Aspects of the psychological management of breast cancer.

Psychological factors influence the survival of patients with breast cancer through the early detection of the cancer and through compliance with the treatment. There is now evidence that psychological factors also influence the immune factors which control micrometastases. In particular, stoical acceptance of cancer is associated with a shorter survival of the patient, while the expression of hostility towards the cancer is associated with a longer survival of the patient. Unrecognized psychological morbidity can impair the quality of a patient's life for years. Such psychological morbidity may be reduced by more open communication with the patient, by encouragement of the expression of feelings (especially anger), by preoperative diagnosis of the cancer by biopsy and by a greater time allowance before a mastectomy is performed. Morbidity may also be reduced by the encouragement of patients to take an active part in their treatment decisions, by the avoidance of a mastectomy, by immediate breast-reconstruction surgery, and by appropriate psychological support which includes self-help techniques, such as meditation. Breast cancer can be a positive turning-point in a person's life.