Myth-Busters: Telling the True Story of Breast Cancer Survivorship
Authors: L. R. Schover
Journal: JNCI Journal of the National Cancer Institute (2004)

The conventional wisdom is that breast cancer devastates women’s lives, even when the disease is controlled by modern, multimodality treatments. We, the general public, take our stereotypes not so much from real life but from novels, movies of the week, and soap operas. Our poor heroine loses her breast (or at least gains an ugly scar that would turn off any but the most desperate man). Needless to say, her sex life falls apart. If she is single, her boyfriend leaves her. If she is married, she ends up divorced while her husband finds a younger partner who flaunts a perfect bosom in skimpy halter tops when our heroine picks up the kids for weekend visits. Of course we learn that our heroine the survivor only got breast cancer because of stress. In the last 3 years, she lost both her parents in a tragic plane crash, her teenaged son was arrested for marijuana possession, she supported her husband emotionally and financially when he was fired from his job for insider trading, and after fending off sexual advances from her boss, she was passed over for the job promotion she clearly deserved. I admit, this is a highly dramatized picture of our stereotypes about the consequences of breast cancer, but many health professionals as well as the general public firmly believe that breast loss is the worst trauma of breast cancer, that men commonly desert women treated for breast cancer, that it is impossible to have a satisfying sex life after breast cancer treatment, that stress plays a major role in causing breast cancer, and that breast cancer survivors typically face job discrimination. Over the last decade, Dr. Elizabeth Maunsell and her colleagues in Quebec have systematically debunked each component of this breast cancer myth. In an 8-year follow-up of 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 results of large surveys in the United States (2– 4). Although having a mastectomy is upsetting, the greatest physical and emotional morbidity from breast cancer comes simply from being diagnosed with a life-threatening illness (2,3). In fact, the cancer treatment that contributes to most long-term physical and emotional morbidity is adjuvant chemotherapy (2– 4). The Canadian (5) and United States (2,3) surveys agree that middle-class, Caucasian women who are long-term survivors of breast cancer have a quality of life that is as good as or better than age-matched control women! Although approximately 50% of survivors of breast cancer report some sexual dysfunction, similar rates are seen among postmenopausal women who have not had cancer (2). Dr. Maunsell’s group did find that breast cancer survivors who lived with a partner had more sexual problems than a group of healthy women matched in age and place of residence (5). This group of women may be those treated with chemotherapy and made prematurely menopausal, and who thus have an increased likelihood of sexual dysfunction, as seen in other cohorts (2–4). Yet the most sexually satisfied women in the U.S. survey were those who had found a new sexual partner after their cancer diagnosis (2). Romance can still trump biology. Maunsell et al. also demonstrated that marital breakdown is no more common among women after breast cancer than among control women matched on demographics (6,7). However, as common sense would predict, women who were dissatisfied with their relationships 3 months after their cancer diagnosis were more likely to have experienced a break-up or divorce by 8-year follow-up than women who were satisfied with their relationships at 3 months (6). Not only have Maunsell and colleagues investigated quality of life after breast cancer but they have also examined the link between stress and breast cancer etiology. They conducted interviews with 673 women several months after breast cancer diagnosis, in which the women were asked, using a standardized checklist, to identify stressful life events they had experienced within the last 5 years. Ten years later, the number of stressful events women experienced was not predictive of survival, even after the analysis was weighted according to standards of severity, or according to the woman’s own perceived severity (8). A meta-analysis of the literature on stress and breast cancer also failed to find a connection between the two events (9). Other recent investigations have not found increased rates of breast cancer after losing a child to death (10) or caring for an ill family member (11). In this issue of the Journal, Maunsell and colleagues (12) have focused on employment experiences among breast cancer survivors after their treatment. In their own pilot work, the researchers had interviewed 13 breast cancer survivors who mentioned job-related problems during a clinic visit (13). These women told about losing jobs, feeling stigmatized in the workplace, and experiencing an inability to meet the physical demands of work. However, population-based studies have not confirmed this picture. In the United States, data from the Health and Retirement Study of 1992 showed that breast cancer survivors were only 10% less likely to be employed than women who were similar demographically but who had not had cancer (14). In a follow-up of a large cohort of breast cancer survivors, Ganz and colleagues (3) reported that 80% of women initially employed and free of disease at an average follow-up of 6-years