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Emotional Aspects of Breast Cancer

After breast cancer treatment, women often find themselves going through many emotional changes.

You may have been going through so much during treatment that you could not focus on anything else. Once your treatment ends, you may find yourself overwhelmed by emotions. This happens to a lot of women. This is an ideal time to seek out support. You need people you can turn to for strength and comfort. Support can come in many forms: family, friends, cancer support groups, church or spiritual groups, online support groups, or individual counselors. The cancer journey can feel very lonely, but you don't have to go it alone. If you aren't sure who can help, the American Cancer Society can put you in touch with a group or other resource.

Quality of Life

Women who have had treatment for breast cancer should know that they can have a normal quality of life after treatment is over. Many studies have proven this. Women who have had chemo may, however, notice a slight decrease in certain areas of function.

Some studies suggest that younger women tend to have more problems with the stresses of breast cancer and its treatment. Some feel isolated. Also, chemo may cause early menopause, which needs to be managed. There may also be sexual problems. These women might benefit from counseling and support groups directed to younger breast cancer survivors.

Body Image

A woman's choice of treatment is likely influenced by her age, the image she has of herself and her body, and her hopes and fears. For example, some women may choose breast-conserving surgery with radiation over a mastectomy for body image reasons. On the other hand, some women choose mastectomy regardless of the effect on their body image. They may be more concerned about the effects of radiation than how the breast will look after treatment.

Many women with breast cancer also find themselves dealing with the fact that treatment changed the way they look. Some changes may be short term, such as hair loss. But even short-term changes can have a major effect on how a woman feels about herself. A number of options are available to help women cope with hair loss, including wigs, hats, scarves, and more. On the other hand, some women may choose to show off their baldness as a way to identify themselves as breast cancer survivors.

Whatever the changes you may face, it's important to know that there is advice and support out there to help you cope with these changes. Talking with your doctor or nurse is often a good starting point. There are also many support groups, such as the American Cancer Society's Reach to Recovery program.

About Breast Forms and Bras

Some women who have had a mastectomy might choose breast forms instead of reconstruction. Your doctor will tell you when you are ready to be fitted for a form. Prices vary quite a bit. Take time to shop for one that looks good and fits well.

The right bra for you may very well be the one you have always worn. You can often have your usual bra adapted for a breast form. Be sure to check your insurance to see what is covered and how to file a claim. Also, ask your doctor to write prescriptions for your form and any special bras. When buying the forms or bras, have the bills marked "surgical."

Be aware that if you submit an insurance claim for a breast form or a bra, the company might not also cover reconstruction if you decide you want this procedure in the future. Get all the facts before turning in any claims.

Be sure to call your local ACS Reach to Recovery volunteer about any questions you have. She will give you suggestions, more reading material, and advice. Remember that she's been there and may understand better than most people.

Sexuality

Concerns about sexuality are often very worrisome to a woman with breast cancer. Aside from body image, some treatments for breast cancer, such as chemo, can change a woman's hormone levels and may reduce her sexual interest or response. It can be especially hard if a woman in her 20s or 30s finds she has breast cancer. Choosing a partner and having children are often very important during this period.

A woman's partner can also find the diagnosis distressing. Partners are often worried about how to express their love physically and emotionally after treatment, especially after surgery.

Treatment for breast cancer can affect the pleasure from touching the breast. In a reconstructed breast, the feeling of pleasure from touching the nipple is largely lost because a rebuilt nipple has much less feeling than a natural one. The skin of the breast itself may be less sensitive, too. But some feeling may return over time.

Some women still enjoy being touched around the area of the surgery; others dislike being touched there and may no longer even enjoy having the remaining breast touched. A few women have chronic pain in their chests after radical mastectomy. Supporting these areas with pillows and avoiding positions where your weight rests on your chest or arms during sex may help.

Breast surgery or radiation to the breasts does not physically decrease a woman's sexual desire. Nor does it decrease her ability to have normal intercourse or to reach orgasm. Some good news from recent research is that most women with early stage breast cancer have adjusted well within a year. They report a quality of life much like that of women who never had cancer.

Please remember that every woman reacts in her own way. Your feelings are not right or wrong, they are simply yours.

By Chris Iliades, MD

Medically reviewed by Lindsey Marcellin, MD, MPH

The effects of alcohol are stronger in women than in men, and women who drink too much alcohol are more likely to suffer from significant alcohol problems than men, studies show. In addition, women who have alcohol problems have higher death rates due to suicide, accidents, and other health related issues — more than twice the rate of men. Given these facts, you may be wondering: Why do women drink, and what can you do to enjoy alcohol without risks to your health?

Understanding Why Women Drink

Women drink for many of the same reasons that men drink: to relax, to gain confidence in social situations, to get to sleep, and to relieve stress.

Other reasons why women may drink alcohol include the following:

Women are more likely to drink if they have problems with a loved one.
Alcohol problems are more common in women who are unmarried, divorced, or separated.
Women whose husbands have alcohol problems are more likely to drink themselves.
Women who have been sexually abused are more likely to drink to excess.
Women may start out drinking more. Seventeen percent of ninth grade girls admit that they had more than five drinks at one time in the past month. This is a higher rate of drinking than for boys of the same age.

Alcohol Affects Women Differently Than Men

The blood alcohol level in a woman who just drank the same amount of alcohol as a man will be higher because women are usually smaller, have less water in their bodies, and metabolize alcohol more slowly than men.

This means that the brain and liver of a woman who drinks are exposed to more alcohol pound for pound than a man's brain and liver. Women who have alcohol problems may drink less than men but still experience the same level of impairment. They can also develop liver damage and other alcohol-related health problems more quickly than men, even though they may be drinking less.

Benefits of Alcohol in Women

If you are a woman over the age of 55, one drink per day may lower your risk for heart disease. Moderate drinking for a woman is defined as one alcoholic drink per day. This translates to one 5-ounce glass of wine, a 12-ounce bottle of beer, or 1.5 ounces of hard liquor.

On the other hand, women who drink beyond moderation may increase their risk of heart disease. If you are younger than 55, there may be no health benefits to alcohol consumption.

Risks of Alcohol in Women

Too much alcohol consumption clearly has risks for both men and women. Other risks to women who drink alcohol include:

Cancer: Women who drink alcohol may increase their risk of breast cancer and head and neck cancers.
Brain damage: Alcohol kills brain cells and women are more susceptible to this alcohol effect than men.
Pregnancy: Alcohol can affect a woman's ability to get pregnant. In addition, alcohol use during pregnancy can have serious harmful consequences on the unborn child. No amount of alcohol consumption is safe during pregnancy.
Victimization: Women who have alcohol problems have a higher risk of becoming victims of sexual assault or other acts of violence.
Depression and personal injury: In addition, alcohol consumption can contribute to depression, sleeping problems, heart failure, falls, and poor nutrition in women, especially older women.

Warning Signs of Alcohol Problems

If the effects of alcohol are causing problems for you or for others, you may have an alcohol problem. The risk of developing an alcohol problem is greater if you have a family history of alcoholism. Some warning signs of alcohol problems are:

Missing work or school because of drinking
Driving while impaired by alcohol
Having a strong urge to drink
Needing more alcohol than you previously did to get a pleasurable response
Finding that people who care about you are concerned about your drinking
Having more than seven drinks per week
Finding yourself drinking alone or early in the day

If you think you might have an alcohol problem, it's important to get help. Experts believe that the hardest part of getting better is admitting you have a problem. Contact Alcoholics Anonymous or talk to your doctor if you are concerned that you may have an alcohol problem.

Last Updated: 04/30/2009

Side effects from breast cancer treatment

May 11, 2009

When I complain to friends about brain functioning issues or eyesight changes due to breast cancer treatment, they generally look at me with the “I know” look and explain that it is all a part of aging. They feel that they experience it too and I just have to accept that it happens to everyone; that it is not because I had breast cancer. I am convinced though that I suffer from chemo brain and that is why my memory lacks and my cognitive functioning isn’t as acute as it once was. In addition, I have often complained of vision changes over the past several years and I am sure it is related to treatment as well. I have suspected that Tamoxifen may play a role. I, like many women my age need reading glasses, but I also have problems with light sensitivity and night vision. I went from a 1.25 magnification for my reading glasses to a 1.5 magnification in a year. I go for eye exams and have had the doctor check for all issues and diseases. I think I need to have further assessment.

Tamoxifen can cause vision problems in women over 50. Research is beginning to show a physiological change in the ocular cup in women who take Tamoxifen over women who have never been treated for breast cancer. I have to wonder why not all oncologists are on board with the continued complaints that women have after being treated for breast cancer. Whether it is sore muscles and frail bones from aromatase inhibitors, or chemo brain or vision problems from Tamoxifen, the usual response from our oncologists is that it’s nothing to worry about. We often leave the office feeling we are crazy! In women who have never had breast cancer, these symptoms would definitely be taken seriously. Begging to have our complaints considered legitimately is part of the disease I guess. Doctors, family and associates just want us to be well and get on with life. Some of us wobble around on stiff limbs, forgetting where we are going and unable to see clearly the path in front of us and yet we are told to be glad that we are alive.

I have to be on Tamoxifen for one more year. I took some time off from it and my oncologist is insisting I follow through on treatment. Five years have passed since I finished chemotherapy and it is becoming apparent that nothing significant has yet been discovered that could lead to a cure. The breast cancer cure is elusive. I have to believe that if we can all just focus and try harder there will be a cure. In the meantime, many of us are battling side effects that are as significant as the disease and the fear that cancer will get us in the end.

Young Women's Breast Tissue Offers Clues to Cancer Risk

4/30/2009

WEDNESDAY, April 29 (HealthDay News) -- Breast cancer risk assessment and prevention should start much earlier in life than it currently does, say Canadian researchers who examined breast cancer risk factors in young women.

The study of 400 women, ages 15 to 39, and their mothers found that breast tissue composition in young women may be associated with their risk for breast cancer in middle age and older.

"It is known that the breast is most susceptible to the effects of carcinogens at early ages. Our findings suggest that differences in breast tissue composition in early life may be a potential mechanism for this increased susceptibility," wrote a team led by D. Norman Boyd, of the Campbell Family Institute for Breast Cancer Research, Toronto. By identifying the environmental and genetic factors that influence breast tissue composition early in life, we may be able to develop safe and effective methods of prevention."

In this study, the researchers looked at the amount of dense breast tissue (mammographic density, or MD), which varies considerably among women and is a significant risk factor for breast cancer in middle-aged and older women.

Experts know that the risk of breast cancer increases as MD increases. However, little has been known about the development of MD early in life or how the MD of young women is related to their height, weight, age, and their mother's MD.

The study authors concluded that a "high degree of mammographic density in middle age, when it is a strong risk factor for breast cancer, may arise from the subset of the population with the greatest amount of fibro-glandular tissue in early life, when susceptibility to potential carcinogens is greatest. Interventions directed at the prevention of breast cancer may therefore be more effective if they are started in early life rather than adult life."

The study appears online and in the June print issue of the The Lancet Oncology.

Family History Increases Breast Cancer Risk

http://www.medscape.com/viewarticle/584292

November 26. 2008 — Women with a significant family history of breast cancer, even if they are negative for the BRCA1 and BRAC2 mutations, remain at increased risk of developing the disease. Having 2 or more cases of breast cancer among close relatives younger than 50 years or 3 cases among close relatives of any age is associated with a risk for breast cancer that is 4 times greater than that seen in the general population.

The data, which were presented at the Seventh Annual American Association for Cancer Research International CoPrevention Research, held in Washington, DC, show that women with a strong family history who lack BRCA1 and BRCA2 mutations are still much more at risk than average women. "All women are at risk for breast cancer and about 10% will eventually develop the disease," said lead author Steven Narod, MD, who holds the Canada Research Chair in breast cancer at the University of Toronto and Women's College Research Institute, in Ontario. "We need to look at screening those who are at the highest risk. When the BRCA mutation was identified, it led to a genetic test."

Relatively few women carry mutations for BRCA1/2, but it increases the risk for breast cancer to 80%, Dr. Narod pointed out. "These women tend to have a family history or young onset, so they go and get tested . . .

About 1 in 5 of these women will be told that they carry a mutation. but what about the thousands who have a negative test and yet have a strong family history of breast cancer?"

To answer that question, Dr. Narod and colleagues conducted a prospective study in which they estimated risk for women with a family history of breast cancer who had tested negative for a BRCA1 or BRCA2 mutation. They identified 1492 women from 365 families who met the criteria of either having 2 or more breast cancers in members younger than 50 years or having 3 breast cancer in members of any age.

The researchers collected follow-up information on cancer status in all first-degree relatives of breast cancer cases. They calculated the standardized incidence ratios (SIRs) for breast cancer by dividing the observed number of breast cancers by the expected number, based on available rates in provincial cancer registries.

Risk of Disease is 4-Fold

The 1492 first-degree relatives of breast cancer cases contributed 9109 person-years of follow-up. Compared with control rates, the number of cancer cases was much higher among women with a strong family history. A total of 65 women developed breast cancer, although the expected number was 15.2 (SIR, 4.3). The highest relative risk was for women younger than 40 years, where the increased risk was nearly 15 times higher than the average risk (SIR, 14.9). The SIR decreased with advancing age, but the absolute risk was higher for women between 50 and 70 years (1% per year) than for those between the ages of 30 and 50 years (0.4% per year). No elevated risk for ovarian or any other type of cancer was observed in this cohort.

The women with strong family histories had a 40% risk for breast cancer, and the findings suggest that other genetic mutations could play a role in the disease. Although these findings do not call for prophylactic surgery, Dr. Narod suggests that this population consider undergoing magnetic resonance imaging (MRI) screening. "The American Cancer Society recommends MRI for women with a 20% to 25% risk," he said. "It is much more sensitive than mammography."

Dr. Narod also points out that women with strong family histories might be candidates for tamoxifen chemoprevention. "We do need to confirm this in other studies, and we need to pinpoint what is putting these women at high risk."

These studies help us to identify patients at risk for cancer, commented Steven M. Dubinett, MD, director of the Lung Cancer Research Program at the UCLA Jonsson Comprehensive Cancer Center, in Los Angeles, California, and moderator of a press briefing in which these data were presented. "The utilization of genetic studies helps us move forward with defining risk in these populations."

American Association for Cancer Research's Seventh Annual International Conference on Frontiers in Cancer Prevention Research: Abstract B7. Presented November 17, 2008.

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Emotional Aspects of Breast Cancer

After breast cancer treatment, women often find themselves going through many emotional changes.

By Chris Iliades, MD

Young Women's Breast Tissue Offers Clues to Cancer Risk