When one of the managers in my office heard Id been diagnosed with breast cancer, he burst into my room, grinned widely, and said, Well, look at it this way; its a quick way to lose ten pounds. Known for my own irreverent attitude, I was nonetheless stunned. I flashed on the paucity of wit in our strained relationship and felt angry he had not earned the right to launch friendly fire my way. Still, the urge to top his crack won out. Not in my case, I grinned back just as widely. (Not even if they lop off both of them, you dodo, I thought.) Having breast cancer quickly removes any lingering taboo about boob talk.
For me and for the alumnae whose experiences appear here, cancer
brought clarity as well as confusion. We faced fears not of losing
our breasts, but of losing our lives and a society that often
didnt distinguish between the two. We grew both stronger and
forever vulnerable. We found unexpected gifts. Letting go of vanities
and minutiae lightens your load. If you dont already know, you
quickly figure out who and what truly count in your life. And,
with its fears, the experience also brings laughter sometimes
nervous, even manic to leaven your middle-of-the-night grasp
of mortalitys dark joke. As one twenty-something mother with
breast cancer advised us at UVMs 1998 Breast Cancer Conference:
If you dont have a sense of humor, you better get one.
But, what to call us. No longer grim victims or sufferers, weve
transmogrified into survivors. Some women call themselves breast
cancer veterans, hoping no doubt they wont be conscripted for
another skirmish. Some of the women Ive met choose survivor;
theyve declared victory and moved on. For them, says Dr. Patti
OBrien 75, MD85, who understands the story from both sides
of the hospital bedside, breast cancer is an episode in their
lives. For her and many others, it cannot be dismissed, perhaps
The alumnae who responded to Vermont Quarterlys open call for
breast cancer experiences laid bare personal and frequently painful
pieces of their lives to a stranger. And, without prompting, they
said why. They want you to know what theyve learned; they want
you to know, as Laurel Stanley 68, G75 says, You can have this
and survive; they want you to know that, if you join their club,
they and others like them will help you. Their lives are filled
with family, friends, fun, work, and good works. They are survivors
by dint of will and spirit. They have my admiration, my deep gratitude,
and my fervent wish that they prevail.
What Is Cancer?
The cause of cancer is genetic, that is due to abnormalities
in the genes, says Dr. Hyman B. Muss, associate director of UVMs
Vermont Cancer Center and director of oncology at Fletcher Allen
Health Care. Cancer is a disease in which cells are able to grow
unchecked and can invade normal tissues and spread to other organs
of the body. Cancer occurs when enough mutations accumulate in
two specific kinds of genes those that encourage cell growth
(oncogenes) and those that limit cell growth (tumor suppressor
genes). In the former, the alteration allows too much cell growth;
in the latter, it fails to stop abnormal growth. Cancer cells
can spread to other parts of the body via the blood or lymphatic
Muss explains it more poetically and graphically. In cancer,
cells are immortal, he says. You get breast tissue in your bone,
liver tissue in your lung.
The American Cancer Society estimates that 178,700 women and 1,600
men will get breast cancer this year, and 43,500 women and 400
men will die. The societys figures dont include ductal carcinoma
in situ, an early-stage abnormality that progresses to invasive
cancer in about 30 percent of cases and accounts for about 36,900
more cases each year.
If you read news articles and catch sound bites on the latest clinical studies, you know theres good news about survival rates, bad news about the growing number of people with breast cancer, and incomplete information on cause, risk, and treatments. You may feel befuddled about your own risk or whether you should get a mammogram. Thats because, educated suspicions aside, no one yet knows what causes breast cancer, and the medical experts cant agree about mammograms for women under 50. What used to be suspect nutrition a high-fat diet, for example apparently is no longer. Of course, there are plenty of reasons to follow a moderate, healthy diet and to exercise. Particularly since, while youre worrying about breast cancer, youre eight times more likely to die of heart disease. You can tick off all your breast cancer risk factors in any womens magazine, but most women who get breast cancer dont fit any risk profile. Most of the alumnae in this article believed they were not at increased risk. Most also had excellent nutrition, exercised routinely, and had regular mammograms. But, they got breast cancer. As Dr. Susan Love (of Dr. Susan Loves Breast Book fame) says, The only thing predictable about breast cancer is its unpredictability.
Playing With Fire
Nancy Squire Burgess 72, G79, a graduate from UVMs home economics
and secondary education programs, can attest to Loves contention.
Her breast cancer saga began in January 1992, when she immediately
suspected that the lump she found in her breast was wrong. I
had an uncanny feeling about it, she says. She was 42 at the
time, married, with a young daughter, and working in a public
school in Concord, New Hampshire.
Confirmation of her suspicions didnt come quickly or easily.
Four days after finding the lump, she had an inconclusive physical
examination and soon after met with a surgeon. A surgical biopsy
in March came back benign. However, in the tissue surrounding
the lump, pathologists found lobular carcinoma in situ, a cancer
somewhat more likely to become invasive than the more common ductal
carcinoma in situ, sometimes called a pre-cancer.
It was a situation where theres time to do research and meet
with consultants, Nancy says, and I did a whole lot of research
on it.. . . I heard it was a time bomb that may never go off,
but not being a big risk taker, I consulted with several oncologists.
She found that 49 percent of the time, this type of carcinoma
does not become invasive. But she and her husband, Fred Burgess
72, both thought youre playing with fire, she says.
Nancy needed a second biopsy because another small lump had been
found in her other breast; it too was pronounced clean, as was
the tissue surrounding it. That was in April. In June, she consulted
a surgical oncologist in Boston and the next month had a bilateral
mammogram. Suspicious calcifications were found, but no one could
tell her what to do. I was looking for someone to say something,
she says, but they said, its your call. It was tough to get
information then. Her options were to be monitored with multiple
surgical biopsies for the rest of her life or choose bilateral
mastectomy. She chose the latter and had surgery in October. The
pathology report concluded that her first tumor was invasive,
a minute tubular carcinoma. So, in November, Nancy returned to
the operating room for lymph-node dissection. They were pronounced
clear, and she didnt require chemotherapy.
A woman who always ate well and exercised, Nancy finds no particular
risk factor in her life. Ive had a wonderful life, very happy.
Im very lucky, she says.
Was It The Water In Your Well?
Once you have breast cancer, finding out why may seem pointless,
but that quest is what engages researchers seeking to prevent
and cure the disease. Hardly a day passes without a report linking
one of our foods, household products, or personal habits to cancer;
weve all become uncertain experts.
Studies implicating one villain get countered by other studies.
The recently released, 14-year Harvard study of high-fat diets,
for example, reversed earlier warnings. It found no evidence
that a high-fat diet promotes breast cancer or that a low-fat
diet protects against it. Dr. John Glaspy of UCLA comments, We
should just accept that good scientists cant tell you yet what
to eat to minimize your breast cancer risk.
That doesnt keep us from targeting suspects, however. Almost
every woman with breast cancer has a theory or at least a hesitant
guess about why she got it. Linda Blow OConnor 64 wonders
if personality didnt have something to do with it, noting that
she reacts to stresses that dont bother others. Helen Whitney
82 wonders if growing up near a power station caused hers, or
was it the well in her familys garden? The pesticide DDT, a known
carcinogen, was banned in 1972, but it has a long life and was
used extensively in farm country, she recalls. Patti OBrien was
a DES baby, meaning her mother took diethystebestrol, a synthetic
hormone, to prevent miscarriage. Although DES is linked to cervical
cancer, OBrien believes it played a role in her breast cancer.
Researcher and author Liane Clorfene Casten (Breast Cancer: Poisons,
Profits and Prevention) agrees that DDT and other pesticides are
suspect, as are DES and other synthetic hormones.
If you started having periods young, entered menopause late, didnt
have children, or had your first child after 30; if a close relative
had breast cancer; if you took birth control pills for a prolonged
period before age 30; if youve taken hormone replacements for
several years; if youre well educated; you might be at higher
risk for breast cancer. Dr. Muss says each factor increases your
risk, but factors are not necessarily additive.
In her book, Understanding Breast Cancer Risk, Patricia T. Kelly
reports that women frequently feel they are to blame for getting
breast cancer because they didnt do breast exams, had had abortions,
didnt breast feed, were unable to love, or had guilt about their
Dr. Muss echoes most of the scientists I interviewed or whose
research Ive read. We dont know what causes it. There probably
are a host of causes, he says. He suggests taking control as
best you can through good diet, physical activity, and using plant
estrogens such as soy foods (tofu, tempeh, miso, for example)
in your diet to lessen heart disease risk a very real risk for
post-menopausal women not taking hormone (estrogen) replacement.
Author Dr. Andrew Weil also recommends eating soy products and,
if you eat meat, beef thats hormone and antibiotic free.
Many breast tumors are what scientists call estrogen-receptive.
Women in that category cannot be prescribed hormone replacement
therapy (HRT) for fear of recurrence. In a Swedish, long-term
study of post-menopausal women on HRT, 10 percent more women got
breast cancer than statistically anticipated. Women on HRT have
a higher incidence of breast cancer but a lower mortality rate
Am I The 1-in-10?
Statistics about risk have added to our worries. Do 1-in-8 or
1-in-9 or 1-in-10 women get breast cancer all figures reported
regularly? The answer is none of the above. If youre young, you
have a higher lifetime risk of getting breast cancer because statistics
predict youll be around a long time, but you have a lower risk
for any given year. From birth to age 50, women have a 2 percent
risk of getting breast cancer; from birth to age 70, about 6 percent.
In her book, Kelly says wed have to live to 110 for the 1-in-10
risk to be valid. All those figures apply if youre white. Black
women have a lower risk, but are approaching the risk of white
women. Asian women have lower risk than either. Native Americans
have a very low incidence of breast cancer, but high mortality
rates from it.
Geography also weighs in on risk. Women in New England die from
breast cancer at a 25 percent higher rate than women in the South
or West, although the incidence of the disease is only 3 percent
higher in New England.
More men get breast cancer now than ten years ago and more die
possibly because men dont expect to get breast cancer, dont
do self exams, and may put off going to doctors. Men have increased
risk if a blood relative male or female has had breast cancer.
In Understanding Breast Cancer Risk, Kelly warns women to be wary
of how risk is stated. If a study says that something about your
life increases your risk 50 percent, check what the basic risk
is. If its 1 percent, a 50 percent increase translates to 1.5
percent; a 100 percent increase, to 2.0 percent.
Some women carry higher risks, however, because of unique genetic
factors. David Yandell, director of the Vermont Cancer Center
at UVM, says approximately 5 percent of breast and ovarian cancers
have hereditary links, meaning strong family connections to the
disease. Dr. Marie Wood, UVM assistant professor of medicine and
director of Fletcher Allens Familial Cancer Program, notes that
women with defects in the gene known as BRCA-1 have a higher,
lifetime risk of breast and ovarian cancers. A higher lifetime
risk also attaches to defects in the BRCA-2 gene, more common
in Jews of European descent. Karen Stabiner, author of To Dance
with The Devil: The New War on Breast Cancer, says that 5 percent
of women with a healthy copy of the BRCA-1 gene will get breast
cancer by the age of 40, and 16 percent of women with a mutated
copy will. Although genetic screening is available, Wood says,
it is costly anywhere from $250 to $2,500 and usually not
covered by insurance. She also recommends not having genetic testing
at the time of cancer diagnosis. Its overwhelming for the patient
to deal with cancer, she says, let alone face information that
their families also may be at risk.
About one-fourth of women with breast cancer have an alteration in a gene known as HER-2/neu. Normally, there is only one copy of that gene in each cell, but when an alteration occurs, too many copies are produced, causing unregulated cell growth.
A Game Plan
Dr. Patti OBrien 75, MD85 is one of the HER-2/neu-positive
women. An assistant professor/doctor at UVMs College of Medicine
and Fletcher Allen Health Care and instructor in Physical Therapy,
she has brightened her cluttered office in Rowell with her childrens
art and photos. She calls her son her graduation baby she felt
his first kick during her UVM Medical College graduation and
her daughter, her residency baby. When we talked in late spring,
she was busy arranging a visit to Germany, to learn more about
her specialty, lymphedema, but her top concern was getting the
kids to the airport to see her off.
Patti was 43 in 1996, when she found a lump in her breast. A recent
mammogram had raised no suspicion, and shed previously had lumps,
cysts, even mastitis during breast feeding. But, her grandmother
had died of breast cancer, and, as a doctor, she was too knowing
to ignore this symptom. Although only one lump was palpable, her
surgeon found five tumors. Her lymph nodes were positive, and
her cancer had spread. The diagnosis effectively rewrote her life,
particularly for the next year, which filled quickly with treatment
protocols. She began with a bilateral mastectomy, because, she
says, the risk was so high that the cancer would appear in her
other breast. Next up was chemotherapy. Then, Patti joined an
out-of-state clinical trial and underwent a stem-cell transplant.
An extreme treatment meant to save or extend a life, the stem-cell
procedure sounds like the R-rated movie scene where you cover
your eyes and hum a tune. Women already in danger of dying have
their stem cells young, bone marrow cells removed and frozen.
The women then endure ultra-high doses of chemotherapy five
to twenty times stronger than normal to kill cancer cells. Their
stem-cells are reinfused after the course of chemo. Not everyone
survives the treatment the risk of dying is about 1-2 percent,
says Dr. Muss. Patti and women like her embrace the procedure
because their survival odds likely would be poorer without it.
However, the jurys not unanimous on that verdict.
During the stem-cell transplant, Patti also received immuno-modulation
drugs, which aim to boost the bodys surveillance of tumors. That
was followed by a month of the experimental interleukin-2 drug,
self-injected into her abdomen, and then, radiation therapy.
Many women choose not to have reconstructive surgery following
mastectomies. Some use breast prostheses, others go without. Theyve
had as much invasive treatment as they can take. That was true
for Patti, but she also says, shes completely comfortable with
The severity of her cancer necessitates vigilance. Patti regularly
gets bone scans, x-rays, and blood tests useful in predicting
recurrent disease. The blood tests are not highly specific or
sensitive, she says, but they are one more tool. Shes also on
tamoxifen, a newer drug proving effective in preventing recurrence
in high-risk women.
Patti believes her cancer will recur, but still thinks, Im very lucky. I have such access to information. Thats important to her personality. Im someone who always has to have a game plan, she says. Although she likes control, she saves it for the big issues. Papers out of place no problem. Cancer cells out of place a few, okay but not big ones, she says.
Mammography Is Not Perfect
Suzanne Germain 76,85, a nurse practitioner, has a practice
in Bristol, Vermont with her husband, Dr. C. Edward Clark MD 82.
If asked in 1997, she would have rated her health as excellent.
A petite, quiet-spoken woman, at 43 she ran three miles a day,
grew organic vegetables in her backyard in Lincoln, and loved
her husband and two daughters and her work. She carried then,
as now, a terrible sadness. Her mother had had a mastectomy at
34 and at 39 died from breast cancer. Suzanne was 8, the oldest
in a family of five children.
Because of her family history, she began having mammograms early
in her life. The past eight, she says, had been negative. Then,
in the course of a routine breast self-exam, Suzanne found a lump
and went immediately for another mammogram. It, too, was negative.
She thought it not a likely diagnosis, and she was right.
Mammography is not perfect, says Berta Geller, UVM research
assistant professor in the Office of Health Promotion Research.
She estimates that 10 to 20 percent of breast cancer is missed.
Mammography errs particularly with younger women, whose breast
tissue is dense, making changes difficult to spot or interpret.
Thats why Geller believes strongly in women doing regular breast
Suzanne underwent surgery, which revealed a 10 cm tumor (considered
very large), an infiltrating adenoma. The lymph nodes under her
arm were dissected during the surgery, and seven of the nodes
tested positive for cancer. Because of the size of her tumor and
its spread to the nodes, Suzannes cancer was labeled Stage 3
(tumors more than two inches Suzannes was about four inches).
And, because of the statistical likelihood her cancer would recur,
she had a bilateral mastectomy, in which all breast tissue is
removed in both breasts.
Suzanne, like Patti OBrien, had a stem-cell transplant. I didnt
want to do stem-cell, she says, and I got second and third opinions.
But everyone agreed I should. The recent news interpretations
of stem-cell studies have upset her. One such article in the Toronto
Star newspaper tried to sort out the conflicting results. While
studies confirm the procedure is effective in leukemia and lymphoma,
the paper reported, its efficacy in breast cancer is less clear.
One study, at the University of Witwatersrand in Johannesburg,
found that 25 percent of women with bone marrow transplants had
a cancer relapse after five years, compared to 66 percent of women
on more conventional therapy. A recent Associated Press article
reported that the latest studies say the procedure doesnt improve
longevity, although it likely keeps women relapse-free for a longer
After I went through all that, Suzanne says, trailing off and
Pattis perspective should ease Suzannes concerns. The press,
she says, has a moral responsibility to improve the way they
report health. I feel very good about having been in a clinical
trial in stem-cell. I do believe the bone-marrow transplant has
Part of the problem is that not many women have had the procedure
possibly only 12,000 in the United States in the past decade
and most of them were not in the clinical trials that comprise
the reported results.
Known for her directness as much as her skill as a breast surgeon
and author, Dr. Susan Love is probably least popular with colleagues
for her description of their professions approach to treating
breast cancer: Slash, burn and poison, she calls it, because
it horrifies her at the same time she bends to its necessity.
Women whove had to enroll in these treatments appreciate that
understanding. Most of the time, success seems apparent, but sometimes
the cure seems worse than the disease.
Helen Whitney 82, a nurse at Childrens Hospital in Boston, knows
first-hand how slash, burn, and poison can backfire. She was 35
when the lump she found was diagnosed as ductal carcinoma in situ,
sometimes called a pre-cancer. I was hysterical initially, she
says and wanted both breasts off. She gave it more thought,
got more information and medical input, but still wanted one mastectomy.
She hoped to avoid radiation treatment, which can create scar
tissue and cause chest-wall changes. Helen settled on a lumpectomy,
in which just the lump and surrounding tissue are removed and
then the patient has about a six-week course of radiation. Surgeons
remove surrounding tissue to be sure they have clear margins,
tissue without any trace of cancer cells. In Helens case, they
couldnt get clear margins, because she had extensive ductal carcinoma.
A mastectomy was necessary after all, and Helen opted for immediate breast reconstruction, a nine-and-a-half-hour surgery. Four days later, a blood clot formed and she had to undergo the surgery all over again. A vein was grafted from her arm. She became anemic and was transfused twice. She woke up in intensive care.
Although she escaped the dreaded radiation treatment, she now
needed chemo. But after just one of six planned sessions, she
had a severe, and rare, reaction to one of the six drugs in her
chemo recipe. She was hospitalized for nine days with a life-threatening,
almost-ruptured intestine. I have chemo envy, Helen says, because
chemo improves your chances of survival.
Side effects from treatments range from the serious, like Helens,
to the annoying, but more common. Mary Ellen Anderson 68 says
she had more lethargy than illness from her radiation treatments.
Joyce Marx Flynn 48 says her first two chemo treatments made
her groggy. Id sleep for 18 hours, but she never vomited. Tests
showed that one-third of her white count had been knocked out,
she says, and an adjusted chemo level made her feel much better.
Nancy Burgess recalls that she got hideously sick from anesthesia.
Other serious risks from treatment, Patti OBrien says, include
heart toxicity the chemo drug adriamycin is the culprit in that
or a second malignancy, also related to chemo. Surgery can leave
scars and cause lymphedema, swelling in the arm and hand from
lymph node dissection. OBrien had a slight case of that after
surgery, made worse when she returned to weight lifting. She now
wears a compression sleeve on her arm and has made lymphedema
and treatment for it well known through her research and teaching.
Tamoxifen increases the risk of uterine cancer and can cause cognitive
changes. Estrogen helps us think, says Patti, and tamoxifen
earns its rep by suppressing estrogen.
A major side effect from chemo treatment is premature, sudden
menopause. Patti OBrien says she was slammed into it. Barbara
Crandell Cochran 72 said menopause was ushered in after three
chemo treatments. Since she cant use HRT, she has had some osteoporosis
problems, but has been on tamoxifen for the past three years with
no side effects. Mary Rusnak 68, G90 was fortunate that shed
had three children before she entered menopause at 29 following
treatment for her first occurrence of breast cancer.
The recent surge of research into breast cancers causes and treatments
owes its impetus to breast cancer survivors, who formed coalitions,
lobbied members of Congress, and kept the issue in the headlines.
Because of them, scientists have had access to more funding, more
information through the formation of mammography and cancer
registries and more research subjects. Joyce Marx Flynn took
part in a UVM research project in Lee County, Florida conducted
by John K. Worden, research professor in the Office of Health
Promotion Research, and others. The Breast Screening Program project
created and evaluated a program of public education and training
for medical practitioners. Mary Ellen Anderson enrolled in a two-year
clinical study at Stanford University, where researchers are seeking
a way to detect breast cancer through blood tests. Last year,
Laurel Stanley participated in a clinical trial at UVM of a procedure
developed by Dr. David Krag, associate professor of surgery and
Fletcher Allen surgical oncologist. Called sentinel node biopsy,
it could reduce significantly unnecessary lymph node dissection.
Normally, many lymph nodes are removed in breast cancer surgeries,
almost always from the armpit, and are tested for cancer cells.
The surgery requires a drain, can leave a patient with lymphedema
or range-of-motion problems, and compromises to an unknown extent
the patients immune response. If the nodes test negative for
cancer which they do in most cases the patient has had unnecessary
surgery. Also, node dissection is an imperfect prognosticator
of metastatic disease. Dr. Krag says that in 20 to 30 percent
of women with negative nodes, the disease has spread, and in 30
percent with positive nodes, it has not. Despite these statistics,
testing the sentinel nodes remains the best tool available to
detect the spread of cancer in at least some patients.
In Krags sentinel node procedure, the surgeon injects a radioactive
tracer into the breast around the cancer site. Using a hand-held
gamma detector, the surgeon locates the nodes that take up the
tracer the sentries are first in the line of defense and, therefore,
most likely to have cancer cells if any nodes do. Only women who
have positive sentinel nodes will then have conventional axillary
surgery and dissection. Although in its early experimental stage,
the procedure shows a 97 percent accuracy rate and soon will be
subjected to a national trial funded by the National Cancer Institute.
Dr. Bronagh Murphy, a former Vermont Cancer Center/Fletcher Allen
medical oncologist, delivered good research news at the 1998 Breast
Cancer Conference to women who over-produce the HER-2/neu oncogene
and develop aggressive breast cancer, like Patti OBrien.
Herceptin, a monoclonal antibody (an artificially produced antibody
that neutralizes just one specific antigen or foreign protein)
works against the HER-2/neu. It has low toxicity and shows promise
in clinical trials of halting the deadly cell division caused
by the altered HER-2/neu gene. Researchers hope it may lead to
a vaccine for those with the defective genes. Herceptin is distributed
through a lottery to women with progressive or advanced disease
after theyve already had two or more therapies.
In other promising research, Dr. Seth Harlow, a UVM/Fletcher Allen
oncology surgeon, will lead Vermonts part of a national, five-year
trial comparing tamoxifen and raloxifene. Post-menopausal women
believed to be at high risk for breast cancer will be assigned
randomly to one of the drugs. Researchers hope that raloxifene,
an osteoporosis-prevention drug, will equal tamoxifen in breast-cancer
prevention but with fewer side effects. Tamoxifen puts women at
a higher risk for uterine cancer and blood clots in the lungs.
Coping And Healing
Despite the best care science has developed, half the patients
of Dr. John Graham-Pole die. A pediatric oncologist at the University
of Florida, Graham-Pole told a UVM audience last year that, to
continue his work, he has had to grasp the limits of scientific
curing and open himself to the art of healing. He and his patients
engage in art and play spontaneous and planned. We need humor
in our lives, even in the face of death, he believes.
Nancy Burgess also speaks of the importance of humor. It plays
a huge role slightly black humor, she says. It helps those
around you, too. Finding something to laugh about puts them at
ease. It also helped her deal with the staff at her insurance
company, several of whom were rude and insensitive. She can laugh
now as she mimics their incredulity in response to her revised
claim for a double, rather than single mastectomy. What? You
need two? The principal of her school was even harsher, threatening
to fire her if she didnt return immediately to work.
Karen Kitzmiller, a Vermont state legislator, says after her diagnosis,
she cried daily for two or three months, then realized it was
a waste of time bemoaning fate when I still felt well. So, she
took up the violin, played tennis, meditated, and let others
into my life and accepted help.
I have a lot of anger, says Patti OBrien, but need to get
it out productively. She relies especially on her support group
meetings, part of the research on coping with breast cancer conducted
by Bruce Compas, UVM professor of psychology (see page 38 for
a review of Compas research). Patti also advocates for breast
cancer survivors and for research through the National Breast
Cancer Coalition, in addition to teaching and working in her practice.
Helping women sort through the myriad treatment options is a primary
responsibility of caregivers at the Breast Care Center (BCC) at
Fletcher Allen. One of a handful of such centers in the country,
the BCC is a comprehensive, multidisciplinary center offering
breast cancer patients everything from the opportunity to participate
in clinical trials to psychological support to genetic screening.
BCC psychologist Ellen Atkins G92 says the treatment options
can be overwhelming. I work with patients to help them develop
skills to cope with cancer, and to give them recommendations on
how to get through each step of treatment, she says. And because
breast cancer affects the lives of family members and friends,
I often work with them, too.
Sometimes, you cope by rejecting too much information. Mary Ellen
Anderson 68 of Pacific Grove, California, felt that way reading
Dr. Susan Loves Breast Book. She read the gloom and doom and
fell apart. She gave away her copy and, after that, read only
what would help me. Mary Ellen found a lump in September 1994,
the year after shed retired as a commander in the navy. Although
her mother had died of breast cancer, she wasnt overly concerned.
Shed had yearly mammograms, but felt she didnt have time for
this. Shes grateful now for the friends who urged her to check
with a doctor. She had an infiltrating ductal carcinoma, and two
of her lymph nodes tested positive for cancer one, she was told,
was completely replaced by a tumor. Mary Ellen chose a lumpectomy,
followed by radiation. Without the radiation, her breast cancer
had a 40 percent chance of recurring, she says. She followed that
with six months of chemotherapy, but first enrolled in a therapy
that helped her accept the chemo. A nurse suggested she change
her negative attitude about chemo or shed have a hard time with
She also found better ways of coping with stress, she says. I
try not to react. ... I take time to enjoy things. Dont react
negatively when theres nothing you can do, she advises. She
also changed a diet that was too weighted with fatty foods, but
allows slips. You cant eat on fear-based ideas, she says. Shes
found another outlet in aerobic exercise good for the bones,
and cancer doesnt like oxygen, she explains.
A report from the House Committee on Government Operations, the
result of a hearing in 1994, says that approximately 97 percent
of women with localized breast cancer survive at least five years;
76 percent of women with cancer that has spread regionally survive
that long; about 21 percent with distant metastases do. Although
the survival rates go down after five years, they are improving
overall, particularly for women with estrogen-receptor-positive
Some of those in the lucky statistics group have survivors guilt.
Joyce Flynns friend died from breast cancer while Joyce was being
treated. Ive been lucky, Joyce says, and I feel a little guilty.
I think often of a woman I met during radiation therapy. She was
40, and she and her husband were about to begin the process of
adopting a child when she was diagnosed with an especially aggressive
breast cancer. Shed been through all the treatments then available
and knew she was doomed. I get so angry at people who complain
about mastectomies, she told me. They lose a breast. Im going
to die. And, she did, about a month later.
Although the answers to cause and cure remain elusive, you neednt
be paralyzed by inaction. Researchers and survivors alike recommend
that you do regular breast exams and strive for prevention through
healthy eating, exercise, and enjoyable activities. At the very
least, youll be enjoying life more and preventing other ills.
Unless you have reason to get one earlier, you should get a baseline
mammogram around age 40 with annual or biannual repeats your
doctor or nurse practitioner will advise which. Nancy Taggart
Tilley 79, who works for the American Cancer Society, says she
has seen many women newly diagnosed with breast cancer. I hope
your article stresses the annual mammogram, she says. So many
women I have seen were in their 30s and with no family history
of breast cancer. This disease strikes the young, the physically
fit it is not just our mothers and grandmothers concern.
If you dont know how to do a breast self-exam, visit your local
breast center or medical caregiver for instructions. Watch for
lumps, thickening, swelling, distortion or tenderness; skin irritation
or dimpling; or nipple pain, scaliness or retraction. Most breast
pains signal benign (non-cancerous) conditions, and most breast
lumps are not cancer. But, you cant tell without having them
checked. Dont hesitate to have a symptom checked. My family doctor
says, happily, much of his practice is ministering to the worried
Almost all the women in this article raved about the support they
got from spouses, families, and friends. Home-cooked meals, lifts
to radiation therapy, child care; they were all needed and greatly
appreciated. And remember that cancer treatments dont heal all
the ailment. Suzanne Germain says that the hardest time usually
comes when treatments are over. People expect youre done, get
on with it, she says.
My favorite how-to-help anecdote came from Gretchen Casey, who
had a lot of support. But the one that stands out, she says,
was the day a neighbor walked in, said nothing, and cleaned my
And, if youre a true intimate, humor will help. Journalist, author
and childrens television host Linda Ellerbee, who sobbed when
she first saw herself in a mirror after a double mastectomy, laughed
about it with two childhood friends. They said they were probably
the only two humans who remembered me before I had breasts, she
And, if you find yourself tapped for membership in this club, take courage from these alumnae. Think about:
Survivor may be the right word, after all. It expresses hope and a belief in healing, if not cure. It has tinges of heroism and luck, of walking out of odds-against, death-dealing situations. Perhaps thats why women with breast cancer wear the term well, even those for whom it is a fickle descriptor. They may be short-timers in lifes lottery but they never stop hoping to draw a high number. They hope to have the last laugh.
Experiences of Alumnae
Lessons from Others: Barbara Crandell Cochran '72
"Lucky To Be Alive": Mary Cota Rusnak '68, G '90
A Surprising Diagnosis: Gretchen Junk Casey G '71
Her Daughter Took Heed: Sharon Newton St. Onge '64
"I Never Felt Alone": Laurel Stanley '68, G '75
Help From Another Survivor: Joyce Marx Flynn '48
Luck Took A Different Turn: Linda Blow O'Connor '64
Survivors' Advocate: Elizabeth Niles Elder '54