Breast Cancer

By Lesley Fallowfield; Andrew Clark | Go to book overview

Chapter four

Psychosocial outcome of breast cancer treatment

Depression is a common sequel to mastectomy, and is marked by anxiety, insomnia, depressive attitudes, occasional ideas of suicide, and feelings of shame and worthlessness.

(Renneker and Cutler 1952)


Psychiatric morbidity

There have been many largely anecdotal descriptions of the extreme psychological distress, social, and sexual difficulties associated with breast cancer treatment. Two seminal papers published in the 1950s by Renneker and Cutler and Bard and Sutherland described the psychological sequelae following mastectomy. Their work revealed that anxiety and depression, together with impairments to physical and sexual functioning were very common features post-operatively. At the time these articles were published radical mastectomy was almost the only treatment available; an unpleasantly mutilating procedure based on the flawed premise that the more tissue that was removed the more likely the surgeon would be to extirpate all the cancer. As was shown in Chapter 1, what we now know of the biology of breast cancer does not permit any confidence in the view that the greater the mutilation the greater the chance of halting cancer spread. Consequently, many thousands of women did suffer significant psychological and physical impairments following unnecessarily radical surgery. However, it is always a salutary lesson to look at the alternative facing women and their surgeons at that time; uncontrolled breast cancer leading to a painful, odorous, fungating, broken-down chest wall is not a very pleasant sight or experience.

-51-

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