Living With Breast Cancer
Edited by Guy Slowik MD FRCS. Last updated on June 28th 2011
The unknowns that women face after breast cancer affect many aspects of their lives. There are primary issues about self-image, fear of recurrence, and the need for continued treatment, as well as issues related to daily activities, career, and relationships. Yet, after the immediate crisis of 'the diagnosis,' most women weather the difficulties of breast cancer without long-term psychological or sexual problems.
Psychosocial Effects Of Mastectomy
The breasts are a profound source of female self-image. Cancer of the breast may seriously affect a woman's perception of her identity, and breast loss can be very psychologically damaging. Therefore, most breast cancer centers employ counselors. The role of the counselor is to help people adjust to the physical and psychological blow of breast cancer. About 30% of women with the disease suffer from prolonged anxiety and depression, which are natural responses to the loss of a breast or fear of the disease. Women who fail to adjust often have other life crises such as divorce or unemployment. These psychological problems can be helped by referral to a psychiatrist (specialist in mental illness), who may recommend psychotherapy or medications to aid recovery.
Physical and sexual rehabilitation can be helped by providing the woman with an adequate prosthetic device (breast form) and by encouraging the woman and her partner to discuss sexual problems in an open way.
The decision to use a prosthesis or to undergo breast reconstruction usually is based on the woman's own body image. Other key factors include her level of physical activity, style of clothing, and her willingness to reveal the diagnosis of breast cancer to others.
The majority of women can return to normal employment after any type of breast cancer surgery. In addition, most are able to enjoy all types of physical recreation, including swimming and golf.
Fear Of Recurrence
Women with breast cancer often assume that changes in the treated breast or other areas of their bodies may be a sign that cancer has returned. Yet many such changes are expected side effects of treatment. For example, radiation therapy may cause changes in the breast area, such as sunburn-like reddening or peeling of the skin, 'puckering,' loss of underarm hair, tingling sensations, or skin thickening that causes the breast to become firmer to the touch and slightly smaller in size. Therefore, women are encouraged to contact their physicians or other members of their healthcare team to determine if their symptoms are any cause for concern.
Sexuality
Certain breast cancer myths still exist and may affect a woman's sexuality. Some women and their husbands or partners may believe that caressing of the breast plays a role in cancer development, or that it may encourage recurrence. The woman's partner also may have fears of "catching cancer." Although such beliefs are unfounded, they may interfere with the reestablishment of a healthy sex life. Therefore, the partner or spouse - as well as the breast cancer patient - should be involved in discussions about breast cancer diagnosis, risk factors, treatment options, and potential side effects of therapy. Cooperation in post-treatment care often enhances the ability of the woman and her sexual partner to adjust to the disease and its treatment.
After breast surgery, many women consider themselves repulsive and may be inhibited during lovemaking. Yet men often claim that their love is not impaired by the loss of their wives' breasts and - if anything - it increases the strength of the bond with their spouse. Therefore specific sexual counseling may be very helpful after breast cancer is diagnosed.
Important topics include:
- getting used to nudity versus concealment of surgical scars with a prosthesis (breast form) or lingerie;
- how to have comfortable sex if the treated breast or arm is tender;
- how to use lubricants to avoid the vaginal dryness and pain associated with
menopause ; - how to perform sensation-focusing exercises; and
- verbal and nonverbal ways to communicate sexual preferences.
Relapse Prevention
One of the difficult problems with breast cancer is that relapses may occur, even though initial treatment appeared successful. Such a relapse may develop near the site of the original cancer or in a distant organ of the body. A recurrence of cancer many years after breast cancer surgery is more likely if the lymph nodes under the armpit were diseased at the time of the original operation. To reduce the chance of relapse, adjuvant (assertive) therapy now is widely recommended. In most cases, this entails 5 years of hormone therapy with the anti-estrogen drug tamoxifen (Nolvadex®) . Tamoxifen is a non-toxic drug that is easy to use and has been found to delay or prevent relapses if taken for at least 5 years after initial breast cancer surgery.
Alternatively, some pre-menopausal women with severely cancerous lymph nodes may benefit from a 6-month course of chemotherapy given every 3 to 4 weeks. There are a variety of programs, most of which begin about 4 weeks after surgery. The frequency of treatment will depend upon the program, drugs used, and the doses. Radiation therapy may be given before, during, or after chemotherapy.
In order to detect cancer relapse at the earliest possible time, follow-up examinations with an oncologist (cancer specialist) should be scheduled at specific intervals after breast cancer treatment.
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