Annotated+Bibliography

**1.** Rowland, Julia H, et al. “Role of Breast Reconstructive Surgery in Physical and Emotional Outcomes Among Breast Cancer Survivors.” Journal of The National Cancer Institute. 92.17 (2000) 1422-1429 Julia Rowland was appointed the director of NCI’s Office of Cancer Survivorship in the fall of 1999. Dr. Rowland has a PhD in developmental psychology from Columbia University, and was one of the first to receive NIH-supported training in the oncology. She helped establish the Post-Treatment Resource program, trained and worked at Memorial Sloan-Kettering Cancer Center, or the MSKCC. She is published extensively on women, and their reaction to breast cancer, and also focuses on pediatric and adult cancer survivorship. She not only speaks frequently in regards to life after cancer, but is the author of more than 75 articles, reviews, and book chapters on the subject. This particular article relates to her research about constructive breast surgery after cancer, and how that affects women’s mental and sexual health. This is an informational report, informing the public about breast surgery, and the negative impact it has on breast cancer patients. The intended audience is probably an expert in the field, since this is a medical journal, but it is a good informational piece for the public eye.
 * Information: **

Rowland is researching the possibility that the recovery of the breast might mitigate the negative effects of breast cancer, while simultaneously researching the compared psychosocial outcomes of women who undergo lumpectomy, mastectomy, or a mastectomy with reconstruction of the breast. The author informs the audience that a study was conducted to investigate the mental health of women who undergo different types of breast surgery, and the possibility that the type of primary surgery a woman receives plays an important role in her self-image. Lumpectomy surgery gave a woman the most positive outcome, more so than the mastectomy, with or without reconstruction. Women who underwent a mastectomy experienced more pain due to the medical procedure. But, there were few differences between physical, social, or emotional outcomes between the different types of surgeries, and the outcome. The author determines that the primary surgery does not determine a women’s subsequent mindset, and that that must be determined by other factors, such as age, other therapies, and health problems.
 * Summary: **

The author is referring to a study she conducted with her colleagues, in which they studied women who underwent different types of breast surgery, and how that affected their self-image afterwards. The different types of surgery seemed to have little impact a year after the surgery on their mental health and self-image. The study did provide and interesting insight though – it stated that African-American women are much less likely to undergo reconstruction of the breast after a mastectomy than white women. Interview data suggests that African-American women are must less likely to experience a negative impact on their sexual functioning after surgery, while white women who are young, and partnered, undergo about twice as many reconstructions as African-American women. This study is useful to me, because it provides an interesting insight into the psychological impact of surgery on a breast cancer victim, and how that differs based on race, age, and different therapies.

The work is clear, logical, and well-documented. Rowland is obviously an expert in her field, and her study is clear and much easier to follow than other medical journals. The topic was covered completely, because she not only researched the different type of surgeries, and how they impact the breast cancer patient, but also refined her studies based on age, race, and different therapies undergone. While this article leaves me wondering about other factors, and how they impact a woman’s mental health after breast cancer, this addressed the issue very clearly. The author certainly takes an objective stance, recording her findings, and relating the discovery to the audiences.
 * Evaluation: **

This source was incredibly helpful to my research, because it not only informed me of the different variables affecting the mental health of a breast cancer patient. The study itself is well thought out and extremely clear, her and her colleagues are very well qualified to conduct this research. The source lead me to a bunch of other sources I would like to read about, and, it helped me refine my research focus. I was unsure about whether or not I wanted to pursue the mental health of breast cancer patients, but I think it will be a very interesting topic that not many other people have covered. It also relates directly to me, and my family, because my mother had breast cancer, and the disease has psychologically impacted me. This source was extremely intelligent and I am very pleased that it came into my field of vision while researching.
 * Reflection: **

**2.** Neise, C, et al. “Risk Perception and Psychological Strain in Women with a Family History of Breast Cancer.” Oncology. 24.5 (2001) 470-5. Although there was not individual information on the authors, all five of the authors were part of the Institute for Sexology and Sexual Medicine at the University Hospital in Charite´ Berlin, Germany. The Charite´ has produced over half of the German Nobel Prize winners in medicine and physiology, and has an international reputation for excellence in training. While the individual authors did not have complete biographies, the institution they work for is competent, with four campuses, 100 clinics, and institutes under 17 different Charite´Centers. This is an informational product about a study done on women with a family history of breast cancer, and is intended for experts in the field, but is informational on a student level.
 * Information: **

Health psychologists think that a patient’s response to preventative behavior to combat breast cancer their ability to see a perceived risk, and is influenced by stress. This group from Germany created a study to see if this was indeed the case with women whose family had a history of breast cancer. The author isn’t arguing anything, but is reported what was discovered in their medical study.
 * Summary: **

The study included one hundred and twenty nine women with at least on first or second degree relative who had breast cancer. They were enrolled in a questionnaire study, the object of which was to ascertain the ability of these women to realistically estimate their chances of contracting breast cancer. It also measured what influence risk perception and stress had on their willingness to undergo preventative treatment measures in pursuit of early detection. In addition, the effects on their physical and mental health were analyzed.

<span style="font-family: Arial,Helvetica,sans-serif;">The results of the study indicated that a family history of breast cancer did not always correlate with the subject’s opinion about contracting the disease. Overall, the majority of the women in the study overestimated their personal risk of contracting breast cancer, despite medical counseling on the issue. Less than twenty-five percent correctly estimated their personal risk, and less than twenty-five percent underestimated it. The majority who overestimated their risk also underwent recommended examinations less than other women with a low risk perception. Women who are subjected to intense strain showed an above average participation in screening programs, meaning that their stress levels were high, and they overestimated their contraction of the disease.

<span style="font-family: Arial,Helvetica,sans-serif;">The author conducted a study on the issue, and is very thorough in explaining their findings to the audience. It is made clear that most women overestimate their risk of contracting breast cancer, and that women under extreme stress are more likely to overestimate, and participate in preventative screenings. It was very clear, and overall well done study.

<span style="font-family: Arial,Helvetica,sans-serif;">The work is logical, clear, and well-researched. Since this isn’t a paper arguing one side or another, you are given the bare-bone facts, and the doctor’s tell their scientific interpretation of what the data shows. The topic has been adequately addressed, because it is shown that while women with a family background sometimes underestimate their risk, most often they overestimate it, showing the psychological strain of an individual whose family has been exposed to breast cancer. The author takes an objective stance, informing the viewer rather than exposing them to one viewpoint over the other.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Evaluation: **

<span style="font-family: Arial,Helvetica,sans-serif;">I learned that women who have a family history of breast cancer are much more likely to overestimate their personal risk, rather than underestimate it or correctly estimate it. The source provides an insight to a family after it has been exposed to breast cancer, and how women who have a higher risk of contracting the disease will most likely be psychologically stressed, and believes that their chances for contracting breast cancer are higher than they actually are. This study helped me gain more evidence for my topic, and showed that breast cancer normally increases psychological strain.
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<span style="font-family: Arial,Helvetica,sans-serif;">**3.** Khoo, K. S. and Ang, P. T. “Psychological Impact of Breast Cancer.” Singapore Med. 34 (1993) 107-108. <span style="font-family: Arial,Helvetica,sans-serif;">Both of these authors are a part of the Department of Medical Oncology, in the Singapore General Hospital. P T Ang is the consultant and head of the department, and a doctor in the field of breast cancer and its effects on mental health. This is an informational report, combining different studies and their efforts to unearth the effects of contracting breast cancer on one’s psyche. The intended audience is probably someone in the field, although it could be read by a less educated audience.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Information: **

<span style="font-family: Arial,Helvetica,sans-serif;">The authors are not only discussing the diagnosis and treatment of cancer, which causes severe mental stress in all cases, but are also investigating breast cancer diagnosis specifically, and its effects on perceived womanhood and sexual function. Any form of surgery on the breast, whether it is a lumpectomy or a total mastectomy, can sexually impact the individual. The absence of a breast alters one’s body image, visibly destroying a woman’s mental image of herself. Not only does it make one more self conscious, but the loss of a breast alters physical activity, clothing preferences, and sexual activity.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Summary: **

<span style="font-family: Arial,Helvetica,sans-serif;">The main arguments are in reference to breast cancer physically and emotionally scarring a woman. Where the loss of organs in other cancers is hidden, the lost of a breast due to cancer is obvious and embarrassing. The author’s state that breast conservation, like a lumpectomy, segmentectomy, and quadrantectomy in appropriate patients alter the morbidity and the fear of losing a breast to cancer. These procedures leave behind a smaller, but never-the-less, a publically acceptable breast, while a mastectomy causes self-esteem issues over the lack of a breast. And, while surgery is morbid, it is much more easily remedied than the psychological effects. All of this reinstates the author’s notion that breast cancer does alter one’s sexual activity, and the loss of a breast increases that.

<span style="font-family: Arial,Helvetica,sans-serif;">The authors call facts from different studies regarding the McArdle et. al. study of depression and anxiety in breast cancer patients. Mastectomy patients had greater psychological stress on all levels, but there wasn’t a measurable amount of difference between individuals with the different types of surgery. But, the study also showed that women who undergo breast conservation overall have a more positive feeling about their bodies, especially while being nude, than mastectomy patients did. This can overall affect a woman’s sexual well-being. Sexual function is also effected by early menopause, which can be inducted by chemotherapy, or ovarian failure, which occurs in premenopausal women undergoing chemo. This study was also done on Eastern women, who are must more conservative, and did not express issues related to sex because it was considered taboo. Many studies demonstrate that group therapy and intervention for cancer patients had positive effects on psychological variables, including mood, adjustments, and pain.

<span style="font-family: Arial,Helvetica,sans-serif;">The work is logical, using studies to base their conclusions. The research is presented in a clear fashion, and is very well-researched, using various studies to combat the different variables present. The topic has been adequately addresses, but the evidence about sexual well-being varies from studies involving Western hemisphere women. The author takes an objective stance, simply expressing the general consensus after studying these scientific projects.
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<span style="font-family: Arial,Helvetica,sans-serif;">**Reflection**: <span style="font-family: Arial,Helvetica,sans-serif;">I learned a lot about how breast cancer affects different races, and how reactions vary in different cultures. Other studies showed that white women are far more likely to get breast reconstruction, and feel insecure about their body after surgery, than an African-American woman is. This study adds to the element of race and how that affects psychological well-being after breast cancer. The Eastern community, or the women in Singapore, all seemed to be conservative in their answers about their sexual function after surgery. These women do not mention the truth because it is either too taboo to speak of sex in their culture, or, their culture is very accepting of the changes that a woman undergoes after breast cancer surgery. This shows the differences in psychological well being after surgery among different races. This helps develop my argument, because it confirms that across different cultures, reactions to breast cancer and self image are different.

<span style="font-family: Arial,Helvetica,sans-serif;">**4.** Moyer, Paula. "Breast Cancer Effects on Physical, Emotional, and Psychological Wellbeing Remain Up to 10 Years Later: Presented at EBCC." Doctor’s Guide. March 23, 2004: <span style="font-family: Arial,Helvetica,sans-serif;">14. Oct. 2010. <span style="font-family: Arial,Helvetica,sans-serif;">Paula Moyer has been a medical journalist for twenty-two years. She has written over 1,300 articles about the clinical, financial, and organizational divisions of medicine. In addition to being regularly published on WebMD, she has been published in fourteen other medical magazines. She graduated from Cameron College in Lawton, Oklahoma with a BA in history, and received her Master’s in creative writing in 1990, from the University of Minnesota. The piece is an overview of a presentation of a study done in Hamburg, Germany on the psychological effects of breast cancer ten years after a patient has been diagnosed. The findings were presented at the 4th European Breast Cancer Conference, on March 17th 2004. Moyer’s intended audience is physicians, but her article is straightforward, and is easy to comprehend.
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<span style="font-family: Arial,Helvetica,sans-serif;">The author doesn’t have a thesis, mainly because it is a piece simply reporting the findings of a study about breast cancer. The author is mainly focuses on the findings, which were that a breast cancer diagnosis has a deleterious effect, particularly in women who were diagnosed when they were younger than fifty. This is a particularly interesting report, because there are now more breast cancer survivors, and the discovery that their diagnosis can affect them for years is a serious one. Dr. van de Poll-Franse is quote in the magazine, expressing her concern, and warning that physicians should not assume that long-term survivors have recovered from the psychological effects of their diagnoses. The reporter draws evidence from the study done based on 362 women who were diagnosed with breast cancer in 1993, in the Netherlands. The patients were taken from eight different hospitals, and of these, seventy percent were alive when the study started, and among those survivors, seventy-two percent responded to the questionnaire. The Illness Intrusiveness Ratings Scale was used to assess the impact of breast cancer on the diagnosed. <span style="font-family: Arial,Helvetica,sans-serif;">Of those survivors who responded, seventy-six percent of the women were still under specialist surveillance, and most respondents complained of physical pain from the breast cancer they once had. Forty percent of women complained of swollen arms due to auxiliary lymph-node dissection, and sixteen percent reported fatigue. Dr. van de Poll-Franse said that these complaints were much more prominent in women who were younger than fifty at the time of their diagnosis. Of women who reported physical problems, seventy-one percent were young, compared to forty-four percent of older women. Among younger women, forty-seven reported arm problems compared to only twenty-nine percent of older women. Fatigue was said to be present in twenty-two percent of younger women, compared to four percent of older women. <span style="font-family: Arial,Helvetica,sans-serif;">The study suggests that younger women may report more fatigue because they still have very busy lives, filled with children and work. But, it seems that the fatigue reported also has an effect on work performance, and younger women found that the disease impacted their relationships with their partners. Twenty percent of younger women reported this, compared to two percent of older women. This research suggests that breast cancer is much more disabling to younger women, and that it can continue to effect women for over ten years after they have been diagnosed. These major life changes contribute to the debilitating affect breast cancer has on those who contract it, and how it changes the lives of those involved with these women. They are no longer who they were – they are now plagued by pain, fatigue, and one fifth of younger women reported a change in their romantic relationships. Breast cancer isn’t just a disease. It is a life-changing experience in all aspects.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Summary: **

<span style="font-family: Arial,Helvetica,sans-serif;">This work is logical, clear, and well-researched. This study was performed very well, and the topic was adequately addressed. Not only does this add to the interesting idea of race, and how that affects the breast cancer experience, but it shows that women can continue to be plagued by evidence of their diagnosis years after the actual event. This reporter takes an objective stance, communicating solely what the study showed, and how that evidence was interpreted by the doctors committing the study.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Evaluation: **

<span style="font-family: Arial,Helvetica,sans-serif;">This was very helpful to my research, because it gave me a European perspective to breast cancer, and taught me a lot about how the reports back vary depending on age, and younger women experience more negative side effects, or are more willing to discuss those with a researcher. This supports my argument, because it is obvious that breast cancer has detrimental effects long after diagnosis occurs. This helped me develop my argument because now I am aware of the differences in reporting problems after a breast cancer diagnosis, and how that varies with age.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Reflection: **

<span style="background: white; color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; margin: 0in 0in 0pt;">**5.** Majure, Janet. Breast Cancer : Diseases and People. Berkeley Heights, NJ: Enslow, 2000. <span style="background: white; color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; margin: 0in 0in 0pt;">**Information:** <span style="background: white; color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; margin: 0in 0in 0pt;">Janet Majure has a Bachelor of Science in Journalism, and a Master of Arts in English from the University of Kansas. She’s the author of multiple books, and has written two books about diseases, one on AIDS, and the other on breast cancer. She is a self-made author, and has written short stories, blogs, and edits her own work. She’s published, and is highly regarded in her field. Majure’s book is informational, and is for high school level readers, and not meant for experts in the field. Her approach to breast cancer is easily understood, and is very comprehensive.

<span style="background: white; color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; margin: 0in 0in 0pt;">**Summary:** <span style="background: white; color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; margin: 0in 0in 0pt;">The book is an informational account of what breast cancer is, how it is formed, and how it is diagnosed and treated. They also focus in on the history of breast cancer, and prevention treatments. The book does not really have a thesis, but is focused more on the generalized information surrounding breast cancer and society. The first focus the different types of breast cancer, and then the causes of it. She discussed the fact that it is known that multiple gene mutations lead to cancer, falling into two categories. The first is genetic, like a trait passed on from mother to daughter, or father to son, or vice versa. Only a very small portion of breast cancer is caused by genetic traits. These mutations occur in the BRCA1 or BRCA2 gene. Other mutations are connected to carcinogens, or cancer-causing substances in the environment. Cigarette smoke is a lung-cancer causing carcinogen, but no known carcinogen is a direct cause of breast cancer.

<span style="background: white; color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; margin: 0in 0in 0pt;">It also discusses the vast use of mastectomy, throughout history, as the primary treatment for breast cancer. As medical science advanced, X-rays were used, and antiseptic became prominent, along with the first hormonal treatment for breast cancer with the removing of the ovaries. Radium was discovered to be useful in the treatment of cancerous cells, and lumpectomies became more popular. Mammograms were developed, and treatment steadily increases, even today. The book’s main arguments are really discussions about diagnosis, treatment, and the history of the disease.

<span style="background: white; color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; margin: 0in 0in 0pt;">Majure references many doctors and experts in the field of breast cancer to comment on breast cancer and its effects, and takes information from the national Cancer Institute, and the American Cancer Society. She references a couple different studies in the book, and her research is well-supported. This information reported in the book helps me understand the disease itself, and the scope of its effects.

**<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt;">Evaluation: ** <span style="background: white; color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; margin: 0in 0in 0pt;">The work is completely logical, well-researched, and very clear. The topic was adequately addressed, although maybe not as thoroughly as it would have been in a medical paper, it was very clear to a high school reader. The author is objective, and simply reports on the issues that breast cancer unearths, and what the disease itself is like, and the treatment options. I think this book was a very smart choice in order to learn more about the disease itself, because it isn’t a long, difficult to understand research paper, it’s very clear and well-thought out. That way, it was an easy read that helped me a lot with my research on the disease.

**<span style="color: black; font-family: 'Arial','sans-serif'; font-size: 10pt;">Reflection: ** <span style="background: white; color: black; font-family: 'Arial','sans-serif'; font-size: 10pt; margin: 0in 0in 0pt;">This was helpful to my research because unlike the more difficult medical papers I have been looking at, this was an easy read that was informative and engaging. It supported my argument because it educated me on the disease itself, and understand exactly what it means to be diagnosed and treated for breast cancer. It didn’t really develop my argument, but it helped to form a solid basis for my knowledge on the subject.

<span style="font-family: Arial,Helvetica,sans-serif;">**6.** “Psychological Stress and Cancer: Questions and Answers.” National Cancer Institute. 29 Apr. 2008. Web. 19 Oct. 2010. <http://www.cancer.gov/cancertopics/factsheet/Risk/stress>.

<span style="font-family: Arial,Helvetica,sans-serif;">The National Cancer Institute is part of the National Institutes of Health, with is one of the agencies that composes the Department of Health and Human Services. The NCI was established in 1937, and is the Federal Government’s principal agency for cancer research. The NCI created the National Cancer Program, and coordinates this to conduct and support research, training, and health information distribution, such as this article. Other programs from the NCI help to diagnosis, treat, prevent, and rehabilitate cancer patients. This is a quality article because it comes from a government agency that must coordinate with a national network of cancer researchers, and has the most up-to-date information. This is key, because this information must be distributed to the public accurately, which is how I came to find this article.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Information: **

<span style="font-family: Arial,Helvetica,sans-serif;">This report does not have a thesis, but is a documenting answering frequently asked questions about psychological stress and cancer. It also addresses the question about stress increasing someone’s risk of cancer. This article addresses how studies for the past thirty years have examined the relationship between stress and cancer risk. Although some studies have indicated a link between psychological factors and increased risk for cancer, and a direct cause and effect relationship has not been proven to exist. Some studies have indicated a relationship between stress and virus related tumor, because stress weakens the immune system, and virus related cancers like Kaposi sarcoma and lymphomas can thrive. The release of hormones into the blood in response to stress can directly alter the important processes in cells that help protect against the formation of cancer. <span style="font-family: Arial,Helvetica,sans-serif;">The article also discusses that these studies are inconsistent because it is difficult to separate stress from other physical or emotional factors. But stress does affect people who have cancer, studies show that the effects of stress can in turn affect the growth of tumors, and there is an association between certain psychological factors, such as helplessness and suppressing emotions, and the growth and spread of cancer. The main argument is that stress can adversely affect cancer, and its growth and spread, and help should be sought out when a cancer patient feels overwhelmed. This supports my argument, because not only does contracting cancer have a huge impact on one’s psyche, but it also can adversely affect the disease that is ailing that individual.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Summary: **

<span style="font-family: Arial,Helvetica,sans-serif;">The work is logical and clear, and is meant for the public to access. It is well-researched, because the NCI must collaborate with many cancer agencies, and they have the most up-to-date information available. The topic was adequately addressed, with all the information possible. Although the article did not prove that there is a correlation between stress and getting cancer, it shows that stress can affect breast cancer, along with other cancers, in a negative way. The author takes an objective stance, simply relaying the facts to the public in a clear and logical fashion.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Evaluation: **

<span style="font-family: Arial,Helvetica,sans-serif;">This source was helpful to my research, because it shows that while there is no proof that stress causes cancer, it can have a negative influence. This provides a wider scope for my argument, because now stress is no longer just effecting the patient’s life outside of the cancer, but also inside it too. Stress can make the disease worse, especially if your cancer is virus based. Even though breast cancer is not virus based, this is a very interesting article, providing a new perspective to my argument and my perception of breast cancer.
 * <span style="font-family: Arial,Helvetica,sans-serif;">Reflection: **

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">**7.** “Living With Breast Cancer.” eHealthMD. 2004. Web. 19 Oct. 2010. <http://www.ehealthmd.com/library/breastcancer/BRC_living.html>.

**<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Introduction: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">This website is a collection of some of the best free health information online, and over one million people use eHealthMed. All content on the website has been written with the cooperation of distinguished physicians, and there is also an honor code tag on the website. It has been certified, and is recognized as having reliable information. The work is an informational one, informing the public how breast cancer works and affects the men and women who are diagnosed. The honor code says that the website is authoritative, and that the authors that collaborated to create this webpage were all qualified. The article is complementary, and supports a doctor-patient relationship, attributes to its sources, is justifiable, and is trustworthy.

**<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Summary: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt; text-indent: 0.5in;">The article summarizes the primary issues of life during and after breast cancer, like self-image, fear of recurrence, need for treatment, and issues related to activities, career, and relationships. The article focuses on the psychological effects of a mastectomy, the fear of recurrence, sexuality, and relapse prevention. The article does not have a thesis, but focuses on the different issues that occur when one is diagnosed with breast cancer. This article also lacks an argumentative stance, and is simply reporting the issues that occur throughout a diagnosis. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt; text-indent: 0.5in;">The psychological effects of a mastectomy are profound, considered the huge focus on breasts as a source of the female body image. The loss of a breast can damage a woman psychologically, and employment of a counselor is normally sought. A little over thirty percent of women with this disease suffer from prolonged anxiety and depression, and women who fail to adjust are often plagued with another life crisis after diagnosis. These psychological problems can sometimes lead to an appointment with a psychiatrist, who then seeks out psychotherapy or medications for the patient. By receiving a breast prosthetic, or discussing sexual problems with a spouse, a woman can relieve the pain of losing a breast. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt; text-indent: 0.5in;">One of the main ideas in the article is that women who are diagnosed are with cancer become paranoid about recurrence, and seek relapse prevention. Women often become paranoid, believing that normal changes in their body are a sign that the breast cancer is coming back, or spreading. Normally, these effects are expected with a certain kind of treatment, like radiation treatment can cause changes in the breasts, or cause the skin to become red and raw. Relapse prevention is also discussed, and it normally occurs near the area that was originally diagnosed or in a distant organ from the original site. Adjuvant therapy is recommended, which includes five years of hormone treatment that lowers estrogen. Pre-menopausal women sometimes benefit from chemo for six months following the completion of treatment. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt; text-indent: 0.5in;">This is from a medical website, and although there are no direct quotes from doctors, the author of the website is credible, so I trust the information. The last topic they cover in the article is sexuality, and that breast cancer myths effect sexual relationships. There are some myths that caressing a breast can encourage recurrence of tumors or that someone can catch cancer, and although these beliefs are unfounded, they could interfere with a healthy sex life. Women can also see their body differently, and find themselves repulsive and inhibited during sex. Men often claim that the loss of a breast does not change the relationship with their spouse, and that is why it is important to discuss issues openly in a relationship where someone is diagnosed with breast cancer.

**<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Evaluation: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">The work is logical, clear, and well researched. The topics have been adequately addressed, and provide insight to the different difficulties a woman encounters when she experiences the diagnosis of breast cancer. The author is objective in their report, and simply discusses the different aspects of treating and dealing with a breast cancer diagnosis.

**<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Reflection: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: 115%;">The source was helpful to my research, and elaborated upon points that were brought up in other articles. Although I knew a mastectomy could affect someone’s personal life, this article delved into all the different aspects it could affect. It also talked not only about how a mastectomy affects one’s sex life, but how to improve it. It also talked about relapse, which was not covered in my other articles, and how paranoid one can become when the constant fear is over one’s head. This supports my point that breast cancer not only tears down the body, but can also have a huge impact on one’s psyche, and that it can be very troubling to deal with, as with any other disease. It also compounds the lack of confidence a woman feels in her body after she is diagnosed with breast cancer. This article was very helpful to my research and helped me develop my argument by delving deeper into issues that other articles briefly covered


 * 8.** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Albrecht, Terrance L, et. al. “The Crisis of Cancer: Psychological Impact on Family Caregivers.” Oncology. 11.2 (1997) 189-194. <http://www.cancernetwork.com/display/article/10165/102043?pageNumber=1>.

**<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Information: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">Terrance L. Albrecht has a PhD, and is a department member of Community and Family Health, from the University of South Florida, in Tampa. His co-workers, Christina G. Blanchard has a PhD and is part of the Department of Hematology and Oncology at Albany Medical College in New York. John C. Ruckdeschel has a MD, and is a part of the Department of Medicine and Community and Family Health in the College of Medicine at the University of Southern Florida. He is also a member of the Moffitt Cancer and Research Institute. This is a informational report meant for experts in the field on breast cancer.

**<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Summary: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">The author focuses on the idea that cancer changes the family’s identity, including roles and daily functioning. Studies show that spouses are as distressed over the cancer as the cancer patients are, and that spousal and patient distress are correlated. Twenty to thirty percent of partners suffer from psychological impairment and mood disturbance as a result of a spouse’s cancer. Factors that may aggravate this condition are the diseases’ stage, the emotional level of the patient, gender, age, and the spouses’ personal characteristics. The author’s thesis is that the changes created by cancer “have long-lasting effects, regardless of the outcome of the disease. Although the effects generally are perceived to be negative… many families describe the positive effects and resulting strengths of coping with the crisis of cancer” (Albrecht, et al.) The author takes the position that cancer not only affects the patient, but the whole family unit as well. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">The main arguments at that the entire family suffers from the affects of cancer, and family members, especially spouses, can have sleep disturbances, eating disorders, heightened anxiety and depression, a sense of helplessness, and fears about cancer and its treatment. Spouses are mainly concerned with the death of the patient; the patient’s coping mechanisms, and maintaining a normal family routine. Sometimes a spouse will deny their own feelings, and support the patient, heightening their own stress. Cancer causes an increase in marital dissatisfaction, anxiety, and depression. A family changes, and old roles are relinquished as new ones are assumed, and shifts in social structure, along with the family’s routines and patterns. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">The different contextual variables about spouses’ general emotional symptoms depend somewhat on gender. Women are more likely to be visibly upset about the disease, and will support their husbands openly. When a woman is ill, such as the normal case with breast cancer, her emotional response and her husband’s are very closely correlated. Younger spouses also react more emotionally than older ones to a partner’s illness. Adolescents are much more likely to exhibit a worse response to a parent’s cancer, <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">This article references multiple studies and reports from doctors and physicians. There is a reference to Northouse and Peters-Golden, which concluded that a spouse has three areas of concern. The first is that the cancer could spread, and the ultimate outcome. Another study, Toseland, Blanchard and McCallion report that fear of the spouse dying is the ultimate concern, even when patients are essentially free of symptom. These multiples references to different medical studies simply support that spouses experience as much stress as a patient.

**<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Evaluation: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">The work is extremely logical and clear. It is very well-researched, and references many different medical studies and opinions of different doctor’s. The topic has been adequately addressed, and the author does not take a bias, but reports on everything with an objective eye. This was a really fantastic source, and is very well developed and easy to understand. It’s use of many different medical studies only helps to support that it is a really good source.

**<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Reflection: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">This was extremely helpful to my research because until now, I had not found an article on spousal response to cancer, and how it affects a family’s structure. This provides a basis for my argument, because it shows how breast cancer changes a family’s life and structure, not only the patient’s routines and life-style. This helped me find more information on how spouses and children react to cancer, which will be extremely helpful in my presentation about breast cancer and its psychological effects.

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">**9.** Heimdal, Ketil, et al., “Quality of Life and Its Relation to Cancer-Related Stress in Women of Families with Hereditary Cancer without Demonstrated Mutation.” Quality of Life Research. 15.3 (8 Sept. 2005) 461-470. [].

**<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Information: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">The six different contributors to this article all came from genetic cancer research centers. The first five authors, including Heimdal, are part of the section for genetic counseling in the department of Cancer genetics, and part of the Rikshospitalet-Radiumhospitalet Trust in Oslo, Norway. The last author is a member of the department of clinical cancer research, in the Rikshospitalet-Radiumhospitalet Trust of Oslo, Norway. Their contribution is widely recognized in the scientific society, and they are all very well qualified to assess the stress a woman experiences in relation to her hereditary chance to contract breast cancer. The hospital itself merged with the Norwegian Radium hospital, and was created in 2005. The authors have written multiple articles on the subject, and I would trust whatever research they are reporting on. It is an informational report on the research they’ve done and it is intended for an expert in the field, which makes it all the more reliable because it is for doctors and other researchers on the topic.

**<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Summary: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt; text-indent: 0.5in;">This research study was done to measure mental distress in women who have a family history of breast cancer, but who haven’t demonstrated breast cancer mutations themselves. Although there wasn’t a thesis, that was the main topic of the study. They took about 330 women at risk for family breast cancer, and the results were strange. The risk group had a better, physical quality of life than the control group, but there was no significant difference between the risk group and the control group on the mental quality of life. But, if a deceased loved one had passed away with cancer, there was an increased risk of the patient having a low quality of life. Mental quality of life showed a moderate correlation with cancer-related distress for these individuals. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">The study concluded that women belonging to familial cancer groups in the absence of symptoms have a good quality of life, despite living with a permanent risk of a cancer-related threat. Only one out of every three women who had a high risk for breast cancer reported cancer-specific worry at pre-counseling. The study shows that normally, cancer risk worry is associated with women who are younger in age, highly educated, and who had perceived that they have a higher risk for developing cancer. This was concluded because after genetic testing, worry increased in groups that were expecting to be diagnosed with the disease, had decided on a mastectomy if the results came back positive, were under the age of 40, or had young children. All of these factors increased anxiety about breast cancer. They also explained the better physical quality of life for women whose were in the risk category, which originally seems strange, but is explained by more awareness and consciousness about healthy-lifestyle. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">Women who have lost someone close to them have a poorer quality of life mentally, and this is associated with the emotional damage that losing someone has among close relatives. The author references the study that they conducted throughout their research, and that is how they provide evidence for their paper.

**<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Evaluation: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">This was a really interesting source, because it showed the different elements of the quality of someone’s psyche. It appears that women who are aware of their breast cancer risk that runs in the family, they take more time to be physically fit, while there is little difference between women’s mental health in the risk and control groups. Women who have lost a member of their family to cancer seem to have a lower mental quality of life, which is associated with the devastation that losing someone involves. This was interesting, to see the different aspects of psychological health, and how that applies to breast cancer. It was also a hopefully source, showing that even women who live with a risk of breast cancer can live a completely normal life in comparison with the rest of the population. The work is logical, clear, and well-researched, and the topic was adequately addressed. The authors do not take a biased point of view, but simply report their findings.

**<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Reflection: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">It was really helpful to see the different aspects of psychological health, and how that changes or doesn’t change with breast cancer risk. This source also gave a lot of hope, showing that women with breast cancer can live a normal life. This is good for my topic because while it shows the changes to a woman’s emotional health, it also shows that you can be okay if breast cancer runs in your family. This is good, because all my other sources have been pretty sad, and this one provides a little hope and relief for my audience.

<span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Information: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> This is a report on a study done to interpret the quality of life female breast cancer patients are experiencing after treatment. This study was supported by two grants, one called the “Quality of Life of Long-Term Female Cancer Survivors,” which is funded by Bristol-Myers through the Oncology Nursing Society. The second is the College of Nursing Research Initiation Grant, funded by Michigan State University College of Nursing. This paper is reliable because two scientific grants were given to the College of Nursing and Department of Psychology at Michigan State University to complete this study. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> Both of these authors are published several times in different medical journals, and although I cannot find separate biographies on each of them to discover their qualifications, it is made obvious in the article that they are employed at the college, and are related to Michigan State University. Since two separate scientific organizations gave grants to fund their project, I trust this source. This is an informational report on a study done about the quality of life after breast cancer, and it is intended for an expert in the field, although it is comprehensive and understandable to high school students. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Summary: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> Although this report does not have a thesis, the purpose of the paper is to present the evolution of the quality of life scale that demonstrates a female cancer survivor’s emotional stableness. The author does not argue anything, but is simply portraying the facts, and reporting on what the study showed the researchers. The paper reflects the idea that more and more women are surviving cancer, and that this may change a woman’s quality of life, because treatment for breast cancer often affect areas associated with gender identity. The main part of this paper is reporting on the change in the quality of life scale, but I am focusing on the breast cancer studies that they pull to support that, and what that tells about the breast cancer population. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> The author argues that a new quality of life scale was necessary to measure the well-being of women with breast cancer, and the author references several breast cancer studies to prove this point. The first is Northouse’s study, which followed breast cancer patients and their husbands for eighteen months post-surgery to assess psychosocial adjustment over time. Northouse concluded that social adjustment was crucial to the quality of life, but she failed to study either physical or spiritual issues on the individual. The lack of a more holistic model resulted in Ferrell’s model, which includes for parts, divided into subsections: physical well-being, psychological well-being, social concerns, and spiritual well-being. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> The new model showed that the different areas of quality of life could not be separated; they interacted to form a whole. The results showed that the physical area was less-significant to women, but the foundation of the other areas rested and related to physical well-being. Women did not let physical issues that they could not change bother them, like the change in their body image or clothes to cover the swelling. Instead, long-term survivors look toward the diet and exercise portions of physical well-being, and did not regret over physical changes and adjustments. For a healthy life, and long term survivor must have a strong social element, and psychological well-being depended on social or spiritual health. Spiritual health was found to be of a higher importance than previously believed. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Evaluation: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> The work is logical, clear, and well-researched. Although some of what was reported wasn’t necessary to my topic, the discoveries made in the study itself pertain to breast cancer psychological health, and quality of life. This study, while it talks about the development of a new quality of life model, also assesses long-term breast cancer survivor’s quality of life in four areas: physical, social, psychological, and spiritual. The topic has been adequately addressed, although I wish there was more information on the study, and less on the new quality of life model. This author takes an objective stance, and simply reports on the study and how it changes the quality of life model. <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Reflection: ** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;"> I learned about how the different dimensions of quality of life, and how they appear to a long-term breast cancer survivor. This is another hopeful source, talking about the progress that has been made in treatment, and the author references different studies, and their own study, to support their topic. This source helped to develop my argument, because it shows exactly how women see their life in long term cancer recovery, and the different aspects that contribute to overall emotional health. I like that this source has a overall hopeful outlook on long term cancer survival, and that normal life is possible after diagnosis, treatment, and surgery.
 * 10.** <span style="font-family: 'Arial','sans-serif'; font-size: 10pt;">Friedman, L. L., and Wyatt G. K. H.. “Development and Testing or a quality of life model for long-term female cancer survivors.” Quality of Life Research. 5.3. (Jun 1996) 387-394