Breast Cancer Survival: The Impact on Relationships and Intimacy

Nicole Seagriff, DNP, Survivor.

There are 3.1 million breast cancer survivors living in the United States today, according to American Cancer Society estimates. Included in the 3.1 million survivors are those newly diagnosed and in treatment, those who have completed active treatment, and those who are living with metastatic breast cancer. Despite our large numbers, few articles are available in print or digital media about who we are and how we are doing.

We include every race, ethnicity, and socioeconomic group. We range in age from as young as our 20’s to as old as our 90’s. Our age at diagnosis and the type and extent of our treatment are factors in what side-effects and issues we may experience as survivors. If we are under 45 years old, and in our childbearing years, our issues will be different than those of us who are postmenopausal.

Grateful to be survivors, most of us accept and deal with the changes that breast cancer may bring to our lives. Many of us view being a survivor as a time to reinvent ourselves, or, at the very least to give ourselves permission to do the things we have always wanted to do, but life got in the way.

We may have different responses to our breast cancers, and the short and long-term side effects resulting from treatment that may continue to be a part of our lives as survivors. Yet, almost all of us share one feeling, and that is fear of a recurrence.

We can all understand having the fear of recurrence. However, many of us are not prepared for the fears we have about the changes in our body image.

Many survivors I’ve spoken with, over the years, expressed ongoing fears about their own reactions to the changes in their bodies, and how that affects their relationships.

It is hard to feel good in any relationship, be it work, social or intimate, when you don’t feel good about yourself and how you look.

Living in a society that views breasts as sexual objects, many of us fear not being sexually attractive to our partner or spouse. For single women who date, there are the fears that accompany beginning a new relationship, sharing information about having breast cancer, and being intimate. Young women, who want children, may face fertility issues because of chemotherapy treatment.

Recently, I had the opportunity to attend a  presentation and discussion hosted by The Breast Cancer Research Foundation, on the topic, “How Breast Cancer Can Impact Relationships and Intimacy”

Dr. Marc Hurlburt, Chief Mission Officer of the Breast Cancer Research Foundation, shared the assessment findings of the American Cancer Society and the American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline, which was issued in the latter part of 2015. Nicole Seagriff, a breast cancer survivor since she turned 27 years old, spoke about her experience as a young survivor.

As Dr. Hurlburt explained, “The purpose of the Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. It identifies issues that may affect female survivors, of all ages, and suggests clinicians speak with them about their quality of life.

Since many women are uncomfortable bringing up problems of intimacy, clinicians are encouraged to bring up the subject of sexual intimacy and relationship difficulties that may be related to their breast cancer."

Dr. Hurlburt identified the major issues in the care guidelines that impact on relationships and intimacy as:

  • Body image and appearance changes, which affect between 31-67 percent of survivors. The most difficult body image problems for most women included:
    • Scarring from mastectomy and bilateral mastectomy surgery and breast reconstruction. Sexually active women identified greater body image problems whether or not they had reconstruction.
    • Chemotherapy-induced early menopause.
    • Changes in the skin due to radiation.
    • Difference in the size of the treated breast due to lumpectomy and/or radiation.
    • Swelling in the arm and hand following surgery (lymphedema).
    • Weight gain related to treatments.
  • Sexual health issues include reduced libido, vaginal dryness, painful intercourse and  difficulty reaching orgasm. Birth control methods for women, in their childbearing years, who take tamoxifen to prevent a recurrence, need to limit their birth control options to the IUD and condoms. Pregnancy on tamoxifen is not safe; it can cause birth defects
  • Cognitive functioning was a problem for over 35 percent of women long-term.
  • Depression and anxiety were reported by 22 percent of the women as being problematic.
  • Other, less frequently reported issues, included: osteoporosis, and bone pain in postmenopausal women as a result of taking a class of hormone therapy called aromatase inhibitors to prevent recurrence.

Much of what the women identified as issues in the assessment can be relieved by getting help from a clinician who can counsel them on what will relieve or reduce their side-effects such as:

  • Scar creams that can reduce the appearance of surgical and reconstruction scars.
  • Lubricants that are safe to use that will ease vaginal dryness and painful intercourse.
  • Breasts that are no longer the same looking, as a result of surgery, can be made so through reconstructive surgery.
  • The side effects of early menopause can be eased with medication and exercise.
  • Skin changes due to radiation that last longer than a few months often respond to treatment.
  • Lymphedema can be treated and swelling reduced for many women.
  • Weight gain from treatment can be kept under control through diet and exercise.
  • Depression and anxiety can be treated with therapy and, if needed, with medication.

A Young Survivor’s Story: Breast Cancer's Impact on Relationships and Intimacy

Nicole Seagriff, President of The Pink Agenda, was diagnosed with breast cancer in 2012 at 27 years old. At the time she was diagnosed, she was established in her career as a nurse practitioner, dating and enjoying the life of a young, single woman. Breast cancer challenged her to adapt to life as a survivor, and deal with the impact that breast cancer can have on relationships and intimacy.

I had the opportunity to meet Nicole when she spoke about her experience with breast cancer and her life as a survivor at the media discussion hosted by the Breast Cancer Research Foundation (BCRF.)

As Nicole put it, “I was no stranger to breast cancer before my diagnosis since my mother was diagnosed at 40. While she is a survivor for many years now, her mother, my grandmother, died from breast cancer when my mother was just four years old. An aunt also died of breast cancer.

“As a nurse practitioner, I am always encouraging my patients to be proactive about their health. I decided to practice what I preach, and go for genetic counseling given my family history of breast cancer.

My mother agreed to go for testing, and a simple blood test indicated that my mother was BRCA2 positive. That meant that I had a 50 percent chance of having the same genetic mutation. I went for testing that confirmed I also had the BRCA2 mutation, which put me at high risk for breast cancer. My risk for ovarian cancer was also higher than a woman who does not carry the BRCA2 mutation. I decided to have an MRI, which found something suspicious, and shortly after my 27th birthday, in 2012, I was diagnosed with breast cancer.”

Having children and nursing her children was a long-held plan of Nicole’s. She hoped her cancer could be treated with a lumpectomy, but her treatment team recommended a bilateral mastectomy.

Since Nicole’s cancer was estrogen positive, meaning that her tumor was estrogen fed and would respond to taking tamoxifen, a hormone therapy that has a track record of success in reducing breast cancer recurrence. Nicole took tamoxifen and managed to cope well with the side effects of this medication for the three years she took it.Tamoxifen is known to cause hot flashes, Vitamin D deficiency, sleep disturbances and weight gain.

Since estrogen is produced by the ovaries in premenopausal women, Nicole will have her ovaries removed as a risk-reduction measure in the future.

Reconstruction brought issues. Breast implant expansion sessions proved painful. Seeing  scars across the center of her reconstructed breasts and not under each breast, was an unexpected adjustment.

While Nicole continues to have the support of family, friends and work colleagues, her need to be part of a group working for a cure for breast cancer drew her to the Breast Cancer Research Foundation and her volunteer role as President of the Pink Agenda, a nonprofit organization that is the young professional branch of the BCRF. The Pink Agenda promotes awareness about breast cancer and raises funds to help support the research activities of the BCRF.

Nicole’s  healthy lifestyle includes an exercise program, a diet high in fruits and vegetables with limited meat consumption. As a survivor, she still enjoys doing the things she did before breast cancer.

When asked about dating, Nicole was encouraging, saying, “Don’t be afraid to date. The best time to share about your cancer is when you feel comfortable with the person.”

Nicole shared, “Getting breast cancer before I was married and had children was hard for me. I encourage young women diagnosed with breast cancer, who want to have children, to go for fertility counseling prior to beginning treatment.

Since my breast cancer, my life has become my work. While I was in treatment, I decided to get my doctorate in nursing and work in community health where I will come in contact with many young women and have the opportunity to educate them about their need for breast cancer screening and genetic testing.” Nicole received her doctorate in nursing in May of 2016!

Today, cancer centers and individual breast cancer treatment providers are offering patients the opportunity to develop a survivor care plan before finishing active treatment or shortly thereafter. Plans focus on the ongoing scheduling of follow-up visits, cancer screenings, and maintenance activities including weight control, exercise and a healthy diet. Many plans have resource information for managing the short and long-term side effects of breast cancer. If this plan is not offered to you, ask about it. If your treatment center doesn’t offer this service learn more about survivorship planning at the National Cancer Survivorship Resource Center.

Sources

"How Breast Cancer Can Impact Relationships and Intimacy" a media breakfast discussion presented by The Breast Cancer Research Foundation, April 14, 2016.

American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline 2015

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