etting a PhD is never easy, but it's fair to say that Marina Kovačević had it especially hard. A third-year chemistry student at the University of Novi Sad in Serbia, she started her PhD programme with no funding, which forced her to get side jobs bartending and waitressing. When a funded position came up in another laboratory two years later, she made an abrupt switch from medicinal chemistry to computational chemistry. With the additional side jobs, long hours in the lab, and the total overhaul of her research and area of focus, Kovačević epitomizes the overworked, overextended PhD student with an uncertain future. And yet she could hardly be happier. "I think I'm exactly where I need to be," she says. "I love going to work each day. I have lots of things to do, but I'm not stressed. I can't imagine anything else that would bring me this much joy." The results of Nature's fifth survey of PhD students bear out Kovačević's experience, telling a story of personal reward and resilience against a backdrop of stress, uncertainty and struggles with depression and anxiety. The PHD POLL REVEALS FEAR AND JOY, CONTENTMENT AND ANGUISH Graduate students mostly love what they do, but workload pressures continue to take their toll, finds Nature's 2019 PhD survey. By Chris Woolston ILLUSTRATION BY THE PROJECT TWINS "We don't want to just look at graduation rates. That's great, but what did it take to get there?"

EXPLORE YOUR OPTIONS Think outside of academia http://go.nature.com/2ytpqli CAREER SUCCESS Reframe your thinking to get ahead http://go.nature.com/2grm3s6 NATUREJOBS For the latest career listings and advice www.naturejobs.comPhD students love what they do -but many also suffer for it. That's one of the top findings from Nature's survey of more than 5,700 doctoral students worldwide.The survey is the latest in a biennial series that aims to explore all aspects of PhD students' lives and career aspirations. Respondents indicated high levels of satisfaction with PhD programmes overall, but also revealed significant levels of worry and uncertainty: more than one-quarter listed mental health as an area of concern, and 45% of those (or 12% of all respondents) said that they had sought help for anxiety or depression caused by their PhD studies (see ' A challenging road'). Many said that they find their work stressful, worry about their futures and wonder whether their efforts will pay off in earning them a satisfying and well-compensated career. For some, it's almost too much to handle. "Every university should have a special room reserved for graduate students to get some crying time in when they are feeling overwhelmed, " said an ecology student at a US university, in the survey's comment section.Responses also uncovered a strong, perhaps crucial, connection between a well-matched PhD adviser and the student's success. Good mentorship was the main factor driving satisfaction levels. Most respondents were happy with their adviser, but nearly one-quarter said they would switch advisers if they could. Students can survive and thrive during a PhD programme -challenges and all -but they generally can't do it alone. "I'm a happy PhD student, " a genetics student from South Africa wrote in the comments. "This life is difficult but it's what I've wanted to do my whole life, so it's worth it. I also have a fantastic supervisor who is understanding, helpful and ready to push me to the next level. " WIDESPREAD STRUGGLESThe respondents to the 2017 survey came from diverse scientific fields and from most parts of the world. Asia, Europe and North America were all strongly and equally represented. The survey was advertised through CAREERS © 2 0 1 7 M a c m i l l a n P u b l i s h e r s L i m i t e d , p a r t o f S p r i n g e r N a t u r e . A l l r i g h t s r e s e r v e d .

reast cancer is perhaps the most-studied malignancy in the world -and no wonder. Some 1.7 million women were diagnosed with the disease in 2012, making it a global priority. Researchers have made great strides in the treatment of some types of breast cancer (see page S102), but the battle continues on many fronts. Perhaps the most exciting area of research is immunotherapy (page S105), whereby scientists are attempting to harness the body's own immune system to fight and prevent malignancies. The success of biological drugs in the treatment of people with a specific tumour demonstrates the potential of targeted treatments (page S110). Meanwhile, researchers are using big data to identify new targets and treatment strategies (page S108). But not every cancer needs treatment, and the hunt is on for biomarkers that can sort the cases that demand action from those that are better left alone (page S114). Research on the interplay between environment and genes has illuminated the workings of the disease and helped to identify who is really at risk (page S116). Although many women try to protect themselves through regular mammograms, worries about false alarms and overdiagnosis have spurred efforts to reform screening to focus on the cancers that really matter (page S118).However, each woman needs to decide for herself whether to be screened (page S104). And patients should have a say in the course of treatment. Some may want to go down the aggressive path no matter what the side effects, and others prefer to take the slow, cautious route. With many of the world's top minds working on their behalf, they should not feel alone in the fight.We are pleased to acknowledge the financial support of the Medipolis Proton Therapy and Research Center, a part of the Medipolis Medical Research Institute, in producing this Outlook. As always, Nature retains sole responsibility for all editorial content. Chris Woolston Contributing editor S102 TIMELINE A tumour through timeThe long history of breast cancer S104 PERSPECTIVEThe risks of overdiagnosis Why Alexandra Barratt may not get screened S105 IMMUNOTHERAPYAnother shot at cancer Revisiting a type of treatment that was all but dismissed S108 GENETICSBig hopes for big data Genomic information could transform patient care S110 MEDICINE Eyes on the targetThe promise of antibody-based drugs S114 MOLECULAR BIOLOGY Marked progressBiomarkers could eliminate surgery S116 GENETICS Relative riskCancer risk could be determined by the environment rather than genetics S118 SCREENING OUTLOOK Nature Outlooks are sponsored supplements that aim to stimulate interest and debate around a subject of interest to the sponsor, while satisfying the editorial values of Nature and our readers' expectations. The boundaries of sponsor involvement are clearly delineated in the Nature Outlook Editorial guidelines available at go.nature.com/e4dwzw CITING THE OUTLOOK Cite as a supplement to Nature, for example, Nature Vol. XXX, No. XXXX Suppl., Sxx-Sxx (2015). Don't look now VISIT THE OUTLOOK ONLINEThe Nature Outl...

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uring a two-year stint as a postdoctoral researcher in computational microbiology at the University of Liverpool, UK, Adrian Cazares suffered despite his successes. "I published papers but I wasn't happy," he says. "[Postdocs] are under so much pressure all the time. We take it to every part of our lives. It really started to affect my mental health." Cazares, who in February started his second postdoc-this one at the European Bioinformatics Institute on the Wellcome Genome Campus near Cambridge, UK-was one of more than 7,600 researchers in 93 countries who responded to Nature's first-ever survey of postdoctoral scientists. The self-selecting survey, which ran in June and July, included a series of questions designed to illuminate postdocs' quality-of-life issues, including mental health, working hours and experiences of discrimination and harassment (see 'Nature's postdoc survey'). 'Tipping point' Through survey answers, free-text comments and follow-up interviews, respondents shared the day-today realities of a pivotal, and often POSTDOCS UNDER PRESSURE: 'CAN I EVEN DO THIS ANY MORE?' Stressful hours and insecurity are making many consider quitting science, finds Nature's first survey of postdoctoral researchers. By Chris Woolston MIGUEL MONKC