Psychology of Breast Cancer, Breast Cancer Treatment and Survivorship

"Breaking Bad" and Psychological Transformation After Cancer Diagnosis

noreply@blogger.com (Linda L. Guerra, Ph.D.) — Mon, 08 Apr 2019 21:20:00 +0000

In the very popular television series, Breaking Bad, the main character's personality begins to undergo a dramatic change after he receives a diagnosis of stage IV lung cancer. Walter White is ostensibly a meek and mild high school chemistry teacher at the beginning of the series. The cancer diagnosis seems to bring out parts of his character that were hitherto unexpressed and unknown either to Walter or to his wife. Slowly and shockingly over the course of the five seasons that the show aired, Walt's character displays increasingly ruthless and sociopathic thought patterns and behavior. By the end, Walt is finally able to admit to himself and his wife, that the reason he did all that he did (i.e. cooking extremely high quality methamphetamine and all of the murder and mayhem that ensued), was that it made him feel truly alive, in ways that he had never felt previously. We watch him sacrifice everything, including his relationships with his family and ultimately his life, in order to give expression to needs and feelings that had apparently been split off and dissociated, and which had as a consequence never been integrated into the other parts of his personality. The cancer offered the excuse and the permission that Walt seemed to need, for his long held back frustration and rage to find a way out. It also seemed to free him to aggressively pursue his desire, something which he seemed unable to do before, resulting in his brilliance going largely unrecognized and unappreciated.

Although most cancer patients/survivors don't undergo the dramatic personality changes that happened to Walter White, they may begin to think and act differently as a result of their cancer experience. With a new awareness of mortality and limits, a cancer survivor may begin doing things that she had always wanted to do but had been putting off, like a trip to an exotic destination, sky diving, painting, writing or some other creative pursuit. She may also reevaluate her friendships and decide to let go of the ones that pull her down more than they support her. Sometimes cancer survivors are also empowered to begin to address issues in their marriages or with their long time partners that have been simmering for a long time. I would never consider cancer a blessing, but it has the potential to bring matters into clearer focus. It sometimes gives us the permission we need to speak our minds, be more fully ourselves, and courageously follow our hearts desire.

Can Breast Cancer Survivors Safely Take Estrogen or Hormone Replacement Therapy?

noreply@blogger.com (Linda L. Guerra, Ph.D.) — Fri, 29 Mar 2019 21:56:00 +0000

The answer according to Dr Avrum Bluming and Dr Carol Tavris in their (2018) book, Estrogen Matters: Why Taking Hormones in Menopause Can Improve Women's Well-Being and Lengthen Their Lives - Without Raising the Risk of Breast Cancer, is a resounding "yes." These authors make the case that it is safe for menopausal women to take estrogen either in the form of estrogen replacement therapy (ERT) for women who have undergone hysterectomies, or in the form of hormone replacement therapy (HRT), i.e. estrogen plus progesterone, for women who have not undergone hysterectomies. Furthermore they believe that HRT is a reasonable option for treating menopause-associated symptoms and improving quality of life even for breast cancer survivors. In asserting this, Bluming and Tavris are swimming against the medical tide. To back up their assertion, much of their book is devoted to a review of the available, scientific research including the Women's Health Initiative (WHI) study and the HABITS study (Hormonal Replacement Therapy after Breast Cancer - is it safe).

Regarding the 2002 WHI findings and reports, Bluming states that the finding that HRT increased the risk of breast cancer was not statistically significant. Furthermore the study's sample was not representative of healthy women - nearly half of the sample were current or past smokers, more than a third had been treated for high blood pressure, and 70 percent were seriously overweight or obese. By 2005, the WHI was saying that their findings show that women taking ERT actually had a decreased risk of breast cancer.

In 2004 the HABITS study was stopped prematurely after only 434 women were enrolled, because after two years, 17.6% of the HRT group and only 7.7% of the non-HRT group developed new breast cancers. There were no new breast cancers in women taking estrogen alone and the increased risk for the women on HRT turned up only among those who were also taking tamoxifen. Despite their being significant problems with the design of this study including the lack of uniformity in the choice of hormone regimen, it was regarded as having lent significant weight to the WHI findings.

Bluming also cites the results of other research studies, including six that were done in the United States, in which treating breast cancer survivors with HRT did not increase their risk of recurrence of breast cancer when compared to matched control subjects. He conducted his own pilot study over a fourteen year period, in which he followed 248 women whom he had given HRT. His goal was to determine if these women showed an increased incidence of breast cancer recurrence in the same breast, developed cancer in the other breast, or developed breast cancer metastases elsewhere in the body. What he found is that they did not. A few did have a recurrence of breast cancer, but not at a rate higher than the comparable women who were not on HRT.

Most research stopped after the WHI results were published, but some investigators continue to evaluate existing studies. In 2006, Dr. Pelin Batur and her colleagues at the Cleveland Clinic published a review of fifteen studies totaling 1,416 breast cancer survivors using HRT compared with a cumulative control group totaling 1,998 patients. The majority of the women in the HRT group began using HRT between two and five years following their diagnosis. On the average, they remained on HRT for three years. Compared to the control group, the women on HRT had a 10 percent decreased chance of recurrence of breast cancer and a slightly reduced mortality rate from cancer and other causes.

We know that hormone therapy for menopausal women has enormous benefits including protection against heart attacks, strokes, bone fractures, diabetes, colon cancer, depression and Alzheimer's disease. According to Dr. Harriet Hall, by the 1990's, the evidence indicated that estrogen reduced the risk of heart disease by 40-50%, hip fractures by 50%, colon cancer by 50%, and Alzheimer’s by 35%. With benefits like these and research results like the ones cited in the Bluming/Tavris book, it's clear that the question of treating menopausal women with hormones needs to be revisited. Additional carefully designed and controlled large scale studies are needed to determine as precisely as possible, what the risks of taking hormone therapy are, for whom and under what circumstances.

Unfortunately most members of our medical community seem to believe that this issue is settled. It may take a lot of women and a lot of physicians bringing up the topic of hormone therapy with their physicians, colleagues and friends to get the matter reopened. Go for it ladies! The quality of women's lives depends on it!

Bluming, A. & Tavris, C. Estrogen Matters: Why Taking Hormones in Menopause Can Improve Women's Well-Being and Lengthen Their Lives - Without Raising the Risk of Breast Cancer

Hall, Harriet. 09/04/2018 blog post in Science Based Medicine.org

iBreastExam - A Cheaper and Less Stressful Prescreening Tool for Breast Cancer

noreply@blogger.com (Linda L. Guerra, Ph.D.) — Wed, 29 Aug 2018 17:06:00 +0000

Two researchers, Mihir Shah and Matthew Campisi have developed a new prescreening tool for breast cancer detection at Drexel University's School of Biomedical Engineering, Science and Health Systems in Philadelphia. This new tool is called the iBreastExam (iBE) and it uses a new ceramic sensor technology to detect subtle variations in breast tissue. It is a battery operated, hand-held machine that can provide results after only a few minutes via a mobile app. Other advantages of the iBE are that it's cheaper than a mammogram, painless, involves no radiation and can be done by a trained female health care worker in five minutes anywhere.

In 2016, a study [1] performed by a group of researchers at the Perelman School of Medicine at the University of Pennsylvania showed that iBE demonstrated acceptable sensitivity and specificity in a cohort of patients who had already had a positive breast exam or an abnormal screening mammogram. This was a study designed to validate the iBE's ability to detect lesions. These researchers state that mammography and ultrasonography demonstrate sensitivity rates of 85-88% and 93-97% for a population of known detectable findings. The iBE in this population demonstrated a comparable sensitivity of 85.7%. Furthermore the iBE meets the threshold of a pre-screening device when compared to the current prescreening tool, i.e. a clinical breast exam, which has a sensitivity of only 50-60%.

In this study cohort, the iBE was able to detect all but two of the malignancies, both of which were less than 1 cm in size which is an important threshold for a prescreening device. Directly comparing the sensitivity of cancer detection demonstrates that both the iBE (83%) and the mammogram (91%) are reliable tools to identify patients with cancer. While the sensitivity of cancer detection is lower, the specificity of iBE (74%) surpasses that of mammography (51%) showing that the iBE is better than mammography at not falsely identifying patients with cancer ( i.e. false positives). For this reason and the fact that the iBE is painless, quick and easy to undergo, and doesn't involve radiation, it appears to be a screening tool that won't trigger undue anxiety and stress in patients. In addition its modest cost relative to other screening tests should make it very attractive to insurance companies and medical providers, especially those in economically deprived areas.

1. Broach et al. World Journal of Surgical Oncology (2016) 14:277.

Evidence Of A Correlation Between Depression and Anxiety and Cancer Mortality

noreply@blogger.com (Linda L. Guerra, Ph.D.) — Thu, 09 Mar 2017 02:01:00 +0000

On January 25, 2017, The BMJ, a respected British scientific journal, published the results of a research study in which the unpublished data from 16 prospective cohort studies initiated between 1994 and 2008 were pooled to examine the role of psychological distress (anxiety and depression) as a potential predictor of site specific cancer mortality. The participants in this research, 163,363 men and women, 16 years of age or older at the time of study induction, make up nationally representative samples drawn from health surveys for England and Scotland. Participants were initially free of a cancer diagnosis, and were asked to fill out questionnaires with items that were designed to capture symptoms of depression and anxiety over the previous four weeks. According to the study's authors, these questionnaires are widely used in population research and have been validated against standardized psychiatric interviews.

The results of this pooling of unpublished data are interesting. They showed that those with the most psychological distress (depression and anxiety), had a higher rate of death from selected cancers than those with the lowest psychological distress. This was after adjusting for other known risk factors such as adverse health behaviors and reverse causality (it is well known that a diagnosis of cancer can give rise to psychological distress so these authors attempted to control for this by excluding participants with self reported cancer malignancy at study entry). The most consistently robust effects were evident for cancer of the colorectum, prostate, pancreas, esophagus and for leukemia.

These authors state that their findings could be important in advancing understanding of the role of psychological distress in cancer etiology and cancer progression. They go on to explain that psychological distress could be considered along with other factors such as smoking and obesity to develop an algorithm that would have predictive utility for common cancer presentations such as colorectal, breast and prostate cancer.

Among the limitations of this study cited by the authors is that the assessment of psychological distress with the instrument that they used, referred to the preceding four week period. A short bout of depression or anxiety is highly unlikely to be relevant to cancer etiology, but the authors state that there is evidence that rates of recurrence are high for psychological distress. Therefore they state that a single administration of a distress inventory seems to capture cases of long term depression and anxiety. Nevertheless, if serial assessments of depression and anxiety had been done over a period of time, that would lend more credence to the findings.

The results of this study suggest associations between depression and anxiety and cancer mortality, and lend support to the idea that psychological distress could have some predictive capacity for the occurrence and lethality of some types of cancer. It is important to note that further research is required to clarify the extent to which each of the associations between psychological distress and cancer are likely to be causal and to examining the precise mechanisms by which they exert their influence. We would need to investigate exactly how depression and anxiety affect cancer. For example, how much of any effect that we see is related to poor lifestyle choices that a depressed person might make, such as compliance with treatment screenings or treatment regimens. Alternatively, we need to learn how much of the impact of psychological distress is associated with biological mechanisms, such as prolonged inflammatory responses.

Using Viruses to Cure Cancer - Getting The Word Out

noreply@blogger.com (Linda L. Guerra, Ph.D.) — Sat, 21 Mar 2015 00:47:00 +0000

On March 6th, just two weeks ago, an HBO television program called Vice aired a documentary about how viruses, some of which used to kill human beings in large numbers, are now being utilized to treat and actually cure cancer. Major cancer research centers such as The Mayo Clinic in Minnesota, MD Anderson Cancer Center in Houston, Texas and The University of Pennsylvania in Philadelphia, are conducting groundbreaking trials with cancer patients using genetically modified viruses such as the common cold virus, the measles virus and the HIV virus. According to the physicians involved in these trials, we are on the verge of a major breakthrough in cancer treatment. As the maker of this documentary states, it is important to get the word out about this so that these technologies can be fast tracked and be made available to anyone who needs them.

Dr. John Bell at the Center for Innovative Cancer Research in Ottawa, Canada, is credited with being the first to discover that viruses can actually attack cancer cells without harming the healthy cells around them. One of the most successful series of ongoing trials has been happening at The Children's Hospital of Philadelphia under the auspices of Dr. Carl June. Dr. June and his colleagues have for about the last four years, been using the HIV virus to treat leukemia in children whose cancer had progressed to the point where other standard cancer therapies were no longer of any use. In these trials, genetically engineered HIV is being used to reprogram the t-cells in the patients' bodies, so that the patients' immune systems can tell the difference between the cancer cells and normals cells, and begin to attack the cancer cells. In this documentary, Dr. June informs us that so far, thirty-nine children have participated, and ninety percent have experienced complete remission with no remaining trace of their cancer. Most seem to be staying in remission for several years. He goes on to tell us that this particular treatment is "probably going to be available and FDA approved in 2016", and that using modified viruses to treat cancer represents "a true paradigm shift".

There are about 300 kinds of cancer. Which viruses attack which cancers most effectively? There is still a lot of research that needs to happen to answer this question. At the Mayo Clinic, they are reengineering the measles virus, and then using it to treat bone cancers. At MD Anderson, they are treating glioblastomas or brain cancers with a modified common cold virus and patients who had no hope are going into remission.

View the entire VICE documentary here:

Treating Posttraumatic Stress in BRCA Survivors

noreply@blogger.com (Linda L. Guerra, Ph.D.) — Fri, 13 Mar 2015 13:52:00 +0000

In an earlier post, I described how breast cancer survivors are often the victims of posttraumatic stress, and frequently display many of the signs and symptoms that are associated with that psychological diagnosis. Things like heightened anxiety, hypervigilance, a change in outlook on life, negative beliefs and expectations about herself or her body, and a change in risk-taking behaviors may be present not just during treatment, but also after treatment has ended.

Now I am going to describe how psychodynamic psychotherapy can help with the disturbing PTSD symptoms that survivors may be experiencing. In addition to discussing problematic symptoms and how the survivor is coping with them, the psychotherapist will work on understanding and appreciating the significance to the client of not only having had breast cancer, but also of each of the treatment interventions to which she was exposed. Today's mainstream cancer treatments, i.e. surgery, radiation, and chemotherapy all act as powerful triggers of complex emotions and earlier traumatic experiences. It is crucial to understand how each breast cancer patient mentally engaged with each of them. Every woman’s breast cancer journey is unique, and is a function of not just her encounters with her medical providers, medical interventions and our health care system, but also of her earlier life experiences. How we engage with the present is always influenced by what we experienced in the past.

It is vital that the psychotherapist assist the client in uncovering and comprehending the psychological meaning to her of what she has been through. For example, what did each treatment modality symbolize to this particular client? Did the chemotherapy represent something positive that was going to destroy cancer cells and restore health, or did it feel like an evil intruder that was wreaking havoc throughout her body? Did the accompanying loss of hair, a well-known side-effect of chemotherapy cause the patient to feel less attractive to her spouse or to potential romantic/sexual partners? Was it experienced as the destruction of an important symbol of femininity? Did it feel like a potent connection to an early attachment figure was destroyed? Perhaps an early caregiver who expressed love by fixing and combing her hair? Did it have both of these meanings as well as others?

How did all of the physiological and cognitive effects of the treatments (fatigue, nausea, memory loss, loss of mental sharpness etc.) affect things like self-esteem, perception of a benign world, sense of bodily vulnerability, or the person’s sense of their future possibilities?

In order to effectively treat symptoms like depression, anxiety and insomnia over the long term, it is often crucial that psychological meanings be patiently explored, in the context of a safe, psychotherapeutic relationship in which trust and mutual respect have been established and are being carefully nurtured.

Posttraumatic Stress – A Frequent Consequence of Breast Cancer Diagnosis and Treatment

noreply@blogger.com (Linda L. Guerra, Ph.D.) — Mon, 09 Mar 2015 00:09:00 +0000

Given the limited state of our current medical knowledge, a diagnosis of breast cancer followed by extensive cancer treatment usually constitutes a prolonged trauma. Therefore when breast cancer survivors appear in psychotherapists' offices, they are likely to be suffering from some degree of post-traumatic stress even if their reasons for seeking treatment seem to be unrelated to their cancer experiences.

Patients, their families and their medical providers may be unaware that it is not unusual for survivors to continue to experience things like irritability, difficulty concentrating, trouble getting a good night's sleep or heightened anxiety for some time after breast cancer treatment has ended. An increased sense of vulnerability is also a very common aftereffect of cancer treatment even when the cancer was caught at an early stage, and patients are told at the end of their treatment that they are cancer-free.

Survivors may display ways of coping that are typical for persons who have experienced trauma. They may for example, become hypervigilant with respect to cancer. Every time they have a new ache or pain that does not have an obvious cause, they may begin to think that the cancer has returned and experience acute emotional distress. Similarly every time they hear that a food, a product or something else in the environment may be correlated with an increased risk of cancer, they may immediately try to avoid that substance. This is of course, a common and reasonable way that humans try to increase their sense of control and decrease their level of free-floating anxiety. However in today’s news/media environment, research study results are often reported without the media outlet taking the time to determine which of the studies have been well designed and which are merely preliminary or speculative. One media outlet after another may pick up and report the same story without ever investigating the actual significance of a study’s results, yielding to the pressure of our twenty-four hour news cycle. It is easy to see how a person who is trying to reduce her exposure to environmental toxins can end up feeling more stressed and overwhelmed.

Posttraumatic stress symptoms are often part of “the new normal”, a phrase that has been adopted by oncologists to describe how their patients are different after cancer treatment from how they were before cancer treatment. These symptoms often make up a significant part of “the new normal” and they can linger for a long time. Fortunately psychotherapists now know a lot about how to identify and treat them, so that survivors can obtain relief and an increased sense of control over their lives.

Sexuality And Breast Cancer Treatment

noreply@blogger.com (Linda L. Guerra, Ph.D.) — Sat, 06 Sep 2014 19:50:00 +0000

There are many ways in which standard breast cancer treatments affect a woman's sexuality, both in the short and long term. The removal of even part of a breast (lumpectomy), let alone the complete removal of one or both breasts, represents a loss and a change in a part of the body that is loaded with sensitive nerve endings and very involved in sexual arousal. Having only a lump removed along with surrounding tissue, can involve severing nerves that were very involved in producing physical sensation in that area. In addition, the alteration in physical appearance caused by breast surgery, may cause a woman to experience herself as less womanly and less sexually desirable. As if that is not enough to process, females who undergo chemotherapy, will usually be thrown into menopause, with all of the changes that entails, such as fatigue, possibly severe hot flashes and decreased vaginal lubrication. Being jolted into menopause via chemotherapy is a very different physical and psychological experience than the experience of a natural and gradual cessation of menses occurring over a period of years. Adding to the menopausal effects of chemotherapy, drugs like tamoxifen and aromatase inhibitors are routinely prescribed to further reduce and suppress estrogen. Sex can become painful, and the walls of the vagina can atrophy and become very thin and dry. Vaginal yeast infections and urinary tract infections are also more likely to occur. (For more information on this, see Dr. Michael Krychman's blog post http://community.breastcancer.org/blog/sex-matters-vaginal-dryness/.)

The good news is that breast cancer survivors are still very capable of experiencing sexual desire and sexual pleasure. However, due to all of the physiological changes induced by breast cancer treatment, women often come to feel that they need to become acquainted all over again with who they are as sexual beings. This realization may come as a surprise, since oncologists often glide over these sexual sideeffects, in their zeal to rid the body of cancer, and because psycho/sexual/emotional aspects of cancer treatment are complex and outside of their area of expertise and comfort. It is important for cancer survivors and psychotherapists who work with them, to understand that along with physical and emotional healing, time and patience may be required for patients to uncover the sexual trauma related to the treatment, and to discover who they now are as sexual beings. Living in the realm of "the new normal", cancer survivors may need to learn what works now for them sexually. For example, where and for how long they want to be touched in order to achieve sexual arousal and gratification, may be different from before cancer treatment. Partners of cancer survivors also need to be educated that what was pleasing and stimulating before the treatment, may be different now, and that their partners' bodies may not function in the same way.

Reflections on the Psychology of Prophylactic Mastectomy

noreply@blogger.com (Linda L. Guerra, Ph.D.) — Wed, 20 Aug 2014 03:02:00 +0000

In an earlier blog post, Psychology and Prophylactic Mastectomy, I summarized an op ed piece written by Peggy Orenstein titled "The Wrong Approach to Breast Cancer" that appeared on Sunday, July 26th, 2014 in the New York Times. In her article, Ms. Orenstein offered some possible psychological motivations for why women choose to have a healthy breast removed after being diagnosed with breast cancer in the other breast, despite the fact that survival is not increased by doing so. I would like to offer additional thoughts on psychological motivation.

Loss Of Control

Breast cancer patients like other cancer patients where extensive treatment is required, usually undergo the experience of a profound loss of control over their lives. Asking the question, “Why me?" is one way that cancer patients attempt to regain some control or at least some understanding about possible causation. Some spend a lot of mental energy reviewing their lives and wondering what may have triggered or contributed to the development of the cancer.

Humans want and need to feel that they have a certain amount of control over their lives in order to function in calm, organized and productive ways. We want to believe that if we eat properly, exercise often, avoid cigarettes, get enough sleep, maintain the correct weight, and so on, then we will be able to avoid serious physical illnesses, at least until old age. Mass media plays to these hopes. Our newspapers, health newsletters, and journals are replete with reports of studies in which associations have been found between a myriad of foods, vitamins, and behaviors and a lower or higher incidence of some type of cancer, continually reinforcing the idea that if we can just figure out what to do and then do it, we will be able to greatly reduce our chances of getting cancer. People are encouraged to imagine that they have more control over what happens to their bodies then they, in fact, have. When a cancer diagnosis is made, it is often a shocking reminder of how little control we actually do have. In addition to feeling shocked or frightened, a patient may also feel a sense of shame over having failed to do what was necessary to prevent the cancer. Making the decision to have a healthy breast removed may offer a chance to regain some sense of being in control, and may also serve to diminish any guilt or shame over not having done the "right" things to prevent the cancer.

Religious Contributions

In some religions, such as Roman Catholicism, sex is viewed as primarily for procreation, and for the pleasure of married men. Roman Catholic women are encouraged to engage in sexual relations only to have children and to please their spouses. Women who engage in sex for their own pleasure, or who use some form of birth control, are induced to experience varying degrees of conscious or unconscious guilt or shame. Sexuality may be experienced as a burden, something that has to be managed and dealt with, something that can lead to sinful behavior and eternal damnation. Breast cancer may be consciously or unconsciously viewed as a punishment, and giving up a breast, as a way to pay for one's sins, thereby restoring a sense of virtue as well as the possibility of a blissful afterlife in heaven with God.

Other psychological issues

Some women are conflicted about their sexuality or sexual attractiveness because they grew up in families in which their physical beauty or sexuality was the cause of jealousy, anxiety or sexual abuse. In these situations, sacrificing a healthy breast may serve to expiate guilt or shame and the patient may actually experience relief when the breast is gone.

Prophylactic mastectomy has not been shown to affect survival in those who are not at increased genetic risk for breast cancer. One can have still have a cancer recurrence in the tissue that's left or in some other part of the body.

Psychology and Proplylactic Mastectomy

noreply@blogger.com (Linda L. Guerra, Ph.D.) — Sat, 09 Aug 2014 20:25:00 +0000

On Sunday, July 26th, 2014, the New York Times printed an opinion piece written by Peggy Orenstein titled "The Wrong Approach to Breast Cancer" in which Ms. Orenstein relays the results of a study published in 2009 in The Journal of Clinical Oncology, showing that the rates of mastectomy with contralateral proplylactic mastectomy (removal of the unaffected breast) jumped dramatically for those with very early stage breast cancer between 1998 and 2005 (Tuttle et al, 2009). Most of these women did not have an increased genetic risk for the disease. Ms Orenstein points out that this occurred even though this surgical procedure has virtually no survival benefit, i.e. women who choose to have this, are apparently not living longer according to a recent study that appeared in the Journal of the National Cancer Institute. In one study, young women chose to have this done even though the majority knew that this procedure would not prolong life. They even often cited enhanced survival as the reason. In addition, there are often complications and side effects associated with contralateral proplylactic mastectomy (CPM) and breast reconstruction such as infections, ruptured implants and lack of sensation in the reconstructed breast.

Why are women apparently so willing to give up a healthy breast even when they are informed that it will not increase their survival? Ms. Orenstein cites several possible psychological motivations such as the desire to flee from the diagnosis and put the whole thing behind them as quickly as possible. She mentions the power of "anticipated regret" - i.e. women want to feel that they have done everything they can to prevent a recurrence, especially when they have young children. "Patients will go to extremes to restore peace of mind, even undergoing surgery, that paradoxically, won't change the medical basis for their fear." She aptly points out that self-sacrifice has long defined what it means to be a good mother.

Breast Symbolism, Breast Cancer and Psychological Impact

noreply@blogger.com (Linda L. Guerra, Ph.D.) — Sun, 27 Jul 2014 20:21:00 +0000

In 2004 prominent psychoanalyst, Joyce McDougall, described how the mutilating breast cancer treatments women are subjected to, invariably arouse considerable psychological distress that can include the loss of the feeling of bodily integrity, disturbance in self-image and the sense of subjective identity, as well as changes in feelings of sexual identity. “With the loss of the breast, the essential symbol of femininity is felt to be destroyed,” McDougall wrote. (See McDougall, J. (2004), The Psychoanalytic Voyage of a Breast Cancer Patient in The Annals of Psychoanalysis: Psychoanalysis and Women, 32:9-28, Hillsdale, NJ, The Analytic Press.)

Due to the current lack of scientific knowledge about effective ways to both prevent and treat cancer, without putting patients through poisonous and assaulting treatments, a cancer diagnosis of any type has the potential to trigger a myriad of emotions and complex psychological trauma. Because the female breast is so symbolic and laden with conscious and unconscious meaning, it is especially important when thinking about breast cancer to consider what may be going on in patients', family members' and medical providers' minds. Breasts universally symbolize femininity, nurture, sexual maturity and fertility. The idea of a toxic presence in the breast shakes the idea of life-giving sustenance right to its core. In many cultures, the female breast is a defining characteristic of female attractiveness and sexual desirability, so when a woman is faced with losing a breast, she will often feel threatened and challenged in many different ways, in addition to having to cope with the idea of having a life-threatening disease.

It is particularly crucial for medical providers to be aware of not just how their patients are being physically and emotionally impacted, but also how they, themselves, are being affected. Medical providers need to be trained to be sensitive to their own emotional reactions and conflicts; they are in the unenviable position of having to offer and impose harsh and sickening treatments that permanently alter their patients physiology as well as external appearance. When physicians lack emotional self-awareness, they are at increased risk of causing unnecessary harm either to patients or to themselves. With patients, they may push for treatments that statistically only reduce the chances of cancer recurrence by a very small percentage, or they may fail to adequately inform patients about the extent of various treatment side effects, i.e. what life will likely be like, both while going through treatment and maybe for years afterward. With themselves, physicians may slide into problematic coping mechanisms such as alcohol abuse, gambling addictions, or abusive behavior directed at medical subordinates or their own family members.

Psychotherapists working with women who are being treated for breast cancer or who have undergone treatment in the past, also need to tune in to what psychological conflicts, emotions, attitudes and trauma are being activated in their own minds as they listen to their patients. The more effectively the therapist does this, the more she will be able to help her client access her own unfelt emotional trauma, with the aim of containing it and working it through.

Lymphedema - An Ongoing Common Side-effect of Breast Cancer Treatment

noreply@blogger.com (Linda L. Guerra, Ph.D.) — Tue, 15 Jul 2014 21:27:00 +0000

Scotland Forest. Photo by Dr. Guerra

There is recent evidence to suggest that lymphedema, a condition that can result from having lymph nodes removed or radiated as part of breast cancer treatment, is something that many patients and their families are often told little or nothing about. Some recovering breast cancer patients only find out about lymphedema at some point after their surgery, from a concerned nurse, blood draw technician, internist or fellow cancer survivor.

Lymphedema refers to "the build-up of fluid in soft body tissues when the lymph system is damaged or blocked". (See www.cancer.gov - National Cancer Institute). Symptoms in a breast cancer survivor include swelling and/or a heavy feeling in the arm, a tight feeling in the skin and trouble moving a joint in the arm. When a person is at increased risk for lymphedema, she always has to be thoughtful about physical activity involving that arm such as gardening, household chores and working out in a gym. Anything that will cause the build-up of lymph in the arm (e.g. cuts, scrapes, bug bites, heavy lifting, hot tubs), has to be monitored or avoided, in order to avoid the possibility of inflammation and lymphedema. Blood pressure checks and blood labs have to be done using the other arm.

Mainstream breast cancer treatment in its current form - the gift that keeps on giving.

Women, Cancer and Anger

noreply@blogger.com (Linda L. Guerra, Ph.D.) — Mon, 14 Jul 2014 01:34:00 +0000

Because women are less likely then men in our culture to be able to fully engage with negative feelings like anger and frustration, they may be at a psychological disadvantage in this particular way when facing a cancer diagnosis. Since a cancer diagnosis typically evokes an intense and complicated set of feelings, the ability to manage and use emotions in a constructive way is crucial.

The importance to psychological health of allowing oneself to fully feel one's anger and other negative feelings is greatly misunderstood in the United States. Women in particular, are not authorized by the mainstream culture to fully engage with these emotions, and many find it difficult to allow themselves to be aware of their anger, let along use it to maximize coping strategies. Instead they often misidentify anger as hurt or annoyance and/or will themselves to "get over" it as quickly as possible. Anger often takes the form of passive aggressive behavior, emotional manipulation, submission or depression.

As any cancer survivor knows, there is plenty to be angry about when going through a cancer diagnosis and treatment regimen. Patients need access to their anger in order to empower them to ask medical providers for information, and to persist until they get the answers they need to make appropriate treatment decisions. Anger is also an important component of coping with the many noxious side-effects associated with most of the treatment protocols currently in use. Finally when a woman is in good command of her darker emotions, she is more likely to respond in an appropriately self-protective way when faced with intrusive, inappropriate, lame and insensitive comments coming her way from medical providers, relatives, co-workers, friends and acquaintances.

Women need to take charge of their cancer journey. They are much more likely to do this and do it well, when they have access to all of their feelings. In the United States, we need to continue to look at why we keep believing and thinking that anger is not compatible with womanhood, and what the reasons are for continuing to deprive females of one of the most empowering coping mechanisms there is.

Lingering Cognitive Effects of Chemotherapy

noreply@blogger.com (Linda L. Guerra, Ph.D.) — Sun, 29 Apr 2007 23:33:00 +0000

Something that breast cancer survivors have been reporting for years is finally being taken seriously. In The New York Times on Sunday, April 29th, 2007, there is a front page article titled, "Lingering Fog of Chemotherapy Is No Longer Ignored as Illusion". The author of this article, Jane Gross, states that due to a "flurry of research" it is now widely acknowledged that "patients with cognitive symptoms are not imagining things" and that some oncologists are now "rushing to offer remedies including stimulants commonly used for attention-deficit disorder and acupuncture". According to Ms. Gross, about 15 % of breast cancer survivors treated with chemotherapy, continue to experience cognitive side effects years after the treatment has ended, and it is this group of women who have been the focus of the cognitive research to date.

How do we know that the percentage of women experiencing long-term cognitive deficits isn't much higher? The same factors that kept doctors from acknowledging the possibility of long term cognitive deficits as a result of chemotherapy, could now be responsible for a continuing underestimation of not only how many women are being affected, but also the nature and the extent of the cognitive changes being experienced.

Before we start rushing to give women more drugs to try to treat these cognitive side effects, it seems that the sensible, logical thing to do is to conduct well designed research studies that include pre-treatment and post-treatment cognitive measures that are sensitive enough to pick up even subtle changes, and that include groups of women who have been through different treatment regimens for differing lengths of time. We also need studies that can help us to discriminate between the effects of the abrupt onset of menopause, depression and anxiety from the effects of the various chemotherapy drugs that are being administered.

Ms. Gross's article is helping to call attention to this ongoing problem, and hopefully fewer patients will receive patronizing responses from their oncologists when they raise or report these issues. Impaired short term memory, increased distractibility and loss of the ability to multitask are things that have been anecdotally reported by many women for many years. Large scale longitudinal research studies that are funded by our government and not just by drug companies, are what we urgently need in order to help all cancer patients make better informed decisions about which treatment options to choose.

Hormone Receptor Negative Breast Cancer - Food For Thought

noreply@blogger.com (Rodney B. Murray, PhD) — Sat, 26 Nov 2005 01:25:00 +0000

There was recently an on-line conference about hormone receptor negative breast cancer sponsored by www.breastcancer.org. The moderator of the conference was an oncologist named Dr. Jennifer Armstrong, M.D. Although not much new information was offered, it was refreshing to see someone finally focus on this topic. One of the things that wasn't said is something that an oncologist once told me, i.e. that if you sample tissue from a breast cancer tumor in different places, it's possible to get different results. For example, the results of one sample might be estrogen negative, 30% positive progesterone while the results of a second sample from the same tumor could be estrogen 30% positive and progesterone 70% positive. In this on-line conference, one of the doctors stated that these hormone receptor tests are difficult to perform, and therefore it may make sense to have the test repeated. If two different results are obtained, how then do doctors/patients confidently make decisions about which drugs to use as treatments?