I think it's safe to say that a large amount of women in this world lack self confidence. Tack on a few incisions and scars, some lop-sided or altogether missing breasts, a handful of scattered blue tattoos, a head full of newly sprouting hair, swelling arms, drug-damaged fingernails and toenails, damaged veins, alien-like ports protruding from underneath skin, unpredictable hot flashes, and a foggy brain and it's clear that women surviving breast cancer may have a few of their own issues concerning self confidence. It doesn't take science to prove this reality -- although there are studies out there that do confirm and validate that breast cancer survivors struggle with positive self images.

Results of a study released Wednesday reveal that the vast majority of breast cancer patients in Taiwan lose self confidence after having their breasts removed. The study shows that 90 percent of participants feel they have lost their beauty and femininity following a mastectomy. Women worry about their partner's perception of them after such radical appearance changes. They doubt their roles in their workplace and families. They are even afraid of having sex with their partners. And if the patients' relationship with their spouses are not good in the first place, breast removal surgery will lead to divorce about 10 percent of the time.

There is no doubt that female roles vary from country to country -- and what studies show in Taiwan may not be completely applicable to women in the United States. But there is one universal truth that knows no boundaries -- all women recovering from the ravages of breast cancer will encounter struggles. Because breast cancer does not discriminate when it comes to compromising the self esteem of its targets.

Just before my treatment for breast cancer began and during a consultation about what chemotherapy drugs I was about to receive, my oncologist stepped away from my exam room to check on something. When she returned to the room, she told me that she was determining whether or not I qualified for a clinical trial. I had no idea what this meant at the time. All I knew was what she told me -- that my prognosis was too good at that moment to qualify for anything currently under study. I did not fit a profile for anything. I was not a candidate for a clinical trial.

I now know that clinical trials are a critical component of research -- they validate a drug's success or weakness and they provide hope for many who may be at the end of their treatment rope and need something new to consider. A clinical trial is a comparison of standard treatments to newer treatments in an effort to discover better methods for the diagnosis and treatment of cancer. Doctors, scientists, and other health professionals conduct these tests according to strict guidelines set by the Food and Drug Administration -- which establishes mandatory guidelines to ensure the maximum safety of the patient.

Clinical trials rely on volunteers -- and sadly, there is a current shortage of patients willing to participate in trials. Experts say that, for the past few decades, just five to 10 percent of all cancer patients in the United States have joined a clinical trial. There is an urgent need -- because the demand for willing, eligible participants far exceeds the supply. Some experts are even recommending that the small pool of candidates that does exist be rationed to only the most important cancer studies -- leaving other studies with no hope for completion. There is no good solution in sight. But the reasons for the shortage are becoming apparent. It's not that patients are unwilling to join. It's that they are unaware, uninformed, not even sure this opportunity is possible -- because doctors are not suggesting trials to their patients. Treatment on a protocol is more demanding for doctors than routine medical care. And it costs doctors to submit to a trial. And trials burden doctors with regulations and paperwork. And some doctors worry about litigation if something experimental goes wrong. So they often don't approach the topic -- and the result is that a wonder drug may sit in a dark freezer because there are not enough people to test it. This potential wonder drug may never show promise, may never save a life, may never see the light of day.

So I guess my oncologist was ahead of the game in this matter -- she compared my diagnosis and prognosis with the needs of all available clinical trials and found that there was not match. Had she not done this, I would have never thought to ask about the possibility -- which is exactly what patients should do instead of waiting for a doctor to make the suggestion. Because it may never happen.

For more information on clinical trials, please visit the Coalition of Cancer Cooperative Groups.