There is no single right way to treat breast cancer, as too many women discover each year upon diagnosis. While a lumpectomy could be appropriate, so could a radical mastectomy. Sometimes chemotherapy is a good idea, or it could be unnecessary. Radiation might help, maybe not. Hormonal medications can halt some types of breast cancer, while other tumors are not affected.
But those are merely the facts of a breast-cancer case. The deepest challenges of the disease are less tangible, rooted in fears and emotions and relationships. These are places of the heart and soul where the most healing occurs — or stalls. This is the stuff of survival.
Doctors and researchers are increasingly recognizing the significance of a woman’s personal life. They are discussing “psychosocial aspects” of breast cancer at medical conferences and conducting new studies to determine effects on the patient and her family. It’s a good sign.
Diagnosis and treatment lead to confusing and scary times. A woman hopes she makes the correct decisions and picks the best doctors. Ideally, she can turn to family and friends for reassurance and much more. Here are the stories of four women who found support in the ways they needed it, when they needed it.
CELIA BATTLE
A year ago, right before her teenage daughter started high school, Celia Battle found out the calcifications indicated on her mammograms were more than that. She eventually required a mastectomy and breast reconstruction, followed by the full complement of chemotherapy, radiation and hormonal medication.
The Deerfield teacher was overwhelmed by the support of parents of children in her class at Christian Beginnings Preschool: Meals were delivered to the Battles’ dinner table for at least six straight months.
“You have to be open to support from all places,” said Battle, who is in her 40s. “I’m a teacher and a giver. I found it hard to receive but realized it helped other people feel like they could do something. I appreciated their generosity so much.”
Her husband, Kevin, was always there for her when she was “falling apart.” He stayed with her in the hospital the first night after surgery because she was scared to be alone. A brother-in-law flew into town to accompany Battle to a chemotherapy session when her husband needed to be traveling on business.
The hardest part involved her children. Liz was 14. The boys, Michael and Jack, were 11 and 9. Battle knew she wanted to be straight with them.
“It was difficult to reassure them during the first few months because I was thinking to myself, `I’m going to die and leave my kids motherless,’ ” recalled Battle, whose prognosis has been pronounced excellent by her doctors at Northwestern Memorial Hospital’s Lynn Sage Comprehensive Breast Program. “I didn’t know myself how things would turn out.”
Liz was especially troubled. She hooked up with a social worker at the high school who was a breast-cancer survivor and who answered many of the tough questions.
Compared with other children, teen girls are most affected by a mother’s breast-cancer diagnosis, research shows.
“We originally thought it would be younger kids,” said Bruce Compas, a clinical psychologist at the University of Vermont, in discussing his research findings at the “Breast Cancer and the Family” conference in Chicago in August. “We figured they were less equipped to handle such bad news.
“But the teen girls actually scored way above what we expected in terms of anxiety. They were more constantly worried and dwelled on the negative.”
A University of Michigan study confirmed the findings: It showed about 30 percent of daughters seek isolation to sort out a mother’s diagnosis — and worry about it — compared to about 10 percent of sons. What’s more, the types of stresses and strains in the family are directly linked to how such daughters subsequently cope.
“Interventions by counselors should focus on teen girls,” Compas said.
Celia and Kevin Battle have made a point of keeping their kids informed. “We tell them anything we find out, we will let them know,” said Battle, who recently comforted her daughter after a classmate teased her about having a mother with breast cancer.
Battle said she kept one thing hidden. “None of my kids or even my husband saw me without hair (which fell out during chemotherapy). It was hard for my husband, but that was one way I asked for support. The bald look may be great for Michael Jordan, but not for me.”
ANNA HUDAK
In early January, Anna Hudak’s mother died. Three weeks later, after discovering a lump in her breast through a self-exam, Hudak underwent a surgical biopsy, which turned out positive. A single woman without living parents, Hudak relied on instincts to get through frightening days.
“The uncertainty is what terrified me,” said Hudak, 36, an accountant with Arthur Andersen who lives in Chicago. “I never had surgery before the biopsy, and I was fearful about the chemotherapy drugs. After the first chemo treatment, I had a much better idea what to expect. I knew when I would get sick and when I would need some help.”
Hudak didn’t find it easy to ask friends for support. She did seek out one friend to accompany her on surgery day and “took turns” by asking another pal to go with her to the first chemotherapy session.
“I wanted everything to be normal,” said Hudak, who completed radiation therapy in late September. “I’m used to being independent.”
Hudak’s reaction is common, according to a presentation by University of Washington researcher Frances Marcus Lewis at the “Breast Cancer and the Family” conference, sponsored by the breast-cancer support and information agency Y-Me and Boston Market.
“Single women are often the most hesitant to ask for help,” said Lewis, who has conducted several studies plus regular workshops on the subject. “The typical pattern is for the single woman to consider not what will help her but what is the cost to the other person.”
Lewis said there is great potential for social marginalization of single women with breast cancer, mostly because they don’t have a husband or partner, and that the patients will feel like outcasts.
“Keeping it to herself will help a single woman to avoid further rejection,” noted Lewis. “Single women in our research studies often say they feel a heightened sense of scrutiny now that they have breast cancer.”
Lewis advises single women not to blame themselves or their bodies when cancer is diagnosed.
“Many single women feel their bodies let them down,” said Lewis. “Doctors and counselors need to address these emotions.”
Hudak benefited from joining Northwestern’s support group for newly diagnosed women, which is part of the Lynn Sage program and is a treatment option established under the supervision of Dr. Monica Morrow.
“Fifteen years ago, nobody thought support was part of a surgical protocol,” said Morrow, an oncologist and surgeon who runs Northwestern’s clinical breast cancer center. “Now we know better. It plays an important role in comprehensive treatment.”
Hudak found solace in the support group. “For one thing, it helped me to meet other women my age who were going through it. I also drew strength from hearing other women verbalize my internal feelings.”
JANET BRANDEIS
She and her family had lived in the Chicago area only seven months when Janet Brandeis discovered a lump during a self-exam in February. A biopsy confirmed her worst fears.
“I had every emotion in the book that first afternoon,” Brandeis recalled about her cancer diagnosis. “I was upset, angry and asking, `Why me?’ I had no history of breast cancer in my family.
“But I basically decided I was going to be a breast-cancer survivor, not a breast-cancer victim.”
Her doctors at Highland Park Hospital recommended Brandeis start with chemotherapy before a lumpectomy was performed. She and her husband, Jeffrey, drove home to Northbrook to talk with their children, Daniel, 12, and Megan, 9.
“We didn’t use the word `drugs’ because that has such a bad connotation with children today,” said Brandeis, 39, a native of Long Island, N.Y. “I called it special medication that would probably make me sick and lose my hair. My son asked some good questions; I was thankful my daughter was young enough not to worry about whether this might happen to her in 20 or 30 years.”
The most difficult situation for Brandeis was telling her parents, which she did in March during a previously arranged trip to Florida.
“My father is a very emotional man,” she said. “He took it hard. I can imagine I would be the same way if it were my daughter.
“Plus, my parents are from a generation which, when they think of cancer, they think of death.”
Brandeis insisted her parents not come to Northbrook during chemotherapy. “I didn’t want them to see me without eyelashes, eyebrows or hair,” she said. “I didn’t want to put them through that.”
Her parents arrived in time to see her through surgery, which seemed to help the entire family, including Jeffrey.
“My husband was always reassuring and patient with me during the down times when I was worried about things or didn’t feel attractive,” said Brandeis. “There were times when I just wanted to be held, and that was enough.”
Sharon Manne, a psychologist at Memorial Sloan-Kettering Cancer Center in New York, said husbands like Jeffrey Brandeis are the exception.
“It’s typical in breast-cancer cases that the women feel they are not getting enough support,” said Manne, who lectured at the Y-Me conference. “On the other hand, male heart patients tend to feel they are getting too much support.”
Manne said patients and partners tend to report similar ways in coping with an illness such as breast cancer. They either practice avoidance of the issue or focus on the positive aspects.
“Any large discrepancy in coping behaviors will be disconcerting for partners,” she said.
Manne’s point is illustrated by an older couple recently counseled by Karen Donahey, director of the Sex and Marital Therapy Program at Northwestern Medical Faculty Foundation.
“The wife is about eight months beyond her last radiation treatment, but she was still worried and doing self-exams several times a week,” said Donahey. “The husband didn’t want to talk and directed conversations to something more pleasant. He said she was dwelling on the breast cancer and overworrying.”
Donahey said the standoff precipitated many more quarrels than normal for the marriage of 30-plus years. She talked to each client separately.
“In talking to the husband, I discovered he was quite concerned and emotional about losing his wife,” said Donahey, who often advises couples who are struggling with the stress of a breast-cancer diagnosis. “He didn’t like his wife discussing her illness because it brought on his own fears about the situation. Once the wife discovered her husband cared so much, that improved their communication and allowed them to talk more freely about her cancer.”
JOAN GREER
As the oldest of 11 children, Joan Greer was accustomed to taking care of her siblings. She changed their diapers, helped them with homework, cooked meals. As they grew up, Greer continued to help when somebody needed a baby-sitter or just a friendly face during an illness.
In 1992, some role reversal occurred. Joan discovered a knot in her armpit just weeks after learning her most recent mammogram showed nothing suspicious (and cleared her mind about a previous mammogram, which had showed some abnormalities in the breast).
Greer thought it might be her deodorant causing irritation. “The lump was not quite as big as an egg,” she recalled. “It didn’t hurt, it never moved. There was no history of breast cancer in the family, and my mammogram had come back OK. I didn’t know what it was, but I wasn’t thinking cancer.”
When the lump didn’t subside after a few days, she decided to see one of her doctors at the University of Illinois-Chicago Medical Center. A biopsy showed a malignancy. Greer was shocked into silence.
“I had no emotions” at the medical center, said Greer, 62, who lives on the South Side with a sister. “It hit me once I got home. I was quite emotional. I said, `Lord, take care of me.’ “
Greer was distraught. She started putting her affairs in order and even thought about taking an overdose of sleeping pills.
Her sister wouldn’t hear of it.
“She said, `I’m with you through thick and thin,’ ” said Greer. “That truly helped me. She was my rock through it all.”
Greer’s other five sisters traveled to Chicago to be with their oldest sibling at various times during chemotherapy, surgery and radiation at UIC. They also called on the phone when not in town.
“I had never been in the hospital or took a sick day,” said Greer, a retired housekeeper. “I didn’t want to be a burden on my sisters. They have their own lives to lead.
“I don’t have any children. They all said, `You took care of our kids when we needed, now it’s our turn.’ “
The sisterly support was just the healing remedy for Greer, whose mammogram in early October showed she was officially in remission for two years.
“I wouldn’t have made it without them,” said Greer. “I was always the rock of the family. That’s different now. We’re all here for each other.”
PICTURE BRIGHTENS, IF ONLY A LITTLE, STATISTICS SHOW
Medical advances have put a more hopeful face on the frightening statistics of breast cancer. Here’s a quick review of some important numbers:
– An estimated 184,300 new cases of breast cancer are anticipated in 1996. Most American women know there is a 1 in 8 lifetime risk for diagnosis of the illness,, but it’s often lost that the mortality rate is lower: it’s about 1 in 30.
– Mortality rates for white and African-American women have both decreased in this decade compared to the 1980s, especially among patients between 30 and 59.
– Studies show less than 10 percent of breast cancers are inherited. The older a woman is when the breast cancer is diagnosed, the less likely it is genetic.
