Background
The end of the treatment for breast cancer (BC) may be a relief for women, but it also represents several challenges related to the return to a “normal” life. While some women may experience positive transformations, including finding joy in their life, being more altruistic or prioritizing their self-care, and improving their work-life balance (Fadhlaoui et al., 2021; Fang & Lee, 2016; Lally & Underhill, 2012), many experience difficulties in different domains: psychological (e.g., fear of recurrence, anxiety or depressive symptoms, poor self-esteem or body image adjustment difficulties), physical (e.g., pain, fatigue, osteoporosis, sexual or reproductive difficulties, often linked to menopausal symptoms) and social (e.g., fear of rejection, isolation, and being a burden for their relatives) (Fobair & Spiegel, 2009; Keesing et al., 2018; Matthews & Semper, 2017; Rees, 2017). These difficulties might prevent women from feeling liberated from cancer (Koutri & Avdi, 2016; Powers et al., 2016; Trusson et al., 2016) and thus leading to enduring distress.
The experience of women and the specific positive or negative outcomes associated with the end of BC treatment has been described as a transitional process (Rees, 2017; Trusson et al., 2016), whose mechanisms and factors of influence are not entirely identified yet. Some authors have used the concepts of liminality (Van Gennep, 1969) to describe the experiences of women after BC (Koutri & Avdi, 2016; Rees, 2017; Trusson et al., 2016); it refers to the transitional process through which the women undergo a change in identity roles: first leaving the patient group after treatment, second, entering a liminal (i.e., intermediary) state between health and illness, where the women do not feel belonging to a healthy society but do not identify themselves as patient anymore, and finally potentially reintegrating into society (Mathieu et al., 2025). Liamputtong & Suwankhong (2015) and Trusson et al. (2016) used the concept of biographical disruption (Bury, 1982) to capture the profound social and identity changes that arise following a cancer diagnosis and treatment. Bury (1982) described that biographical disruption correspond to a questioning of what was considered established before the illness, a questioning of oneself and the meaning given to life, as well as an attempt to normalize the situation. Both concepts highlight women’s difficulties in reclaiming their sense of health after BC. A third concept, posttraumatic growth (Tedeschi & Calhoun, 1996), is used to describe life after cancer. This approach focuses on growth development and, therefore, positive aspects of women’s experiences (Lally & Underhill, 2012; Sterba et al., 2014; Trusson et al., 2016). By increasing knowledge about women’s experiences, we can better understand how this transitional process unfolds in time and ends up with specific outcomes.
Difficulties and positive adaptations have been described in the vast majority of countries where the experience of women after BC has been studied: in the United States (Burke et al., 2012; Lally & Underhill, 2012; McCann et al., 2010; Raque-Bogdan et al., 2015), United Kingdom (Matthews & Semper, 2017; Rees, 2017; Trusson et al., 2016), Australia (Keesing et al., 2018; Powers et al., 2016), Taiwan (Fang & Lee, 2016), Belgium (Dauphin et al., 2020), Greece (Koutri & Avdi, 2016), and Canada (Bilodeau et al., 2019; Fadhlaoui et al., 2021). However, there is a lack of data about women’s experiences after BC in Switzerland. While studies from other countries provide insights into the experiences of Swiss women after BC, it is important to recognize that their situation can vary significantly, partly due to socio-cultural variations between countries. Adeponle et al. (2012) pointed out that the cultural norms (e.g., individual or community society, gender role attribution, or illness perception) and socio-economic context influence illness recovery and interpretation. The differences in perception and understanding affect the behavior, as well as the perceived needs. According to Adeponle et al. (2012), some European or American countries are more individualistic, while African or Asian countries are described as more embedded in community and altruistic relationships, which modify social support. For instance, the situation differs regarding care or societal support (e.g., health insurance is mandatory in Switzerland, which could presuppose lower pressure to resume work compared to North American countries).
Aims of the study
In terms of epidemiological data, Switzerland has one of the highest five-year BC survival rates in the world (Allemani et al., 2018). However, the country’s population is growing, which is increasing the incidence of BC (Swiss Federal Statistical Office, 2021). Therefore, the conditions of life of women after BC pose an acute question of public health to adapt or develop specific public policies targeting their needs. For these reasons, we aimed to study the experience of women who have faced BC in Switzerland. Such knowledge will help us to better improve the needs of BC women after the end of their treatment.
Methods
Design
The present study is a qualitative follow-up to a mixed-method research on women’s psychosocial adjustment to non-metastatic BC. The original study was designed as a longitudinal research with four measurement points: 2 weeks, 3 months, 1 year, and 2 years after surgery. Women who had a diagnosis of non-metastatic BC that required surgery (mastectomy or tumorectomy) were recruited at the Breast Center of the University Hospital of Lausanne, located in the French-speaking part of Switzerland, during their pre-hospital consultation (1–2 weeks before surgery). They had to be able to read and speak French, and they should be aged 18 years or older. Women that had a stage IV cancer were excluded. Charvoz et al. (2016) presented a description of the original study. This study, representing the fifth measurement point, explores women’s experiences 5 to 7 years after surgery. This study was not preregistered.
Theoretical framework
We adopted a critical realism ontology and constructionist epistemology (Guba & Lincoln, 2005). We chose a qualitative research design that allows us to explore women’s discourse in depth through an inductive thematic analysis (Braun & Clarke, 2022). We are committed to staying as close as possible to the participants’ lived experiences. We acknowledge the diverse nature of their experiences and recognize language as a pivotal mediator that allows researchers to gain partial insight to the intricate realities of women’s experiences. This linguistic lens provides a comprehensive understanding of individual experiences within specific social and medical contexts.
Study setting and recruitment
An information letter containing a consent form and a self-addressed envelope were sent to women who participated in the last follow-up of the original study. An individual interview at home was planned with women who agreed to participate. One hundred twenty-seven women were contacted, and 34 participated. Although the sample exhibited a wide age range (from 40 to 90 years), the present analysis focuses exclusively on the interviews conducted with the 11 women under 50 years old at the time of data collection. These women represent the youngest subgroup within the sample. This methodological choice was made to obtain a more homogeneous group and reduce the potential confounding effect associated with age-related difference and limit the variance related to different life cycle stages. Furthermore, women in this age group are more likely to have searched for solutions to re-engage in society, whether in their professional endeavors or social relationships, making their experiences particularly relevant to the objectives of the present study. Although women under 50 are statistically less likely to develop breast cancer than older women, the incidence among younger women is rising (International Agency for Research on Cancer, 2026; National Agency for Cancer Registration, 2025). This trend warrants focused attention on the specific needs and characteristics of this age group.
Data collection
The third, fourth, and last authors developed a semi-structured interview guide based on current knowledge in the field of cancer survivorship and the scientific and clinical expertise of the involved researchers. The interview guide (supplementary material 1) covered different topics to ensure a comprehensive data collection, such as physical and psychological health, sexuality, body image, social and partner relationships, and professional life.
The third author, a trained and experienced psychotherapist, conducted the interviews under the supervision of the fourth author, a senior researcher and clinical psychologist. The interviews were conducted at participants’ home between June and November 2019, before the Covid pandemic. They lasted, on average, 78.28 minutes (sd = 17.05, range = 53.1–114.4). Interviews were audio-recorded and transcribed verbatim to be analyzed via NVivo (release 1.7.2).
Data analysis
We use an inductive thematic analysis (Braun & Clarke, 2006, 2019) to analyze our data. Firstly, we familiarized ourselves with the content of the interviews by reading the transcripts repeatedly. After careful reading, the third author created a series of codes. The first author resumed and completed her work when she suddenly passed away. Codes identify a feature of the data (semantic or implicit content) that is considered interesting and relevant to the researcher to answer the research question. Next, codes were regrouped into a smaller number of categories. According to Clarke & Braun (2007/2016), categories represent repeated ideas, concepts, or meanings in the list of codes. These categories were regrouped to create themes, which are “patterns of shared meaning underpinned by a central organizing concept” (Braun & Clarke, 2019, p. 589). Back-and-forth iterations between the analysis and the writing process allowed us to refine the analysis.
Additionally, analyses were independently cross-checked with the second and last authors to ensure the integrity and consistency of categories and themes. Firstly, despite being very interesting, the initial codes were overly interpretative. After several discussions, we tried to limit the interpretation to reduce the bias resulting from the coders. Throughout analysis, we remained sensitive to participants’ perspectives while regular collaborative discussions among us mitigated individual biases and ensured interpretive rigor. Secondly, we discussed the architecture of the categories and themes. We particularly tried to avoid overlap among themes. We resolved our divergences collaboratively until reaching consensus. Finally, during the writing, discussions on the interviews and the analysis enabled the first author to gain a deeper insight, leading to a more comprehensive perspective.
Rigor and reflexivity
As critical realist researchers, we were aware of our impact on participants and acknowledge that our subjectivity influences analysis and data interpretation (Braun & Clarke, 2019). We slightly reduced our subjectivity by discussing interviews; however, it fostered our introspection. Our insights, experiences, and the use of post-interview diaries enhanced reliability by mitigating biases such as preconceived ideas. While this approach may marginally reduce reflexivity, the benefits outweigh the concerns (Tufford & Newman, 2012).
The five researchers (a Ph.D. student in psychology, two doctors in psychology, and two psychotherapists) observed considerable variation in women’s responses to breast cancer diagnosis, ranging from significant distress to remarkable resilience. This aligned with literature showing that psychological and social challenges can remain or be overcome over time (Matthews & Semper, 2017; Rees, 2017).
The first author, a Ph.D student at the time of the analysis, worked several years in a hospital as nurse’s aide and was engaged in university politics. The second author, a full professor, worked several years a clinical psychologist. He is specialized in the family and couple relationships. The third author was a psychotherapist. She was engaged in family therapy. The fourth author is a psychotherapist specialized in children healthcare’s and family therapy. The last author, a doctor in psychology, realized several studies related to breast cancer and couple relationships. We were all convinced that the psychological and social situation of some women might be improved. Thus, we tried to explore their realities to determine how care could be enhanced. We committed our research and work to promote individual well-being.
Ethical considerations
The study protocol was approved by the ethical committee of the canton of Vaud (Switzerland) (protocol number 228/11 for the original study in July 2011 and PB_2017-0058 for the present study). Written informed consent was obtained from all participants included in the study.
Results
Characteristics of participants
The 11 participants (m = 47.55 years old; sd = 3.08, range = 40–50) were professionally active at the time of diagnosis. They worked at a mean rate of 67.8% (sd = 25.39) (one respondent did not give her work rate), and 7 were engaged in a relationship. All women had undergone surgery: Five of them had undergone a mastectomy, and 6 had a lumpectomy. Among surgical interventions, 6 included the removal of sentinel lymph nodes and 3 axillary lymph node dissection. Six participants had undergone chemotherapy, 5 hormonotherapy, 5 radiotherapy, and 2 immunotherapy. The mean time between breast surgery and the interview was 7.12 years (sd = 0.80, range = 5.67–7.92 years). All treatments were completed except hormonotherapy, which lasted until 10 years after primary treatment (Burstein et al., 2019). Four participants were undergoing hormonotherapy at the time of this study.
Themes created
We created inductively four themes that describe women’s experiences, highlighting a range of difficulties they face: (1) experiencing physical changes, (2) social challenges, (3) identity change, and (4) living with the fear of cancer recurrence. In the following section, we will describe each theme in detail. The supplementary material 2 presents the codebook (in French) which present all the codes and categories belonging to each theme.
Experiencing physical changes
Physical changes were perceived through limitations in physical activity, body image changes, and reduced sexual activity. Regarding physical activities, resumption was slower than expected. Several found limitations in the practice of a sport (e.g., dance or horse riding). Most women complained about long-term fatigue, such as P1 who explained: “The process of fatigue is long and slow. But the body won’t recover in five minutes.”. Some suffered from back pain, osteoporosis, or unbalance due to prosthesis. P2 stated: “The only thing I manage to do is a little water gymnastics and then some walking.”. Nevertheless, a few reported feeling good in their bodies and perceived a return to normality. P3 expressed: “I’m in good health again, for me nothing has changed compared to before. In terms of physical health, I’ve got everything back.”. BC women in such case expressed generally a satisfying quality of life. It also appears that some specify that their life was even better than before the cancer.
Regarding body image issues, treatments leave physical consequences that impact their daily lives in many areas. The loss of a breast created a long-time emotional distress. Most participants reported reduced choices when it came to their clothing options. They avoided low-cut necklines and felt that bras offered to them were unsuitable for their age. Appearance difficulties were tied to bodily sensations. Participants reported changes in skin texture or a feeling of being “flabby”. Many women perceived their bodies as mutilated. They reported discomfort and inconvenience. P1 illustrated that she: “know[s] when the weather changes. Automatically, bam, that’s it, my breasts are swelling.”. This type of statement demonstrates increased bodily vigilance and the tendency to relate physical sensations to changes in daily life, such as meteorological conditions.
Despite these challenges, many participants stressed the importance of accepting the modifications. They acknowledged that feeling comfortable again in their bodies takes time. P2 reported: “I had a nude photo taken. […] I realized that, oh, there’s a balance! Ah, but I have two breasts! […] And in fact, when I looked at myself in the mirror, I saw something completely different, like a puzzle that had been badly put together, like something by Picasso.”. This quote depicted the difficulties to accept the body changes, considered as unsightly or mutilated. One strategy to move forward was breast reconstruction. P4 stated: “All the people I’ve come into contact with who haven’t undergone reconstruction have remained completely stuck on their cancer.”. Nevertheless, the reconstruction was often met with disappointment, despite the initial hopes it aroused. Such disillusionments are difficult to endure and may reinforce the feeling that nothing can be done to improve their body image. P1 emphasized: “We all imagined that our breasts would be more beautiful than before. […] But in fact, not at all.”. Some women still faced challenges after reconstruction and did not regain a sense of comfort. Moreover, the numerous operations were exhausting for women and some simply gave up. P1 shared: “How do I look at myself with my breasts, which aren’t finished yet? Because I really don’t have the courage to go through with these latest operations, where I have to go back into my thighs to get a nice curve and so on. I don’t have the courage anymore. Physically and psychologically, it’s no longer possible.”. This particularly highlights that some women may resign themselves to live with a reduced quality of life.
The alteration of the body influenced the sense of desirability. It can affect the couple sexuality, as P5 illustrated: “I thought [my breasts] were ugly, period. They were something you shouldn’t look at, shouldn’t touch.”. Negative feelings about the body may consequently lead to avoidance of intimate moments within the relationship. Those who overcame their body change appearance were relieved. P5 expressed her change of mind when she accepted her body changes: “It’s the word ‘free’ that comes to me, free to be… free. Free to be naked, free to make love without asking myself too many questions, about how to hide maybe or how to make sure he doesn’t touch.”. Such thoughts underline a capacity to adapt and overcome difficulties. Moreover, after an enduring absence of libido, the latter could come back, as by P6 who expressed relief: “And uh… on the other hand, what’s finally coming back to life, hallelujah, after two years, is my libido!”. Such recovery aroused a lot of hopes but also uncertainties. Women expect improvements in their situation but encounter difficulties to achieve their aspirations. This sometimes-temporary decrease of libido was associated with a disconnection from the body. P7 described: “For me, [sexuality] is something important. And that was the hardest part. […] No more pleasure. Well, the body doesn’t respond. Really, you get the feeling that if I’d been a piece of wood, it’d have been the same.”. Many women reported pain during vaginal penetration, likely due to vaginal dryness caused by hormonotherapy. This can prevent sexual intimacy. P4 explained: “Well, either I use lubricant, cream or something, or I won’t be able to. […] I don’t want to lose contact, so uh… I’ve incorporated that into the relationship. […] It’s either that or there’s nothing left”. This quote illustrates that some women might engage in non-desired sexual intercourse to maintain a connection with their partner. P8 described the dilemma to provide sexual satisfaction to her partner while lacking any libido and sexual desire herself: “In fact, I’m in a period where I can please my boyfriend but not let him touch me.”.
Social challenges
Social challenges were perceived through social fears, isolation, social pressure, and complexified couple relationships. Some participants expressed concern about burdening others when asking for support. P1 explained: “Well, people are empathetic for, um… fifteen days, ten minutes, a quarter of an hour. We each have our own threshold of empathy. Then, after a while, they get a bit fed up.”. Such beliefs might result in some women giving up on seeking psychological assistance among their friends or family, leading to feelings of isolation and lack of understanding. These interactional difficulties might explain why women fail to receive the support they need.
Additionally, concerns about the potential lack of benevolence in the offered assistance or the search for sensationalism prompted them to select their relationships. P1 recognized that: “The illness also allowed me to sort out the people who really cared about me… or not.”. Several participants developed a quasi-friendship relation with healthcare professionals, as P3 described: “Each time we had [name of nurse], who was more of a friend than a nurse, but who offered to see my daughters and talk to them if they needed to debrief.”. The strengthening of these caregiver-patient relationships may indicate a shift in social network. The burden of pitying or sympathetic looks and indelicate reactions constrained women to avoid discussing the disease and its aftermath. P5 related: “When you talk about your breasts, people break down. […] If it’s a man, well, that’s a disaster, because you immediately see those who know.” and P5 continued: “My sister-in-law said to me: ‘Ah [husband’s name] didn’t see on which side it was’. And she added: ‘But me, I saw it right away’.”. Women must face social pressures, particularly regarding breast reconstruction and beauty standard. P3 recalled that someone told her: “But you can’t stay like that, you have to do something, you’re a woman, you can’t stay with just one breast.”. Thus, most of the participants concealed the absence of a breast to avoid causing discomfort to those around them or themselves. P3 stated: “If I’m at home in the evening, I’m very happy to be able to remove [the prosthesis]. But if I have guests arriving, I’m going to have trouble receiving them like this.”. However, entourage feedback could be positive. P6 evocated a discussion about her post-chemotherapy alopecia with a friend of her daughter: “If you put this cap back on your head for me, it’s not worth it. I find you much prettier without it. But if you put it back on for yourself, I’ll understand.”. These positive experiences might promote a positive reappraisal of their situation and body image.
Those who chose to keep their experiences private often felt isolated and experienced depressive tendencies. Indeed, P9 reported: “I had a breakdown. This change completely destroyed me.”. Women might lose their perception of life meaning. P2 stated: “I’ve withdrawn a little, but I don’t know why, as if the illness had weakened me in that respect and I’d buried myself in my shell and said, “Leave me alone!”. This social isolation might come from a sense of no longer being understood and supported by her original social group. Furthermore, the transition from almost daily interactions with healthcare providers leaves a significant vacuum at the end of treatment. P4 discussed her feelings of abandonment and vulnerability, particularly by comparing herself to a helpless baby: “You’ve seen plenty of white coats for six to eight months. And then after the baby, we drop it. We let go.”. Several women reported these experience and thoughts. Several women also reported a lack of empathy and understanding in the society. This was particularly evident in professional life. Job-seeking presented a dilemma. P9 recalled: “’What have you been doing for four years?’ So, what should we say? That we’ve been sick?”. Several BC women reported cancer-related preconceptions that engendered fears of rejection based on their medical history. Their medical journey may be viewed as a transformative event that set them apart from society, leading to temporary social exclusion.
These challenges were mirrored in family life. The varying levels of support from partners had an impact on the strength of their relationships, sometimes consolidating it or leading to break up. P10 stated: “It rather weakened [our relationship] because each of us was perhaps questioning the other, and we weren’t… we couldn’t really step back at the moment.”. Single participants faced the added difficulty of navigating the dating scene post-diagnosis. A successful pairing boosts their morale, as P9 mentioned: “I didn’t know anybody. I wasn’t dating anyone. So uh, and I met someone great, and that also helped me.”. Such experience was categorized as very positive and probably might help to reappraise positively their situation.
Identity change
Some women demonstrated that they were striving to regain a sense of normality and femininity through identity changes. P5 attempted to “continue to live normally” or at least maintain an illusion of success in doing it. For fear of not being able to adapt, some unsuccessfully tried to return to their pre-cancer lives. Others found a new balance by altering their language or perception of their current life to move forward. P2 stated: “I’ve now decided that I’m no longer convalescing but getting back into shape, it’s psychological. […] It’s also a way of accepting your new life.”. Such reframing helps them to change their perspective and accept the changes they are facing. Some women who succeeded in accepting the changes and even considered their life to be better than before their cancer diagnosis.
Furthermore, several identity dimensions of women were disturbed. One of the most challenging hurdles to overcome was the redefinition of their femininity. P7 mentioned: “No matter how much I said to myself, ‘Well, that’s… you’re like you were before’, it doesn’t change a thing. Well, no. Personally, I had a very hard time not having a breast anymore. I didn’t feel like a woman.”. This quote highlights a feeling of biographical disruption. And P2 asked: “What is femininity really? Is it my two big tits, or does it go a little further? Is femininity something else?”. Breast loss following mastectomy represents a critical threat to identity and body image. Adaptation to this loss varies considerably, with some women achieving psychological adjustment through cognitive reframing that decouples identity from specific physical characteristics. Another disturbing aspect of identity was the possibility of being a mother. It could turn into uncertainty because of hopes of still being able to conceive. P10 complained: “The fact that I was told: ‘well, now you won’t be able to have [children]’, was a small grief to do, even if I didn’t want it anymore.”. This quote highlights the suffering caused by infertility. Societal norms surrounding femininity, whether related to the body or social roles confront women with multiple challenges. Successful adaptation might require them to reframe their perceptions of these normative expectations.
Most of the participants made significant changes to their daily routines. Most adopted defensive attitude, preserving themselves by avoiding overload, learning to say no. P6 made it clear that her opinion had changed: “The ability I had before, where I thought I was a wonder-woman managing my two daughters, being single, what have you, and then three jobs, now I realize that maybe that wasn’t really fair either.”. This quote particularly highlights her shift in self-perception: she transitioned from viewing herself as a ‘superwoman’ to recognizing herself as a woman with physical and cognitive limitations. P8 declared: “I was more open, I listened more to others and everything. And now I just keep myself to myself.”. The awareness of their limits led them to modify their attitudes and behaviors. A few mentioned altruistic changes, such as having more empathy for the sick. Overall, most of them began to prioritize self-care than before. Finally, their new life choices generated needs and desires. P10 indicated her urge to change her life habits: “We don’t want to stay in a life straitjacket that may not suit us.”. P2 agreed: “I used to be someone who wasn’t necessarily very sporty, but who loved going out, running, doing things. Now, I don’t even feel like it anymore.”. Some women appeared to be attempting to change this situation, while a few seemed to have already resolved this challenge. Their cancer experience heightened their awareness of mortality, leading them to recognize the importance of embracing life more fully. Many advocated for being more attuned to their needs. A few asserted that they now had the right to complain. However, this view was not shared by everyone. P9 emphasized: “When you know you’re going to lose [your life], you appreciate it better and you don’t balk at everything and anything. […] I wasn’t a complainer by nature, but even less so now.”. Ultimately, some asserted being less tolerant of certain trivial complaints from their surroundings.
Living with the fear of cancer recurrence
The fear of a recurrence was a constant and significant factor in the future perspective. The regular intake of medications, such as hormonotherapy, and the check-ups modulated it. They structured the participants’ live and are often perceived as protective against recurrence. As P10 shared: “I’m dreading the day when I won’t be taking any medication, because it’s part of life, it’s a bit of a rhythm, we’re used to it, we know it’s preventive.”. Several women felt reliant on continuous treatment to stay healthy, a dependence that may reflect a loss of confidence in their bodies’ functioning. Once the treatments were over, it was difficult for participants to believe in their recovery. Some of them desired a certificate or official confirmation from medical professionals. P11 said: “We’d almost have to organize, not a party, but a graduation ceremony. […] Something to make it official.”. Such thinking showed the difficulties to feel reintegrated in the “healthy society”. Most of them still feel vulnerable and some even could not believe in their recovery. Moreover, the intake of hormonotherapy also prevented some to move on. P1 explained: “It’s that every morning, taking this medication, I had the impression that I couldn’t tell myself that I didn’t have cancer anymore.”. It reveals the feelings of persistent vulnerability expressed by several women.
The risk of recurrence was a central concern. P11 was relieved to her that she was back in the ‘normal’ statistics: “That’s pretty good, it means you’re falling back into the mass of people, you’ve reached a stage where the risk of it coming back is the same for you as it is for everyone else.”. Her reflection demonstrated confidence in her current health status. Others find reassurance in numerous follow-up mammograms, despite the anxiety generated by these events. P9 illustrated her fears: “Every time I go for an appointment for an MRI or a mammogram, my heart is always in my throat, I’m always apprehensive that there might be something there, that’s all.”. Medical appointments constitute both a source of anxiety and a means of relief. If they had any doubt or pain, they would immediately consult. P8 recalled: “[My doctor] gave me the breast marker test, the cancer test, the tumor test. […] Everything was negative, there was nothing. I said, ‘I thought I had cancer’. Of course, because I was aching all over.”. This quote emphasized the importance placed on corporal signs and symptoms. Most of the women become much more attentive to their bodies. To alleviate their pervasive fears, some engage in breast self-exam. Nevertheless, concerns about recurrence persisted. As P10 used a metaphor to illustrate it: “We still have a sword of Damocles hanging over our heads…”. The experience of cancer durably marked them, as a traumatic event that change their world perception. P6 was convinced of her cancer vulnerability despite positive inputs: “I told my partner, who’s twelve years older than me, that I’d be leaving before him.”. This quote illustrates the strong belief in their vulnerability. Because of this perception, women may give up activities or consider some their life goals to be unattainable. Overall, the participants’ perception of the future was significantly impacted by their fear of recurrence. Most were able to manage medium-term projections, such as planning next year’s vacations. However, long-term life plans, such as buying a house, become unattainable. P9 highlighted the change since the cancer: “I don’t project much. Some people say ‘Yeah, I’ll do that in ten years’ time’. But that’s never the case. I live from day to day. […] Since the illness, I can’t manage at all. […] You never know what might happen.”. This inability to project oneself into the future might stem from fear of vulnerability. These women might be categorized as feeling neither cured nor in good health, which prevent them for making plans.
Despite their fears, several participants indicated they would not treat themselves in case of recurrence, partly because of the treatment-induced suffering. P1 stated that she was exhausted: “If there’s a third time, I don’t do anything. I’ve, I’ve had enough. I’ve exhausted all my psychological and physical resources… […] I feel I don’t have that kind of strength anymore.”. Several expressed a preference for a shorter but better quality of life.
Discussion
In this inductive qualitative analysis, we aimed to explore BC post-treatment experiences of Swiss women. We highlighted that these women face numerous physical challenges, such as pain, osteoporosis, and body image changes, which may limit their ability to resume activities. Treatment side effects, including breast ablation, vaginal dryness, and skin texture changes, can impact women’s sense of desirability and sexuality. Social challenges arise from a reluctance to seek support, a fear of burdening others, and encounters with social pressures, particularly those concerning breast reconstruction. This leads to communication difficulties and social isolation. Furthermore, women often experience identity changes and uncertainties related to femininity and fertility, which further complicate their ability to adapt. Finally, the fear of cancer recurrence is prevalent among women, affecting their sense of recovery and future perception, with events like pain or medical check-ups triggering this fear.
Our results led us to think that Swiss women might be categorized through three profiles: negative, fluctuating and positive. They relate to women experience after BC treatment. These profiles are only hypothetic and should be confirmed in further research. Additionally, because of the cross-sectional design of our study, it is impossible to affirm that these profiles might reflect a fixed or transitional experience. First, the negative profile relates to women struggling with body image issues and fear of recurrence; these women often feel isolated and have difficulty in projecting themselves into the future. Second, the fluctuating profile is characterized by women who can generally move on from cancer and its consequences but face enduring challenges like intermittent pain, sexual issues, societal misunderstandings regarding their needs or difficulties, and fear of recurrence from symptoms or check-ups. They may succeed in planning long-term goals but struggle to do it. Third and finally, the positive profile is associated with well-being, where women feel good, manage remaining difficulties, accept body changes, feel socially integrated, and do not fear or accept a potential cancer recurrence. It reflects a state of well-being with minimal disruption, where women appreciate their life. They learned the value of life and enjoy every moment. Based on our observations, we believe that the majority of women follow the fluctuating profile.
Moreover, even if we have not analyzed our data following the concepts of biographical disruption, liminality and posttraumatic growth, we propose to consider the extent to which our data can be understood according to these concepts, based on the previous literature (Liamputtong & Suwankhong, 2015; Rees, 2017; Trusson et al., 2016).
The concept of biographical disruption might explain the disruption of the sense of embodiment of some women (Trusson et al., 2016). Breast loss following mastectomy might represents a critical threat to identity and body image. In this perspective, the concept of biographical disruption appears appropriate for explaining the rupture in meaning attributed to corporal modifications (e.g., betrayal of the body, change of perspective related to the sexual identity), as theorized by Bury (1982). Such rupture in meaning might be durable (Rees, 2017; Trusson et al., 2016). Women might also be confronted to social difficulties, where they feel losing their previous social roles. Their world perception might thus be disrupted. Finally, their life purpose might evolve. The concept of biographical disruption seems then pertinent to explain the feeling of vulnerability, induced by the difficulties to normalize their situation and the impossibility to accept the corporal and social modifications. The effect of biographical disruption might be linked to the negative profile (Liamputtong & Suwankhong, 2015; Trusson et al., 2016).
The second concept, liminality, might also be pertinent to describe the experience of several women. According to previous studies (Little et al., 1998; Mathieu et al., 2025), liminality allow to describe a feeling of being in-between to states. This duality might be viewed in the hopes of women to find back their previous health status (e.g., pain or fatigue) or abilities (e.g., strength, ability to conceive), but in the knowledge that it is impossible or unpredictable. Rees (2017) related such uncertainty to liminality. Another aspect of liminality lies in the temporary social status (Koutri & Avdi, 2016; Trusson et al., 2016). In this regard, the medical journey may be perceived as a transformative event that set women apart from society, leading to temporary social exclusion: they do not belong to healthy people, while being not patient anymore. The social shift might explain the lack of support and the interactional difficulties impede help-seeking. Our results also highlithed that women tried to adapt their behavior and attitudes in order to fulfill their needs and reach a feeling of normality. Hvidt (2017) associated this phenomenon to liminality. Finally, the challenge of projecting themselves into the future might stem from the fear of cancer recurrence or death. Such debilitating anxiety was associated with the vulnerability inherent in liminality (Avery et al., 2024; Campbell et al., 2024). Women experience that might be conceptualized through liminality appears predominantly challenging. It could represent the experience of women who hope to improve their situation, while still facing difficulties that impend progress. In this perspective, the experience portrayed by liminality seems to be correspond to those depicted by the fluctuating profile.
The third concept, posttraumatic growth, seems relevant to describe the experience of a few women. It describes an improvement of the perception of the quality of life regarding to the pre-traumatic situation (Tedeschi & Calhoun, 1996), which could be represented by the cancer diagnosis and the treatments. Our analysis showed that a few women accepted the changes they faced and considered their life to be better than before their cancer diagnosis. Several studies related this phenomenon to posttraumatic growth (Lally & Underhill, 2012; Sterba et al., 2014; Trusson et al., 2016). These women seem also more affirmative about their willingness to pursue treatment if cancer recurs. It underlines their confidence to be cured or at least their perception of importance to live. The experience that posttraumatic growth depicts appears relatively similar to those described by the positive profile.
The links between BC women reported experiences, profiles, and theoretical concepts appear complementary and coherent with previous studies. However, because our analysis was inductive and not based on profiles or concepts, the links remain hypothetic. Moreover, we lack longitudinal data to document profile transitions over time. It is possible that women’s profiles may be dynamic rather than static. Some women appear to encounter positive interactions that facilitate cognitive reappraisal of their situation. Consequently, they might transition from the fluctuating profile to a the positive one. Conversely, negative trajectory shifts are also possible. Women with fluctuating profiles who face substantial adversities may experience profound distress, potentially leading to a shift toward a negative profile. Such evolution would imply that the situation of BC women might be improved. It would be then crucial to support them effectively to facilitate their physical acceptation or avoiding them to isolate socially.
Our study shows that, with a few exceptions, Swiss women experience similar psychological, physical, and social difficulties after BC to those related by women in other countries where the experience of survivorship has been investigated (Drageset et al., 2020; Keesing et al., 2018; Matthews & Semper, 2017). Swiss women present difficulties after BC in planning their future, as it has been described in international studies (Powers et al., 2016; Rees, 2017; Trusson et al., 2016). Furthermore, Swiss women expressed concerns regarding their social roles after BC, similar to most other international studies. Studies have linked such evolution to women’s body image (Dauphin et al., 2020; Trusson et al., 2016), physical limitations, and the need to regain confidence and take back responsibilities (Bilodeau et al., 2019; Fadhlaoui et al., 2021; Powers et al., 2016). Our results indirectly describe the difficulties of getting back or modifying women’s social roles. The four themes highlighted in this study suggest that physical changes result in discomfort and activity limitations, while social situations may be avoided to prevent embarrassment. Furthermore, identity changes necessitate role redefinition over time, and the fear of recurrence influences women’s behaviors and social roles. Swiss women may thus struggle to resume or modify their social roles after BC.
On the other hand, our results are in stark contrast with some US and Canadian studies (Bilodeau et al., 2019; Fadhlaoui et al., 2021; Liska et al., 2020; Raque-Bogdan et al., 2015), which highlight pressure to return to work because of financial challenges. Swiss women did not report such pressure, probably because social insurance covers health sickness in most European countries. European (Dauphin et al., 2020; Koutri & Avdi, 2016) and Swiss women may thus have more opportunities to take time to recover and regain confidence in their skills and energy before returning to work. This specific difference apart, women present similar difficulties worldwide. Presumably, the consequences prevail over the socio-cultural differences, which highlights the long-term impact of cancer and treatments. Despite receiving improved treatments and the development of precision and personalized medicine, women still struggle to adapt even years after the end of treatment. We must deepen our knowledge of women who have faced BC and find solutions to support them from the treatment beyond.
Limitations of the work
This study has several limitations. Firstly, it should be noted that the participants were from the French-speaking region of Switzerland, which may not represent the experiences of Swiss German or Swiss Italian women due to cultural differences. Additionally, restricting the analysis to participants aged of 40 to 50 years old limits the generalizability of the findings to older women, whose experiences may differ substantially. Consequently, the results should be interpreted within the context of the specific age group. Secondly, the participants underwent different treatments, including surgery, chemotherapy, and radiotherapy, which undoubtedly impacted their experiences differently. Our analysis did not differentiate between specific surgical procedures, such as mastectomy and lumpectomy. These surgical approaches result in distinct physical outcomes and may be associated with different psychological, physical, and social challenges. For example, women who undergo mastectomy may experience diminished quality of life related to altered body image and social pressures. Results might thus be used with caution. Furthermore, four participants are taking hormonotherapy, which has introduced several additional difficulties, often related to premenopausal symptoms. Due to the recruitment challenges, we did not select participants based on treatment type and lacked sufficient data to assess potential effects linked to different treatments.
Recommendations for further research
The concepts of liminality, biographical disruption, and posttraumatic growth might highlight that women will experience various experiences after BC, some of them with possible adverse outcomes. More research is needed to confirm the applications of these concepts to women experience. Additionally, we proposed three profiles categorizing the experience of BC women. The experience depicted by these profiles appear consistent with the three concepts, however further research is needed to explore their pertinence. Moreover, because our study is cross-sectional, we do not know if the profiles, as the difficulties evolve with time. If it is the case, it would imply that it is possible to support BC women in order to improve their quality of life. A longitudinal design would be a good way to gain a deeper understanding of how women progress to a more or less successful return to a “normal life.
Implications for policy and practice
These results show that we need to pay close attention to the experiences of women who have faced BC. We must make improvements in the support we provide women from the time of diagnosis to the end of the treatment and beyond. It seems crucial to improve cognitive reappraisal, physical acceptation and social contact. It would help women to have a better quality of life. The proposed profiles that described the experience of BC women appear coherent with the concepts of biographical disruption, liminality and posttraumatic growth. Some attention should be addressed to confirm these profiles which might help to identify women needing support.
Conclusion
Our results show that most women experience long-lasting physical, social, and identity difficulties after BC. Furthermore, most of them live with the fear of recurrence. Our results align with the results of studies from other countries, which confirm the consequences of cancer and treatment and the needs to continue to support BC women after the end of treatment. The three proposed profiles might allow describe in depth BC women experience and appear coherent with theoretical concepts. These profiles and the application of these concepts should be confirmed through further longitudinal studies.
Data Accessibility Statement
The datasets generated and analyzed during the current study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author on reasonable request.
Transparency Statement
We reported how participants were selected and described the rationale for the sample size. To achieve a sufficient sample size, we accepted all individuals that previously participated in a follow-up study. We reported all relevant research contexts, data collection conditions, and analytic procedures. In this study, no data were excluded. Because qualitative analysis does not use statistical outlier criteria, such cases were addressed through interpretive analysis rather than exclusion. Finally, inclusion and exclusion criteria were established prior to data analysis.
Additional File
The additional file for this article can be found as follows:
Ethics and Consent
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the ethical committee of the canton of Vaud (Switzerland) (protocol number 228/11 for the original study in July 2011 and PB_2017-0058 for the present study. Written informed consent was obtained from all participants included in the study.
Acknowledgements
We are very grateful to our colleague and friend, Tania Antonini, who conducted the interviews. She sadly passed away in 2021.
Competing Interests
The authors have no competing interests to declare.
Author Contributions
T.M. led the conceptualization, formal analysis, methodology, and writing of the original draft and review & editing while also supporting project administration. N.F. led project administration and supervision, equally contributed to funding acquisition, methodology, and validation, and supported the writing process. T.A. led the investigation plus data curation and supported formal analysis. S.N. supported formal analysis, investigation, and writing of the original draft. S.C.N. equally contributed to conceptualization, funding acquisition, methodology, and validation while supporting formal analysis, investigation, project administration, supervision, and writing processes. All authors reviewed and approved the final version of the manuscript.