Addressing Fear of Recurrence in Breast Cancer Survivorship Care With Armaan Jamal

Defining and Framing Fear of Cancer Recurrence

FCR is common, impactful, and variably adaptive to each survivor. Jamal notes that some level of fear can promote engagement in follow-up and healthy behaviors, but an excessive amount of fear can lead to maladaptive behaviors such as appointment avoidance and excessive reassurance-seeking. When excessive, FCR becomes clinically significant and “can interfere with daily life, leading to many problems like anxiety, depression, sleep issues, and reduced quality of life.

Study Aims

The team sought to identify who is most at risk for high FCR. Jamal summarizes, “We wanted to better understand which patients are most at risk, focusing on identifying both clinical factors as well as psychosocial factors like stress and caregiving needs.” The goal was to highlight groups for targeted survivorship support.

Study Design and Cohort

Jamal’s group surveyed a large, diverse group of participants from the Chicago Multi-Ethnic Epidemiologic Breast Cancer cohort between July and September 2023. Approximately 1,390 patients with stage I to III breast cancer completed a validated questionnaire called the Fear of Cancer Recurrence Inventory, linked with clinical, demographic, and psychosocial data from the electronic health record (HER) and other surveys. Notably, the cohort was racially and ethnically diverse, enabling analyses beyond predominantly White or non-US samples.

Key Results

Nearly 20% of participants reported clinically significant FCR. “The strongest predictors included younger age, higher stress, a cancer recurrence in the past, another cancer diagnosis, or estrogen receptor–positive breast cancer,” Jamal reports. Advanced stage at diagnosis also correlated with high FCR. Importantly, demographic factors like race, income, and marital status were not significantly related, suggesting FCR is a “universal experience that cuts across various social groups.”

Clinical Implications and Interventions

These findings highlight that screening for FCR as part of survivorship is essential, especially for younger patients and those with recurrence/other cancers or high stress. Evidence-based options include acceptance and commitment therapy or metacognitive therapy, along with mindfulness, peer support, survivorship mentorship, and education on actual recurrence risk. Jamal emphasizes, “Clinicians play a critical role in normalizing these fears, asking patients about them directly, and making timely referrals,” aligned with National Comprehensive Cancer Network (NCCN) guidelines recommending regular distress screening.

Breast Cancer Awareness Month Message

FCR is common, normal, and addressable. “For patients, I would say these fears are normal to experience, and you’re not alone,” Jamal shares. For clinicians, “listening, validating patients’ concerns, and connecting them with psychological or social support can make a major difference.”

Key Takeaways

• Screen routinely for FCR, prioritizing younger patients, those with prior recurrence/second primaries, estrogen receptor–positive disease, advanced stage, and high stress.
• Normalize FCR in survivorship visits; ask directly and validate.
• Refer patients to evidence-based therapies and supportive programs (mindfulness, peer groups, mentorship).
• Provide education on individualized recurrence risk to reduce uncertainty.
• Recognize that FCR transcends sociodemographics—build universal screening into care pathways.

About the Speaker

Armaan Jamal is a PhD student in Epidemiology in the Department of Public Health Sciences at the University of Chicago, mentored by Dr. Dezheng Huo. His research focuses on cancer epidemiology, particularly breast cancer survivorship, pharmacoepidemiology in breast cancer treatments, and biomarker development for cancer prognosis. He is also a Research Fellow at the Stanford Center for Asian Health Research and Education, where he works with a multidisciplinary team to investigate the drivers of health outcomes in Asian American communities. Through his work, Armaan aims to advance equitable, data-driven approaches to cancer prevention, survivorship, and aging research.