Breast cancer is the most commonly diagnosed cancer in females, affecting approximately one in every nine females in industrial countries. Cancer is a disease that literally infests and chokes the life out of the body, and its prevalence and resistance to treatment makes it one of the scourges of the twentieth century. It is devastating for both the patient and their family and friends, and tends to co-occur in a lot of cases with depression and heightened anxiety, as a result of the immense stress it is associated with, and due to the resultant drop in quality of life.

Depression is a highly disabling disorder consisting of a persistent sad or "empty" mood, feelings of guilt, helplessness and worthlessness, restlessness and irritability, fatigue, and sleep and weight disturbances. As well as being a commonly diagnosed disorder itself, there is a high incidence of it occurring in conjunction with cancer, where it complicates the cancer and can be an obstacle to recovery. Therefore it is important to know the facts and to seek treatment for the co-occurring depression as well.

Patients who are depressed experience greater distress, more impaired functioning, and less ability to comply with medical regimens. The more severe the medical condition, the more likely the person is to develop clinical depression. Many people even assume that feelings of depression are common for people struggling with serious health conditions, but while clinical depression is a common medical illness, it is never a "normal reaction" to another illness. When depression occurs with another medical problem, both conditions must be treated. This can improve the psychological condition of the patient, enhance their quality of life, improve compliance with medications, and reduce suffering.

As well as being a result of cancer, recent studies have found that anxiety and depression could also play a role in the development of cancer, which is why if you feel you may be suffering from either of these, you should seek treatment as soon as possible. The Depression and Anxiety Support Group offers telephone counselling by trained counsellors, and referrals to appropriate mental health professionals and to various support groups, throughout South Africa, for depression and anxiety disorders. They can be contacted on 783-1474/6, Monday to Friday, between 8am and 7pm, on Saturdays, from 8am to 5pm, and on Sundays from 9am to 1pm.

It has been basically accepted that cancer is inheritable and that it has definite genetic links, but these are mostly incorporated into a diathesis-stress model of cancer, which means a genetic and/or psychological predisposition, combined with various external factors or carcinogens, and various psychological stressors can then trigger the onset of cancer.

Due to the nature of the disease, it is difficult to determine whether the psychological symptoms associated with cancer, like depression, a lower internal locus of control, heightened helplessness, and a lower ability to cope with stress, are results or causes.

In 1966, Rotter introduced the notion of "locus of control"; with an expectancy that people either have an internal or external locus of control. Since then there have been numerous applications of this theory to various aspects of human existence, and also a good deal of confusion as to which orientation is better, overall and in specific circumstances. A general conclusion that has been reached is that the idea of perceived control has implications for what we do, how well we do it, for how we feel about ourselves, and even for how healthy we are. It has been decided that having an internal locus of control is beneficial in circumstances where there is a positive outcome, but the argument begins with which is better in circumstances where there is a negative outcome.

An internal locus of control for positive outcomes was found to be associated with lower levels of depression, and also with better social adjustment. Social adjustment has also been found to be an important predictor in the course of breast cancer and in survival. It was also found that anxiety levels affected adjustment, with lower levels of anxiety correlating with higher levels of adjustment. These adjustment problems found in cancer patients are very much a result of the trauma and heightened anxiety associated with the diagnosis and treatment of breast cancer, but then other studies have also found difficulty in coping with stress to be a characteristic of a certain personality type (Type C) that is thought to be associated with a higher risk of developing cancer.

Various variables have been found that could predispose someone to or even cause breast cancer, and these make up the "cancer-prone personality type". Eysenck, a researcher states: "There is now considerable evidence for the existence of a cancer-prone personality type (Type C) characterised by a tendency to suppress the expression of emotions, to find difficulty in coping with stress, and to succumb to feelings of helplessness and opelessness."

The factor they found that related specifically to the development of breast cancer was the repression of the expression of emotion. They found that those women who later developed breast cancer tended to have higher mean values for the blocking of feelings and needs towards parents and present partners. Interestingly, they also found that overall, women who later developed cancer had higher mean values in chronic hopelessness due to traumatic life events.

Another important consideration of breast cancer, is its heritability, with family history of breast cancer being the most prominent known risk factor. Statistics show that women who have a first-degree relative with breast cancer are two to three times more likely to develop the disease than women with no such family history. Studies done show that women who are at greater risk genetically are also more likely to be in psychological distress, with higher levels of anxiety and depression. Interestingly, anxiety disorders and depression are also genetically inheritable.

Another factor that could influence overall stress levels is that of available support. The main way social support buffers stress is through influencing the person's stress-coping process, which interestingly, has already been implicated in the Type C personality, by Grossarth-Maticek.

All these factors, like a lower internal locus of control, feelings of helplessness, low levels of social support, repression of emotion and poor stress management skills are also implicated in the development of depression and anxiety disorders, showing that these disorders and the development of breast cancer are highly intertwined. People suffering from these disorders could then also be assumed to be at a greater risk for breast cancer genetically and also in terms of external stressors which could trigger the disease.