Stress and coping in women with breast cancer:unravelling the mechanisms to improve resilience

• Dealing with breast cancer can be extremely stressful. • Women are at greater risk to develop depression in response to stressful situations. • Stress-related neuro-immuno-endocrine mechanisms contribute to changes in the pathophysiology of cancer. • Stress management is able to buffer the deleterious effect of chronic stress in breast cancer. • Psychosocial interventions reducing stress should complement cancer care. Breast cancer diagnosis, surgery, adjuvant therapies and survivorship can all be extremely stressful. In women, concerns about body image are common as a result of the disease and can affect interpersonal relationships, possibly leading to social isolation, increasing the likelihood for mood disorders. This is particularly relevant as women are at greater risk to develop anxiety and depressive symptoms in response to highly stressful situations. Here we address the mechanisms and the pathways activated as a result of stress and contributing to changes in the pathophysiology of breast cancer, as well as the potential of stress management factors and interventions in buffering the deleterious effects of chronic stress in a gender perspective. An improved understanding of the biological mechanisms linking stress-management resources to health-relevant biological processes in breast cancer patients could reveal novel therapeutic targets and help clarifying which psychosocial interventions can improve cancer outcomes, ultimately offering a unique opportunity to improve contemporary cancer treatments.