Women who’ve had breast cancer and disfiguring surgery often feel discouraged and vulnerable in the dating world, but York researchers say there is good news. It is possible to develop successful intimate relationships. Unknown to either, though, the new partner will have to pass a “man test” first.

In addition, dating and establishing a new relationship post-cancer had the potential to restore the women’s often diminished self- and bodily-esteem.

“Previous research has shown that dating is a top concern for single women post-breast cancer,” says York psychology Professor Karen Fergus. “But there was surprisingly little research in this area. Not much was known about the dating process, its success or the role of cancer in any new relationship.”

Fergus of York’s Faculty of Health and her grad student Darya Kurowecki, currently at the University of Ottawa in the Faculty of Medicine, looked at the process that 15 heterosexual women, most now in intimate relationships, underwent following breast cancer and surgery. They found that these women went through a process often over several years before feeling ready to date. Once they met someone, there was a series of successive disclosures, which tested whether or not the man could accept them as cancer survivors, scars and all. If not, the women decided not to pursue the relationship further.

“It’s a stigmatized illness. It can recur and it entails disfiguring surgery,” says Fergus. “In addition, there are often other impairments or losses.” A woman could be thrown into early menopause, before having had the opportunity to have children. There are usually self-confidence issues following breast cancer and surgery and that can affect the woman’s ability to start new relationships.

“The first level of the man test is, can they accept I’ve had a cancer history. The next step is, will they accept the fact I’ve had a disfiguring surgery – a lumpectomy, one or two mastectomies, and/or reconstruction,” says Fergus. “Basically, what they’re doing is testing the safety of this budding relationship, but they’re also playing their cards close to the vest. They are protecting themselves in that they’re not going to subject themselves to more potential rejection and vulnerability than is necessary.”

If the men were accepting of these disclosures, then the couple needed to discuss some serious issues and that seemed to accelerate the emotional intimacy of the new relationship, she says. They may need to discuss the fact the cancer may recur or that they may carry a cancer gene that could be passed on to their children, or perhaps they are no longer able to conceive children.

The third or ultimate step is physical intimacy and revealing their scars.

“What struck us the most,” says Fergus, “is their vulnerability combined with this incredible amount of courage and strength that it takes for these women to put themselves out there in the dating world and later, to share their cancer history both verbally and physically with a prospective partner. That combination of profound vulnerability and strength is admirable.”

To Fergus, the “man test” is great.  “At one point Darya said to me, ‘you know, it’s as though these men are being tested’ which led her to develop this category.”  It’s an empowering concept, says Fergus, because “it turns the feeling of inferiority on its head and says are you going to be strong enough to accept my history and accept me as I am. So instead of please don’t reject me, it’s are you going to be strong enough to accept me.”

As it turns out, for many that answer was yes. That is a message of hope Fergus wants women to get.

“For a lot of women who are single and don’t know other women who have a satisfying new relationship after cancer, they don’t even know that’s possible,” says Fergus. “The fact that we were able to go and find these women and interview them, and not withstanding these were women willing to come forward – our findings did affirm that fulfilling intimate relationships were possible after cancer, and this truly is a message of hope.”

The research, “Wearing my Heart on my Chest: Dating, New Relationships, and the Reconfiguration of Self-esteem after Breast Cancer”, was published this year in the print issue of Psycho-Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer.

By Sandra McLean, YFile deputy editor

Before there are any telltale behavioural signs of dementia, a simple test that combines thinking and movement could point to those with a heightened risk of developing Alzheimer’s disease and who are already having visuomotor difficulties, according to new research out of York University.

That’s important as it can alert clinicians and otherwise healthy adults to potential problems with daily functions, says York Professor Lauren Sergio.

Study participants were given increasingly demanding visual-spatial and cognitive-motor tasks to see if the tests could tease out those who were having difficulty even though they were not showing outward signs of the disease. The participants were divided into three groups – those who had already been diagnosed with mild cognitive impairment (MCI) or had a family history of Alzheimer’s, and two control groups – young adults and older adults – without a family history of Alzheimer’s disease.

Sergio of York’s School of Kinesiology and Health Science in the Faculty of Health and PhD Candidate Kara Hawkins found that 81.8 per cent of the participants who had a family history of Alzheimer’s disease and those with MCI displayed difficulties on the most cognitively demanding visual motor task.

The study, Visuomotor Impairments in Older Adults at Increased Alzheimer’s Disease Risk, was published yesterday in the Journal of Alzheimer’s Disease.

“The brain’s ability to take in visual and sensory information and transform that into physical movements requires communication between the parietal area at the back of the brain and the frontal regions,” says Sergio. “The impairments observed in the participants at increased risk of Alzheimer’s disease may reflect inherent brain alteration or early neuropathology, which is disrupting reciprocal brain communication between hippocampal, parietal and frontal brain regions.”

Detecting impairment to that communication may prove to be an early indication of those at risk for Alzheimer’s disease. A visual-spatial and cognitive-motor test that requires thinking and movement at the same time may help detect subtle changes associated with the disease before the usual cognitive-only tests do. Once Alzheimer’s is visibly noticeable in people’s behaviour there is already significant brain damage, says Hawkins.

Participants were required to complete four tasks on a dual-screen laptop computer. One such task involved moving a cursor in the opposite direction of a visual target on a touch screen, which required the person’s brain to think before and during their hand movements. This is where the most pronounced difference showed between the MCI and family history group and the two control groups.

“In terms of being able to categorize the low Alzheimer’s disease risk and the high Alzheimer’s disease risk, we were able to do that quite well using these movement measures,” says Hawkins. “This group had slower reaction time and movement time, as well as less accuracy and precision in their movements.”

Hawkins says the findings don’t predict who will develop Alzheimer’s disease, but they do show there is something different in the brains of most of the participants diagnosed with MCI or who had a family history of the disease.

“We know that really well-learned, stereotyped motor behaviours are preserved until very late in Alzheimer’s disease,” says Hawkins. These include routine movements, such as walking. The disruption in communication will be evident when movements require the person to think about what it is they are trying to do.

There has been little research into visuomotor impairment in those with MCI or Alzheimer’s. This study shows that there are measurable impairments in visuomotor control in those participants who are already at increased risk of developing the disease.

By Sandra McLean, YFile deputy editor

Adults with autism spectrum disorder (ASD) are at a higher risk of being sexually victimized than those without the disorder, according to a new study out of York University.

Seventy-eight per cent of the ASD group in the study had at least one occurrence of sexual victimization relative to 47.4 per cent in the non-ASD group. The study also found that a lack of sexual knowledge in those with ASD played a role in increasing the risk of sexual victimization – experiences of sexual coercion, unwanted sexual contact, attempted rape or rape.

“I think what is the most important and the most concerning findings of our study were the high rates of sexual victimization that we are seeing,” says Stephanie Brown-Lavoie (MA ’11), co-lead of the study along with Michelle Viecili (BA Hons. ’08, MA ’11). Both are clinical-developmental psychology PhD students at York University.

“But the study really pointed to how having a lack of sexual knowledge placed these individuals at risk and that increasing sexual knowledge is a really important avenue for intervention to increase sexual safety,” says Brown-Lavoie.

The researchers used an online survey involving 95 adults with ASD and 117 without, ranging in age from 19 to 43. “Research has shown that with anonymous questionnaires you may get more honest answers because there isn’t a researcher in front of you and no one is evaluating your responses,” says Viecili.

Although she admits the participants cannot be considered representative of the entire population, Viecili says, “I think we really had a good picture of what rates could look like with this type of survey.”

As Brown-Lavoie points out, they asked about specific situations, not just a general “have you been sexually victimized” question. “Some may not know that the experience they had is actually classified as sexual victimization. But if you give them a specific situation, like someone touching you inappropriately after you said no, they may say, yeah, that has happened to me.”

After getting some idea of the rates of victimization experienced, the study delved into the reasons. It looked at where both the ASD and non-ASD groups got their information.

“We were interested in identifying what was related to higher risk. There seems to be a really pronounced difference,” says York Professor Jonathan Weiss, Canadian Institutes of Health Research Chair in Autism Spectrum Disorder Treatment & Care Research. “Adults on the autism spectrum tended to get their information from non-social sources, but that’s not what we typically saw for adults who weren’t on the spectrum. Adults without ASD got a lot of their information about sexual behaviour and sexual safety from social sources.”

Non-social sources of information could include television, the internet, pamphlets and even pornography, whereas social sources would include parents, teachers and peers.

Brown-Lavoie and Viecili first recognized there may be an issue with how much knowledge adults with ASD had regarding sex and romantic relationships when they worked with students in the Asperger’s Mentorship Program and during their clinical work with individuals with ASD.

“In general, there was a lack of knowledge around romantic relationships and sex,” says Viecili. “We found we were trying to fill in the gaps for students we were working with and clients that we had, and really recognizing there wasn’t literature out there to support what we were seeing.”

Viecili and Brown-Lavoie approached Weiss with the idea of doing research to see if what they were witnessing held true for a larger sample of adults with ASD compared to those without ASD.

“I think there is a larger story that is emerging about the risks of victimization of people with ASD across the spectrum and the lifespan,” said Weiss. “Increasingly, clinicians and researchers are identifying this topic as something that’s important if we’re to understand and promote health and well-being.

“In the end, I hope what this research does is call attention to a really important issue that needs more investigation and that it spurs further research, more detailed and larger scale research. I think that would be a wonderful outcome of this study, that more people pay attention to this and start talking about it, especially the research and clinical communities.”

Veicili and Brown-Lavoie hope it will also lead to more acceptance of teaching sexuality to individuals with disabilities and how it could perhaps lead to less victimization. Already the pair has taken their research back to the community, where they have held one workshop for 60 clinicians and another for parents.

Sexual Knowledge and Victimization in Adults with Autism Spectrum Disorders was published online in the Journal of Autism and Developmental Disorders and is now available in the print edition.

By Sandra McLean, YFile deputy editor