NEW YORK--There is a soap opera scenario surrounding breast cancer
survivors that goes something like this: "Breast cancer ruins
the womans life. Her husband leaves her for another woman. She
loses her job. She considers suicide but bravely goes on, knowing no
man will ever want her. Looking in the mirror is her worst nightmare."
Speaking at a Cancer Care teleconference, Leslie Schover, PhD, a
psychologist with the Cleveland Clinic Foundation, debunked this
"Days of Our Lives" script, as well as some prominent myths
about breast cancer, sexuality, and fertility, taken from her book
Sexuality and Fertility After Cancer (John Wiley & Sons, 1997).
Myth #1, she said, is that breast cancer leads to
depression. In fact, survivors have a good overall quality of life
compared to those with other chronic illnesses. Women diagnosed with
early-stage disease do not have a high rate of depression a year
later, but depression does increase with debility, Dr. Schover said.
Myth #2 is that breast cancer leads to divorce. The
reality, Dr. Schover said, is that breast cancer survivors do not
have a higher divorce rate. In many cases, the illness brings couples
closer. There is also no difference in marital happiness reported by
patients who have had mastectomy and those who have had lumpectomy.
Myth #3 is that tamoxifen (Nolva-dex) causes menopause. Most
premenopausal women taking adjuvant tamoxifen continue to menstruate
and are fertile after treatment, although pregnancy is not advised
due to the risk of birth defects, she said. Although tamoxifen is an
antiestrogen in breast tissue, in other parts of the body it acts as
a weak estrogen, and in the genital tract it may be helpful with
vaginal lubrication. However, tamoxifen does increase the risk of
Myth #4 is what Dr. Schover calls "Happiness is a Whole
Breast." There is no difference in mood or psychiatric disorders
between women who have had mastectomy alone, breast conservation, or
mastectomy with breast reconstruction, according to several studies.
Myth #5, Dr. Schover said, is that lumpectomy
preserves ones sex life. Sexual satisfaction is unrelated to
the type of breast treatment. But women who have had breast
conservation are more likely to experience pleasurable breast
caressing. They also rate themselves as feeling more attractive.
Women who have had breast conservation and women who have had
reconstruction feel about the same in regards to their attractiveness
in the nude or dressed.
Myth #6 is the "politically correct myth," Dr.
Schover said, or You Must Learn to Love Your Scars. "I think
that women have different coping mechanisms. Some do very well being
able to look at and touch their scars and in their ability to make
love without clothes. Others feel much more comfortable during sex
camouflaging some of those changes. Neither approach is better than
the other," she said.
Myth #7 is that chemotherapy does not damage a
womans sex life. "For younger women with breast cancer who
go through chemotherapy, it is probably the single most destructive
factor to sexual function." Dr. Schover said. Short term, it
interferes by causing fatigue and nausea and by altering body image
through hair loss and weight gain. Long term, chemotherapy can lead
to premature menopause and symptoms of vaginal atrophy.
Dr. Schover cautioned that androgen is not necessarily the answer to
reverse the effects of chemotherapy. "Androgen treatment is more
an art than a science," she said, adding that most women who
have normal ovaries and still have menstrual cycles will not benefit
from additional androgen.
It may be helpful to restore sexual desire in women who suddenly lose
ovarian function, but there are still not enough good studies in this
area, she said, and there are also concerns that giving androgen to
women who have breast cancer may be just as risky or more so than
Myth #8 is that pregnancy is always risky after breast cancer
treatment. It is true that young women who have breast cancer have
the added concern that the high estrogen levels of pregnancy could
possibly trigger a cancer recurrence or even a second primary in
women who have a genetic predisposition for cancer.
But most studies suggest that women who are node negative at the time
of their cancer treatment and free of disease for 2 years, have, if
anything, better survival when they are pregnant than similar
survivors who are not pregnant, Dr. Schover said, adding that more
research is needed in this area.
Women who have completed chemotherapy can also breast-feed. Even
women who have had breast conservation, including radiation, have
been able to produce some breast milk from their treated breast as
well as their untreated breast.
Chemotherapy is the only breast cancer treatment that directly
affects fertility, Dr. Schover said. Alkylating drugs like
cyclophosphamide are the most destructive. Women over age 35 who use
CMF typically go into permanent menopause; women under 35 who receive
this regimen often resume normal menstrual cycles, but it is unclear
whether they are at risk for premature menopause.
Once menopause is permanent, Dr. Schover said, ovarian-stimulating
hormones usually do not work. If a woman is in her 20s, the hormones
that stimulate ovulation can work, but may be risky because of the
high estrogen levels that result. Women can be "sexual
survivors" after breast cancer, she said, "but survival