March 2006: Coping with Your Changing Feelings and Relationships

Partner fears touching breasts after reconstruction?

Question from cmanuel: Is it common that your husband/significant other will be "afraid" to touch your breasts after reconstruction? I had a bilateral mastectomy ten years ago and my husband now seems to think that anything above my waist is off limits.

Answer —Jennifer Armstrong, M.D.: I think this can be a very common occurrence. Oftentimes both the patient and her significant other can have quite mixed feelings about reconstruction, and/or about lumpectomy or mastectomy sites without reconstruction. Learning one's body all over again can be a process that can take time. Talking to your partner about your own feelings and your perceptions of their feelings can be helpful and even therapeutic.

Partner's distance hurting relationship?

Question from gosox: My partner has not been close to me since my chemo. Now I am in radiation and he does not ask how I am feeling etc. It seems he has completely ignored me and my cancer. We have not been intimate since. He says he is afraid of losing me. Please help.

Answer —Lidia Schapira, M.D.: Sounds to me that this illness has taken a toll on your relationship. You are both suffering and not able to connect at this time. Perhaps your partner is terrified, and the best advice I can give you is to go slow, invite him or her to talk with you, and be open about your fears. Don't try to rush things. And, if you find that you can't make any progress together, seek out a third person (a mental health worker, a therapist or a common friend) to help you start to talk about this experience. There is no set formula for how long it takes for people to come to terms with a crisis such as cancer.

Husband admits loss of attraction?

Question from mgal: What is the best advice for a woman whose husband openly admits he is no longer sexually attracted to a woman without breasts?

Answers —Lidia Schapira, M.D.: The best advice for a woman in this situation is to begin a dialogue about the entire relationship. It seems to me to be a pretty hostile comment, and one that needs to be explored if the relationship is to continue. I would guess that this has to do with more than the lack of breasts, and would recommend that you take some counseling, either separately or together.

Jennifer Armstrong, M.D.: I must agree that counseling can be an incredibly important option for couples and patients to pursue, either alone or together. Both the patient and the partner can have intense experiences during the time before, during and after treatment. And having a safe place to discuss these issues can be incredibly helpful.

Tamoxifen affecting quality of life?

Question from alfin: Since I have been taking tamoxifen, I feel disconnected and depressed, not like myself. I have trouble sleeping and performing at work. Sleeping pills do not work, they make me weepy. My doctor says I cannot take anything lower than 20 mgs but a study indicates that 10 mgs might be enough. I feel like I am being forced to choose between a longer life or a life I can enjoy. What should I do?

Answers —Lidia Schapira, M.D.: The correct dose of tamoxifen is 20 mgs, so I support your doctor's advice that you should be on the dose that has been proven to be effective in treating this disease. I'm also concerned with your symptoms—your lack of sleep and feeling weepy—and hope that those symptoms can also be treated.

Those symptoms lead me to believe you may also be depressed. It is worth following up on this, and asking your physician for a referral to a mental health worker such as a psychologist or a psychiatrist. There are specific medications and other interventions which do not require medication, which may help boost your mood and make life much more pleasant for you.

Jennifer Armstrong, M.D.: Dr. Schapira nicely outlined important symptoms to be aware of, and steps to take to address them. There are some women who are not able to tolerate tamoxifen, despite all of what was mentioned. We always like to support patients maximally with all of their side effects, but there certainly are women who feel that the benefits of tamoxifen are outweighed by the side effects they are experiencing, and these issues are important to discuss with your healthcare providers. I am not aware of the studies that indicate that 10 mg dosing is effective. The standard dosing is indeed 20 mgs.

Femara's side effects causing strain in marriage?

Question from carman: I am a 3-year survivor, now taking Femara. Since then I have noticed more hot flashes, mood swings, and a loss of libido. I have only been married for three years and it is causing me to be depressed and my husband to think I don't love him any more. What can I do?

Answers —Lidia Schapira, M.D.: It seems so unfortunate that your marriage coincided with your starting this medication! It would have been easier if you and your husband had had a period of time when you were not incapacitated or inconvenienced by this. What you are describing is common with what women experience when taking aromatase inhibitors, and that is menopause-like symptoms of hot flashes, mood swings and loss of libido.

It may be helpful to consult the special part of Breastcancer.org's website that talks about facing menopause and its symptoms.

Lidia Schapira, M.D.: The loss of interest in sex often results from having had uncomfortable experiences. That is sometimes the result of having a condition known as atrophic vaginitis, which means that the vaginal area is dry and cracks and bleeds easily, and often does not allow for an intimate relationship. In those cases, you may want to talk with your oncologist about using some tiny amount of vaginal estrogen, which may work wonders.

Many women are afraid to contemplate using even a small amount of estrogen after breast cancer. But it seems to me, in your situation, your relationship and your whole outlook is in danger because of this unfortunate consequence of treatment.

So, stay calm, and discuss all of this with your husband as well as your physician. Perhaps the three of you should meet and work out a strategy so that your sex life can improve, and hopefully with that, so too will your interest in life and your relationship.

Jennifer Armstrong, M.D.: Dr. Schapira raised several very important points. In terms of loss of libido, I think this is a side effect that is under-discussed and more common than realized. Certainly vaginal dryness can contribute to this. In this scenario I often have patients start with simple vaginal lubricants such as KY Jelly, Astro-Glide or Replens. Warming these products can also be helpful.

That being said, I certainly hear from patients of mine about loss of libido that does not always seem to be related to vaginal dryness, and whether this is your situation, you can also explore increased intimacy with your partner, even in the absence of intercourse. Spending romantic time together can help both of you stay in touch with each other, and feel connected. If, after pursuing any of these options, you still feel depressed, I think it's very important to discuss this with your partner and your health care provider. You have been through a lot, and you deserve not to suffer with these feelings. You may also want to read more about this in the special section on sex and intimacy right here at Breastcancer.org.

Appropriateness of sharing at work?

Question from LisaT: When should I stop sharing particulars of my illness at work? I am really close to my staff but don't know if this is appropriate.

Answer —Lidia Schapira, M.D.: You are in control of the information you choose to share with your co-workers. Decide how much is comfortable for you, and if you need to set boundaries, go ahead and clearly state so. There is no right measure of information that fits all situations, or satisfies all people, so it's important for you to decide what's comfortable for you, and make it clear for everybody else.

Editor's note: Visit Breastcancer.org's section Breast Cancer and Your Job to learn more.

Partner pulling away, cold and mean?

Question from Cathy: After 26 years with my boyfriend and second go-round with breast cancer (now metastatic), he is treating me rotten. Takes me for my treatment but at home is cold and mean to me. Have no family support and must rely on him even to bury me. What to do?

Answer —Lidia Schapira, M.D.: I'm sorry to hear that you are so alone in this situation, and that the one person you depend on both for practical matters such as transportation, and for emotional support, is pulling away from you now. If you think he is treating you rotten, perhaps you could confide in somebody, and just talk about all of the things that are going on at home. I worry that you may not be getting the support you need, and also worry that in some way he is making you suffer. I don't know from your question just how bad things are, but I do hear that you need more help than you are getting. Perhaps start talking with your nurse or social worker when you go for treatment next time, and let them know that you need more support and let them help you find other means of transportation, as well as support during this difficult time.

Best way to express concern to ailing friend?

Question from Nancy: How do I support a friend with a potentially fatal outcome and not dash her hopes of recovery? What is the best way to express my concerns for her?

Answers —Lidia Schapira, M.D.: Your friend needs to know that you celebrate every day that you are here and together. You can talk about your sense of impending loss if you think it is appropriate to discuss with her, and also talk about the good times you've had together. Even if you know that she will die soon, it is really important to stay in the picture, remind her of your love, and find reasons to express joy at the bonds you share, and your close friendship.

Jennifer Armstrong, M.D.: You may want to ask her how you can best support her, especially if you're able to phrase it as beautifully as you did for this question, in that you want to support her in every way possible. Sometimes when it's difficult to talk about the disease, it's easier to talk about the friendship, and how much she means to you, and why. If you're willing to talk with her about what she's going through, willing to listen to her fears, and willing to be there when she doesn't want to talk about anything, she is lucky to have you.

Depression, mood swings, hot flashes, anxiety normal?

Question from Rosina: I have been on Zoladex plus 25mg of Aromasin. I continually have symptoms of depression and I take 40mg of Paxil daily. The mood swings and hot flashes really get to me so that I am limiting social interaction and events that cause anxiety. Is this normal?

Answers —Jennifer Armstrong, M.D.: I think what you are describing is unfortunately too common, but I do not think that you need to accept it as the only option. It sounds to me as though Paxil (chemical name: paroxetine) may not be doing the trick for you, and that you may have additional symptoms that need better treatment. If your symptoms are limiting your social interaction and events, this is a huge loss in the quality of your life. Whoever has been prescribing your Paxil (your primary care physician, your oncologist, or a psychiatrist) needs to hear about the symptoms that you are experiencing. These symptoms should be able to be controlled to a greater extent than they have been so far for you.

Editor's Note: If you are taking tamoxifen, talk to your doctor about which antidepressants are safe for you to take. Some antidepressants -- including Paxil, Wellbutrin (chemical name: bupropion), Prozac (chemical name: fluoxetine), Cymbalta (chemical name: duloxetine), and Zoloft (chemical name: sertraline) -- interfere with the body's ability to convert tamoxifen into its active form, preventing you from getting the full benefit of tamoxifen. For more information, please visit the Tamoxifen page.

Lidia Schapira, M.D.:  I agree with Dr. Armstrong. In my practice I would refer you to a psychiatrist or psycho-pharmacologist, because I do believe that some fine tuning of the medications may help decrease the anxiety you feel, and help you to feel comfortable in a social setting again.

How to cope with severe emotional changes?

Question from gwja:  I am depressed and moody most of the time. I hate my body and all the drugs I have to take, I have no interest in having sex with my husband and the thought of living this way for the rest of my life is more than I can handle. How do I cope with all the changes going on with me?

Answers —Lidia Schapira, M.D.: You sound overwhelmed. And it seems to me that the illness and/or the treatment have taken a huge toll on your mood, your relationship, and your whole outlook on life. I strongly encourage you to take this seriously and ask your physician for a referral to a psychiatrist. Sometimes support groups and informal help can help women to lift themselves out of this depression, but in this case I do think you need some professional help. I have seen women climb out of this hole and regain interest in life, and I sincerely hope that you will get some help, and start to feel better soon.

Jennifer Armstrong, M.D.: You do not have to cope alone. Asking for help can be difficult, but getting it can help bring you back everything you have been missing.

Worried about getting cancer in other breast?

Question from skipper: I have feelings like I should have my other breast removed as a precaution. Having ILC in the one has me feeling scared of getting it again. How do I gain confidence in my body not rebelling against me again?

Answers —Lidia Schapira, M.D.: You bring up a very interesting point, and one that I hear frequently from my patients. And that is, how can I trust my body after it betrayed me once? The answer is a very personal one. In some cases the anxiety and the worry over having a second breast cancer leads some women to choose prophylactic surgery; having the normal breast removed so you can stop worrying about having a cancer in that breast.

But that fear may be excessive. I would suggest that you talk about your fears and anxiety with your oncologist, and talk about what the chances are of getting a cancer on the other side. After that you may have to talk about your fears with a mental health worker, and finally come to a decision that will help you make peace with your body, so that you can move on with your life. There is no one answer that fits all worries. You have to find one you are comfortable with, and move on with no regrets.

Jennifer Armstrong, M.D.:  I think it is worth mentioning that it is often during the time following treatment that anxiety levels can rise and many different fears may come to the surface. That is, while patients are undergoing treatment they feel that they are doing everything they can be doing to fight cancer. Once they complete therapy, patients often feel vulnerable, and this transition from treatment to surveillance can be difficult. I echo Dr. Schapira's advice to discuss these feelings, and to gather more facts that pertain to your particular case with your health care providers.

Children are distant and unsupportive?

Question from Vele: Every time I bring up the words "breast cancer," my children get angry and they say, "There she goes talking about the breast cancer, now she's going to cry." I feel like I have no support emotionally from my sons, who are 12 and 14. I feel my kids are distant, because they are afraid they are going to lose me. Any advice on how to show them that I am crazy about them?

Editor's note: Read more about talking to your kids about breast cancer.

Answer —Lidia Schapira, M.D.: Sounds to me as though you're proving our point that cancer really affects the whole family. Your example illustrates how a mom's cancer really impacts the emotional health of two adolescent boys. Talk openly, but remember that boys of this age may not want to talk about feelings. Respect the boundaries that they set for you, and express your love for them in ways that they understand. They may not be able to support you emotionally in the way that you want, however they may be crazy about you, and just feel awkward that they have to talk about the illness. The best conversations with youths happen spontaneously when you are working side by side, perhaps working in the garden, or driving somewhere. Be spontaneous and not overly emotional in how you show your love for them, and they may reciprocate.

Okay to take time to process experience?

Question from AmyE: How do you deal with all your changing feelings after treatment is over? I'm still trying to process this entire experience, grieve what I have lost, such as my innocence, my hair, etc. So many people around are so ready to "move on," but I'm not quite there yet.

Answers —Lidia Schapira, M.D.: You bring up such wonderful points. The timing of recovery is so personal and so variable. Often well-meaning relatives and husbands want things to snap back into shape the moment active treatment is over, while the patient herself feels she's actually needier after treatment than during treatment. It also takes time to grieve for one's losses, and there are multiple losses in the experience of living with cancer. There are shifts in relationships. There is the loss of innocence about one's health, and a new way of experiencing what is normal. Many people describe the illness as a journey, and you may need to explain to those around you where you are in your journey. Take your time; you can't rush the process. I wish you courage and wisdom as you move further and further into your recovery.

Jennifer Armstrong, M.D.: Amy, I congratulate you on recognizing your needs. Your hair will grow back. Your innocence may or may not. But you will take the time that you need to gain the strength that it sounds you already have.

Normal to reconsider decision of implant?

Question from aliwag: Recently, for the first time, I felt like my implant was a hindrance and I wanted it out of me. Is it normal to feel this way at times? I've only had the implant for a year and am confused by my feelings all of a sudden.

Answer —Lidia Schapira, M.D.: I am not a surgeon, I'm a medical oncologist, so I'll answer this question for you based on my experience listening to my patients. I hear this kind of regret quite frequently. Many women tell me they're upset by the cosmetic results, or by having an implant, and these kinds of issues often come up several months or years after the surgery has been completed. My advice is to explore this with a member of your medical team, and figure out if it's just a matter of accepting the foreign body in you, or if you really need to reconsider your decision. It's a difficult issue to have to say, but if you feel this way, the best advice I can give you is to talk with someone on your medical team—your surgeon or your oncologist.

Expectations of recovery too much?

Question from Bartlett: I'm 9 months out from my last radiation treatment, and 15 months out from my last chemo. I'm still having trouble with fatigue, concentration, anger, and mood, among other things. Exercise helps a lot, but it's tough to motivate. Am I rushing things, in expecting myself to be able to use self control, getting along in relationships which were once blissful, by now?

Answer —Lidia Schapira, M.D.: Women recover at different speeds, but if it's been 9 months from your last radiation, and 15 months since your last chemo, I'd expect you might be feeling better than you describe. Some women do experience trouble with concentration and mood swings for over a year, but again I think it's important to check in with your medical team, and make sure there are no physical reasons for these problems that you describe.

I also want to comment on the fact that you say you're angry, and that I worry about too. Dealing with the physical symptoms, as well as the emotion that result from the diagnosis and treatment of cancer is equally important to having a good and speedy recovery. You mention exercise helps, so perhaps go ahead and use exercise and other things in your life that make you feel good, to help you along and find joy in the relationships that you describe as having been blissful. There is help, in the form of support groups and individual counseling, and other ways. Remember, you don't need to do this alone.

Do men understand the mental anguish?

Question from bonnie: I was diagnosed with DCIS in September, had a mastectomy and reconstruction in October. My husband seems to think it's no big deal because I'm pretty much back to doing things the way I used to. However, do men ever understand the mental anguish that we go through?

Answers —Lidia Schapira, M.D.: Probably not. I don't want to generalize, but here I am doing just that! As I said earlier, even the best husbands really want things to snap back in an orderly way, and want to restore the sense of peace and comfort that preceded the shock of illness. It is quite typical for women to feel the stress of the diagnosis and treatment months and sometimes years afterwards. This is a fact, and one that does not need to separate you from your husband or produce distance between the two of you.

I would strongly encourage you to talk about your fears and anxieties in the safe surroundings of a support group or with a friend, and accept the fact that your husband cannot accompany you in this aspect of the journey.

Jennifer Armstrong, M.D.: I don't think one person can ever understand the mental anguish of another person, male or female. But my advice is slightly different than that of Dr. Schapira. I would encourage you to at least try to talk about your feelings with your husband first. Sometimes that which is so obvious to us is not as obvious to those we love. But that doesn't necessarily mean that there is not caring, or that your husband would not wish to accompany you on this journey. He just may need a little more guidance on where it has started, and where it is going.

If you are not able to get the support you need from him, I totally agree with Dr. Schapira in reaching out to others who can support you in the way that you need. You should certainly check out the Breastcancer.org Discussion Boards and Chat Rooms to talk with other people who may be going through similar experiences.

Help for child with angry reaction?

Question from shere: My sister has breast cancer and her 15-year-old son has stopped eating and is extremely angry (weighs 93 at 5'8"). How does she help him?

Answers —Jennifer Armstrong, M.D.: This sounds concerning. I think both your sister and her son may need help from professionals trained in these issues. Dr. Schapira mentioned earlier that it is not just the patient, but the family that experiences cancer, and it is important that all members of the family who need support get it. If the son has a pediatrician, that physician can be a helpful point person for getting your nephew some trained help. Your sister's oncologist or primary care physician should be able to recommend a therapist to your sister who can help her get through this experience as a patient, and as a mother as well.

Lidia Schapira, M.D.: This case demonstrates that your nephew is suffering from what's happening in the family. It is an emergency, and needs to be handled with immediate and specialized care. I agree that a phone call needs to be made quickly to the child's pediatrician to get him the help that he needs, and I also agree that your sister needs additional support because she's not coping well either, and this may have contributed to her son falling apart. Your role here is a bit tricky, but hopefully you can persuade your sister to act on her own behalf, as well as her son's.

Trouble communicating with doctor?

Question from mary: When I ask a question of my oncologist he becomes angry and I finish the appointment depressed. What can I do?

Answers —Lidia Schapira, M.D.: Sounds like you're having trouble communicating with your oncologist, Mary. You need to come up with a new way to try to establish a connection that will get you through your illness, and will meet your needs. Try taking someone with you to your next encounter. Try perhaps starting with a very frank statement such as, "I left here angry last time, and I hope today that you'll be able to answer this question for me." Or perhaps some other statement that you can practice before you go in, that will put your issues on the table and that will let your oncologist know that you have some questions that need to be answered during your next visit.

It's valuable to acknowledge that there's a limited amount of time, and to deal with how you want to use that time. You might ask if your doctor wants to receive questions in advance. You are in control of the time, and it's important that you make it clear that you have goals as well, and that you need to work together to accomplish both of your needs.

Jennifer Armstrong, M.D.: Sometimes it can be helpful to set up a different office visit just to discuss some questions that you have. While it may seem that this should be unnecessary, sometimes it can free up both you and your physician to focus on these questions. I totally agree with Dr. Schapira that bringing along someone can be a big help. I'm sorry that you're having to work so hard at this, but I congratulate you for recognizing the importance of your needs.

Reveal experience in new relationship?

Question from lesley: Do you have any advice for someone entering into a new relationship about revealing my new shape (after mastectomy) to a potential new partner?

Answers —Lidia Schapira, M.D.: I've had many chats with patients over the years about this point, and I think that it's a very sensitive issue. Some women feel comfortable disclosing the details of their medical history and possible scars very early on, and others wait until the relationship has a more solid foundation and they are ready to become physically close. I can't tell you the right moment exactly. It depends on how you and your partner work out the details of the relationship. But I must say that in order to build a trusting and open relationship, it is important to talk about this relatively early on. The exact moment depends upon the circumstances and the two of you. I wish you the best of luck.

Jennifer Armstrong, M.D.: Sometimes it can be helpful to think about when in a developing relationship you would want or anticipate or expect reciprocal disclosure if it existed. For instance, if your partner were feeling that he or she had a significant issue concerning their physical health, appearance or otherwise, when you would feel the time is right for him or her to talk to you about that? That can sometimes give you a sense of where you are in the relationship, and the closeness that you've formed.

Fun and distraction instead of counseling?

Question from lilysmama: I guess this is less of a question than a statement. I just feel like adding counseling to our already busy lives with kids, doctor appointments and full-time work would be exhausting. Sometimes I think just adding more fun and distraction is the answer.

Answers —Jennifer Armstrong, M.D.: I think you're absolutely right! Sometimes that can be the answer. But sometimes you feel too exhausted to add fun and distraction, and sometimes it seems like there's not enough fun to distract you. And sometimes adding counseling can unburden an otherwise overwhelming experience and make everything seem easier, so everyone is able to have more fun.

Lidia Schapira, M.D.: I agree with you that adding fun and laughter is a great tonic. However, I worry about those who have shared with us their feelings of exhaustion and depression, and think that they may just snap out of their depression through laughter. Some find it easier to cope with the extra challenge of an illness and others, unfortunately, are burdened by anxieties, fear and depression. For them, and for those who are suffering, there needs to be more than just fun and laughter, and counseling or therapy may be the necessary ingredient that leads them to recovery.

Possible to not have anger and depression?

Question from Kate: It's been three months since my diagnosis. I haven't cried, or felt sorry for myself, or asked, "Why me?" Friends and family think I'm in denial, but I think I'm handling it really well. Is it possible to skip the anger and depression typically associated with a new diagnosis or am I kidding myself?

Answer —Lidia Schapira, M.D.:  I think you may be coping just fine. You may be engaged in a process of sorting through your treatment options, and actively taking treatment, and doing everything you can to get better. If you are able to come to terms with the situation, and name your emotions, and don't feel the need to cry, then hang in there! And don't be surprised if perhaps the tears come later. There is no set formula for how to cope, and perhaps your friends and family may expect a different reaction from what they're seeing, but nothing in your statement suggests to me that you're not coping well.

Creative solutions for satisfying intimacy?

Question from Beth: On the issue of sexual satisfaction, I think I may be able to help with some answers. I've been honest about my lessened desire but reassuring that the act of lovemaking isn't the same thing as sex. Lovemaking doesn't have to be a climax for us both. He enjoys receiving oral sex and we just recently added a clitoral vibrator thing and have been having fun getting it to work.

Answer —Lidia Schapira, M.D.: Sounds like a creative solution, and one that works well for you! Clearly, there is more to intimacy than sex, but for many couples, sex is a very important piece of a strong relationship, and I just urge those who are having trouble to look for help. There are trained sex therapists, and others with experience and knowledge who may help couples who are having troubles to find the right solution.

Cheer up worried and depressed mom?

Question from maryam: My mom is 70 and just had breast cancer surgery. Now she is so depressed and is worried that maybe I will get breast cancer as well (I am 40). What is the best way for us to make her a little happy?

Answers —Lidia Schapira, M.D.: Help your mother understand the facts. Perhaps the best way is to accompany her to see her oncologist at the time of her next scheduled visit, and ask that question of the doctor. Have your mother's oncologist address the question of your risk. This may reassure her and lessen some of her guilt.

Jennifer Armstrong, M.D.: If your mom seems to be experiencing depression or anxiety concerning her diagnosis or its impact on the family, there may be some additional issues that could be explored with either her oncologist, primary care physician or therapist, to alleviate some of her feelings.

Good idea to divorce, battle alone?

Question from jd: My marriage was on rocky ground before I was diagnosed with breast cancer. I actually had planned to ask my husband of 22 years for a divorce last summer, but did not after my diagnosis. After going through three surgeries and chemotherapy, I now feel I am ready to go on by myself. Am I foolish to think I can continue to battle this on my own?

Answer —Lidia Schapira, M.D.: Of course you're not foolish. Sounds like a difficult situation, and one to which you have given a lot of thought. I cannot give you any advice based on this short paragraph, but certainly you need to follow your instincts and do what you think is best for you.

Specialized support groups available?

Question from Seminole Becky: I would like to attend a support group, but I feel like they don't think I belong there. My cancer was Stage 1 and I did not have a mastectomy or chemo. Are there specialized groups?

Answers —Jennifer Armstrong, M.D.: There are certainly specialized groups, but not necessarily in every region. If you live in an urban setting you are more likely to find support groups separated by stage and often other factors (young women with breast cancer, older women with breast cancer). If you live in a rural area, these may be harder to find, although you may be able to access them through other means, such as the internet—for example, the discussion boards and chat rooms at Breastcancer.org. Usually these groups have a coordinator, who may be able to direct you to a group that may best meet your needs. Most groups are interested in accepting everybody, and all cancer survivors regardless of their disease or stage deserve support for their experiences. You may find your needs are best met in an early-stage breast cancer group.

Jennifer Armstrong, M.D.: Another resource can be your oncologist's office. They may have several patients with similar disease stages who can act as a resource for more recently diagnosed patients. You're right that a support group that feels right to you will be the one that ultimately will be the most effective and helpful for you.

Jennifer Armstrong, M.D.: Thanks for being with us this evening. We hope the support and information you've gotten here tonight will help you discuss some of these issues with your doctor and make the best choices for YOU.

Jennifer Armstrong, M.D.: We also look forward to hearing from you at future Ask-the Expert Online Conferences right here at Breastcancer.org.