Body-Image Conflicts and Incidence of Breast Cancer

By seventh grade we had been hearing that our bodies were going through a lot of fascinating changes. Hardly anyone I knew could tell, and everyone was thinking there was something wrong with them and this pretty much set the tone of the next six years.

--cartoonist Lynda Barry

Teen-age girls and their body-image traumas are standard fodder for lighthearted commentary. Seattle cartoonist Lynda Barry, for example, devoted an entire book to the theme of an adolescent’s perception of the physical changes going on in her and her peers. “It seemed like nearly everyone was deformed without ever having a chance to be normal,” she wrote.

In reality, this obsession with physical perfection is sometimes less than amusing--for instance, when young women starve themselves or alternately binge and purge in their lust to be thin. And now an associate researcher at the UC San Francisco School of Medicine has uncovered what she believes to be yet another grim outcome of young women’s perennial dissatisfaction with their bodies.

In her book, “The Silent Wound: A Startling Report on Breast Cancer and Sexuality” (Addison-Wesley, $14.95), Peggy Boyd reports that women who harbor conflicts about their sexuality during adolescence are at least twice as likely as their untroubled counterparts to later develop breast cancer.

“I’m not saying that this (unresolved adolescent conflict) is the cause of breast cancer,” said Boyd, 47, in an interview at her home near the UCSF campus. “The causes are multidimensional. You have to have a lot of things going on at the same time in order to get breast cancer.”

Boyd, who holds a doctorate in public health from UC Berkeley, said her findings simply contribute one more item to the roster of known factors--among them age, heredity, reproductive history and diet--that determine who is likely to get the disease.

Most Common Form

According to new statistics issued by the American Cancer Society, breast cancer will strike one woman in 10 in her lifetime. It is the most common form of cancer in women.

The medical director of the Woman’s Breast Center in Santa Monica, Dr. Saar Porrath, said that Boyd’s report is not likely to be embraced by physicians. Much of what is published in psychological literature never makes it into the medical consciousness, he said. And doctors who do come across theories such as Boyd’s, he noted, are often reluctant to accept psychological factors as contributing causes of cancer.

“I have difficulty (with Boyd’s findings) on the basis of one study,” Porrath said. “But it’s an interesting thesis, and I would not discount it.”

Body-image conflicts, he added, are not unique to women with breast cancer. “That’s a tremendous problem among women in general,” he said. “That’s a universal.”

Boyd was working as a nurse on an oncology ward in the Bay Area several years ago when she began to notice that breast cancer patients differed from patients with other diagnoses.

“They’re the kind of people nurses like because they never complain about anything and always have a smile,” she said. “I also began to notice (during evening visiting hours) that these patients behaved differently toward their husbands and their families,” Boyd added. In the book she explains that the breast-cancer patients appeared to be “courteous and superficial” when interacting with their spouses.

She began researching theories of psychosomatic medicine, and discovered a school of thought that held that stress-triggered illnesses could be organ-specific. Rather than illness striking randomly when the body is under stress, the theory said, negative feelings toward an organ or body part could weaken the body’s defenses in that region, leading to localized disease.

Boyd’s theory took shape as she had long talks with two close friends who were diagnosed as having breast cancer. Both admitted to lifelong fears about dating and intimacy. The women tended to be remote from their husbands. True to Boyd’s hypothesis that such women repress anger and conflict by always behaving in a good-natured manner, the victims shielded news of their impending surgery from their co-workers and families, so as not to disturb anyone.

Boyd tested her ideas on Dr. Nicholas Petrakis, chairman of the Department of Epidemiology and International Health at the UCSF School of Medicine. Boyd said she had been warned that Petrakis was notorious for rejecting proposals for psychologically based research.

He Cleared the Way

But when she suggested to Petrakis that women who develop breast cancer tend to be “physiologically mature, but psychologically immature,” he said,” ’I think you may be absolutely right,’ ” Boyd said. Petrakis cleared the way for her study to be funded.

Petrakis later endorsed the project in the foreword to Boyd’s book. However, he told The Times that an editor had omitted an important part of his statement, which was that Boyd’s work could provide an important new approach to the illness only if it could be confirmed by future studies.

Although it is now generally accepted that emotions can affect the immune system, Petrakis said there remains the question of how, in physiological terms, adolescent conflict translates into breast disease. “We don’t have the connecting link,” he said.

Using the medical school’s tumor registry files, Boyd located 180 pairs of sisters living in the Bay Area (which has one of the highest incidences of breast cancer in the United States). One woman in each pair had been diagnosed with breast cancer. Boyd reasoned that by studying sets of sisters she would be “over-controlling” against error. The sisters were likely to be similar in diet, socioeconomic background and biological susceptibility to breast cancer, she said. And as adolescents they would have been influenced by the same parental attitudes.

Subjects completed questionnaires, which were analyzed by the same biostatisticians who had worked on the data on type A and type B personalities.

Results showed overwhelmingly that the sister who was made uncomfortable or frightened by physical changes in adolescence was more likely to have breast cancer in late adulthood. Those women who were poorly informed about what was happening to them were also more susceptible, the results suggested.

The Silent Wound

Conflicts regarding sexuality surfaced again for these women at menopause, Boyd found in her study. She took this to be evidence that, among the afflicted women, the “silent wound”--as she dubbed the adolescent crisis--had never healed.

Boyd theorizes that menopause and adolescence are actually mirror-image experiences. There are new sexual roles and accompanying anxieties to be encountered at each end of the reproductive years, she said.

In one-to-one interviews, the researcher found that many breast-cancer patients had matured physically at an earlier age than their peers and felt themselves thrust into the dating arena before they were ready. “This (the breasts) is the organ that probably got most women into feeling that they are sexual beings,” Boyd said. “While a teen-age girl can recognize the beauty of her breasts and appreciate that they get people to look at her, they can also cause events to happen that she can’t deal with.”

While women are powerless to change some of the factors that place them at risk for developing cancer, the researcher said her study suggests an area where women can make a difference. Those readers who recognize themselves in the personality type sketched in “The Silent Wound” should be able to resolve many of their leftover adolescent conflicts by simply recognizing and working on them, said Boyd, who is widowed and has three grown sons.

Parents should take note of negative body images that may be developing in their own teen-agers. She urges both parents to talk with their adolescent girls not simply about the mechanics of sex, but about emotional issues as well.

Before presenting her findings in book form to a lay audience, Boyd said, “I had to look at the question: What if this theory is wrong? Well, we are espousing better relationships between parents and children, and talking about the importance of the role of the father in the family. We are saying that at adolescence a woman can have conflicts that may stay with her throughout her life, and she may not be aware of.”