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What Do I Do Now?

When you or someone you care about has or is facing the possibility of breast cancer, it is natural to feel many bewildering and frightening emotions.

No one wants to get sick at all. Certainly no one wants to get cancer. And there are kinds of cancers that seem particularly terrible, not only because of their death-dealing potential, but because they or their treatment hits us "where we live." Breast cancer, for most women, is one of those diseases.

The possibility that you may have breast cancer is made even more stressful because it is an illness in which you are going to be called upon to make several decisions that don't necessarily arise in other situations. It's important that along with a carefully chosen team of physicians, you and the people in your personal support system take a very active role in the management of your case. Though that may feel a little intimidating right now, it can make a real difference in your welfare.

There are people who, when they are ill, take the attitude, "I'm going to find a good doctor and turn myself over to him. He knows better than I what should be done." Only to a certain extent is that a reasonable attitude in any medical situation. But breast cancer, with its many treatment possibilities, offers a special challenge to the patient.

For most of us, a serious threat to our health immediately takes center stage. Other concerns seem less important than they were before we learned of our illness. Though we may not articulate the thought, we understand that if we don't give first priority to taking care of the health crisis, there may not be any other concerns.

Even so, some women are so terrified of the thought of breast cancer that though they have found a lump or other abnormality in their breast, they suppress the knowledge, at least for a time. They may say to themselves, "That's nothing. I'm just imagining it," or "Next time I go to the doctor, I'll mention it," or "I've always had that. It's not worth worrying about."

Don't do this. We have seen too many women who became victims of their own fright and denial. Their illness, which would almost certainly have responded to treatment in its early stages, had so advanced by the time they sought help that it was too late.

So, the answer to the question "What do I do now?" is, first, get some perspective on what you are facing. Second, find good allies, the right doctors, to help you.

These are the concerns that women seem to worry about most:

Will I Survive?

Is the diagnosis of breast cancer a death sentence?

The answer isn't a simple "yes" or "no" but rather, in most instances, an optimistic "probably not, and certainly not immediately."

Those answers were not always available to us. A couple of generations back, women did not talk about breast cancer and there was not nearly as much public discussion of the illness or the almost overwhelming coverage in newspapers and magazines, on radio and television, as occurs today. Self-examination was seldom done, and even when women did notice a small lump, they may have postponed taking any action out of a combination of ignorance and fear. Therefore, by the time they got to the doctor, they tended to be in later stages of the disease, and that very adversely affected their chances of beating it.

Moreover, in the past, the medical profession was much less effective in dealing with the illness than it is now. The prevailing treatments were, in general, less successful, more disfiguring, and more seriously disruptive of the quality of the patient's life. Surgery was much more extensive, chemotherapy and radiation techniques were less refined, and we did not have as much experience with their use, their results, and their side effects as we now do.

What Is Today's Success Rate?

To understand the changes that have taken place, bear in mind that a five-year length of time is often used to express the success rate. And though we'll get into the stages of cancer, for the purpose of this comparison it is enough to say that generally speaking, cancers are mainly classified by how far they have spread. With those factors in mind, it is encouraging to see how much progress we have made:

Between 1960 and 1964, the five-year survival rate for all stages of breast cancer was 64 percent. For local cancers, it was 84 percent. For cancers that had spread to lymph nodes near the affected breast, the rate was 54 percent. Where the cancer had spread to a distant site, only 7 percent of the affected women survived.

From 1979 to 1984, the five-year survival rate for all stages was 75 percent; for local cancers, 90 percent; for those that had spread to nearby lymph nodes, 69 percent; and for distant cancer, 10 percent.

The most recent five-year figures show and overall survival of 83 percent and parallel improvements in the other stages. For local cancers, it is 96 percent; for those involving the regional lymph nodes, 75 percent; and for distant cancer, 20 percent. [Editor's note: The most recent statistics from the National Cancer Institute show an overall five-year survival rate of 89.1 percent; 98.3 percent for local cancers; 83.5 percent for those involving regional lymph nodes; and 23.3 percent for distant cancers.]

So, many more women are surviving. That doesn't mean that anyone can tell you definitively, without any doubt, that you are not going to be on the wrong side of the statistics. It does mean that your chances of conquering this condition are generally good.

Will I Be Disfigured?

Actually the question is often phrased more dramatically: many women use the word mutilated. "Will I be mutilated?" The answer to that is a lot easier. It's a clear and unequivocal "no."

What women quite rightly dread most -- the disfiguring radical mastectomy, in which the entire breast and a lot of the surrounding tissue and musculature are removed -- is rarely needed anymore.

The modified radical mastectomy removes the breast but leaves the muscle intact. The result is much less damage to the body and a much better situation for breast reconstruction.

Many women now are treated with what is commonly called a lumpectomy, a surgical procedure that is technically referred to as a wide excision. In this technique for saving the breast, only the cancer, some surrounding tissue, and the nearby lymph nodes are removed. The remainder of the breast is then treated with radiation.

Most important to this question of disfigurement is breast reconstruction. It is helpful to realize that the techniques the plastic surgeons employ have been so refined in the past few years that after mastectomy, the breast can be reconstructed and a sense of wholeness almost completely restored. Most patients who have undergone reconstruction are pleased and relieved at the results.

-- Adapted from BREAST CANCER: THE COMPLETE GUIDE by Yashar Hirshaut, MD, FACP; and Peter I. Pressman, MD, FACS; copyright 1992 by Yashir Hirshaut. Used by permission of Bantam Books, a division of Random House, Inc. For online information about other Random House, Inc. books and authors, see the Internet Web Site at http://www.randomhouse.com.

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