October 2001: Quality of Life

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Stressed about family history of cancer?

Question from Milly: I have a family history of breast cancer, and it is constantly on my mind to the point where I am starting to obsess about it. How can I get past this?

Answers —Patricia Ganz, M.D.: If possible, you should find a clinical program, either in a breast center or a cancer center, where they are working with high-risk individuals, so that you can get accurate information about your risk and things you can do to reduce your risk of getting breast cancer. There are breast centers at many cancer centers and community cancer centers with people who are experts in counseling women who have family histories. So a local referral would be the first step.

Marisa Weiss, M.D., president and founder: Frequently, a person's sense of her own risk is usually greater than her calculated risk once her family history is reviewed carefully at one of the centers. If, however, you are in fact at high risk, there are some effective strategies and practical things that you can do to help reduce your risk.

Is experience over when treatment ends?

Question from Penny: Now that my treatment has ended, many family and friends try to change the subject when I try to talk about what I have been through. Am I supposed to pretend this has never happened now?

Answers —Patricia Ganz, M.D.: This is a very common problem, because family and friends think it is over because your treatment is over. In fact, you have to do a lot of recovery, and these include physical, emotional, and social recovery in terms of prioritizing important things and resuming a normal life. It is not uncommon for women to feel this way. Sometimes a support group can be particularly helpful.

Marisa Weiss, M.D., president and founder: Not uncommonly, your own expectations of yourself to get back to normal ASAP can also be burdensome. Managing your own and others' expectations becomes important. Your doctor or nurse can help set realistic expectations for you and your family. Bring them in with you as you finish up your treatment so you can best make way for a good period of recovery and to get support from your family.

How to get back to "old" self?

Question from Maggie P: How do I get back to my 'old' self? Nothing seems the same anymore.

Answers —Patricia Ganz, M.D.: Many things do change after breast cancer, and sometimes they include an increase in symptoms associated with menopause, such as hot flashes, sweats, and vaginal dryness. If you are having these problems, talk to your doctor about some strategies to manage these symptoms.

However, it takes some time for recovery. Most of the research that has been done suggests that by a year or so after diagnosis and initial treatment, women have resumed normal levels of activity and function.

One of the problems that women experience is that while they are recovering, they are also getting older, and some of the symptoms they experience might be related to aging rather than the cancer treatment.

Marisa Weiss, M.D., president and founder: Recovery can involve a lot of ups and downs. Try not to get too discouraged when you go through a series of bad or not-so-good days. The goal is to keep heading in the right direction. We know it is hard to be patient, because there are so many things that you would like to be doing. You probably won't return back to the same 'normal' that you had before, but what you need to shoot for is to arrive at a new 'normal'. What that is going to look like, and how long it will take to get there, depends a lot on who you are and what matters most to you.

Changes in body image cause bad self-esteem?

Question from Sylvia: It has been months now, and I still can't look at myself in the mirror. How can my husband look at me if I can't even bear to look at myself?

Answers —Patricia Ganz, M.D.: Changes in body image are very common after breast cancer, and even women who have not lost their breasts as a part of the treatment may complain about feeling uncomfortable with how their body looks. You may want to try some exercises where you begin to look at yourself in the mirror and examine your body and be comfortable with your new body. You may also be misinterpreting the concerns of your husband or partner, because you may be more worried about how your body looks than your partner is. You may also want to seek some advice in counseling from a social worker or other mental health professional to help you adjust and adapt to your new body.

Marisa Weiss, M.D., president and founder: This is not easy to do. Relatively few of us were happy with our bodies before the diagnosis occurred, but it's true that additional changes have happened that may make it even harder to feel good about yourself. This is where your strong will needs to kick in. You really do need to be one of your own best friends. Your own sense of your body tends to be much harsher than a potential partner's perception of it.

Remember, most intimacy takes place in dark rooms and under the covers.

Try to be more accepting of yourself.

Patricia Ganz, M.D.: Also, you may want to consider reconstructive surgery if you have had a mastectomy to help you make you feel better about your body.

This should be covered by health insurance in most states. You should have a consultation with someone to find out what would be helpful to you. If you are using prosthesis, there are attractive options that women can use in bed so they don't have to undress completely if they are uncomfortable.

Need husband to lighten up?

Question from Sally: I am coping okay with my diagnosis and treatment, but my husband has turned into a fusspot and is driving me insane. I feel like I am in the hospital permanently with the constant attention. How do I get him to lighten up and help me enjoy life?

Answer —Patricia Ganz, M.D.: This is a situation where maybe having him have an opportunity to meet with a social worker or join a support group for partners of women with breast cancer where he can share his feelings and anxieties openly about the threats to your health is a good idea. You are obviously very important to him. He is worried about your health, and he is responding by being overprotective. It sounds like you are trying to communicate this to him, but, perhaps, a professional in a health care setting, such as a social worker, might be able to help him with this feeling and reassure him.

How long from depression to happy self?

Question from Why Me: Since my diagnosis, I have been very depressed. Nothing seems to make me happy. Why do I feel this low, and how long before I can be my happy self again?

Answers —Patricia Ganz, M.D.: Depression is a very common symptom of women at many times in their life and can occur after a serious diagnosis like breast cancer.

Research done with breast cancer patients and survivors has not found that there is a higher rate of depression after breast cancer. That is not to say that you may not have important symptoms that were precipitated by your diagnosis. There are very effective medications to help with depression and symptoms that you are describing, and these may be appropriate in helping you recover. In addition, finding a support group or a mental health specialist to talk about your concerns and mood would probably be helpful.

Marisa Weiss, M.D., president and founder: Connecting with other women experts and each other can make a big difference. Please visit the Discussion Boards at Breastcancer.org. There are a lot of people there that share some of your same concerns.

Worried about young children's fears?

Question from FJB: I worry about my young children. I want to show them how strong I am and that I am still the same old mom they know, but I tire easily, and they are very fearful that I won't be here for them. How can I get them through this?

Answers —Patricia Ganz, M.D.: This is a very common problem for women diagnosed with breast cancer, and more difficult for women with young children and many responsibilities. After breast cancer, most women want to put on a brave front, resume their activities, and assume that nothing has changed in their life when, in fact, they may have a change in their physical stamina and new emotional issues. It is important to reassure your children that you are there for them, but you may also need to let them know that your energy level hasn't recovered so that they will understand when you are tired and can't do what they want. This can be frustrating for children, but it is better to be realistic about what you can or cannot do.

Marisa Weiss, M.D., president and founder: If you are tired and pale as a result of the treatment, don't let your family know this. They may assume the worst and think that your lack of energy and power are due to active cancer. Keeping the communication going will make things much easier for you. Not communicating regularly can make you and the people you care about feel isolated from each other.

Support group for whole family?

Question from H Judd: Do you think that I should get my whole family into a support group? I find it invaluable, but my husband thinks he doesn't need any help.

Answer —Patricia Ganz, M.D.: Many women after breast cancer find they want to continue having an opportunity to share their feelings and emotions about their experience. Often, family does not want to continue talking about this. It is not because they are not interested, but that they no longer want this to be the focal issue in their life. This is why support groups are so helpful for women, because they can share their feelings with other women who have had the same experience. No matter how close and supportive your family is, they haven't had your experience, and they may have trouble with the ongoing dialogue.

Sporting activities affected after surgery?

Question from Irene P: I have recently had a breast removed. Luckily, it all happened so fast that I didn't have time to really think about it. But, now, as I recover, I am worried I won't be able to do all the wonderful sporting activities I was doing before. I am 37, and I have always lived for my sport.

Answer —Patricia Ganz, M.D.: I don't know of any significant limitations concerning sporting activities after having a mastectomy. Sometimes, if you have had your lymph nodes removed under the arm, there may be some limitation in arm motion or precautions you must take to reduce the risk of swelling in the arm. There are many women who resume very physically active lives after breast cancer surgery without any difficulty.

Chemo causes early menopause?

Question from Jo: I am concerned that my chemo treatment could cause early menopause. This has all happened so fast that I don't think I am asking the right questions when I see my specialist.

Answer —Patricia Ganz, M.D.: This is a very reasonable concern. There have been good scientific studies that show that there is a significant risk of premature or early menopause in women receiving chemotherapy, particularly if they over the age of 40 and the closer they are to age 50, which is the usual age of menopause. If you are concerned about this, you should ask your physician about the risk for the particular chemotherapy drugs that you are taking.

Estrogen to relieve symptoms of menopause?

Question from Vera: I'm only 45, yet I'm already having hot flashes. Breast cancer is in my family, but I've never had it. Can I take estrogen?

Answers —Patricia Ganz, M.D.: Symptoms of menopause can begin in the 40s, several years before a woman stops menstruating, and we call this the perimenopause.

During this time, it is common to have sweats and hot flashes, and these are early warning signs of menopause. The best way to handle these symptoms if you cannot sleep or are uncomfortable is to take estrogen to relieve the symptoms. At the present time, it appears that short-term use of estrogen and progesterone which is often given with it—short-term being 2 or 3 years—does not seem to lead to an increased risk of breast cancer. However, if you need to take hormones for a long time, for 5 or more years, then you could increase your risk of breast cancer.

Marisa Weiss, M.D., president and founder: This increased risk for long-term users is not a big increase; it is a relatively small increase. If you choose to take estrogen replacement, you do need to be followed carefully for your overall health, as well as your breast health. When you do follow a program of early detection, breast cancers tend to be detected earlier, which is when they are most effectively treated. That is why women on HRT, who develop breast cancer, tend to be diagnosed with earlier stage breast cancer.

Patricia Ganz, M.D.: At this time, we do not have good information about women with a family history of breast cancer using HRT compared to women without a family history.

Suggestions for pick-me-ups?

Question from Nancy T: What do you suggest as a pick-me-up for women during treatment? I would like to help out a friend, and I just don't know where to start (she is pretty down at present).

Answer —Patricia Ganz, M.D.: I think you are talking about her mood, but you might be talking about her energy level. Both could be affected during treatment. In terms of mood, talking to your friend and allowing her to share her feelings would help support her through this and let her know you care. Other things that can be done are to help out with household chores to make it easier for her to rest and restore her energy. If her change in mood is very different from how you knew her before, you might encourage her to talk to her doctor about her changes in mood or lack of interest in activities. The physician may be able to prescribe medication to help her or advise other counseling and support.

Concern for returning to work after treatment?

Question from Kate: My concern is how am I going to return and fit in at work? My career was on the move before my diagnosis, and I am afraid that now I will be passed up for promotion because I am a health risk.

Answers —Patricia Ganz, M.D.: You have raised a very important question that is, "What are your rights as a cancer survivor?" Fortunately, there is federal legislation in the Americans With Disabilities Act that protects individuals with a cancer history against discrimination in the work place. Although you may have had to cut back on some of your work activities while you were getting treatment, this cannot be used as a way to discriminate against you in terms of opportunities and promotion. Most of the time, this can be dealt with informally in the workplace by talking to your employer and making your employer know you are aware of your rights as a cancer survivor. Occasionally, it may be necessary to resort to litigation if one is discriminated against in the workplace. A good resource for information about this is the National Coalition for Cancer Survivorship, which has detailed information to help individuals who may be facing job discrimination.

Marisa Weiss, M.D., president and founder: Many bosses are taking their cue from you. They may have no idea how your diagnosis will affect you and your work. Communication here is very important. If you can prepare your immediate coworkers for what to expect, then it's less likely that they will be disappointed with unmet expectations. If you are asked to do extra work, you can be up front and say, "I'd love to help out with this extra project. Now is not the best time for me to help out in this way like I usually do, but I expect that when I am feeling better, I will once again feel up to taking on that challenge." It's also a good idea to keep a journal of your work, your progress, and your assignments, as well as comments that people make about your work. In the future, if you need documentation about your accomplishments and the 'drifts' at work, then you have something to support yourself. Avoiding confrontation but sticking up for what you know is right is a good approach.

Will hot flashes, panic attacks end?

Question from Lindel: Will I get past these silly hot flashes and panic attacks? They are ruling my life.

Answers —Patricia Ganz, M.D.: The answer is yes. Very few women have persistent hot flashes for the rest of their lives. Women who are experiencing menopause may have these symptoms for a 2 or 3-year period of time. Ten to 15 percent of women may have hot flashes and sweats for an indefinite period of time. However, you can talk to your physician about medications to control your symptoms during this time.

Marisa Weiss, M.D., president and founder: There are some medications that can help with both hot flashes and panic attacks. In my practice, I have taken care of a number of women who experience both symptoms. They have had a good response to medications like Effexor or Paxil. Talk to your doctor about the possible use of such medications. I have been quite impressed by the ability of these medications to ease panic attacks, in particular, and hot flashes, second.

Dealing with weight gain after treatment?

Question from Nancy: I've gained 10 pounds during chemo and radiation that I can't seem to shed. I'll finish chemo in early Christmas. Advice?

Answer —Patricia Ganz, M.D.: You are part of a big club of aging women who have problems with weight gain. I don't know if you have become menopausal as a result of your treatment, but as women get older and go through menopause, their metabolism changes, and there is a difficulty in losing weight and a tendency to gain weight. It is also possible that with increased fatigue with treatment you might not be exercising as much as before your diagnosis. Whatever you can do to resume a regular exercise program and be careful about what you eat, the better off you will be. Sometimes, I encourage women not to focus on losing weight but just not gaining any more. If you can stay steady now instead of gaining a pound or two a month, you will be that much thinner at Christmas.

Long double TRAM flap recovery time?

Question from Grace: Is the recovery time much more than a year when a double TRAM flap was performed?

Answer —Patricia Ganz, M.D.: Double TRAM flap means that the breast has been reconstructed from tissue usually from the abdomen to the breast area. These are big operations, and the physical recovery procedures are most significant in the first 4-6 months after the surgery. Most of what we see as far as long lasting effects are related to the side effects of chemotherapy and radiation, so in spite of the initial difficulties of recovering from the TRAM flap, one can still expect a good recovery.

Priorities change after diagnosis?

Question from Nana: It seems that my priorities have changed since I have been diagnosed with breast cancer. Why would this happen?

Answer —Patricia Ganz, M.D.: This is a very common report that women who have had breast cancer tell us. Having this type of experience really sorts out who are your friends and what is important to you. Things get prioritized in a way that you have never thought about them before, having faced such a serious illness. Many women I have taken care of have had complete transformations in their occupations and interests as a result of breast cancer diagnosis, and there is often a sense of freedom to change one's mind about what one is doing on an everyday basis, because life is precious, and you want to live it to the fullest.

Help friend open up and share?

Question from Judy: What if I can't get my friend to talk? She says she is fine, but, honestly, she is falling apart trying to cope on her own.

Answer —Marisa Weiss, M.D., president and founder: Each woman has her own way of handling stressful situations. If your friend was shy and private to begin with, it's hard to change that style 'overnight', particularly when struck with a serious diagnosis. I have been quite impressed by how quickly people can adjust and find new ways to cope with hardships. If you can show her how much you care, make it clear that you want to be part of the process that helps her, and just 'be there' and keep talking and listening, I think you will see her open up some more.

There is no question, that what makes the biggest difference in women's recovery are the connections that they make with other people, spiritual aspects in their life, places that are meaningful, and helpful information that can come from many different sources. She is very lucky to have you and your commitment in her life. Support groups can also be quite helpful. An encouraging word from doctors and nurses, helping her open up and helping her reach out for strength from others can also make a difference.

Oophorectomy decreases recurrence chances?

Question from Bio Pat: Do you think it is helpful at all to consider hysterectomy/ovary removal for someone with breast cancer that was premenopausal at diagnosis? Would it help chances of not having recurrence?

Answer —Patricia Ganz, M.D.: That's a very good question. Women who have had breast cancer at an early age still have their ovaries functioning, and, if that is the case, ovarian hormones may still continue to stimulate the breast tissue. This could lead to a continued risk to a new breast cancer in the unaffected breast, and potentially relate to a risk of the recurrence of the original cancer. There are some research studies in younger women with breast cancer using a medication that suppresses the ovarian hormones. When used in combination with tamoxifen, the studies find it is superior to tamoxifen alone. However, this is an extreme procedure, and should not be proceeded to lightly. Women with breast cancer are also at a slightly increased risk of getting ovarian cancer. The general population has a 1 percent lifetime risk, and with women with a history of breast cancer, the risk is 2 percent. While that number is not very large, it is more difficult to detect ovarian cancer early, and some women may choose to have surgery to remove the ovaries to reduce their potential risk of getting ovarian cancer in the future.

This is particularly an issue for women who may be carriers of the breast cancer heredity susceptibility genes—BRCA1 or BRCA2. Women who carry one of the breast cancer susceptibility genes may have an increased risk of ovarian cancer ranging from 10 to 35 percent.

Proactive steps to take when family history?

Question from Rosie: With a history of breast cancer in the family, what are some proactive steps I can take for my daughters and myself to ensure our lives are not ruled by this constant threat yet remain vigilant?

Answers —Patricia Ganz, M.D.: First of all, most women with a family history overestimate their risk of getting breast cancer. For example, if your mother had breast cancer after the postmenopausal years—after 65 years of age—your risk might only be 15 to 18 percent, compared to a woman without a family history whose risk might be 10 or 11 percent. So your risk might be higher, but not 100 percent higher.

The value of knowing your family history is that you can take steps to reduce your risk of breast cancer, just like if you knew diabetes was in your family. If you know you are at risk for diabetes, for instance, you'd try to watch your weight and diet. If you are worried about heart disease, take steps to lower blood pressure. For breast cancer, have regular exams by a health professional every six months, so if an abnormality is detected, it can be evaluated further.

Similarly, mammography can be used to detect breast cancer earlier, and this is generally started in the early 40s and continued annually, thereafter. If your family member had breast cancer at a young age, less than 40, you may want to consider mammography earlier than your other family members. In addition to an early screening, we now have the medication tamoxifen, an anti-estrogen, which clinical trials find reduces the risk of breast cancer about 50 percent in women with a high risk of getting breast cancer.

The risk factors that we consider when calculating whether someone is at high risk for breast cancer include the number of close family members that have had it—mother, sister, or daughter, whether the women have had a breast biopsy and abnormal tissue on the biopsy, whether she menstruated at a young age and whether she had children. Also, there is another study going on in the US and Canada called the STAR trial, which is studying tamoxifen versus raloxifene to see if they are equivalent or better in postmenopausal women at high risk for breast cancer.

Marisa Weiss, M.D., president and founder: Lifestyle changes may also help reduce your risk. Each one alone may have a minimal benefit, but when added together, they may be significantly more helpful. These include weight control, trying to stay as close to your body weight as possible, regular exercise, try to shoot for 3 to 4 hours a week, trying to minimize the amount of alcohol that you drink. Also, smoking cessation is important for your overall health, and may also be helpful in reducing breast cancer risk a little bit. There are studies that show that regular support groups and an active spiritual life are likely to improve your overall health and may reduce your risk for experiencing illness.

Recurrent/metastatic cancer likely terminal?

Question from Sam: My sister has just had her second breast removed (she had her first breast removed 8 years ago). She is incredibly sick with the chemo. I have great fears that we could lose her. Is it true that to have the cancer return after such a long time that it is likely to be terminal?

Answers —Patricia Ganz, M.D.: I am uncertain from your question whether your sister has a new cancer in the other breast or a recurrence of the initial cancer.

By a recurrence, I mean that the initial breast cancer has now spread to another part of the body, like lungs, bones, etc. This is called metastatic breast cancer. If this is the situation, she is likely to have some response to the treatment, but the prognosis might be uncertain. If you are concerned about her prognosis, the best thing is to discuss it with her physician and get specific information. Do not assume that she is more significantly ill than she is.

Marisa Weiss, M.D., president and founder: Sometimes, the effects of treatment are very scary to watch.

Don't assume that she is feeling lousy because of active cancer. Often times, she may look sick because of the treatment's side effects. These days, there are many effective ways to reduce side effects like nausea and vomiting. This is important. Not only will it help her feel better, but it will also help her stay hydrated and energetic. We also have medications that will help keep up red blood cells, as well as immune cells. If she is experiencing nausea, make sure she reports it to her doctor. Some patients are reluctant to do that, because they don't want to be seen as complaining. The best way to help your doctor help you is to let them know what you need.

Pass breast cancer on to daughter?

Question from Tess: I am worried my daughter will end up getting cancer, too, and it will be entirely my fault.

Answers —Patricia Ganz, M.D.: While there is a risk to your daughter because you have had breast cancer, the cause of breast cancer, in most women, is not hereditary, but more what you are exposed to over your lifetime. In particular, your hormones in your own body, and how your body and, particularly, the breast responds to those hormones. Things to think about are to make sure she eats a healthy diet, and that she remains physically active. Young girls will usually exercise throughout their life and have a reduced risk due to the exercise. In addition, preventing obesity can be helped by exercise. The other thing to tell your daughter is that breast cancer, when detected early, is highly curable, and many women can have a normal life span from early detection and treatment. In her lifetime, there may be many more treatments available to prevent breast cancer.

Marisa Weiss, M.D., president and founder: Dr. Ganz is so right to express this optimism about the future. Know that your daughter will take her cues from you. If you keep looking at her with worried and guilty looks, you may make her more anxious than she needs to be. Helping her find the right information, and giving her the necessary guidance to learn how to lead a healthy life will be the most constructive way to help her if she is or if she is not at increased risk for developing breast cancer.

Family history can lead to male breast cancer?

Question from Ben: I know that breast cancer affects way more women than men, but it's very prevalent among women on both sides of my family. Should I be worried about breast or other forms of cancer (I find I'm just feeling anxious).

Answer —Patricia Ganz, M.D.: You are right. Breast cancer is extremely rare in men. While there will be 190,000 new cases in women in the US this year, there will only be about 1,000 cases in men. Most of the men who are at risk do come from families where there may be a hereditary predisposition to the gene. Those families are characterized by early onset of breast cancer in the 20s, 30s, or 40s. If you are concerned that you may be one of these families, you might want to discuss genetic counseling with your female relatives to determine if this may be an issue for you.

Therapy to replace chemo in the works?

Question from Kate: Are we much closer to getting more women-friendly drug treatments that could possibly replace the debilitating chemo? It's bad enough having the cancer, but the chemo is just awful, and I get so, so sick.

Answers —Patricia Ganz, M.D.: You have probably heard about the excitement about targeted therapy that specifically targets the cancer cells where they are vulnerable. One of the things on the horizon is the ability to do a better genetic fingerprint of your own tumor. This is becoming possible because of the results of the human genome project where the genes of all of the chromosomes have been mapped. They are beginning to be able to test tumor tissue in individual cases, the kinds of genes that have been turned on or off in an individual cancer. We will likely be able to determine profiles of high and low risk individuals in the future, so we may not need necessarily to treat so many people with chemotherapy in the future.

Marisa Weiss, M.D., president and founder: Make sure you have signed up for the Breastcancer.org email updates, which will let you know when Research News on information like this becomes available.

Impatience attributed to hormonal changes?

Question from Sunshine: I am much more impatient now than I've ever been. Could this be coming from the changes in my hormones?

Answers —Patricia Ganz, M.D.: Many women note changes in their mood and ability to be patient as a result of menopause or perimenopause, where their hormones are fluctuating, and this could be what you are reporting.

Marisa Weiss, M.D., president and founder: As we get older, I think that all of us experience a natural impatience. We have so much we want to do, and we don't want to waste our time on things that are relatively unimportant. I think that many women who develop breast cancer experience an extra 'wake up call' and want to get on to what they need to do and move past the obstacles that may be in the way.

How to find a good support group?

Question from Regards: How do I find a good support group?

Answer —Marisa Weiss, M.D., president and founder: The Breastcancer.org Discussion Boards are active day and night. Living Beyond Breast Cancer has a free help line. Their number is 888-753-LBBC. Y-Me has a 24-hour a day hot line. For support groups in your area, try your local hospital. There may also be a Wellness Community in your neck of the woods; they are a terrific resource. Soon, they will offer support groups online. If your local hospital does not offer a support group, urge them to start that service. Team up with a few of the other women you might know who have had breast cancer, and, as a group, you may be surprised at how responsive the hospital may be.

Emotional fragility normal after treatment?

Question from Boadicea: I feel I may need to change my life a bit after mastectomy/chemo, but I seem to be very fragile, emotionally. Is it the same for many?

Answers —Patricia Ganz, M.D.: You have gone through a very challenging experience. Based on the past, this may be more difficult for you than others. Seeking support from your peers from a support group or a discussion online may give you suggestions how to make it to the other side of this experience.

Marisa Weiss, M.D., president and founder: If you are experiencing anxiety, panic attacks, sustained fear, or depression, these symptoms can also respond very nicely to medication. You have been through a very difficult experience. Many of the treatments for breast cancer can shake up the natural balances in your body. If, after treatment, your natural balances do not realign and equilibrate, these medications may help you feel better. Ask your doctor to see if they may have a role in your care.

Recurrence related to stress, immunity?

Question from Bio Pat: What are your feelings about the correlation between stress and immunity on the risk of recurrence?

Answers —Patricia Ganz, M.D.: This is a tough question, because we all have stress in our lives, and we don't always have evidence that stress leads to an increase of cancer or recurrence. However, in some individuals, there may be changes in the immune system associated with stress, and this indirectly might lead to an increased risk of cancer. These issues are hard to study scientifically. But, if we can find a relationship between stress, immunity, and cancer, we might have interventions. At this time, the evidence is uncertain, and we don't want to blame individuals for putting themselves at risk for cancer because of the stress that they might be experiencing.

Marisa Weiss, M.D., president and founder: Until we have better answers on the connection between stress and risk of cancer, I think we can all agree that stress can really make you feel lousy. It is not good for anybody, and, most likely, it certainly is not good for your health. On the other hand, leading an active life that is full of things that you enjoy doing, activities that bring meaning into your life, are quite healthy. If your life is full of these things, then you may lead a demanding life. This is probably healthy for you. Try to convert some of the stresses to enjoyable demands.

Tamoxifen lowers chance of recurrence?

Question from Nana: I will be finishing radiation in two weeks with no chemotherapy. I have been placed on tamoxifen, but I still have this fear that the cancer will come back. I keep having the fear that it will return. Is the success rate good with tamoxifen?

Answer —Patricia Ganz, M.D.: Tamoxifen is a very effective agent in preventing the recurrence of breast cancer. Also, there may not be any additional benefit to giving chemotherapy in some women. It is more important to understand the characteristics of your own tumor. These are important questions, and you should discuss them with your physician.

Positive attitude helpful in outcome?

Question from Candy: My mother had a mastectomy in April of this year. She has not let this horrible disease get her down! A positive attitude must be helpful for someone who has breast cancer, am I correct?

Answers —Patricia Ganz, M.D.: A positive attitude certainly is helpful in getting through difficult experiences such as treatment for breast cancer, but, at this time, there is no significant evidence that a positive attitude changes outcome. It certainly is a good way to cope with the illness.

Marisa Weiss, M.D., president and founder: Going through breast cancer is a very difficult experience.

It is normal and healthy to experience uncomfortable feelings like anger, fear, envy, and guilt. You can't sweep these things under the rug. When you are in the midst of treatment, you may not have the energy to deal with them all either. Your mother's ability to talk about these things, air them out, and share them with you is probably healthy. This is probably the best way for her to work through them and move beyond them. By working through them, she increases the possibility of experiencing more upbeat feelings as she moves along.

Will memory recover after chemotherapy?

Question from Barbara: My memory is shocking since starting chemotherapy. Will it recover after a while?

Answer —Patricia Ganz, M.D.: That's a good question. We know that when women are getting chemotherapy, they may be very tired, and they may not sleep well. These things, along with medications given to prevent nausea, may contribute to difficulty in concentrating. This is sometimes called chemo-brain, and is most acute when you are taking treatment. However, some women complain of persistent changes in their thinking even after finishing treatment. Many in research are doing studies as to how and why this is occurring, and what treatments it is associated with. There also might be an issue of menopause occurring along with the chemotherapy, and effects of menopause with trouble sleeping and concentrating.

How close is a breast cancer cure?

Question from Bio Pat: I guess since having breast cancer myself, I wouldn't wish it on anyone. My greatest wish is for a cure. How close do you think a cure might be?

Answers —Patricia Ganz, M.D.: If I were to be a true optimist, I would say it's just around the corner. However, knowing that breast cancer is a complex disease, and that it is not one disease but has many faces, I am reluctant to say that. Unfortunately, there are many women diagnosed with cancer who have a good outlook who can still have the disease recur many years later. It is not common, but it can occur. Alternatively, some women with small tumors can expect to be cured with the treatments that they have had. It is hard to generalize when and how the cure may be here.

Marisa Weiss, M.D., president and founder: We have all seen an explosion of new information, a much deeper understanding of what causes breast cancer, and what might eradicate it. The progress is strong and steady.