Article one

Yoga and Breast Cancer

“Tell your students that it will enable them to maintain positivity, and allow them to deal with what comes up without fear.”

Satya answers my question thoughtfully and yet without hesitation. She is once again dealing with the issue of breast cancer, 11 years after her initial diagnosis, this time in the form of aggressive secondary breast cancer.

Before this episode of her illness she talked to me about how she had dealt with her initial breast cancer through yoga, knowing that this was a field of yoga in which I specialise. I had just completed giving her a Yoga Nidra ¹(deep relaxation), and asked her how her yoga practices were helping her now.

Her answer humbled me and reminded me of the very great privilege I have had in watching this dedicated and spiritual aspirant of Yoga deal , through meditation, relaxation, chanting and other yoga practices, with the invasion of her body, while living at home and being cared for by her sons and friends. Her palliative care has been drug- free.

Most of us will not use yoga to the same extent as Satya in dealing with breast cancer. However, her words confirm a great amount of research that has shown the many benefits of yoga.

Research conducted by the Vivekenanda Yoga Research Foundation in India has shown that yoga practices of breathing, chanting, visualisation and meditation have notably lessened the degree of anxiety and depression that women can experience from diagnosis and through treatment of breast cancer. (2009, Raghavendra R et al p 17, 1—8)

Other research they have undertaken has shown the lessening of nausea from chemotherapy experienced by women who did a daily integrated² yoga program while receiving chemotherapy.(2007 Raghavendra R et al 16:462—74.)

In America, research conducted at the M.D. Anderson Cancer Centre in Texas has shown that women experienced a greater sense of well-being from a twice- weekly yoga practice based on breathing, relaxation and gentle movements, during the time of their radiation treatment .(2006 , Cohen L. at the 42nd annual meeting of the American Society of Clinical Oncology) While a study at the Ohio State University found that daily relaxation reduced the risk of breast cancer recurrence.(2009, Sydney Morning Herald)

A web search will reveal many more studies highlighting the physical, mental and emotional benefits experienced by women doing yoga during and after treatment, in addition to their medical treatment.

So, why yoga?

Take a moment to think of someone you know who has ever been diagnosed with breast cancer..…. Take a few minutes to recall the emotions they experience, from diagnosis, through treatment and recovery. Reflect also on the changes to their life, including relationships that they went through. Now remember the actual physical effects they experienced.

1. Systemised by Swami Satyananda.

2. Integrated yoga practice refers to all practices in one session, breathing, pranayama, basic postures, meditation, relaxation.

I’m sure you will have recalled emotions such as shock, disbelief, grief, confusion giving way to their very strong will to survive. You may have also remembered how important hope and love were for them, from which their amazing resilience and courage continues to grow. I am certain you will have remembered how their usual routines had to change for a while, and how their relationships were affected. Perhaps the physical effects they endured, that seemed so unrelenting, were the easiest to recall.

In other words, the effect of this illness occurs on many personal and inter-personal, as well as physical, levels.

The effects of yoga

I’m sure this is why yoga can be so useful. Yoga offers a means to work on ourselves on all these levels in a way that respects and honours whatever state our body is in.

The breath can bring an agitated mind and tense body to a calm mind and relaxed body. Pranayama³can balance the nervous system. “Witnessing practices” can enable awareness of what is happening in the present, without being drawn into fear or another negative emotion. Chanting will change a negative mind to a positive mind.

My students have told me that visualisation helps them to see the cancer cells being destroyed. The deep relaxation of yoga gives them rest, when fatigue overtakes them or they are unable to sleep at night.

They tell me that gentle, then stronger, yoga postures and movements with the breath, based on what they can do, restore their own sense of body and health and give them a sense of bringing about their own recovery. In time, this progression of postures (asana) will re-build their strength and vitality in a way suited to each individual.

At every stage, meditation allows self-defeating thought- patterns to change. As fear and negative thought patterns subside meditation enables us to reconnect with that deep inner sense of constant and pure self that is always present, no matter what else is happening in our lives. From this we are able to face the uncertainties and life changes that dealing with breast cancer bring, knowing that our own self-integrity is intact.

The yoga principles known as the Yamas (precepts to help us relate to the outside world with equanimity) and the Niyamas (precepts to help us relate to our inner world) can also be beneficial.

An example of a precept which helps us deal with the outside world at this time (Yama) is the principle made famous by Gandhi is that of non-violence or “ahimsa”, as it is written in Sanskrit. In times of illness, we need to remember to not be violent to ourselves. Many women have told me that, in the days after diagnosis and while receiving treatment, they could only cope with talking to very few family and friends in order to maintain and conserve their own sense of dignity, positivity and energy.

Purity or “Shaucha” is a Niyama, a way to look after oneself. It may be practised physically, perhaps by drinking lots of water or eating healthily etc to purify the inner body. Mentally and emotionally, it may be by having a refuge in the home, where we can go to replenish and purify our mind.

3. Pranayama is a name given to a set of practices in yoga that use breath and energy (prana) to balance the energy within us. Effects can include calming the nervous system, creating clearer thinking and making us feel better.

As a teacher of yoga

Over the past fourteen years, I have being teaching women who have had or are having treatment for breast cancer. My own learning curve has grown enormously. As well as learning about the nature of breast cancer, I have had to understand the effects of the different treatments, which are many and varied. Similarly, as a teacher, it is essential to know the effects of secondary breast cancer - for example, is it in the spine or liver? Postures will change accordingly. The effects of lymphoedema in the arm or chest, that can affect women who have had total axilla lymph node clearance⁴, is another parameter that needs to be considered.

Yet, as with all yoga, it is possible to work together with each woman to create a yoga practice that is suitable for her, while she is dealing with breast cancer. The womans’ age and type of breast cancer vary and so students include new and young mothers, through the whole age spectrum to older women. Women of all nationalities and backgrounds, including indigenous women, can be diagnosed with breast cancer. It is, after all, currently the most common cancer affecting women in Australia. (2010. NBCF website) The good news is that women are surviving longer and that more and more research is being conducted for prevention, treatment and survival, including in the field of yoga.

Some students will continue their most appropriate practices of yoga from the moment of diagnosis, like Satya. Other students may be totally new to yoga and commence when their treatment is complete. Stephanie was one of the latter. She says:

“Sue proposed that I join a yoga group that was held in our suburb. I was a bit sceptical as I had just finished my treatment on the previous Friday. But, with some encouragement, she came by and collected me on the following Monday and I commenced my recovery program through yoga. I tried to go twice a week. Little by little my aches and pains left. Also, I slept so well after each yoga session. Now ten years after my treatment for breast cancer, I still attend yoga, even though my husband’s job moved us to Paris! It has changed the way I think - I take each moment one at a time and ‘take time to smell the roses’ now.”

Other students will not have known they had a primary breast cancer, and be treated for secondary breast cancer. So, they will attend yoga lessons while having treatment for the rest of their lives. Sue is one such inspirational woman. Courage is a quality she abounds in, and interestingly this transfers to her favourite posture being the yoga posture about courage - the Warrior Posture (Virabhadrasana) . She told me:

“The warrior position is two- fold to me – firstly, I have this overwhelming feeling of peace and being ‘at one with myself’, then I have a feeling of empowerment where nothing is going to defeat me.  I imagine this is what the Warrior Pose was meant to do originally!  Surprisingly, I am at peace with my cancer, I do not consider it the enemy as it is part of me and it has in many ways made me a more tolerant, compassionate and giving person.  Our lives change for all sorts of reasons - mine I feel ultimately for the better because of my experiences and my acceptance of what you cannot change makes you stronger.  My experience with yoga has definitely made me stronger - physically, spiritually and psychologically.”

For me personally, the benefits I have seen from yoga in the women I have taught and the increasing body of research showing positive outcomes, are proof that this ancient system will continue to be of use mentally, emotionally and physically for women who have been diagnosed with breast cancer.

4. Total axilla clearance (taking out the lymph nodes from under the armpit) will eventually lessen, as sentinel node dissection becomes more common. If the sentinel node is taken out and is clear, the removal of the other lymph nodes does not occur. Axilla clearance,along with radiotherapy,can increase the chances of a woman getting lymphoedema.

References

Cohen L. The feasibility of integrating a daily yoga program into the treatment care plan for women with breast cancer undergoing radiation treatment, presented at the 42nd annual meeting of the American Society of Clinical Oncology, representing the MD Anderson Cancer Centre, 2006

National Breast Cancer Foundation. Facts about Breast Cancer in Australia. 2010. http:/ nbcf.org.au

Raghavendra R.M., Nagarathna R, Nagendrab H.R. et al. Anxiolytic effects of a yoga program in early breast cancer patients undergoing conventional treatment: A randomized controlled trial in Complementary Therapies in Medicine, 2009, 17: 1—8

Raghavendra .R.M., Nagarathna R, Nagendrab H.R. et al. Effects of an integrated yoga program on chemotherapy- induced nausea and emesis in breast cancer patients. Eur J Cancer Care 2007, 16: 462—74.

Stephens A. Relax. It’s good for you in “Life & Style”, Sydney Morning Herald, August 20, 2009

It is with my hearfelt gratitude that I acknowledge the inclusion in this brief article of the words of Satya, Stephanie and Sue. Each has given her permission for her words to be included, always in the hope of helping someone else who is undergoing what they have had to face. You are my heroines. AL

©Annette Loudon May 2010