STRESS MEDICINE, VOL. 4: 177-183 (1988)

BOOK REVIEWS

BOOK REVIEWS

*Stress and Breast Cancer. Edited by Cary L. Cooper. Published by John Wiley and Sons. Chichester, U.K. 1988 ISBN 0471-91744-3.

Nearly two thousand years ago, the Greek Galen suggested in his De Tumoribus that cancer occured more frequently in melancholic than sanguine women. Since that time, the medical literature contains substantial anecdotal evidence to suggest that stress, depression and sadness may be a predisposing factor in the onset of cancer. Only since the 1950’s has a serious attempt been made to make a scientific analysis of the possible relation- ships between different types of stress and the occurrence of cancer. As cancer of the breast is a frequent and clearly diagnosable entity it is not surprising to find that attention has recently been paid to the relationship between stress and breast cancer. Thus Cary Cooper has assembled a group of nineteen experts in various areas of oncology and psychosomatic medicine to critically review the evidence linking breast cancer with stress. The resultant monograph* will be of interest not only to the specialist but also to the general clinician who all too frequently has to treat the cancer patient.

The book is divided into five sections. The first section gives a general account of research into the possible relationship between stress and breast cancer. Stolbach and Brandt begin this section by critically assessing the various psychosocial factors in the development and progression of breast cancer. Despite the abundant anecdotal reports from their critical assessment of the evidence these authors conclude that a strong causal association between the behaviour of the patient and the occurrence of cancer has yet to be established. Most of the studies have failed to meet essential epidemiological criteria such as strong causal association, consistency, reproducibility and specificity. They conclude that while there is no evidence that psychosocial factors can initiate a tumour, such factors may serve as promotors or accelerators of tumour growth. Hu and Silberfarb take up some of the issues raised by Stolbach and Brandt in their chapter on the possible influence of psychological factors on cancer and summarize the main methodo-

logical problems that impinge on this area of research. These vary from the selection of appropriate patient and control groups and statistical analysis of the results to the impossibility of demonstrating that findings in retro- spective studies do not occur as a consequence rather than an antecedent to the disease. The authors then critically assess the studies which have been made and conclude that the evidence linking psychological causes to cancer is unproven. Nevertheless, they correctly emphasize that ‘regardless of whether psychotherapy actually does prevent or modify the cause of cancer, it can still aid the cancer patient in dealing with a serious and difficult illness’.

In this section dealing with psychosocial factors and the progression of breast cancer, Watson discusses the possible link between the brain, the immune system and neoplastic disease. After reviewing the possible influence of psychological factors in the early and later stages of breast cancer, the author questions the widespread assumption that being stressed somehow inevitably reduced the patients survival. Indeed, the argument could be turned on it’s head to suggest that positive healthy aggressive responses (e.g. ‘cancer is not going to beat me’) may prolong survival. Levy and Wise discuss how such changes in behaviour may affect the outcome. While animal studies clearly show that the rate of growth of a cancer can be considerably influenced by behavioural manipulation, so far the properly designed clinical studies to validate the hypothesis have yet to be undertaken. Winching and colleagues summarize the results of those studies which attempted to analyze the influence of psychosocial factors on the development of breast cancer. Although only a pilot study has so far been undertaken by these investigators, they have shown that those psycho- logical factors affecting the course of the malignant cancer also produce significant effects in the control group of patients with benign growth.

The next Section is devoted to the biochemical processes that may underlie breast cancer. Stoll summarizes what is generally known of the endocrine changes associated with cancer and stresses the physio- logical link between the limbic regions and the pituitary-

@ 1988 by John Wiley & Sons, Ltd.

178 BOOK REVIEWS

adrenal axis. The influence of stress is postulated to occur though psychoendocrine (sex hormones, prolactin, gluco- corticoids) and/ or through psychoimmunological mecha- nisms. However, the author does not indicate the mechanism whereby the immune system could be affected by psychological factors. The reader would find it useful, for example, to have a synopsis of the function and relationship between the different types of lympho- cytes and how they play a complex and diverse role in the immune process. It is too simple to expect that only the natural killer cells are involved in protecting against cancer!

The penultimate Section deals with the more practical aspects of intervening and coping with stress in breast cancer patients. Cunningham suggests that individual and group therapy may objectively benefit the patients fight against the disease while Baider and De-Nour, in their chapter emphasize the contribution of the family to the patient’s recovery. Hoffman then argues for the need of a new specialist, the psycho-oncologist, whose primary function is to deal with the specific psychological factors appertaining to cancer patients as a part of a multidiscip- linary team.

The final Section, a methodological consideration in research, gives a critical assessment of the various problems and pitfalls in this area of psychosometic medicine. The single chapter in this section is covered by Cella and Holland who, though critical of the relevance and interpretation of many of the psychoimmunological studies referred to in their own chapter and elsewhere in the monograph, nevertheless conclude that such effects are likely to be present in pre-menopausal women with breast cancer. As with all areas of medicine, ‘new and more comprehensive approaches to examining this and other interesting questions are necessary to help advance the current state of knowledge in the area’.

In conclusion, this is an interesting and readable synopsis of the present state of knowledge of an important area of psychoimmunology and is to be recommended to both clinicians who treat cancer patients and t o psychiatrists and psychologists who have an increasingly important role to play in improving the mental attitude of the patient towards the illness.

BRIAN LEONARD Galway, Irish Republic

7;he Career Psychology of Women. Nancy E. Betz and Louise F. Fitzgerald, Academic Press, Inc. Harcourt, Brace, Jovanovich, Publishers San Diego 1987.

The stress of being today’s woman is brilliantly explicated and documented in The Career Psychology of Women by Nancy E. Betz and Louise F. Fitzgerald, respectively of The Ohio State University and The University of California, Santa Barbara.

This book is not about the traditional woman, whose exclusive preserve is being wife, mother and homemaker. Rather it is concerned with the new woman whose ‘place’ is in the labor force as well as the home.

The inequities with which this new woman must cope, according to the authors, are shocking. This is true even though in 1984 63% of all women from 18 to 64 were working outside the home. The expectation is that by 1990 the number will be 70 to 75%. Yet the average male high school drop-out earns more than the average female college graduate, and men who completed less than eight years of elementary school earn more than is earned by female high school graduates.

Even more disturbing is the fact that in contrast to men in general, women’s intellectual capacities and talents are not reflected in their educational and occupational achievements. This lack of self-realization has been characterized as the ‘homogenization of the American woman’.

The present volume, however, deals with more than dollars and cents, statistics and recommendations. It is in all likelihood the first attempt systematically to examine

the present knowledge about women’s career adjustment presented within the framework of traditional vocational psychology. The authors make recommendations for necessary theory, research, educational counseling and organizational intervention.

This study by implication also becomes a revelation of the misogyny of American socity and of the conformity or rebellion of women against the stereotypic roles imposed by this society. Significantly the authors main- tain that highly career-oriented women are characterized by a constellation of personality and attitudinal behaviors that are androgynous. To what extent, we may ask, are not all human beings an amalgam of masculine and feminine traits so that the dominant behavior is imposed by society rather than by the inherent nature of the individual? I’m not referring to the sex relationship or to child-bearing but only to the non-biological roles including aptitudes, abilities, talents, and capacity for making contributions to society outside the home. It is distressing that because of the emphasis on woman’s biological role, as the authors point out, women as a group, minimize rather than develop their abilities. Society hs stereotyped men and women into separateness with regard to talents and aptitudes whereas they are linked in these respects by the oneness of being human.

This book is an important text for sociology and psychology courses and will appeal as well to serious readers who want to see society, in Matthew Arnold’s phrase, ‘steadily and whole’.

FLORA RHETA SCHREIBER John Jay College of Criminal Justice, City University of

New York