Beyond Survival: Understanding How Breast Cancer Can Impact Survivors' Relationship with Food

Breast cancer is the most common cancer among women worldwide, and advancements in treatment have significantly improved survival rates. 

Breast cancer survivorship comes with both physical and psychological challenges. Fear of recurrence and changes to body image can influence a survivor's relationship with food, sometimes leading to disordered eating, restrictive dieting, or other maladaptive eating behaviors. These patterns can negatively affect overall health and quality of life but are rarely spoken about in survivorship care. 

Dietitians can provide evidence-based, compassionate guidance to help breast cancer survivors cultivate a healthy relationship with food and body image.. This article explores the role dietitians can play in supporting a healthy relationship with food in breast cancer survivors. 

What the Research Shows 

1. Body image disturbances can be common and persistent in breast cancer survivors 

• Body dissatisfaction is strongly correlated with psychological distress, including depression, anxiety, and low self-esteem

• Mastectomy and radiotherapy scars are linked to greater body dissatisfaction and lower self-esteem​

• Weight gain post-treatment significantly impacts body image and often leads to restrictive eating and dieting behaviors​

  
  

2. Eating disorders and disordered eating behaviors in breast cancer survivors 

• Binge eating, restrictive eating, and emotional eating are common among breast cancer survivors, particularly those with higher psychological distress​

• Survivors may turn to extreme dietary control as a way to cope with the loss of control over their bodies during treatment

• 36.5% of breast cancer survivors in a one study had symptoms of orthorexia nervosa (ON), often driven by fear of recurrence​. ON was not strongly correlated with cancer stage or treatment type, suggesting it stems more from psychological factors than medical ones​

  
  

4. The role of psychological factors

• Depression and anxiety are associated with negative body image and disordered eating behaviors​

• Survivors with chronic fatigue and low physical activity tend to engage more in restrictive or emotional eating behaviors​

• Social support and counseling help survivors develop a more positive body image and relationship with food​

Strategies for Dietitians to Support Breast Cancer Survivors 

1. Screen for disordered eating: This can support early intervention for body image concerns and disordered eating in breast cancer survivor 

   
   

2. Refer to a skilled and experienced mental health: If you feel that food fear, anxiety and body dissatisfaction is having a severe impact on quality of life, refer to a mental health colleague and support your client collaboratively 

   
   

3. Encourage non-restrictive eating patterns: Promote Mediterranean and DASH diets for cardiovascular health and lower recurrence risk. Focus on nutrient density and flexibility, rather than restrictive meal plans

   
   

4. Dispel food myths: Educate survivors on common misconceptions about nutrition and breast cancer. Many survivors turn to the internet or social media for advice, and misinformation can cause more confusion and distress 

   
   

5. Support lifestyle habits that promote psychological wellbeing : Encourage mindful eating to reduce food anxiety, regular movement for mental and physical well-being, and social eating to foster a positive food environment 

Key takeaway 

For breast cancer survivors, nutrition is about supporting overall well-being, resilience, and a thriving life post-treatment. Dietitians play a crucial role in guiding survivors toward balanced, evidence-based dietary patterns, which promote heart health, metabolic function, and a healthy relationship with food.

By dispelling nutrition myths, addressing mental health, and fostering a flexible, non-restrictive approach to eating, dietitians can help survivors feel confident in their food choices, rebuild trust in their bodies, and support long-term health in a sustainable way.