A diagnosis of breast cancer can be terrifying. The good news? Although an estimated 225,000 cases of breast cancer are diagnosed every year, the mortality rate is rapidly decreasing, thanks to early detection, aggressive treatments and new conclusions regarding hormone use. The American Cancer Society’s statistics show that in 2005 there were more than two million survivors of breast cancer in the United States alone. Even so, the moment of diagnosis can still induce shock, fear and depression.
“It felt like a bad dream,” says Cinthia Reed, who, days before her 47th birthday, learned she had early stages of breast cancer. “All I could think about was my 10-year-old daughter waiting for me outside. I didn’t know how to keep it together in front of her.”
When Reed, who is a widow and bringing up her daughter alone, finally got the courage to leave the examining room and greet her daughter, she says she didn’t say a thing about the cancer. “I didn’t want to worry her, and anyway, I couldn’t get myself to say the words.”
John Kleinbaum, a clinical psychologist and program director at The Wellness Community of Southwest Florida, says that after receiving a diagnosis of cancer, people experience fluctuating emotions that include shock, anger, sadness, and denial.
“It’s a real challenge to simply accept that your life is now changed forever,” he says. “It often takes weeks or months before people can fully engage in their recovery.”
Reed says it took about three weeks before she felt she had a grip on her situation. “Right away, I started thinking about wills, about dying. I got pretty maudlin,” she says. Reed admits she’s one of the lucky ones; her condition required only removal of the small tumor—a lumpectomy—followed by several weeks of radiation therapy. Before treatment she spent a long weekend camping with her daughter. “One thing this experience has inspired in me is to spend more time with the people I love—and enjoy the life I still had,” she says.
It takes time to sort through all your emotions, says Dr. Deanna Doyle-Vallery, an area-based obstetrician and gynecologist. “My advice is for them to understand that there is a natural process we undergo when we are given life-challenging news like this,” she says. “There are decisions to make, and the better prepared you are to make them, the better off you’ll be.”
Doyle-Vallery, who serves on the board of Breast Health Sarasota, Inc., also advises patients to “trust your health care team. Your family and friends will all try to give you advice and tell you about the newest treatments. Don’t overload yourself with too much information because it can be overwhelming. Trust your doctors and follow their treatment plan; they’re there to support you. Focus on trusting them and getting better.”
After the initial shock come “the rigors of the treatment itself,” says Kleinbaum. “On top of all of the emotional weight, the woman now has to face the adverse physical affects of surgery, chemotherapy, radiation.”
The end-of-treatment phase can also be stressful, says Kleinbaum. “Before this, you had the support of a full medical team—nurses, doctors, technicians, and office staff. Now you feel alone, alienated.”
Both Kleinbaum and Doyle-Vallery urge cancer patients to build a strong support system. “Tap into your local wellness community,” says Doyle-Vallery, “especially if you don’t have a strong support system at home. Find a safe place and speak to other people who have experienced what you’re going through.”
Kleinbaum couldn’t agree more. “The most important aspect of recovery is to find a supportive environment. If you don’t have this at home, then reach out to community support groups. There’s no better comfort than to speak with people who are also experiencing it. In fact, there’s a real gallows humor among survivors. A favorite response, for instance, to [the greeting] ‘Glad you’re here,’ is ‘Glad I’m anywhere.’”
Reed says that the few times she found herself getting angry during the treatment period were when friends or family would suggest that she change her diet or lifestyle. “It sounded to me like they were blaming me for ‘getting’ this,” she says. “That maybe if I had eaten more raw vegetables, I’d be OK. And although I want to be healthy, it was hard enough for me to get up every morning and just get through the day—without having to change my life.”
This is a typical response from loved ones, says Doyle-Vallery, but it’s not always helpful. “Yes, it’s a general rule of thumb that you should keep your weight down, avoid alcohol abuse and eat healthily in order to fight the disease process,” she says. “But cancer is not discriminatory; it comes to all sorts of people, and to imply that somehow someone did something wrong because she has cancer is uninformed.”
Kleinbaum says that cancer can affect lives in a positive way. He calls people who have gone through cancer “victors.”
“Most people feel that they have been changed by cancer,” he says. “It’s not unusual for a cancer victor to feel she is stronger because she survived this challenge. Often cancer victors reorder priorities in their lives. Some report a deepening sense of spirituality. People ask themselves big questions like ‘What do I want my life to look like now?’”
Reed says she understands that sentiment. “Although I’m still scared, I also feel more certain about what’s important to me,” she explains. One of the first things she did after receiving her diagnosis was to quit her job. “Even though I’m facing tough financial times, the job wasn’t good for me. So I’ve decided to go back to school and take up something new,” she says.
Breast cancer doesn’t end with the final chemotherapy or radiation treatments. Reed and others live with the daily knowledge that the cancer may come back. It’s important they find adaptive strategies to keep healthy and sane. Colleagues, friends and family also have to realize that just because treatment is over, these women may not be able to spring back into their pre-cancer routines.
Professionals in the wellness community often refer to cancer survival as running a marathon, not a sprint. “Continue to follow up with your doctors for routine physical exams and breast exams,” says Dr. Caryn Silver, a breast cancer specialist with Florida Cancer Specialists. “Continue to do monthly breast self-exams. Since there is data suggesting that high body fat might be associated with breast cancer, I encourage women to get 30 minutes of aerobic exercise a day—six days a week. That might sound excessive, but most women find it therapeutic for body and mind.”
Below are some other coping strategies for dealing with life after the diagnosis:
· Find a support group: Whether it’s family, friends, or a community-based program, share your experiences with people who will really listen.
· Give yourself a break: Windows need washing, and the laundry is piling up? Let it go. Focus on your own immediate needs and let unimportant tasks fall to the wayside.
· Ask for help. People want to help, so give them specific tasks to do. Shopping, laundry, childcare—delegate!
· Communicate with your doctors: Schedule regular visits, ask questions, follow treatment plans. Even after a mastectomy, routine mammograms are necessary.
· Exercise: Find something you enjoy—biking, walking, a fitness center—and add a regular fitness routine to your life. Start slowly.
· Pamper yourself: If finances allow (or if friends contribute), now is the time for massage, acupuncture, and spa treatments. Your body has undergone a tremendous assault; treat it kindly.
· Regain a healthy body image: Most lingerie manufacturers offer sexy, sporty and demure bras and swimsuits for breast cancer survivors. For women who have lost their hair during chemotherapy, wig options are endless. Contact your local American Cancer Society office for stores and mail order options.
· Don’t blame yourself: Cancer doesn’t discriminate. You are not to blame for this. Millions of women are experiencing this journey. And millions of women have survived breast cancer. You’re a survivor, too.
Local breast cancer support groups:
The Wellness Community of Southwest Florida offers a wide variety of programs, always at no charge, and all intended to help cancer patients and their loved ones play an active role in the recovery process. TWC programming is offered in a home-like setting where you can join a community of others fighting the same disease. Services include professionally facilitated support groups, relaxation and visualization sessions, light exercise programs, nutrition workshops and educational programs. All services are offered to both cancer patients and their caregivers. On Oct. 26, Dr. Caryn Silver will present “Living with Advanced Breast Cancer” at the Stonewood Grill in Sarasota. The lunch and seminar are free and offer an excellent opportunity for women to learn about coping with breast cancer. Call for reservations. 3900 Clark Road, Sarasota (941) 921-5539.
Breast Health Sarasota, Inc. provides a wealth of early detection and breast cancer prevention services to the community. Revenues are used to facilitate breast cancer prevention and to help women and their families in need. 3663 Bee Ridge Road, Sarasota (941) 927-2226.
The Breast Cancer Rehabilitation Program of Sarasota Memorial Hospital offers a full spectrum of physical rehabilitation for the breast cancer in a supportive environment. Services include post-operative physical or occupational therapy, general exercise and fitness, and lymphedema management. Each program is individually designed based upon the patient's needs and current stages of treatment. This program is staffed by a physical therapist trained in the special needs of the breast cancer survivor and modeled after the nationally renowned "Recovery in Motion" breast cancer rehabilitation program. Info: (941) 917-4516.
· 96 percent of women who find and treat breast cancer early will be cancer-free after five years.
· Early detection of breast cancer, through monthly breast self-exams and annual mammography after age 40, offers the best chance for survival.
· Over 80 percent of breast lumps are not cancerous, but benign.
· You are never too young to develop breast cancer. Breast self-exam should begin by the age of 20.
Helping a Loved One with Breast Cancer
· Call or send a card to convey "I'm thinking of you."
· Don't relay others’ negative experiences with breast cancer.
· Avoid giving too much advice.
· Take her to lunch, a movie, or shopping.
· Babysit the children at your home.
· During treatment do things for her that might be difficult—e.g. shopping for school clothes, getting gifts/cards for birthdays or holidays, or taking the children for haircuts.
· Encourage her to do as many of her daily activities as possible. Don't encourage helplessness or "feeling sick."
· Drop by for 15-20 minutes when you can, but call first. Don't assume sickness requires rest at the expense of communication.
· Cook dinner. Offer a choice of two courses and bring the food in disposable containers.
· Make your offers of assistance specific. If you say, "Call me any time for anything," she probably will not ask.
· Offer to run one or two meaningless errands a week for the family. Pick up stamps, milk, dry cleaning, etc.
· Share your humor. Even if it isn't funny today, it may be relished later.
· Allow her to feel sad or express her worst fears. Sometimes the greater part of the cure is the release of fear.
· Say the word "cancer" around her and talk about the real life you are living. This will help her feel more involved with the world of normalcy.
· Most of all, be there for her and don't forget to remind her that you care.
Common types of breast cancer
In situ breast cancer: Refers to a type of cancer in which the breast cancer cells have remained contained within their place of origin; they haven't invaded breast tissue around the duct or lobule.
Ductal carcinoma in situ (DCIS): Refers to abnormal cells in the lining of a milk duct that haven't invaded the surrounding breast tissue. This is early-stage breast cancer. Almost all women with DCIS can be successfully treated, and no evidence suggests that DCIS affects a woman's life span.
Lobular carcinoma in situ (LCIS): LCIS means that abnormal cells are contained within a lobule of your breast, but they haven't invaded the surrounding breast tissue. Whether LCIS is an early form of breast cancer or is just a marker for the future development of cancer remains a point of controversy in the medical community. However, experts do agree that if you have LCIS, you're at an increased risk of developing breast cancer in either breast in the future.
Invasive breast cancer: Invasive (infiltrating) breast cancers are those that break free of where they originate, invading the surrounding tissues that support the ducts and lobules of your breast. The cancer cells can travel to other parts of your body, such as the lymph nodes.
Invasive ductal carcinoma (IDC): IDC accounts for the majority of invasive breast cancers. If you have IDC, cancer cells form in the lining of your milk duct, break free of the ductal wall and invade surrounding breast tissue. The cancer cells may remain localized—staying near the site of origin—or they can spread (metastasize) even farther throughout your body, carried by your bloodstream or lymphatic system.
Invasive lobular carcinoma (ILC): ILC starts in the milk-producing lobule and invades the surrounding breast tissue. It can also spread to more distant parts of your body. With ILC, you might not be able to detect a breast lump. You may perceive only a general thickening, or a sensation that your breast tissue feels different. ILC can be harder to detect by touch, and it's also less likely to appear on a mammogram.