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The Breast Cancer Blame Game

By Betsy Lee-Frye

Updated May 23, 2008

(LifeWire) - As more is learned about lifestyle risk factors for breast cancer, there's one clear downside: Patients who are diagnosed with the disease may blame themselves for not having minimized such risk factors long ago.

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According to the American Cancer Society, lifestyle factors that increase a woman's risk for breast cancer include having postmenopausal hormone therapy, also known as hormone replacement therapy; consuming more than one alcoholic beverage per day; being overweight, obese or too physically inactive; short-term or no breastfeeding; and not having children or having had them later in life.

For example, in a 2007 issue of Stanford Medicine Magazine, journalist Amy Adams discussed her increased risk of breast cancer due to having children later in life. Adams implied that, should she be diagnosed with breast cancer, she might feel responsible to some degree.

Adams wrote, "... Where our breasts are concerned, nothing can overcome all of those years spent in school, shunning motherhood in favor of a bright illustrious future career."

Almost all patients who are newly diagnosed with cancer will run through a list of could-haves and should-haves. But with regard to breast cancer, there are science, social norms and sexuality to help create a lengthy list of places to point the finger. It may be hard for women diagnosed with breast cancer to avoid asking, "Why did this have to happen to me?" But it's best -- for them and their families -- to avoid getting stuck in the blame game.

Finger Pointing

In a study presented at the 2007 conference of the American Psychosocial Society, women were asked about breast cancer self-blame at an average of 21 months post-diagnosis. Nearly 70% blamed themselves for not having gotten sufficient exercise; 57% said they hadn't eaten proper foods; and more than 30% focused on their decision to take oral contraceptives.

These modern lifestyle choices are frequent areas of recriminations among women diagnosed with breast cancer. According to a commentary published in The New England Journal of Medicine, "modernized" lifestyles have increased breast cancer rates in industrialized countries.

While women most often seem to blame themselves for their cancer diagnosis, there are other places to point the finger. The media has reported that everything from environmental pollution to indoor lighting could be contributing to the increase in breast cancer.

Families aren't immune to the breast cancer blame game. A mother's exposure during pregnancy to the drug diethylstilbestrol, or DES, used during the 1950s and 60s, is known to increase a daughter's breast cancer risk. And some women may even feel angry with their parents for passing down a genetic risk factor for the disease. Others may blame a spouse for encouraging them to wait to have kids.

Although there are no exact figures, some women also blame God or some higher power for their cancer diagnosis. But, more commonly, women seek solace in religion. According to one study, women who mention religion in their online support group postings seem to express more positive emotions, a higher level of engagement in their health care and a greater sense of well-being.

The Impact of the Blame Game

Although temporarily assigning blame is a normal and even healthy way to cope with a breast cancer diagnosis, studies show that women who blame themselves report poorer quality of life during and after their cancer experience than those who avoid protracted self-blame.

Assigning blame can also impact familial relationships, especially if there's a genetic history of breast cancer. Male relatives who carry the breast cancer mutation may feel particularly guilty, at least according to one study of men who tested positive for the mutation. Opening the lines of communication about this issue can be helpful for family members, whether male or female. In addition, seeking genetic counseling can help families with a strong history of breast cancer learn more about their risks.

According to the University of Michigan Comprehensive Cancer Center, placing blame is a common behavior among people with any type of cancer. But  it's an avoidance behavior. It can limit an individual's ability to move on and take action to deal with the diagnosis, emotionally and medically.

Moving Forward

It's important not to feel guilty for blaming someone or something. Wanting to hold someone (even if it's you) accountable is understandable. But it's not a place to stop or get stuck. Blame can be a barrier to supportive familial relationships and to a healthy attitude regarding breast cancer treatment.

Women who feel that their lifestyle choices may be responsible for their cancer should remember that we don't fully understand the factors involved -- particularly in the case of the individual woman. There's no foolproof way to move from population-based risk factor data -- a business of statistics and averages -- to the case of unique individuals. While it makes sense to do what we can with what we know, it's important to recognize that our knowledge of risk and cause is fragmentary.

And the biggest risk factor -- age -- is something none of us can control. According to New York's Cedars-Sinai Health System, "Over 70% of breast cancers occur in women who have no identifiable risk factor other than age." But there's been relatively little study of the impact of increased life expectancy on breast cancer rates.

Several studies suggest that oncologists should talk with their patients about blame issues. If your doctor doesn't bring up this topic, don't hesitate to ask questions about what might be responsible for a breast cancer diagnosis. If thoughts about blame become intrusive or seem to be interfering with a positive attitude about treatment, mention this to a physician or a counselor who can provide additional coping mechanisms.

Communication with family and friends is also important. The American Cancer Society encourages newly diagnosed patients to share their regrets and concerns with loved ones, and for patients to allow their loved ones to do the same.

In addition, patients may find it helpful to join a support group, whether online or in person. These groups can allow women with breast cancer to talk about blame in a safe environment.

Sources:

Adams, Amy. "Pink Think." Stanford Medicine Magazine. 2007. Stanford School of Medicine. 2 May 2008.

"Coping with Physical and Emotional Changes." Cancer.org. 8 Jan. 2008. American Cancer Society. 2 May 2008.

Duffy, Sonia., Marcia Valenstein, Christine Kowalski, Shara Kilarski, Jeffrey Terrell, Lynn Gregory, David Ronis and Fred Blow, Ph.D.. "The Emotional Impact of Cancer." University of Michigan Comprehensive Cancer Center. 2008. University of Michigan Health System. 2 May 2008.

Friedman, L.C., C. Romero, R. Elledge, J. Chang, M. Kalidas, M.F. Dulay, G.R. Lynch and C.K. Osborne. "Attribution of Blame, Self-Forgiving Attitude and Psychological Adjustment in Women with Breast Cancer." Journal of Behavioral Medicine 30. 4. Aug. 2007. 351-357. 31 Apr. 2008.

"Genetic and Risk Factors for Developing Cancer." Saul and Joyce Brandman Breast Cancer Center. 2008. Cedars-Sinai Health System. 2 May 2008.

Mayo Clinic Staff. "Breast Cancer Prevention: Lifestyle Choices and More." MayoClinic.com. 15 Dec. 2006. Mayo Clinic. 2 May 2008.

Romero, Catherine. "Self-blame, Self-forgiving Attitude and Spirituality as Predictors of Mood and Quality of Life in Women with Breast Cancer in a Public Sector Setting." American Psychosocial Society: 2007 Conference Abstracts. (2007): 35-36.

Porter, Peggy . "'Westernizing' Women's Risks? Breast Cancer in Lower-Income Countries." New England Journal of Medicine 358.3. 17 Jan. 2008. 213-216. 1 May 2008.

Shaw, B., J.Y. Han, E. Kim, D. Gustafson, R. Hawkins, J. Cleary, F. McTavish, S. Pingree, P. Eliason and C. Lumpkins. "Effects of Prayer and Religious Expression Within Computer Support Groups on Women with Breast Cancer." Journal of Psycho-Oncology 16. 7. Jul. 2007 676-87. 1 May 2008.

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Betsy Lee-Frye is an independent journalist living in Kansas City, Mo. She is a fellow with the Association of Health Care Journalists. Her work has appeared in The Dallas Morning News, Better Homes and Gardens Special Interest Publications and the St. Joseph News-Press.
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