NEW YORK--There is a soap opera scenario surrounding breast cancer survivors that goes something like this: "Breast cancer ruins the woman’s 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(Drug information on 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 uterine cancer.
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 one’s 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 woman’s 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 estrogen replacement.
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.
‘Sexual Survivors’
Chemotherapy is the only breast cancer treatment that directly affects fertility, Dr. Schover said. Alkylating drugs like cyclophosphamide(Drug information on 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 comes first."
