Breast cancer is 365 days a year, not 31,” said Bri Majsiak, who co-founded a nonprofit organisation for people affected by breast and gynaecological cancers. Ilana Panich-Linsman/The New York Times

There’s a quote from “Anne of Green Gables” that I’m already sick of hearing. “I’m so glad I live in a world where there are Octobers,” said Anne. “It would be terrible if we just skipped from September to November, wouldn’t it?”

No disrespect to one of literature’s most beloved protagonists, but actually, that sounds pretty great.

October is Breast Cancer Awareness Month and I am a person who’s had breast cancer, which means for me October is basically 31 days of low-key PTSD. My inbox is crammed with marketing emails featuring other survivors’ stories. My hummus suddenly has a pink lid.

I appreciate the focus on fund-raising, but the spotlight is a double-edged sword. And with 3.8 million breast cancer survivors in the United States, I’m not alone.

“It is definitely not my patients’ favourite time of year,” said Kathleen Ashton, a psychologist at the Cleveland Clinic Breast Center in Ohio. “Some do enjoy the opportunity to raise awareness, but the majority of my patients find the month distressing.”

It brings all back to the surface

Becca Forrest, 37, a project manager in Durham, NC, was diagnosed with breast cancer in 2018. Since treatment ended, she’s worked hard to put the experience behind her.

“But October is as if someone is waving a neon pink flag at me all month to remind me that the most traumatic moment of my life could happen all over again,” she said.

Most breast cancers are diagnosed in patients 50 or older. While being diagnosed younger than that is associated with a higher fear of recurrence, it’s a common anxiety for survivors of all ages, said Dr Ashton — one that can be exacerbated by the increased coverage during awareness efforts.

“Watching other people’s stories can be a real trigger for patients to worry about their breast cancer coming back,” she said.

Deborah Serani, a trauma psychologist and professor at Adelphi University in New York, said we can feel anxious or upset at a particular time of year because of a phenomenon known as the ‘anniversary effect’ or ‘anniversary reaction,’ a unique set of unsettling thoughts or feelings that occurs around the anniversary of a significant experience.

In a study six years after the Gulf War, 32 veterans were asked to identify which month they had felt the worst during the past year. For 38 percent, this coincided with the month they’d also experienced the most trauma during the war.

While specific dates — like the day of diagnosis — can be obvious triggers for cancer survivors, anything that reminds you of what you went through can prompt an anniversary reaction, Dr Serani said.

“For some, Breast Cancer Awareness Month is a moment to celebrate empowerment, but for others it can be a re-traumatising experience,” she said. “Many may recall the traumatic moment of learning their diagnosis or the treatment they endured, how scary or uncertain that time was.”

It highlights the gap between marketing and real life.

One of the most frustrating things about Breast Cancer Awareness Month for Caroline Ilderton, who was diagnosed in 2018, is how the disease is presented as a monolith.

“Marketing is based on images, but there’s no one image of breast cancer,” said Ilderton, 61, a therapist in Charleston, SC “Each person’s experience is different.”

The month can be particularly hard for those whose cancer has progressed. “It can feel like only the happy stories are presented,” said Emma Fisher, 40, who has incurable metastatic Stage 4 breast cancer.

It’s hard to see campaigns where “everyone’s laughing and smiling and having bake sales and doing fun runs,” said Fisher, who lives in Sheffield, England, and volunteers with metastatic patient advocacy group MetUpUK.

“It makes me feel invisible,” she said. “It’s almost like metastatic patients are this dirty little secret of the breast cancer world, because nobody wants to portray breast cancer as a killer.”

For Bri Majsiak, 27, who had a preventive mastectomy after her mother died of breast cancer, the month can feel like a seasonal bandwagon that every company wants to hop on.

“It’s a pink tsunami of ‘We see you, we feel you,’ and then it’s November and it’s like, ‘Well, that’s over, time to get the Thanksgiving stuff out,’ said Majsiak, co-founder of The Breasties, a nonprofit organisation for people affected by breast and gynaecological cancers. “Breast cancer is 365 days a year, not 31,” she said.

You can get through October as a survivor

It may seem like all eyes are on you this month, but “it’s important not to feel pressure to be a spokesperson for breast cancer,” Dr Ashton said.

Ilderton gives herself permission not to participate in awareness-raising activities — and then permission to change her mind and participate after all.

“You don’t have to use your experience to shout from the rafters as some sort of preventative story,” she said. “Maybe you just want to tell another person about it in a more intimate way.”

Limit your exposure to things you might find upsetting, said Dr Ashton, which may mean taking a social media break. Davia Moss, 36, a breast cancer survivor in Syracuse, NY, bought an Instacart Express membership for October so she wouldn’t see rows of pink-packaged groceries at the supermarket. Majsiak unsubscribes from as many marketing emails as she can.

Don’t be afraid to set boundaries with loved ones who may not understand why you find the month tough, Dr Ashton said. Moss, a nurse practitioner, politely asked her co-workers not to bring in pink-ribboned merchandise. “I said, ‘October is really difficult for me, and it would be so helpful if I didn’t have to have extra triggers here at work,’” she said.

Realise you’re not alone in feeling distress this month, said Dr Serani, and reach out to other trusted survivors. Refocus your energy by taking on a low-stakes activity that’s meaningful to you, suggested Dr Ashton, like thanking a friend who supported you through treatment.

For many survivors, October will always be triggering, Dr Ashton said, but some find it gets easier with time.

Patricia Watson had breast cancer twice, first in 1985 and then again in 2002. These days, “I hardly think about it anymore,” said Watson, 89, who lives in Kansas City, Kan. “My daughter actually had to remind me yesterday that it was Breast Cancer Awareness Month.”

You can also help a survivor get through October.

If you’re the friend or relative of a breast cancer survivor, any overture you make this month is undoubtedly well-meaning. But here are the things I’ve found unhelpful: Using cutesy language like “save the tatas” (weirdly sexual), sharing my story without asking (weirdly exploitative) and telling me about your lump that turned out to be nothing (I’m glad yours was a near miss, but mine wasn’t).

While friends and family may assume this is a celebratory month for survivors, they “need to understand that a serious personal illness like breast cancer is a traumatic experience,” Dr Serani said.

One of the simplest things you can do is just acknowledge that fact, said Dr Ashton. “Say ‘I’ve heard Breast Cancer Awareness Month isn’t always positive for survivors, how are you doing?’”

Don’t make the survivor in your life into a case study, said Ilderton, whose friend once sent an email to a group “using me as an example of why to get a mammogram.”

If you want to make a purchase to support the cause, look at where the proceeds go, and “think about if it’s something you want to fund or if you’d be better off making a donation to a more focused, local opportunity, or to a research-based foundation such as METAvivor or BCRF,” Forrest said. Or ask if there’s an organisation you can honour that was helpful during treatment, Majsiak said.

Above all, said Forrest, “if you know someone who has been through it, who has survived, maybe tell them you’re proud of them, of how far they’ve come, of what they’ve endured.”

Holly Burns is a writer in the San Francisco Bay Area and a four-year breast cancer survivor

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