“I know why I have the scars that I do, and the bottom line is that I need them to exist”: Cancer treatment and women’s body image
With October being Breast Cancer Awareness month, we revisit this great post exploring the impact of breast cancer treatment on women's body image.
The month of October is a time when charities,
individuals, brands and businesses in the UK raise awareness of diagnosis and
treatment of breast cancer. Breast cancer is the most common cancer affecting women
in the UK, and in any one month around 5000 women will be diagnosed with the
disease (Breast Cancer Care, 2018). Surgery, chemotherapy, radiotherapy and
hormone therapy are used to treat women affected, and cancer survival has
doubled in the last 40 years (Cancer Research UK, 2018).
Procedures and therapies
impact on women’s bodies physically and emotionally as they experience the
changes caused by the disease and treatments.
Women might find it difficult to come to terms with a body that differs
from idealised media images, and previous work on women’s body image and
well-being after cancer treatment has focussed mostly on the negative impacts
(e.g. Baucom, Porter& Kirby, 2006). To
understand more fully women’s experiences of cancer treatment and body image from
their own perspectives, and to enable reports of both positive and negative
experiences, we gave women space to report anything they felt was relevant. We did not want to assume that the experience
would be wholly negative, and so we used methods that enabled women to share as
much as they were comfortable with, and in their own words.
Study 1: An Analysis of Women’s Written Accounts
Design and
Methods
Our first study (Grogan & Mechan, 2016) was an
investigation of women’s experiences of mastectomy with and without
reconstruction/augmentation. We focused in particular on younger women (aged 45
years or under at diagnosis) who have been underrepresented in research on
women’s experiences of mastectomy in the past (Holland, Archer, and Montague, 2014) and our key question was What are the impacts of mastectomy on
younger women’s body image?
Image: Cancer Research UK |
To encourage disclosure and ensure that women
felt comfortable discussing their experiences, we asked participants to
complete a series of open-ended questions anonymously through an online
questionnaire. As part of these questions, women were asked “In addition to
the removal of the cancer, please share with us what was important to you when
you were advised or decided (prophylactic) to have one or both of your breast
removed”, and “How do you feel about your body image currently, has this
changed since diagnosis and if so how has it changed?” Thematic analysis was used to identify themes.
Findings
One
key theme was the desire to survive, which dominated
women’s experiences at the early stages from diagnosis to mastectomy. Women
distanced themselves from the infected parts of their breasts, which were
objectified and seen as separate from their well bodies. After treatment, many
women felt self-conscious about their changed bodies, though others reported
that having good levels of body confidence before they had cancer treatment protected
them against some of the more negative impacts.
Many had renegotiated how they should be
treated as women “I am who I am and I don’t go out to impress people” and recognised
that they would need to be realistic and habituate to their new, changed
bodies: “I'd obviously prefer to be how
I was but had no choice but to have surgery so am just accepting of the scars
and reconstruction”. For some participants, getting to recognise and feel
comfortable with their post-mastectomy bodies was challenging, and some were
concerned about showing their scars. Others took a pragmatic view, seeing
scarring as a necessary result of treatment that had enabled them to survive, “I
know why I have the scars that I do, and the bottom line is that I need them to
exist”. Some women even reported feeling proud of their scars as these
represented their successful ‘battle’ for survival “My scars are my war wounds
of life. I don’t hide away from them. I'm proud of them. Yes my breasts are
different and not natural but that doesn't change who I am”.
Study 2: Focus Group with Women Who Have
Experienced Cancer Treatment
Design and Methods
In our second study (Grogan, Mechan, Persson,
Finley, & Hall, 2017) , we used focus group methodology to give women some
control over the agenda, leaving space
for unexpected findings and positive as
well as negative constructions of the body. Our key question was How do women construct body image following
cancer treatment?
Women were invited through an
advertisement placed on a UK cancer charity website, and were asked to take
part in a study to investigate stories and personal experiences of cancer
diagnosis and treatment. Four women aged 32-67 years who had experienced cancer
treatment for breast or bowel cancer took part in one focus group, where they were
encouraged to talk freely about their experiences of cancer treatment.
Our analysis aimed to help us
to understand how women who had undergone breast or bowel cancer treatment
reflected on their everyday experiences, and in particular, we were interested
in how these women’s talk resisted social norms around women’s bodies and
cancer.
Findings
Women identified both positive and negative impacts, talking
about concealing their bodies and illness from public interest and judgment,
sometimes wanting to blend in by not drawing attention to themselves in social
situations, and also about developing increased trust in, and acceptance of,
their changed bodies. Women aimed to present their post-cancer
bodies as positive whilst not necessarily feeling comfortable with their naked
bodies. Participants spoke about the use of cosmetics, wigs, prosthetic
devices, different types of clothing or alternative ways of wearing clothing in
order to hide any perceived body imperfections, and also spoke about the
management of their naked bodies by “hiding” them in public spaces such as
public changing rooms. The degree to
which women reported engaging in these activities did not necessarily relate to
the level of scarring.
Despite
issues with the management of their bodies in public, some participants talked
openly about how they had developed renewed trust and respect for their bodies
as a result of cancer treatment and survival.
For instance one woman talked about having “a really huge respect” for
her body, and another discussed how she has developed “trust” and “new found
respect” for her body since cancer treatment. All participants indicated they
accepted their post-cancer bodies. For instance, “I sort of, I have accepted
sort of who I am“.
Summary
and Conclusions
Women who completed our online questionnaire and
who took part in our focus group presented much more positive stories than we
had expected based on work suggesting that mastectomy and other cancer-related
treatments produce mainly negative impacts on women’s body image and wellbeing.
Women had been inspired to create new body identities as a result of cancer
treatment, and some women said that their scars were like war wounds, symbols
of survival, suggesting a good level of perceived control and self-efficacy. Women used acceptance discourses and talked
about renegotiating gender identity. In both studies, we were struck by the
variability in accounts of women experiencing a relatively similar life event.
It is therefore important that health professionals and others do not expect
homogenous patterns of negative responses in women who have had cancer
treatment, so that they are able to provide tailored support if and when
needed.
Sarah
Grogan is Professor of Psychology, Health and Wellbeing at
Manchester Metropolitan University. She is interested in body image and links
between body image and health-related behaviours such as smoking, UV
protection, and alcohol consumption as well as media and other social
influences on body image.
Jayne
Mechan is Senior Lecturer in Fashion Technology in the
Manchester Fashion Institute, Manchester Metropolitan University. She is
interested in mechanisms of body representation and
diversity within the fashion industry.
References
Baucom, D.,
Porter, L.& Kirby, J. (2006). Psychosocial issues confronting young women
with breast cancer. Breast Disease,
23, 103-113. https://content.iospress.com/articles/breast-disease/bd000209
Breast
Cancer Care (2018). Facts and
statistics. Available at: https://www.breastcancercare.org.uk/about-us/media/facts-statistics
(accessed 26 August 2018)
Cancer Research UK (2018) Cancer statistics
for the UK. Available at: https://www.cancerresearchuk.org/health-professional/cancer-statistics-for-the-uk#heading-Zero
(accessed 10 August 2018).
Grogan, S. & Mechan, J. (2016). Body Image after Mastectomy: A Thematic
Analysis of Younger Women’s Written Accounts. Journal of Health Psychology. E-pub ahead of print 24 Feb 2016. http://dx.doi.org/10.1177/1359105316630137
Grogan, S., Mechan,
J., Persson, S., Finlay, S., & Hall, M. (2017). I’ve got a very dichotomous
difference in the way that I perceive myself”: Positive and negative
constructions of body image following cancer treatment. Journal of Health Psychology. E-pub: https://doi.org/10.1177/1359105317730896
Holland, F., Archer, S., & Montague, J. (2016). Younger women’s
experiences of deciding against delayed breast reconstruction post-mastectomy
following breast cancer: An interpretative phenomenological analysis, Journal
of Health Psychology, 21(8), 1688-1699. http://dx.doi.org/10.1177/1359105314562085
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