Network News - Winter/Spring 2010 - Canadian Breast Cancer ...

The Psychobiological Risk and Resilience of Young
Families Affected by Maternal Breast Cancer
By Melissa A. Vloet, PhD Candidate and Mario Cappelli, PhD, C. Psych.
Among Canadian women,
breast cancer continues to lead
cancer incidence rates. In 2009
alone, 22,700 women were diagnosed
with breast cancer. Breast cancer
affects women across the lifespan,
and has been identified as the most
commonly diagnosed cancer in women
between the ages of 20 and 49. 1 This
specific group of women faces many
of the same trials as other women
who are negotiating breast cancer
diagnoses and treatment options;
however, less is known about how
this group of younger women copes
with their illness. Research groups
like ours, located at the Children’s
Hospital of Eastern Ontario (CHEO),
have taken a special interest in this
younger population of breast cancer
patients and survivors. Our research
has traditionally been focused on
identifying how women with breast
cancer and young families juggle the
competing factors in their lives. In
addition, our investigations have also
provided insight into how children and
adolescents cope with their mothers’
breast cancer diagnoses.
The available literature on the
occurrence of breast cancer in younger
populations suggests that younger
groups of women diagnosed with
breast cancer differ from their older
counterparts in a number of important
ways. For instance, this younger cohort
of women is more likely to be engaged
in parenting activities. To date, the
literature on cancer and parenting has
identified several important factors
that impact the family’s ability to cope
with cancer. One of the most important
determinants of family well-being
appears to be family communication
about breast cancer. Researchers
studying parental cancer have found
that many children and adolescents
hold misperceptions about their
parents’ cancer. These misperceptions
are believed to develop from a lack of
information and reassurance within
the family and between health care
providers and children. 2 3 Investigators
have determined that communicating
clear and consistent information (in a
developmentally appropriate manner)
promotes more effective coping in
children and adolescents. For instance,
children and adolescents who believed
they were better informed about their
parents’ cancer reported using more
adaptive coping strategies to deal with
some of the difficult emotions they
experienced. 4
One of the common myths about
mothers with breast cancer is that
their children experience higher
rates of anxiety and depression than
other kids. However, research has
demonstrated that, in general, children
and adolescents of mothers with
breast cancer actually cope quite well.
Certainly, this is good news for families
adjusting to breast cancer. Despite this,
there is still reason to be concerned
about young families coping with breast
cancer. Researchers have found that,
although most children and adolescents
cope well, female adolescents often
experience significant struggles related
to their mothers’ diagnoses. Compared
to all other groups of children and
adolescents studied, adolescent
daughters report the highest levels of
anxious and depressive symptoms when
faced with parental breast cancer. 5, 4 In
part, this distress is due to role shifts
and added familial responsibilities
that are commonly experienced by
adolescent daughters.
Adolescent daughters often report
feeling torn between assisting their
families and establishing independence
(an important developmental task for
all adolescents). They also experience
Melissa A. Vloet
concerns about how the shifts in
their family roles will impact their
mother-daughter relationships in the
long term. 6 Many of the adolescent
daughters studied also report concerns
related to the disease of breast cancer
itself. Personal risk for breast cancer
seems to be one of their chief concerns.
In some cases, this concern can develop
into a maladaptive preoccupation with
their own breast health.
Evidence indicates that breast cancer
diagnosed in women under 50 years of
age is more commonly associated with
genetic factors. To date, scientists have
identified two specific gene alterations
associated with an increased risk for
breast cancer occurring in BRCA1
and BRCA2. Researchers studying
genetic testing for breast cancer have
found that if a woman has alterations
in BRCA1 and/or BRCA2, there is
a 50% chance that her children will
inherit the same alteration. Adolescent
women who grow up in families
where the risk for developing breast
cancer is higher are often aware of the
hereditary nature of breast cancer and
may believe that they are more at risk
for developing the illness themselves.
Our research group is currently
studying how adolescent girls feel
about their mother’s breast cancer,
familial breast cancer risk, their
personal risk for breast cancer, and the
communication that occurs within the
family concerning breast cancer risk.
28 Network News Winter/Spring 2010