either to run or to confront the problem. The brain releases adrenaline and other hormones into the blood that increase heart rate, breathing and perspiration, shut down digestion (causing nausea or the “butterflies in the stomach” sensation), and tense up the muscles.

Some people are genetically predisposed to be anxious, although they may not necessarily become worriers as adults (just as having a family history of cancer doesn’t guarantee you’ll develop it yourself). Other factors contributing to anxiety include a person’s childhood environment, brain chemistry, personality and history of traumatic events.

Anxiety can actually be good for us, sharpening our senses and tuning us in to details we might need to survive, says Jon Maner, Ph.D., assistant professor of psychology at Florida State University. Too much of it, though, keeps our body in a state of stress, depleting our resources and leading to fatigue, weakened immunity and depression. In its most extreme form, anxiety can manifest itself in panic attacks, phobias, obsessive-compulsive disorder and other clinical illnesses.

Doctors measure anxiety using diagnostic tools such as the Hospital Anxiety and Depression Scale, in which patients rate their reactions to 14 statements such as “I feel tense and wound up,” “I get a sort of frightened feeling” and “I look forward with enjoyment to things.” Low scores on the test mean the person’s level of worry is not excessive. Higher scores point to anxiety that could interfere with her quality of life. In the case of a breast cancer diagnosis, such anxiety could result in a woman avoiding or delaying treatment because of fear and the expectation of the worst possible outcome.