You’ve just received your genetic testing results and no mutation was detected! What a relief to know that your risk for cancer is no greater than that of the average population. Then you look over to your sister who has been told that she does carry a mutation which significantly increases her lifetime risk for cancer. She is faced with many questions about her medical care that do not have easy answers and with knowing that her children have a 50% chance of inheriting the mutation from her while your children are not at risk of inheriting the mutation at all. Now, it is no longer just relief that you are feeling but also sadness and fear for your sister, anger at the injustice of the situation and maybe even guilt that the haphazardness of life dealt you the better hand.

What you are experiencing is survivor’s guilt and it is a well-known phenomenon that may occur among family members who test negative for the mutation in the family. Survivor’s guilt is also common among those who have survived traumatic events – war, natural disasters, accidents and long-term illness. For someone who has had negative genetic testing for a known family mutation, you survived the potential of dealing with the trauma associated with a hereditary cancer diagnosis while others in your family did not. Symptoms associated with survivor guilt may include anxiety, depression, insomnia, and social isolation to name a few.

Survivor’s guilt is sometimes referred to as imagined guilt – the feeling of guilt is real but the foundation of it is imagined. Keeping in mind that the foundation is imagined, it is important that you understand that there is nothing you or your family member did or didn’t do to affect your genetic test results. It is completely due to random chance. Coping with survivor’s guilt can start with recognizing and accepting that both your feelings of relief for your negative mutation status as well as those of anger or sadness for those in your family who tested positive are completely normal and appropriate. Journaling, participating in a support group or talking with a therapist may help you to process those feelings and understand that while they may be real, the guilt you are feeling is unrealistic.

Some people take those negative feelings and turn them into positive actions such as becoming an advocate for a particular cause or using them to reassess their life and focus in on a particular purpose. One word of caution, though; if your outreach, caregiving, or new life direction do not allow you to take care of yourself (i.e. good health habits, maintaining your own screening appointments, etc.) then you may be punishing yourself for your “good luck” rather than finding a positive outlet for your guilt. If you find out that your depression, anxiety and anger are not improving or getting worse or you have feelings of wanting to harm yourself, please seek out help from your health care provider for counseling and/or medication. Not everyone who receives a negative genetic test result will experience survivor’s guilt; however, for those who do, the good news is that most cases of survivor’s guilt improve over time.