Today, there are more breast cancer survivors in the United States than any other group of cancer survivors. Four million, to be exact.

"If you've completed treatment for breast cancer, you may think that the hard part is over once you've completed treatment, but you may face new challenges that come with survivorship," says Northwestern Medicine Physician Assistant Melissa Duffy, PA-C, who helps run the Breast Cancer Survivorship Program Breast Cancer Survivorship Program in the Robert H. Lurie Comprehensive Cancer Center of Northwestern University's Cancer Survivorship Institute at Northwestern Memorial Hospital.   

Challenges Breast Cancer Survivors May Face

Less Frequent Medical Attention

During treatment, breast cancer survivors are used to being under the constant surveillance of a care team while following a detailed care plan. After treatment, you may feel like you're on your own without a plan and wondering, "what's next?"

New Emotions, Including Guilt

Breast cancer survivors are often struck by the realization that their treatment and diagnosis could have been worse, which can lead to guilt. Survivors may also feel guilty for not feeling happy right away, even though they've been looking forward to the end of treatment.  

In addition, survivors might be anxious about going back to work, school, or having to take care of their family. They could still feel very tired. They may also experience symptoms of anxiety or depression.

Body Image

Treatment for breast cancer can involve drastic changes to the body, including surgery to remove both (bilateral) breasts or one (unilateral) breast. Survivors may also have had a lumpectomy, or a surgery to remove a tumor from their breast, which can change the shape of their breast.

Some cancer medications may also cause weight gain during treatment.

Another thing some people struggle with is how their hair grows back after chemotherapy — thicker, thinner, curlier, or even a different color. Hair loss and regrowth can have a big impact on survivors' outlook and ability to feel like themselves again.

Screening Peace of Mind

After a mastectomy, patients typically do not require annual screening mammograms because the breast tissue has been removed. This means they may not have total peace of mind that they are cancer-free. It's very common to overanalyze every symptom, or worry that they are not getting adequate screening for cancer recurrence.

Other Health Issues

Breast cancer survivors often experience pain, fatigue, sexual dysfunction, dermatology concerns, cardiovascular issues, low bone density and other health problems due to their cancer treatment.  They might even experience cognitive problems after chemotherapy, including mental fogginess and trouble concentrating and multi-tasking. This condition is often called "chemo-brain" and usually improves over time. 

With all these challenges in mind, here are a few tips for embracing your new normal after surviving breast cancer.

"Breast cancer treatment can be difficult and everyone needs to allow themselves time to heal," says Karen Kinahan, DNP, APRN, FNP-BC, a certified nurse practitioner, who helps run Lurie Cancer Center's Breast Cancer Survivorship Program at Northwestern Memorial Hospital. "Recovery looks different for everyone. Survivors need to show themselves some grace."

How to Deal With Breast Cancer Survivorship Challenges

Establish Primary Care

One of the most important things survivors can do after breast cancer treatment is to make sure they have a primary care clinician. They are an integral part of the team who helps manage survivorship issues and basic health maintenance. A primary care clinician can also facilitate a referral to a mental health professional if needed.

If survivors have access to a survivorship program like the Breast Cancer Survivorship Program at Northwestern Medicine, they can work with their care team to create a survivorship care plan which includes a plan for surveillance and general health maintenance including screening for other cancers and chronic health conditions. It also provides resources for seeking more information and assistance after receiving a breast cancer diagnosis and undergoing treatment.

It's important to share as much personal and health information as possible with your primary care clinician to bridge the initial gap between your cancer treatment and continued primary care.

Be Patient

Even when treatment is over, your physical body and emotional spirit are still healing. It's important to remember that fatigue and other side effects of treatment don't go away as soon as treatment ends. Whether it was surgery, radiation therapy, chemotherapy or all of the above, a survivor's body just went through a major trauma and needs time to heal. Medications may be needed to prevent cancer from returning and can also have side effects that impact quality of life.

Embrace a Healthier Lifestyle

Some people equate surviving cancer with getting a new lease on life. It's a good opportunity to ditch bad habits and focus on things that make them feel good — inside and out. Eating a heart-healthy diet that's high in antioxidants is one of the best and easiest ways to boost your health. There are even certain foods that can strengthen your immune system and help you maintain a healthy body weight, which are primary factors in the fight against cancer. Some of these foods include broccoli, tomatoes, blueberries and walnuts.

According to the National Cancer Institute, there is convincing evidence that physical activity is associated with a reduced risk of cancers of the colon and breast. But even more importantly, there's also research that shows that regular exercise can reduce the recurrence of breast cancer.

Exercise can also play a huge role in helping you feel energized again. Evidence shows that exercise boosts your mood, your memory and can even help reverse the effects of stress.

Exercise can also help with bone health, reducing the risk of osteoporosis.

Choose How You Move On

"Breast cancer doesn't have to be a survivors' identity," says Karen. "It's something they need to manage, but it doesn't have to define who they are."

Everyone will handle survivorship differently, so survivors should not compare themselves to others.

"They may find a way to heal is to do breast cancer walks, dress in all pink and raise awareness," says Karen. "But it's completely fine if they want to deal with it more quietly. Their health care team will always be there to support them."

Breast cancer can affect anyone, but many men may face a stigma of being diagnosed with a disease that predominantly impacts women.

Because breast cancer knows no boundaries, there are many different types of support groups or volunteer opportunities that can fit survivors' personal needs and desires.

Look to the Future

Life after breast cancer will have its ups and downs. Some days will be better than others, but survivors will always have a unique perspective on life to draw from.

All of the feelings and concerns that come with survivorship are completely normal. With a little patience and support from friends and family, and frequent checkups with your health care providers they can gradually find a new normal.