Breast Cancer Basics and Beyond

Hunter House Inc., Publishers

Contents

Foreword.....................................................................................................xiIntroduction.................................................................................................11: Diagnosis.................................................................................................72: A Postdiagnosis Checklist.................................................................................423: Facts, Fiction, and Urban Legends.........................................................................684: Types of Breast Cancer....................................................................................895: A Primer on Risks, Part I: Age, Genes, and Ethnicity......................................................1246: A Primer on Risks, Part II: Obesity, Hormone Replacement Therapy, and Other Exposures.....................1567: Surgery...................................................................................................1748: Radiation Therapy: Medicine's High-Energy Treatment.......................................................2079: Chemotherapy..............................................................................................23310: Hormone Therapy: Counteracting Estrogen..................................................................26511: Recurrence: If Breast Cancer Comes Back..................................................................28212: A Final Word: Life Beyond the Odyssey....................................................................292Appendix: Researching Breast Cancer and Finding Support via the Web..........................................304Notes........................................................................................................310Suggested Reading............................................................................................315Resources....................................................................................................321Index........................................................................................................355

Chapter One

I wanted it to be a lie. I sat down and stared out the window and imagined that if I sat very still all of this would just go away. But of course that didn't happen. -Diahann Carroll, actress

When word of the diagnosis comes, however it comes-face to face with your doctor or from a nurse over the phone-life splits instantaneously into distinct parts: the time before breast cancer and the time afterward. There's no moving backward in time. A breast cancer diagnosis brings the meaning of mortality front and center. Life from the point of diagnosis onward, survivors say, is viewed through a different lens.

From a medical viewpoint your diagnosis is a sequential process that very likely may have begun with you. You may have noticed a telltale sign such as a lump, a discharge, or a reddening or deeper discoloration of the skin. But as is often the case, the symptom may have been invisible and painless, revealed to you and your physicians only after a routine test, such as a mammogram or ultrasound.

Naturally, reactions vary to the prospects of breast cancer. No two people respond identically. You may react calmly to the news or respond with a sense of shock, disbelief, sadness, rage-or some indescribable combination. The diagnostic process may mark your first encounters with myriad medical tests and the likelihood of surgery.

Mindful of all these possibilities, this book is intended as a resource for anyone who has been told that she-or he-will be treated for early breast cancer (which involves a tumor that has not spread to a distant site). Your cancer may have been discovered at any one of several stages, from the very earliest point in a tumor's evolution to a stage in which it has invaded deeply in the breast. Your adjoining lymph nodes, in the armpit, may show evidence of the cancer or may be free of the disease. Whatever the case, this book has been written to help you.

In this chapter you'll meet people who recount the moment when they found a lump or were told of a suspicious shadow on a mammogram. Later in the chapter you'll learn what doctors think about the role of mammography and other imaging procedures. The purpose of the biopsy is discussed, as is the range of emotional responses that occurs with the conveyance of unfavorable health news.

But take a deep breath. No treatment decisions have to be made within a week or so after diagnosis, even if you are facing care for invasive breast cancer. The key to emerging from the jolt of the diagnosis is to understand where in this medical odyssey you've been and where along its paths you have yet to go.

Noticing a Lump or Other Symptom

Finding a mass, the symptom most often associated with breast cancer, is a sobering discovery. You may have noticed the abnormality during a routine self-examination. Your doctor may have found it during a physical, or your spouse or partner may have come upon it during lovemaking. Palpable growths are not the only way breast cancer makes its presence known. Symptoms of the disease are numerous and insidious.

Your lesion may have been discovered on a mammogram and may be far too small to palpate. Or it may have developed in a nearby lymph node, producing a nodule in the armpit. Some people notice a dimpling in the breast, pronounced changes in skin texture, a discharge, or an eczema-like rash affecting a nipple.

While breast cancer usually develops silently and produces no discomfort, some patients do report episodes of breast pain preceding their diagnosis. Certain forms of the disease have very conspicuous and striking symptoms. Paget's disease, a very rare form of breast cancer, can cause a crusting and scaling around the nipple. Inflammatory breast cancer can trigger an intense reddening on the chest. Some patients who have been diagnosed with inflammatory breast cancer report itchiness and swelling among their symptoms, which they initially mistook as the prelude to their menstrual cycle. Paget's disease and inflammatory breast cancer will be discussed in greater detail in Chapter 4, "Types of Breast Cancer."

Most who seek medical attention do so after discovering a suspicious lump. Forty-five-year-old Lynne J. discovered one while showering.

I had been really busy. I'd noticed a couple of times while taking off my bra that my left nipple seemed to point a little off center. I somehow thought my bra was too tight and I needed to buy new bras. One day in the shower, while soaping up, I felt a hard, gravelly lump in my left breast. I made the immediate connection with my nipple's appearance and knew that the lump shouldn't be there, and it was probably bad news.

I was traveling at the time. For days, I kept touching my breast to see if the lump was still there. It always was. When I got home, I called the doctor's office right away, but at first I let them talk me into an appointment far in the future for a "checkup." My fear of having this lump confirmed as breast cancer had to battle my fear of not having it looked at and treated. I finally called back and got an...