Associations Between Breast Cancer Survivorship and Adverse Mental Health Outcomes: A Systematic Review
Open accessAbstract
Background: We aimed to systematically review the evidence on adverse mental health outcomes in breast cancer survivors (≥1 year) compared with women with no history of cancer. Methods: Studies were identified by searching MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Social Sciences Citation Index, and through backward citation tracking. Two researchers selected the studies, extracted data, and assessed the risk of bias. Results: Sixty studies were included. Of 38 studies of depression, 33 observed more depression in breast cancer survivors; this was statistically significant in 19 studies overall, including six of seven where depression was ascertained clinically, three of four studies of antidepressants, and 13 of 31 that quantified depressive symptoms. Of 21 studies of anxiety, 17 observed more anxiety in breast cancer survivors, statistically significant in 11 studies overall, including two of four with clinical/prescription-based outcomes, and in eight of 17 of anxiety symptoms. Breast cancer survivors also had statistically significantly increased symptoms/frequency of neurocognitive dysfunction (18 of 24 studies), sexual dysfunctions (5 of 6 studies), sleep disturbance (5 of 5 studies), stress-related disorders/PTSD (2 of 3 studies), suicide (2 of 2 studies), somatisation (2 of 2 studies), and bipolar and obsessive-compulsive disorders (1 of 1 study each). Studies were heterogeneous in terms of participants' characteristics, time since diagnosis, ascertainment of outcomes, and measures reported. Approximately one-half of the studies were at high risk of selection bias and confounding by socio-economic status. Conclusions: 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.
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86% of studies in a meta-analysis described more depression in breast cancer survivors compared to women without breast cancer.
“Breast cancer survivors were significantly more likely to report depressive symptoms compared to women without breast cancer, with 86% of studies in a meta-analysis describing more depression in breast cancer survivors compared to women without breast cancer and an increased risk for suicide [7].”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [7]
The Results (Depression and Suicide) report that 33 of 38 studies (86.8%) described more depression in breast cancer survivors, and that two studies found increased suicide risk. However, only 19 of the 38 depression studies reported statistical evidence of an increase; the paper is a systematic review, not a meta-analysis. (LLM, conf=0.85)
Experimental — accuracy not yet measuredBreast cancer survivors are significantly more likely to report depressive symptoms compared to women without breast cancer.
“Breast cancer survivors were significantly more likely to report depressive symptoms compared to women without breast cancer, with 86% of studies in a meta-analysis describing more depression in breast cancer survivors compared to women without breast cancer and an increased risk for suicide [7].”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [7]
The Results (Depression and Suicide) report that 33 of 38 studies (86.8%) found more depression in breast cancer survivors and that two studies found increased suicide risk. But only 13 of 31 studies using depressive-symptom scales found strong statistical evidence of higher symptom severity. The claim overstates how consistently the depressive-symptom finding was statistically significant. (LLM, conf=0.87)
Experimental — accuracy not yet measuredLong-term anxiety symptoms in breast cancer survivors decline over time.
“Studies of breast cancer survivors suggest 20–50% of patients experience long-term anxiety symptoms, with symptoms declining over time and being associated with younger age and receiving chemotherapy [7].”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [7]
The Results > Anxiety section says clinically diagnosed anxiety in breast cancer survivors tended to decrease over time since diagnosis. The Discussion also describes declining anxiety trajectories, but says evidence on long-term trajectories is scarce. The source therefore supports a decline over time, but not a firm conclusion specifically about long-term anxiety symptoms. (LLM, conf=0.82)
Experimental — accuracy not yet measuredUp to 50% of breast cancer patients report sleep problems.
“Insomnia is common among breast cancer patients, with up to 50% of breast cancer patients reporting sleep problems [7].”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [7]
The Results section on sleep disturbance reports that all five studies examining it found a significantly higher prevalence among breast cancer survivors than among women without cancer. This supports the general point that sleep problems are common in survivors, but the paper does not give the claimed figure of up to 50% reporting sleep problems, and its findings concern survivors rather than breast cancer patients generally. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measured20-50% of breast cancer survivors experience long-term anxiety symptoms.
“Studies of breast cancer survivors suggest 20–50% of patients experience long-term anxiety symptoms, with symptoms declining over time and being associated with younger age and receiving chemotherapy [7].”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [7]
The Results > Anxiety section reports 20–50% anxiety prevalence when measured with scales, and says clinically diagnosed anxiety tended to decline over time and was associated with younger age and chemotherapy. It does not establish that 20–50% experience long-term symptoms specifically: prevalence was generally below 20% using health records or anxiolytic prescriptions, and the Discussion says evidence on long-term trajectories is scarce. Page numbers were not available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measured
75% of studies in a meta-analysis of breast cancer survivors showed changes in neurocognitive symptoms.
“Additionally, 75% studies in meta-analysis of breast cancer survivors showed changes in neurocognitive symptoms [7].”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [7]
The Results (Neurocognitive Dysfunction; page unavailable) report that 18 of 24 studies (75%) found strong statistical evidence of worse neurocognitive performance in breast cancer survivors than in noncancer controls. However, the Methods (Statistical Methods; page unavailable) explicitly say a meta-analysis was not possible, and the 75% figure describes between-group findings rather than necessarily changes over time. (LLM, conf=0.90)
Experimental — accuracy not yet measuredLong-term anxiety symptoms in breast cancer survivors are associated with younger age and receiving chemotherapy.
“Studies of breast cancer survivors suggest 20–50% of patients experience long-term anxiety symptoms, with symptoms declining over time and being associated with younger age and receiving chemotherapy [7].”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [7]
Breast cancer survivors have an increased risk for suicide.
“Breast cancer survivors were significantly more likely to report depressive symptoms compared to women without breast cancer, with 86% of studies in a meta-analysis describing more depression in breast cancer survivors compared to women without breast cancer and an increased risk for suicide [7].”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [7]
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Self-citationSexual Minority Women's Health Behaviors and Outcomes After Breast Cancer
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Flagged first, then by citations
Cited by
Sorted by citations
Juanjuan, L., Santa-Maria, C. A., Hongfang, F., Lingcheng, W., Pengcheng, Z., Yuanbing, X., Yuyan, T., Zhongchun, L., Bo, D., Meng, L., et al. (2020) · Clinical Breast Cancer · doi:10.1016/j.clbc.2020.06.003 · Cited by 124 · see citing works
Carreira, H., Williams, R., Funston, G., Stanway, S., & Bhaskaran, K. (2021) · PLOS Medicine · doi:10.1371/journal.pmed.1003504 · Cited by 78 · see citing works
“Increased risks of other mental health outcomes including suicide and neurocognitive and sexual dysfunctions have also been observed; existing evidence on sleep disturbance is insufficient to draw conclusions [5].”
BackgroundInfluentialSelf-citationBower, J. E., Partridge, A. H., Wolff, A. C., Thorner, E. D., Irwin, M. R., Joffe, H., Petersen, L., Crespi, C. M., & Ganz, P. A. (2021) · Journal of Clinical Oncology · doi:10.1200/jco.21.00279 · Cited by 81 · see citing works
Saevarsdottir, S. R., & Gudmundsdottir, S. L. (2023) · Journal of Medical Internet Research · doi:10.2196/42852 · Cited by 68 · see citing works
A systematic review of risk factors associated with depression and anxiety in cancer patients
Ikhile, D., Ford, E., Glass, D., Gremesty, G., & van Marwijk, H. (2024) · PLOS ONE · doi:10.1371/journal.pone.0296892 · Cited by 59 · see citing works
Worry and rumination in breast cancer patients: perseveration worsens self-rated health
Renna, M. E., Rosie Shrout, M., Madison, A. A., Lustberg, M., Povoski, S. P., Agnese, D. M., Reinbolt, R. E., Wesolowski, R., Williams, N. O., Ramaswamy, B., et al. (2021) · Journal of Behavioral Medicine · doi:10.1007/s10865-020-00192-9 · Cited by 41 · see citing works
Bilenduke, E., Sterrett, J. D., Ranby, K. W., Borges, V. F., Grigsby, J., Carr, A. L., Kilbourn, K., & Lowry, C. A. (2022) · Scientific Reports · doi:10.1038/s41598-022-23793-7 · Cited by 39 · see citing works
Koç, Z., Kaplan, E., & Tanrıverdi, D. (2024) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x211069663 · Cited by 33 · see citing works
Lake, P. W., Conley, C. C., Pal, T., Sutton, S. K., & Vadaparampil, S. T. (2022) · Patient Education and Counseling · doi:10.1016/j.pec.2021.12.020 · Cited by 23 · see citing works
Psychological Intervention and Breast Cancer
Ashton, K., & Oney, K. (2024) · Current Breast Cancer Reports · doi:10.1007/s12609-024-00559-w · Cited by 21 · see citing works
“Breast cancer survivors were significantly more likely to report depressive symptoms compared to women without breast cancer, with 86% of studies in a meta-analysis describing more depression in breast cancer survivors compared to women without breast cancer and an increased risk for suicide [7].”
InfluentialNielsen, A. W. M., Lundorff, M., Nielsen, H. M., Alsner, J., Vrou Offersen, B., Kristensen, M. H., & Zachariae, R. (2021) · Acta Oncologica · doi:10.1080/0284186x.2021.1981550 · Cited by 22 · see citing works
Schäfer, A., Jírů-Hillmann, S., Widmann, J., Montellano, F. A., Salmen, J., Pryss, R., Wöckel, A., & Heuschmann, P. U. (2025) · Journal of Cancer Survivorship · doi:10.1007/s11764-023-01470-6 · Cited by 23 · see citing works
- Authors
- Carreira, H., Williams, R., Müller, M., Harewood, R., Stanway, S., & Bhaskaran, K.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Clinical Practice Research Datalink (GB)
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Royal Marsden NHS Foundation Trust (GB)
- Corresponding author
- Carreira, Helena
- Venue
- JNCI: Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-11-07
- Volume
- 110
- Issue
- 12
- Pages
- 1311-1327
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- PMC
- PMC6292797
- OpenAlex
- W2900208351
- Cited by
- 416
- References
- 131
- Citations by year
- 2026: 46 · 2025: 66 · 2024: 82 · 2023: 57 · 2022: 77 · 2021: 55 · 2020: 26 · 2019: 7
- FWCI
- 2.30
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- BORIS (University Library Bern) (submittedVersion, cc-by)
- Open Access CRIS of the University of Bern
- Funders
- Medical Research Council
- Clinical Practice Research Datalink
- Medicines and Healthcare products Regulatory Agency (MR/M016234/1)
- Bangerter Foundation and the Swiss Academy of Medical Sciences (TCR 14/17)
- Wellcome Trust and the Royal Society (107731/Z/15/Z)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Keywords
- breast cancer survivors, mental health outcomes, depression, anxiety, suicide, neurocognitive impairment, sexual dysfunction, sleep disorders, post-traumatic stress disorder, somatization, bipolar disorder, obsessive-compulsive disorder, antidepressants, cancer survivorship
- MeSH terms
- Cancer Survivors, Survivorship, Anxiety, Breast Neoplasms, Depression, Humans, Mental Health, Outcome Assessment, Health Care, Publication Bias, Cognitive Dysfunction
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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