Women deserve better from the CBC than to be told their “bad attitude” can give them cancer

I rarely catch White Coat, Black Art, but I was intrigued by the subject of the January 19th program “After breast cancer and failed reconstruction, this mom found beauty by going flat”, which I listened to recently. 

Like most middle-aged people, I'm no stranger to cancer: in November, I accompanied a close relative to her second lumpectomy (and associated follow-up treatment), my aunt died of breast cancer nearly a decade ago, my mother-in-law died of breast cancer in 1980 (~12 years post-mastectomy, no reconstruction), and a friend who had reconstructive surgery post-mastectomy is experiencing post-surgical infection and necrosis. And that’s just the breast cancer stories.

What surprised me was the program’s attempt to balance the terrible experience of Joanna Rankin, who describes being bullied into reconstructive surgery in Toronto (frankly, needing a double mastectomy at 32 means reconstruction was not her greatest worry) with the pro-reconstruction attitude of the “expert” interviewed by Dr. Brian Goldman on the program, Dr. Angel Arnaout, breast cancer surgeon and Ottawa region director of breast surgical oncology.

Basically, Arnaout said being happy and well-adjusted after breast cancer surgery reduces the chances of cancer recurrence. Which is misinformation, coming from a layman, but flat out shocking when delivered by a breast cancer specialist. 

Between approximately 21:23 and 22:25 of the recording. Dr. Arnaout says:

The reason [for encouraging immediate breast reconstruction] is because there is a lot of evidence now, especially in breast cancer, that your psychological emotions and your outlook on life is a very strong predictor of how well you will do from cancer, prognosis-wise. And that linkage of how you feel about yourself and therefore how confident you are and how well you present yourself and integrate yourself back into a normal life, and breast reconstruction is supposed to help with easing you back into a normal life and getting out there and doing exercise and being happy. All of it is linked in a lot of studies to your survivorship and your prognosis from a cancer point of view. There is a lot of evidence to show that if you are happier and you’re exercising, because you’re happier you’re taking care of your body and you’re eating well, all those things reduce your chances of recurrence. And so having the option of breast cancer reconstruction is actually now considered part of cancer treatment.

In this rambling, slightly incoherent paragraph, Dr. Arnaout is actually saying that how a patient/survivor feels about herself will directly influence cancer recurrence and "survivorship". Now, this is a wonderful thing to believe (especially if you’re a cancer patient/survivor or surgeon) but unfortunately, it’s not true. Which makes it gobsmacking to have been uttered on CBC, and by an oncology specialist to boot. That Goldman has no problem accepting this proposition is equally staggering.

Because the corollary is: if you don’t feel good about yourself or you don’t have "a good attitude", you’re bringing the cancer (or recurrence) on yourself.

This is known as blaming the victim.

This isn’t just my opinion. The American Cancer Society website goes to great lengths to dispel these antiquated notions, on their page on “Attitude and Cancer”:

Treatment that deals with our emotions and relationships (sometimes called psychosocial interventions) can help people with cancer feel more upbeat and have a better quality of life. But there’s no good evidence to support the idea that these interventions can reduce the risk of cancer, keep cancer from coming back, or help the person with cancer live longer.

Further down that page, in a section on “Personality Traits and Cancer”, they go on:

For many years there have been those who were convinced that people with certain personality types were more likely to get cancer. The common thought was that neurotic people and introverts were at the highest risk of cancer. Along with that, some believed that personality affected the outcome of cancer – the likelihood that a person with cancer might die….In 2010, the largest and best-designed scientific study to date [on the question] was published. It looked at nearly 60,000 people, who were followed over time for a minimum of 30 years. This careful study controlled for smoking, alcohol use, and other known cancer risk factors. The study showed no link between personality and overall cancer risk. There was also no link between personality traits and cancer survival.

Finally, in a section titled “Does a positive attitude affect cancer?”, they write:

…many people want to believe that the power of the mind can control serious diseases. This is a comforting belief that can make a person feel safer from the risk of serious illness. If it were true, you could use your mind to stop the cancer from growing. But the down side of such beliefs is that when people with cancer don’t do well, they may blame themselves. To learn more about attitude and survival, researchers looked at the emotional well-being of more than 1,000 patients with head and neck cancer to find out whether it affected survival. Over time, those who scored high on emotional well-being showed no differences in cancer growth or length of life when compared with those with low scores. Based on what we know now about how cancer starts and grows, there’s no reason to believe that emotions can cause cancer or help it grow.

At Mayo Clinic.org, one finds, in a section on cancer myth-busting, the following:

Myth: A positive attitude is all you need to beat cancer

Truth: There’s no scientific proof that a positive attitude gives you an advantage in cancer treatment or improves your chance of being cured. 

Huge sums are no doubt being spent in the public system to provide reconstruction to mastectomy patients. Joanna Rankin’s story is that some women are bullied into accepting it. Maybe CBC journalists should be investigating that, and whether many/most oncology specialists have confused quality of life issues with the science of recurrence.

CBC Journalistic Practices related to Science and Health read, in part, “In matters of human health we will take particular care to avoid arousing unfounded hopes or fears in persons living with or close to those living with serious illnesses.”

Given the above, I would like Drs. Goldman and/or Arnaout to provide evidence for the notion they are putting forward: that breast reconstruction (and “a good attitude”) results in lower breast cancer recurrence rates.

And, if they cannot, I would expect the program to be corrected or pulled, and an apology to be prominently published on the White Coat, Black Art website.

Because people with cancer, and those who love them, deserve better from the CBC than to be told that their sadness, anger, or other “bad attitude” can give them cancer.

Depression drugs may fight cancer (from the archives)

 

Groundbreaking McGill research yields compelling results

Beverly Akerman | Could the black cloud of clinical depression have a silver lining? A recent study by McGill researchers shows that commonly prescribed anti-depressant medications known as Selective Serotonin Reuptake Inhibitors (SSRIs) may protect against developing colorectal cancer. The groundbreaking research was published in the April edition of the prestigious Lancet Oncology journal.


Previous work in mice demonstrated that SSRIs both retard the growth of transplanted human bowel tumours and make mice that are susceptible to developing colorectal cancer less likely to do so. "Serotonin has a stimulating effect on cell division and multiplication so [if] serotonin is a promoting factor, the logic for using antiserotonin drugs is strong," epidemiologist Jean-Paul Collet pointed out. "The strength of the study is that we started with a clear a priori hypothesis coming from animal studies. . . the question was to verify whether we would find the same type of association in human beings. What we found is that people with cancer had less use of SSRIs than the control subjects. This is why we think that SSRIs have a protective effect."


Jean-Paul Collet  
Photo: Claudio Calligaris

Russian doll syndrome

The study, funded by the U.S. National Institute of Health, was conducted with PhD student Wanning Xu and Professor Stanley Shapiro, a colleague of Collet's in the Department of Epidemiology and Biostatistics and Occupational Health, using the administrative databases of Saskatchewan Health and the Saskatchewan Cancer Agency registry. Although over 10,000 cancer patients and 40,000 age- and gender-matched controls were studied in the population-based, nested case-control study, it took Xu only about six months to perform the actual number-crunching.

There are some caveats to the results. "The study is large by number of patients but it is not an experimental study like a randomized clinical trial, [where] you administer a placebo or a true drug and follow patients prospectively. Randomized trials are the gold standard for evidence," Collet pointed out. Observational studies such as his can be biased by many uncontrolled factors. So in the conclusion, his Lancet paper notes "we support conducting more studies about this question and maybe studying SSRIs with high risk patients [who] because of genetic factors or polyposis would have a high risk of [developing] cancer. Another interesting population would be patients with cancer to see if SSRIs could prevent recurrence or metastasis."

Collet cautions that treating millions of people with SSRIs in the hope of preventing colorectal cancer in some hundreds of thousands would be a risky business. "This type of research is extremely useful to conduct more research to determine what is the real effect." Collet likens these studies to playing with nesting Russian babushka dolls: open one and there's almost always another one inside. He's confident there will be a definitive answer to the question of using SSRIs to prevent or treat colorectal cancer within 5 to 10 years, depending on international collaborative research networks and the attitude of the pharmaceutical companies involved.

Originally published in The McGill Reporter, March 30, 2006.