EDITORIALS
Myth-Busters: Telling the True Story of Breast CancerSurvivorship
Leslie R. Schover
The conventional wisdom is that breast cancer devastateswomen’s lives, even when the disease is controlled by mod-ern, multimodality treatments. We, the general public, takeour stereotypes not so much from real life but from novels,movies of the week, and soap operas. Our poor heroine losesher breast (or at least gains an ugly scar that would turn off any but the most desperate man). Needless to say, her sex lifefalls apart. If she is single, her boyfriend leaves her. If she ismarried, she ends up divorced while her husband finds ayounger partner who flaunts a perfect bosom in skimpy haltertops when our heroine picks up the kids for weekend visits.Of course we learn that our heroine the survivor only gotbreast cancer because of stress. In the last 3 years, she lostboth her parents in a tragic plane crash, her teenaged son wasarrested for marijuana possession, she supported her husbandemotionally and financially when he was fired from his job forinsider trading, and after fending off sexual advances fromher boss, she was passed over for the job promotion sheclearly deserved.I admit, this is a highly dramatized picture of our stereotypesabout the consequences of breast cancer, but many health pro-fessionals as well as the general public firmly believe that breastloss is the worst trauma of breast cancer, that men commonlydesert women treated for breast cancer, that it is impossible tohave a satisfying sex life after breast cancer treatment, that stressplays a major role in causing breast cancer, and that breastcancer survivors typically face job discrimination.Over the last decade, Dr. Elizabeth Maunsell and hercolleagues in Quebec have systematically debunked eachcomponent of this breast cancer myth. In an 8-year follow-upof women who had mastectomy versus breast conservation
(1),
Maunsell et al. found no major differences in quality of life between the two groups of women, confirming the resultsof large surveys in the United States
(2–4).
Although havinga mastectomy is upsetting, the greatest physical and emo-tional morbidity from breast cancer comes simply from beingdiagnosed with a life-threatening illness
(2,3).
In fact, thecancer treatment that contributes to most long-term physicaland emotional morbidity is adjuvant chemotherapy
(2–4).
The Canadian
(5)
and United States
(2,3)
surveys agree thatmiddle-class, Caucasian women who are long-term survivorsof breast cancer have a quality of life that is as good as orbetter than age-matched control women!Although approximately 50% of survivors of breast cancerreport some sexual dysfunction, similar rates are seen amongpostmenopausal women who have not had cancer
(2).
Dr. Maun-sell’s group did find that breast cancer survivors who lived witha partner had more sexual problems than a group of healthywomen matched in age and place of residence
(5).
This group of women may be those treated with chemotherapy and madeprematurely menopausal, and who thus have an increased like-lihood of sexual dysfunction, as seen in other cohorts
(2–4).
Yetthe most sexually satisfied women in the U.S. survey were thosewho had found a new sexual partner after their cancer diagnosis
(2).
Romance can still trump biology.Maunsell et al. also demonstrated that marital breakdown isno more common among women after breast cancer than amongcontrol women matched on demographics
(6,7).
However, ascommon sense would predict, women who were dissatisfied withtheir relationships 3 months after their cancer diagnosis weremore likely to have experienced a break-up or divorce by 8-yearfollow-up than women who were satisfied with their relation-ships at 3 months
(6).
Not only have Maunsell and colleagues investigated qualityof life after breast cancer but they have also examined the link between stress and breast cancer etiology. They conducted in-terviews with 673 women several months after breast cancerdiagnosis, in which the women were asked, using a standardizedchecklist, to identify stressful life events they had experiencedwithin the last 5 years. Ten years later, the number of stressfulevents women experienced was not predictive of survival, evenafter the analysis was weighted according to standards of sever-ity, or according to the woman’s own perceived severity
(8).
Ameta-analysis of the literature on stress and breast cancer alsofailed to find a connection between the two events
(9).
Otherrecent investigations have not found increased rates of breastcancer after losing a child to death
(10)
or caring for an ill familymember
(11).
In this issue of the Journal, Maunsell and colleagues
(12)
have focused on employment experiences among breast cancersurvivors after their treatment. In their own pilot work, theresearchers had interviewed 13 breast cancer survivors whomentioned job-related problems during a clinic visit
(13).
Thesewomen told about losing jobs, feeling stigmatized in the work-place, and experiencing an inability to meet the physical de-mands of work. However, population-based studies have notconfirmed this picture. In the United States, data from the Healthand Retirement Study of 1992 showed that breast cancer survi-vors were only 10% less likely to be employed than women whowere similar demographically but who had not had cancer
(14).
In a follow-up of a large cohort of breast cancer survivors, Ganzand colleagues
(3)
reported that 80% of women initially em-ployed and free of disease at an average follow-up of 6-years
Correspondence to:
Leslie R. Schover, PhD, Department of Behavioral Sci-ence, The University of Texas M. D. Anderson Cancer Center, 1515 HolcombeBlvd.—243, Houston, TX 77030-4009 (e-mail: lschover@mdanderson.org).DOI: 10.1093/jnci/djh346
Journal of the National Cancer Institute,
Vol. 96, No. 24, © Oxford UniversityPress 2004, all rights reserved.
1800 EDITORIALS Journal of the National Cancer Institute, Vol. 96, No. 24, December 15, 2004
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