Breast Cancer in the 21st Century
So where is all the so-called progress? And why have our medical and scientific powers not improved upon the Stone-Age diagnostic tool of mammography, which yields both false-positive and false-negative results, exposes women to low doses of ionizing radiation, and, for all we know, compresses encapsulated cancers to the degree that they explode in the body and spread?
(Better diagnostic tools exist—3D ultrasound, MRI, and PET scans—but mammography remains the primary tool, likely because of the expense of replacing the obsolete technology.)
About one in eight US women will develop invasive breast cancer over the course of their lifetimes. An estimated 230,480 new cases of invasive breast cancer were expected to be diagnosed in women in the United States in 2011, along with 57,650 new cases of non-invasive (in situ) breast cancer. About 40,000 women die each year of the disease, just about the same number that died from the disease annually when I started writing about breast cancer on Long Island in 1985. The main risks are being a woman and getting older.
The overall death rate from breast cancer among US women 50 and over is currently declining at the rate of two percent a year according to the American Cancer Society. The ACS attributes this to early detection and treatment, and to the fact that, for the past decade, millions of menopausal women stopped taking hormone-replacement therapy due to numerous studies that linked the treatment to a significant increase of breast cancer.
While breast cancer prevention has not shown the strides we would hope for, the past 25 years have seen a radical change in women’s attitudes about the disease. Most people know a breast cancer survivor living a vibrant, active, meaningful life, often after undergoing both radiation and chemotherapy. The feeling today—about most types of cancer—is that it’s a disease you live with, not die from!
That doesn’t mean that going for yearly mammograms, being diagnosed with breast cancer, having the surgery and follow-up treatments, and getting back to “real life” are not fraught with anxiety and often depression. How could it be otherwise? You enter the office for this yearly test looking and feeling fine, only to have your life change in a second if the technician (who has spoken with the radiologist) says she wants more films, or a follow-up sonogram, or a biopsy.
If the diagnosis is cancer, every woman then embarks on a journey into the foreign land of searching for surgeons and/or oncologists, learning mysterious medical lingo, making lists of all the questions that arise, arranging for help with the children and home, figuring out how to “break the news” to her family, rearranging her work schedule, dealing with matters of sexuality, and mostly thinking about her own mortality.
The good news in this anxiety-producing picture is that women are overwhelmingly good at multi-tasking, a skill that the diagnosis of breast cancer demands of them. They are also great at coping—it’s not that an avalanche of tears is not shed, moments of panic don’t set in, or despair doesn’t grip the heart. They do. But after that, women get on with it!
A good example is a young woman I know from Long Island. Adopted as a baby, Brandy grew up in a loving home, married the love of her life in her early thirties, and had a baby. But at 37, she was diagnosed with breast cancer and plunged into the medical maze I described above. She had a lumpectomy and radiation, and all seemed fine. But five years later, the cancer reappeared in the same breast and she opted for a double mastectomy and reconstruction.
Like women of all ages, life was never the same for Brandy after breast cancer. “Every sniffle you get, every backache, even if you’re just tired, you think the worst,” she said. “You think that the cancer has come back and it’s zooming around your body like a runaway train.”
She could whisper her anxieties to her husband but bottled her feelings around other family members. “I made sure my walking-talking-understands-everything toddler never heard a word,” Brandy continued, “and I couldn’t even talk about it with my mother because she would burst out crying.”
One thing parents can’t protect their adopted children from is their DNA, but then again, neither can birth parents! After years of not being very curious about her birth origins, Brandy conducted an extensive search and learned that her birth mother had died of a malady unrelated to cancer, but that she had a “fabulous” half-sister. (They have since become best friends.)
Another Long Island resident, Eleanor, a boutique owner, wasn’t diagnosed until she was 67 and chose to have a lumpectomy and follow-up radiation. “People think that when you’re older, it’s easier to accept because you’ve lived your life and should have a good philosophical perspective about dying,” she explained. “To them I say hogwash! I just thank God for modern medicine that I was diagnosed early and got great treatment.”
Both Brandy and Eleanor said the huge amount of resources they found on the Internet helped immensely through their ordeals. This included:
>> Online support groups
>> Online organizations devoted to breast cancer information (for instance breastcanceraction.org)
>> Lists of questions for doctors
>> Helpful hints in coping with radiation and chemotherapy
>> Useful dietary information
>> Advice on the sexual issues that arise with husbands or significant others
>> Great ways to speak to children of all ages
>> General support for anxiety and depression
>> Numerous support groups in most communities throughout the United States
>> Helpful books available online
>> Ways to get involved in organizations working toward a cure
Breast cancer is still difficult to cope with despite the advances in treatment and the change in attitudes and perception that has occurred in the culture. But, thanks to pink ribbons, breast cancer walks, and even professional athletes wearing pink shoes, the disease is on the front burner of public consciousness and women themselves are leading the way to making it obsolete!
JOAN SWIRSKY, RN, is a New York-based journalist and author. Joan was a science writer for The Women’s Record. She is a New York-certified psychotherapist and was awarded a Nurse of Distinction Award by the New York State Legislature in 1991. Joan was also co-founder and editor-in-chief of REVOLUTION: The Journal of Nurse Empowerment.