June 2000: Easing Breast Cancer Fear


Ask-the-Expert Online Conference

On Wednesday, June 14, 2000, our Ask-the-Expert Online Conference was called Easing Breast Cancer Fears. Marisa Weiss, M.D. answered your questions about managing emotional effects of breast cancer diagnosis and treatment.

Advice to encourage friend?

Question from twinkle: Hi, my friend was just diagnosed with breast cancer for the second time. I am looking to give her encouragement. What can I tell her to make her feel better?
Answers - Marisa Weiss, M.D. I think that the most important thing, I would say, is to spend time with her, and to listen to what she is saying and feeling. Based on that, you can best understand how you can be most helpful to her. Let her know that you really care about her. And, ask her if she would like you to go with her to doctor's appointments, offer to find important information about treatment options, and try to encourage her to let other people in, also.

What level of concern for red/painful lump?

Question from Abbafan: Yesterday I discovered a lump that I hadn't noticed before in my breast. It is red and painful. I'm going to go to the doctor next week to check it out. I'm concerned because I just found out about a year ago that cancer runs high in my family. I'm only 32. How concerned should I be about this?
Answers - Marisa Weiss, M.D. A breast lump that becomes painful and red very quickly in someone your age is most likely due to inflammation or infection. If this lump persists, go see your doctor immediately. An infection should respond quickly to antibiotics. A biopsy or fluid removal is only necessary if the lump persists, the redness does not resolve, or you are worrying and need reassurance.

Is radiation the last treatment option?

Question from EZguest113: My mother has been told that because her platelets are shot they can no longer do chemotherapy (small cell lung cancer). She will be starting radiation. And she is afraid that radiation is the end....is it? What happens if the radiation doesn't work?
Answers - Marisa Weiss, M.D. Radiation therapy is an important and effective treatment for many types of cancers, including lung cancer. It's best to wait for her blood count to return closer to normal before starting. Her doctor may recommend Neumega, a medication that boosts platelet counts.

Remove blame for daughter's diagnosis?

Question from foreverforu: My best friend's daughter has breast cancer. This lovely woman blames herself for her daughter having been diagnosed with the disease in the first place—"What did I do wrong when raising her?" How can I tell her it's not her fault? Thank you.
Answers - Marisa Weiss, M.D. Why is it that women always blame themselves for what happens to the people they love? I think all of us feel this woman's pain. She is not responsible for her daughter's illness! Her concern for her daughter shows how much she loves her. And, raising a child with such love is the essence of her strong connection with her daughter. This mom needs to shift her thinking, and at this point, support her daughter, encourage her, be with her, and as a family, help her become as healthy as possible. And I think that if this mother's guilt continues, she really deserves compassionate counseling immediately.

What can husbands do to cope with fear?

Question from quaker: What can husbands do to cope with the fear?
Answers - Marisa Weiss, M.D. Clearly, those people closest to us suffer from some of the same fear and uncertainties. It is normal to be scared of something that threatens your life, and the lives of the people you love. But, the anxiety can sometimes escape control. I think that talking to each other, and expressing your fears and uncertainties, makes a huge difference. Don't worry that sharing these fears will make your wife's burden worse. It's best to get it out. You may find out that you have different sets of fears. And, that expressing your fears is another way of showing your love for each other. That can be very comforting. Try to talk to each other during the day and evening, when you're able to think and express yourself most clearly.

Wait time for biopsy results?

Question from emtdmm: I'm scheduled to go for surgery for a lump in my breast, not a cyst, in seven hours. They tell me I won't know if it is cancerous for three to five days. Is this normal?
Answers - Marisa Weiss, M.D. It may take three to five days to do a careful analysis of the lump under the microscope. They have to be extremely careful to come to the right conclusion. The uncertainty stinks! All of you know that so well. While you are waiting, tune into resources at Breastcancer.org so that the information and support can empower you.

How much information to give kids?

Question from flipalot: I am 32 and have breast cancer. My biggest concern is my children, Rebecca 5 and Christopher 3. I talk with them about my condition; however, sometimes I just do not know if I am giving them too much information??
Answers - Marisa Weiss, M.D. The main thing is to talk, talk, and do a lot of listening to what they are saying to you. Don't jump in right away if they are talking and letting you know what their specific concerns are. Then, respond in a gentle way to each of their concerns. After you finish responding, listen again. You will be amazed how much you can learn about what they need and want and find comfort from, by their words and their expressions. There are a lot of resources on Breastcancer.org for this challenging and important topic. Children are very resilient. Avoid whispering between adults, because children will suspect that something is wrong. Children often blame themselves for problems in the family. Talk, love and listen.

Help daughter to cope with mom's hair loss?

Question from kheyala1: How can I help my daughter cope with hair loss from chemo?
Answers - Marisa Weiss, M.D. Hair loss is temporary, but terrible. Go with her to a special hair salon that understands the best way to help a woman deal with this problem. Identify a number of different solutions, including a wig, a nice hat, a soft turban, or just going bald. Listen to what your daughter is telling you, and try to support her choices. Just your being there means so much. And, have fun talking about new hairdos she might experiment with once her hair grows back in.

Suggestions to relieve depression, fatigue?

Question from MelindaB: My cancer is going away, but I'm still awfully depressed. It seems like this stuff never ends. I know much of this depression is from the fever, low white counts, hospital stays.. I have so much to be thankful for, but I'm so tired of fighting. I would just like a time of rest when I felt good. Any suggestions?
Answers - Marisa Weiss, M.D. You yourself said that you need to take time out to heal. I think that the fatigue and the "not feeling like yourself" will linger but eventually resolve over a time that is at least as long as your treatment took. If your treatment took eight months, I think it takes at least eight months to feel like yourself again.

Give yourself credit for all that you have been through. Take confidence in the effective treatment that you've had. Reach out to people you care about, and find a support group or an individual therapist that can help ease your down times. It is the connection to people you care about, places that are beautiful or meaningful, information that's hopeful, and a caring team of doctors and nurses that will be invaluable to you. And very importantly, don't expect too much of yourself. Try to head in the right direction, but understand that you may not feel better and better every day. Some days will be good, some days will be very good, some days will be difficult. Recovery can feel like a bumpy road. All of the things that you have said are very normal. And all of us wish you that you will feel yourself and begin to enjoy your life again, sooner than later.

Precautions to take to avoid recurrence?

Question from sarah378: I am fearful of a recurrence, since my cancer was infiltrating lobular. What precautions beside the every 3 month check ups do you recommend?
Answers - Marisa Weiss, M.D. Please refer into the site to learn about what infiltrating lobular cancer is. Just because you have that type of breast cancer does not mean that you are more likely to have a recurrence. It is reassuring to be followed carefully over time, every three months, with a physical examination, careful talking and listening, and high quality radiologic tests. MRI scans seem to be particularly helpful in women with infiltrating lobular cancer. This type of cancer does seem to be associated with a slightly higher risk of a new cancer forming, in either breast. But, still, this is unlikely.

Emotional advice for pregnant and diagnosed?

Question from nannyfine: Well, I was diagnosed with breast cancer during my 34th week of pregnancy. I am 27 and didn't think I'd get breast cancer this soon. My mother and her sister are both breast cancer survivors. When the baby is born I will have surgery. Any ideas on how I can get through this emotionally? It's tearing me apart.
Answers - Marisa Weiss, M.D. All of us feel for you. At the same time that you are bringing new life into this world, you are worrying about the threat to your own life. Soon you will meet and connect with your own child, which is an amazing, magical moment that many of us have had the privilege of having. Keep your mind on that special thought. Make sure you have a team of doctors that will provide the most effective treatment for you, as quickly as it is safely possible. And, understand that there has been amazing progress in breast cancer treatment, even in the last few years. Breast cancer does not have to be a death sentence. In your family, I am sure it has brought all of you much closer together. Breast cancer during pregnancy, and breast cancer that runs in families, is not necessarily any worse or more life-threatening than cancer in a woman without those factors. We wish you sleep-filled nights, and the chance to experience the joy ahead.

Tips to encourage mom to get mammogram?

Question from ValleyGurl: Is there anything I can do to encourage my mother to have a mammogram? She is dead set against it, but I know she should have one. She is 55 now and going through menopause.
Answers - Marisa Weiss, M.D. Take her out to lunch, and go with her to her mammogram. Tell her that you love her, and that this is an important part of taking care of herself, for everyone who cares about her. Be a nudge!

Soy bad for estrogen receptor positive?

Question from KathyS: Is soy really bad for you if you are estrogen receptor positive?
Answers - Marisa Weiss, M.D. The estrogen-like substance in soy protein is much, much weaker than your own body's estrogen. If a weak estrogen sits in the estrogen receptor instead of the stronger estrogen then this is a good thing. Therefore, I think that eating soy foods which are a healthy source of protein--low or no fat, no cholesterol--as a substitute for meat and chicken is probably a healthy choice. I do not feel comfortable with the use of soy supplements--powders or pills--which may give you too high a dose of plant-like estrogens. Fortunately, or unfortunately, soy foods don't taste good enough to eat too much of them.

Risk of heart problems on chemo?

Question from Helen: Dr. Weiss, I got CHF from chemo (AC). Why don't the oncologists tell you more about it during chemo? Now I am on lots of heart meds and my BP is so low.
Answers - Marisa Weiss, M.D. Adriamycin chemotherapy is associated with a very low risk of heart problems. But even though the risk is low, if it affects you, it feels like 100 percent risk. Hopefully, the medications and other types of treatments can help keep your heart strong. Your doctors will probably encourage you to get your body in the best condition possible, to reduce the stress on your heart.

Tamoxifen's affect on weight, memory?

Question from Karen: Dr. Weiss, please tell us about Tamoxifen and what is known about weight gain and memory loss?
Answers - Marisa Weiss, M.D. Tamoxifen is an "anti-estrogen therapy." It blocks the effect of estrogen on the breast. Estrogen stimulates breast cell growth; tamoxifen reduces breast cell growth. Tamoxifen reduces the risk of breast cancer recurrence, it reduces the chance of developing a new breast cancer unrelated to the first breast cancer, it keeps bones strong, and it reduces cholesterol. There is tons of information about tamoxifen on the Breastcancer.org site. This is a powerful medicine that's appropriate in many women, but not all women. In a large study, weight gain was no more common in women taking tamoxifen than it was in women taking a sugar pill. Memory loss can be due to so many things, and perhaps tamoxifen may also contribute to memory loss in an individual woman. We know that many women are struggling with the problems of weight gain and memory loss, and there is a lot of information available on this at Breastcancer.org.

Pregnancy, breastfeeding possible for survivors?

Question from kristin: I am a 34 year old 2-year survivor hoping to have children someday. What is the chance of young survivors having a successful pregnancy? Will I be able to breastfeed?
Answers - Marisa Weiss, M.D. If your period returns, then you are almost just as likely as a woman your age without breast cancer, to get pregnant and have a successful pregnancy. You have already made it past the two year "waiting zone"—congratulations! I'm sure it's been a difficult wait. Breast feeding is safe after breast cancer, to you and your baby. If you had radiation to the breast, your breast will not be able to make a significant amount of milk. But it's OK to allow your baby to suckle on that breast, to give your other breast a rest. If you have had a mastectomy, and only have one breast remaining, you will be amazed by how much that one breast can compensate. We wish you luck in this exciting project.

Normal to fear moving on with life?

Question from molly: I want to move beyond, to forget that I ever had breast cancer, but I get scared that if I get on with my life, it will come back. Is this normal?
Answers - Marisa Weiss, M.D. Moving on with your life, trying to recapture the pleasure of living, trying to do things that make you feel fulfilled and connected to other people, will only enhance your life, make it meaningful, and improve your health. Of course, you still need to take care of yourself, avoid smoking, try to exercise, eat a well-balanced diet, limit your alcohol intake, try to control your weight, and be followed closely by your team of caring doctors and nurses and other health care professionals. All of you on the conference know so well about the big whale--the fear and uncertainty--that moves into your living room with a breast cancer diagnosis. Moving on helps to shrink the whale. And taking care of yourself and connecting to others helps keep that whale small. There is so much on Breastcancer.org's site that helps you manage the fear of breast cancer.

Second opinion after suggested hysterectomy?

Question from karen: After seeing an oncologist, he suggested that I have a complete hysterectomy and that I should take Tamoxifen. Should I go for a second opinion?
Answers - Marisa Weiss, M.D. Yes! I would go for a second opinion. The risk of uterine cancer from Tamoxifen is less than one percent (less than one woman out of one hundred will have this problem from Tamoxifen). Removal of the uterus to prevent this problem is not standard care. Perhaps there are other reasons why your doctor has made this recommendation. A second opinion is a great opportunity to get more information to make the best decisions possible.

How to explain cancer to child?

Question from Rainbow: How do you explain to a child who has no knowledge of biology what cancer is?
Answers - Marisa Weiss, M.D. The answers to this question depends on the age of your child, and the personality of your child. There are many resources available to you at Breastcancer.org at the Resources section of the site, including books and audio tapes. Look in Dealing With Breast Cancer Fears on the site.

Editor's note: See Talking to Your Family and Friends About Breast Cancer for more.

Extent of scarring after mastectomy/reconstruction?

Question from KatieD: My mom is about to have a mastectomy and I was wondering about scarring involved with the reconstruction (trans) and complications with the reconstruction.
Answers - Marisa Weiss, M.D. After your mother's breast has been removed, the doctor will try to recreate a new breast by borrowing extra tissue from her belly, and moving it up into the breast area. This leaves a scar across your belly as well as at the breast area. We have beautiful illustrations of this procedure in Moving Beyond, Reconstruction.

Relief for overwhelming nighttime fears?

Question from Belle: My nighttime fears are so big, I dread going to bed at night. What can I do?
Answers - Marisa Weiss, M.D. First, understand, that it's very normal for your fears to be bigger at night than during the day. The ceiling of your bedroom becomes the movie screen of all your nightmare movies. Before you get into bed, try to identify what's most scary to you. Address one fear at a time. If you have a burning question, talk to your doctor to try to get an answer to that question. Whenever you can, try to resolve some of the uncertainty that can be so tough to live with. You will be amazed by how many other women share your same fears. Join a support group, participate in the discussion boards on Breastcancer.org, call the Living Beyond Breast Cancer Survivor's Help line (1-888-753-LBBC)--it's there for you.

Connect with people, places, and thoughts that are encouraging, supportive, and hopeful. Avoid people that pull you down, or contribute to your anxieties. Imagine beautiful places that continue to give you comfort, and imagine yourself there. Have faith that you are part of a community of people that cares for you and that will be there for you. Have faith in the effectiveness of the treatment that you've had. Don't expect too much from yourself. You have been through so much. A slow recovery does not mean that you are at higher risk for having cancer again. There are many other suggestions and ideas at Breastcancer.org at Dealing With Breast Cancer Fears, and we invite you to join the discussion boards, and to call the LBBC helpline to connect to other women who share many of your concerns.
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