Support for women with breast cancer
The diagnosis of breast cancer can change a woman’s life and the lives of those close to her. These changes can be hard to handle. It is common for the woman and her family and friends to have many different and sometimes confusing emotions. Having helpful information and support services can make it easier to cope with these problems.
People living with cancer may worry about caring for their families, keeping their jobs, or continuing daily activities. Concerns about tests, treatments, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful to people who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for help with rehabilitation, emotional support, financial aid, transportation, or home care.
Friends and relatives can be very supportive. Also, it helps many patients to discuss their concerns with others who have cancer. Women with breast cancer often get together in support groups, where they can share what they have learned about coping with their disease and the effects of their treatment. It is important to keep in mind, however, that each person is different. Treatments and ways of dealing with cancer that work for one person may not be right for another–even if they both have the same kind of cancer. It is always a good idea to discuss the advice of friends and family members with the doctor.
Several organizations offer special programs for patients with breast cancer. Trained volunteers, who have had breast cancer themselves, may talk with or visit patients, provide information, and lend emotional support before and after treatment. They often share their experiences with breast cancer treatment, rehabilitation, and breast reconstruction.
Sometimes women who have had breast cancer are afraid that changes to their body will affect not only how they look but how other people feel about them. They may be concerned that breast cancer and its treatment will affect their sexual relationships. Many couples find that talking about these concerns helps them find ways to express their love during and after treatment. Some seek counseling or a couples’ support group.
Several useful National Cancer Institute booklets and other materials are available from the Cancer Information Service and through other sources listed in the “National Cancer Institute Information Resources” section. The Cancer Information Service can also provide information to help patients and their families locate programs and services.
The promise of cancer research
Doctors all over the country are conducting many types of clinical trials (research studies in which people take part voluntarily). These include studies of ways to prevent, detect, diagnose, and treat breast cancer; studies of the psychological effects of the disease; and studies of ways to improve comfort and quality of life. Research already has led to significant advances in these areas, and researchers continue to search for more effective approaches.
People who take part in clinical trials have the first chance to benefit from new approaches. They also make important contributions to medical science. Although clinical trials may pose some risks, researchers take very careful steps to protect people who take part.
Women who are interested in being part of a clinical trial should talk with their doctor. They may want to read the National Cancer Institute booklets “Taking Part in Clinical Trials: What Cancer Patients Need to Know” or “Taking Part in Clinical Trials: Cancer Prevention Studies,” which describe how research studies are carried out and explain their possible benefits and risks. NCI’s cancerTrials Web site at http://cancertrials.nci.nih.gov provides general information about clinical trials. It also offers detailed information about specific ongoing studies of breast cancer by linking to PDQ, a cancer information database developed by the NCI.
Causes and prevention
Doctors can seldom explain why one woman gets breast cancer and another doesn’t. It is clear, however, that breast cancer is not caused by bumping, bruising, or touching the breast. And this disease is not contagious; no one can “catch” breast cancer from another person.
Scientists are trying to learn more about factors that increase the risk of developing this disease. For example, they are looking at whether the risk of breast cancer might be affected by environmental factors. So far, scientists do not have enough information to know whether any factors in the environment increase the risk of this disease. (The main known risk factors are listed in the “Breast Cancer: Who’s at Risk?” section.)
Some aspects of a woman’s lifestyle may affect her chances of developing breast cancer. For example, recent studies suggest that regular exercise may decrease the risk in younger women. Also, some evidence suggests a link between diet and breast cancer. Ongoing studies are looking at ways to prevent breast cancer through changes in diet or with dietary supplements. However, it is not yet known whether specific dietary changes will actually prevent breast cancer. These are active areas of research.
Scientists are trying to learn whether having a miscarriage or an abortion increases the risk of breast cancer. Thus far, studies have produced conflicting results, and this question is still unresolved.
Research has led to the identification of changes (mutations) in certain genes that increase the risk of developing breast cancer. Women with a strong family history of breast cancer may choose to have a blood test to see if they have inherited a change in the BRCA1 or BRCA2 gene. Women who are concerned about an inherited risk for breast cancer should talk to their doctor. The doctor may suggest seeing a health professional trained in genetics. Genetic counseling can help a woman decide whether testing would be appropriate for her. Also, counseling before and after testing helps women understand and deal with the possible results of a genetic test. Counseling can also help with concerns about employment or about health, life, and disability insurance. The Cancer Information Service can supply additional material on genetic testing.
Scientists are looking for drugs that may prevent the development of breast cancer. In one large study, the drug tamoxifen reduced the number of new cases of breast cancer among women at an increased risk for the disease. Doctors are now studying how another drug called raloxifene compares to tamoxifen. This study is called STAR (Study of Tamoxifen and Raloxifene).
For more information about prevention clinical trials, call the Cancer Information Service or refer to one of the other sources listed under “National Cancer Institute Information Resources.”
Detection and diagnosis
At present, mammograms are the most effective tool we have to detect breast cancer. Researchers are looking for ways to make mammography more accurate, such as using computers to read mammograms (digital mammography). They are also exploring other techniques, such as magnetic resonance imaging (MRI), breast ultrasonography, and positron emission tomography (PET), to produce detailed pictures of the tissues in the breast.
In addition, researchers are studying tumor markers. These are substances that may be present in abnormal amounts in people with cancer. Tumor markers may be found in blood or urine, or in fluid from the breast (nipple aspirate). Some of these markers may be used to check women who have already been diagnosed with breast cancer. At this time, however, no tumor marker test is reliable enough to be used routinely to detect breast cancer.
Through research, doctors try to find new, more effective ways to treat cancer. Many studies of new approaches for patients with breast cancer are under way. When laboratory research shows that a new treatment method has promise, cancer patients receive the new approach in treatment clinical trials. These studies are designed to answer important questions and to find out whether the new approach is safe and effective. Often, clinical trials compare a new treatment with a standard approach.
Researchers are testing new anticancer drugs, doses, and treatment schedules. They are working with various drugs and drug combinations, as well as with several types of hormonal therapy. They also are looking at the effectiveness of using chemotherapy before surgery (called neoadjuvant chemotherapy) and at new ways of combining treatments, such as adding hormonal therapy or radiation therapy to chemotherapy.
New biological approaches also are under study. For example, several cancer vaccines have been designed to stimulate the immune system to mount a response against breast cancer cells. Combinations of biological treatments with other agents are also undergoing clinical study.
Researchers are exploring ways to reduce the side effects of treatment (such as lymphedema from surgery), improve the quality of patients’ lives, and reduce pain. One procedure under study is called sentinel lymph node biopsy. Researchers are trying to learn whether this procedure may reduce the number of lymph nodes that must be removed during breast cancer surgery. Before surgery, the doctor injects a radioactive substance near the tumor. The substance flows through the lymphatic system to the first lymph node or nodes where cancer cells are likely to have spread (the “sentinel” node or nodes). The doctor uses a scanner to locate the radioactive substance in the sentinel nodes.
Sometimes the doctor also injects a blue dye near the tumor. The dye travels through the lymphatic system to collect in the sentinel nodes. The surgeon makes a small incision and removes only the nodes with radioactive substance or blue dye. A pathologist checks the sentinel lymph nodes for cancer cells. If no cancer cells are detected, it may not be necessary to remove additional nodes. If sentinel lymph node biopsy proves to be as effective as the standard axillary lymph node dissection, the new procedure could prevent lymphedema.
Chemotherapy can reduce the ability of bone marrow to make blood cells. That is why researchers are studying ways to help the blood cells recover so that high doses of chemotherapy can be given. These studies use biological therapies (known as colony-stimulating factors), autologous bone marrow transplants, or peripheral stem cell transplants.
National Cancer Institute/National Institutes of Health