Breast cancer: a patient's view.

Six weeks before my fifty-third birthday I stepped out of the shower, glanced in the mirror, and saw something that changed my life: a "crease" in my left breast that I had never noticed before. Though fairly ignorant of breast cancer, I thought this was a bad sign. I then discovered a lump about the size of a quarter.

If you're still reading this article, you're smarter than I was. Since my early 40s, when my breasts became lumpy and painful with a benign condition called fibrocystic disease, I was so afraid of breast cancer that I avoided every mention of it.

While the media were attempting to educate the public on breast cancer prevention and treatment, I was hiding under the bed, and when the monster came out of the closet, I barely recognized it. The doctor's call with the dreaded diagnosis was shattering. My first reaction was fear - fear of losing a part of my body (believe it or not, I was concerned about undressing in the health club locker room); fear of having my identity changed to "cancer patient"; and fear of losing control of my life, because it was taking a path I hadn't chosen. My second reaction was anger. I was absolutely furious that this happened to me and my family, because I had had a mammogram and a breast exam by my doctor every year. I guess I forgot that life isn't fair. Only when the doctor told me I'd had the cancer for at least five years did I realize how blessed I was, that it could have been throughout my body and threatening my life.

Difficult choices. Breast cancer patients must make difficult choices about treatment during a time when they're emotionally shaky. I lost eight pounds in four days because I could not eat and had severe bouts of diarrhea because of the stress. If I had been better informed before the diagnosis, I probably would not have been quite so upset. I was totally unprepared and had to learn what I needed to know while I was in a state bordering on panic during a very long, exhausting day, going from specialist to specialist, leaning on my husband.

Fortunately, the clinic did a good job of educating me. I was given the option of a partial mastectomy (removal of about one fourth of the breast) or a modified radical mastectomy, and was told that the prognosis for both procedures was the same.

However, breast-conserving surgery must be followed by radiation to kill any cancer cells remaining in the breast. Usually five treatments a week are given for six weeks. With a mastectomy, decisions must be made about reconstruction; whether to have it at all, have it at time of surgery or later; and if done, whether to have an implant or have a breast constructed with tissue from your own body.

Chemotherapy to "mop up" any cancer cells in the body is now recommended for many patients, even those without lymph node involvement. But you need to be educated about its purpose and side effects.

I had a partial mastectomy, six weeks of radiation, six months of chemotherapy, and ongoing tamoxifen.

No excuse. Because of my fear, I had managed to ignore the pamphlets on breast self exam (BSE) doctors had given me and performed only cursory exams a couple times a year, when I was feeling especially brave. Now that I've had breast cancer and have been through treatment, I realize how foolish I was. It obviously makes no sense to avoid the very thing that can save your life, namely, education.

Women tend to be full of excuses for not doing BSE routinely, but I believe many are just plain scared they'll find something. Even if they do, chances are it won't be malignant. Seven out of eight women will not get breast cancer.

If it is cancer, however, you can get through treatment. (If a scaredy-cat like me can do it, anyone can.) I'd like to share what I feel is important for women to know, based on my personal experience.

Radiation usually does not cause side effects (except some fatigue) for breast cancer patients because it is directed at the breast only and does not invade the body cavity.

For the same reason, the physical recovery from breast surgery is not as difficult as that from abdominal surgery, for example. Even chemotherapy has become more easily tolerated thanks to an excellent new drug for nausea. Many women are able to work during treatment. We went ahead with planning large weddings for two of our daughters during this time.

Life is about choices, and this is a big one. You can do BSE, find breast cancer early, have it treated, and get on with your life. Or you can make excuses, skip BSE, and take the chance of having a cancer discovered later, maybe too late.

When actress Ann Jillian was asked the single most important lesson she learned from breast cancer, she said, "Early detection can save your life." I'm convinced that BSE is the most important factor in early detection.

Mammograms are not enough. Mammograms are excellent for screening, but the fact is that 15 percent of malignancies are missed, as nine was on at least five occasions. If I had been performing BSE faithfully, I surely would have found the lump sooner.

The doctor's examinations of your breasts are a vital link in the chain of early detection, but he or she examines hundreds of women. You have only one pair of breasts to be concerned about, and you can become an expert on that one pair. The key is to do BSE without fail every month so you will know what's normal for you and will notice any changes. When you visit your physician, ask him or her to explain the different textures you feel. Some doctors provide model breasts with different types of lumps in them.

When doing BSE, press firmly and focus your attention on what you're feeling. Draw a diagram (two circles) and indicate the location of anything you feel. Refer to your diagram from month to month. Do a visual exam from all angles, standing up and bending over. If the skin looks like it's being pulled from the inside, see your doctor and be sure to tell him or her everything you observed. Mark your calendar for BSE just as you do for everything else you want to remember.

How others helped. The emotional aspects of breast cancer, especially facing your mortality, can be as difficult to deal with as the physical. My closest friend managed to say the perfect thing when I told her my diagnosis. First she cried with me and then said, "Don't worry about it. We're going to pull you through this." That made me feel that I didn't have to venture into the unknown alone. My husband was very caring and reassuring. He made it clear throughout treatment that I was his priority; no matter where he was or what he was doing, he would be there if I called. I called him my "rock." He held my hand and made me laugh. When I complained, he gave me sympathy, not advice. When I needed nursing care, he did it cheerfully. He also let me know that to him breasts were of no consequence compared to my life.

Until it happened to me, I never realized how important phone calls, cards, and hugs are to a friend in crisis. I now truly believe that the caring of loved ones is healing, probably because it puts the patient in a healthy frame of mind. Our son's decision to take his first year of college at home so I didn't have to deal with his leaving at this time, and the flowers our daughters sent with a "You did it!" card on the day I finished chemo were a complete surprise and touched me deeply.

Not everyone will have a supportive family and friends, but today breast cancer is discussed openly, and help is everywhere. My support network included the public library, where I found a wide variety of books on coping with cancer ranging from inspirational to clinical to humorous. After treatment I went to the YMCA and learned to lift weights for upper body strength (ask your doctor before trying this). I also walked and did aerobics to improve my energy level. I found a support group helpful when I needed to talk and when I needed to see that others were surviving this disease and getting on with their lives. The church or synagogue, the nutritionist, and the psychologist are valuable resources too. Most important is a caring physician who listens patiently and answers your questions until you understand.

Although I don't deserve any credit, I was blessed. My cancer had not spread to the lymph nodes, and my prognosis is good. Because breast cancer is a systemic disease, doctors don't say you're cured. There is the possibility it could appear in the breast or elsewhere in a few months or many years. Fear of recurrence is difficult to live with, but I try to keep in mind that nobody knows what will happen to him or her tomorrow.

Medical research offers the promise of new therapies and the hope of a cure, but until that day early detection offers the best chance of survival.

I've learned that life is better when you let yourself really live it, feeling the good and the bad, and not hiding from it. Now I'm less afraid of death and less afraid of life. Cancer teaches you that each day is a gift, so make the most of it, and don't forget BSE!