Pia Wülfing is a gynecologist and set up the "PINK!" platform during the corona pandemic. brought to life. There, sick women can find medical, psychological and organizational information for breast cancer patients. A great help for those affected, who often feel left alone. Among other things, an app provides patients with support on their way to a more mindful life and in dealing with their fears.

What fears and worries do breast cancer patients bring to you?

Prof. Pia Wülfing: The main concern is the fear of death - of dying. Cancer is a potentially deadly disease, although 80 percent of breast cancer patients are cured. In about 20 percent, there is a spread in the course of the disease, from which they die. Patients know and suspect that there is no guarantee of being cured. This sword of Damocles that the cancer could metastasize hovers over the patient. Uncertainty is a big burden.

Hair loss from chemotherapy is a big issue for many women. Hair is closely linked to femininity and identity, so for sufferers it is more than a change in appearance. The side effects of chemotherapy, such as nausea or weakness, are also frightening. Some breast cancer patients fear pain, but neither the disease nor the treatment is painful - in the curable situation. The thought of losing one or both breasts is also very painful for most patients.

What happens to women when they lose their breasts to cancer?

Nowadays it has become rare that breast-conserving surgery cannot be performed. Also, the ways to rebuild a breast have become much better. In fact, no patient has to live without a breast permanently. But a reconstructed breast is not a real replacement and, above all, cannot be compared to cosmetic surgery - scars remain and the patients often no longer have any feeling in the breast. The fear of losing a breast is probably so great because it affects femininity, sexuality and the integrity of the body. The perception of the sick women is very different. For some women their breasts are very important for their self-image and aesthetics and for other women their breasts are not so important, they just want to get healthy and be absolutely sure that the cancer will not come back.

Why do some women choose and some choose not to have breast reconstruction?

One reason against this is the concern about the effort and the operations that are to come. Often it is not just an operation, but corrective interventions are necessary. And the nipple reconstruction is always done in a further step, because the reconstructed breast must be complete and healed. Anyone who has their breast reconstructed has to be treated in the hospital again, it takes time to heal and – as with any procedure – there is a risk of complications.

For other women, rebuilding is just not that important. From my point of view, self-perception plays a role in the decision for or against reconstruction. But the stability of the partnership and the partner can also influence the decision.

According to estimates by the Robert Koch Institute, around 66,800 women are diagnosed with breast cancer every year. For women, it is the most common type of cancer. Young people are also increasingly affected. The German Cancer Society speaks of over 18,000 women dying of breast cancer every year. Men can also get breast cancer, with them there are around 770 new cases each year. The breast cancer month of October draws attention to the situation of patients.

What does a healthy way of dealing with your own cancer look like?

I think that is also very individual. There are patients who are very open about their illness and tell relatives, friends and also their employer. Some women, on the other hand, don't want their environment to find out at all and deal with everything on their own. In the end, the most important thing is that the patient has as little suffering as possible. It is important to be able to deal with fears well with yourself or to talk to someone about them. I think it makes sense for every patient to have professional care: through psycho-oncological concomitant treatment, to which every breast cancer patient is entitled. There are always topics that you cannot or do not want to bring into your circle of friends or family.

How does the psyche affect the healing process of cancer?

It's not well researched. What we do know is that (continuous) stress weakens the immune system. Anxiety also causes stress on the body. Mental health plays an increasingly important role in oncological research. Meditation, mindfulness, yoga and behavioral therapy approaches can reduce the psychological stress on patients, reduce the side effects of therapies and improve the quality of life of breast cancer patients. We also expect good mental health to have a positive impact on the disease.

What can I expect from psycho-oncological treatment? What's in store for me?

Psycho-oncology is a "general store". Cognitive behavioral therapy is the basis. It includes building blocks such as acceptance of one's own diagnosis or recognizing one's own worries and needs. During therapy, patients receive help on how to deal with their fears. Such a treatment also includes meditation, dream journeys and relaxation exercises. Every psycho-oncologist I know also advises getting too much exercise in the fresh air. So it is a guide on how to deal with the diagnosis of breast cancer and live stronger.

You have developed an app for breast cancer patients. Where does it start?

Our app "PINK! Coach" pursues the idea of ​​strengthening and guiding the patients. Many patients have reported back to me that they feel alone when they leave the protected area of ​​the hospital or breast cancer center after the acute phase. For many women, the fears come back. Breast cancer patients are often very committed and want to work to get and stay healthy.

However, many women are overwhelmed in everyday life with the need to incorporate exercise, healthy nutrition or mindfulness into their lives. Our "PINK! Coach" app suggests daily goals from these three areas so that patients can adopt a healthy lifestyle. They get weekly plans and know exactly how to live healthily every day. The app is a "digital health application" or app on prescription. Means: It can be prescribed to breast cancer patients by doctors and psychotherapists on prescription.