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Questions
Hearing that someone you love has breast cancer affects everyone differently. Since the possibility of death is there, I find that everyone seems to go through the stages of grief - denial, anger, bargaining, depression and acceptance.

It is easy to get stuck in any one of these stages, possibly even for years. Anger or depression are two stages that are easy to hold on to even after treatment is over. I was depressed for a long time after my mothers first diagnosis.

For me seeing a therapist was a life saver. The anxiety, anger and depression I was feeling was affecting my work, my social life, my relationships, etc. I was terrified of talking about cancer in my therapy sessions and instead kept busy talking about the other issues I was having. I was still partly in the denial stage and saying the words aloud were difficult. But now after therapy I feel as though I have finally accepted the reality of the situation.

At first I thought therapy was a never ending experience that I would have to go every week for years. But I just went for a few months until I felt my anxiety was easy to handle and I was able to say my mom has cancer aloud without breaking down.

If you have insurance, out-patient therapy may be covered. If you are without coverage, look for therapists and social workers in your area as they may work on a sliding scale fee, meaning your fee is based on your income. Group therapy may also be a free or inexpensive option.

You can ask and answer questions on this site at any time of day or night and someone will answer. You never know, you may be asking a question someone else is too afraid to ask. Beyondboobsinc.org has listing of support groups as well as ways to start your own. Menagainstbreastcancer.org supports husbands, sons and dads of breast cancer patients.

Taking care of you mental health is important and necessary when you are taking care of someone else. One other way that I made myself feel better was to start checking myself regularly for preventive needs. You can check out selfchec.org for how-tos, and to sign up for monthly reminders for you and your loved ones.
Top Answer by: Tanya (Family member) in topic(s) Family Member, Mental Care, Depression Symptoms, Depression, Family, Anxiety
Over the years, I went to maybe five, but only stayed with two.

They were genuine and I knew that I had their confidence as professionals, which is SO important, when you need to talk with someone about your mental state.

One was at a local "behavioral sciences" center, that also had an in-house psychiatrist. Because of money issues I was not able to go to this one for about 5 weeks, but he was so good, I made alot of positive progress in that time. He had me "journal", and actually gave me affirmation and praise in my hard work to try to improve myself, because it was me that called for help. That had a huge positive impact on my mental state.

The second place was the mental health facility based out of one of our hospitals. There I saw one young woman, who was absolutely fantastic. She was a very attentive listener. So I would write down anything that "shook my mental tree" inbetween visits, so that I could get her feedback. It was good system, and I saw her almost 3 yrs. Finally, she told me I had to leave (ha) that I was "highly functioning" and there were too many others that needed to see her! The co-dependent (ha) part of me wanted to hang onto her coat strings, but, alas, I knew it was time to stand on my own, and as she put it "put into practice what I've learned"! (Will I EVER grow up?)

I can now say that I've not had any more "emotional breakdowns" because of these two special people, and I'm still journaling when I have nightmares, or start having negative thought patterns, so can interrupt them, and MOVE ON!





Top Answer by: RannPatterson (Survivor (Greater than 20 years)) in topic(s) Mental Health Support, Mental Health Professionals, Mental Health
For all the great progress made in breast cancer treatment, disparities do persist. The incidence of breast cancer is 17% lower in African-American women than in white women but the mortality rates are 41% higher in African-American women than in white women. African-American women are more likely to delay getting a biopsy and five times more likely to delay getting treatment once diagnosed.
While Hispanic/Latina women have a lower incidence of breast cancer, they are more likely to be diagnosed with larger tumors and at advanced stage.
When Asian women migrate to the US, their risk of developing breast cancer increases up to six-fold.

We also know that women who lack health insurance and have less than a high school education are less likely to obtain mammograms.

Hope this is helpful, there is so much more but I could give a talk about this!
Top Answer by: Kathie-AnnJosephMDMPH (Physician - Surgery - Breast (Verified)) in topic(s) Breast Cancer, Health Disparities, Cancer
So much of the experience depends on the relationship between you and your health care providers, your personal experience with the disease and treatment and insurance/financial issues. Having said that, my experience in Switzerland was excellent. If anything says to me that it's important for everyone to have access to adequate health coverage, it is my Swiss experience.

In Switzerland, you're required to have insurance coverage. We do pay a monthly premium, but I have a small deductible and then I pay the first 10% up to about $700. That covers everything, including prescription meds. With that coverage, I had excellent physicians, first rate care, and good communication between physicians. Ten days between diagnosis/biopsy and lumpectomy, chemo less than a month after. My case was fairly clear cut, and I didn't feel the need for a second opinion. No arguing with the insurer, no waiting for authorizations, and we not were financially strapped by the event.

To be fair, I don't have to work and I wasn't working at the time. But I understand that people who do work get time off for their treatments.

It's also a matter of luck, because you are dependent on referrals from your physicians, and I had good referrals.

I followed a lot of online resources and looked at the experiences of other women. I found that the chemo/support medication/side effects were handled just as well as in the US, and medications to suppress nausea, anxiety, and reflux were standard rather than something requested. I was followed by my oncologist and primary care doctor weekly.

Perhaps I was lucky in my choice of physicians too, because I had good interactions with all of my physicians, and their staff - both nursing and administrative were very kind, cheerful and happy to know that I was doing well, sympathetic when I was not feeling as well.

One difference here is that your surgery is most often performed by a gynecologist with an expertise in surgery, and mine did a great job. I don't know how common reconstruction is, most women I know have had either lumpectomies or mastectomies. I had a lumpectomy with no need for further surgery. It might be a disadvantage if you desire reconstruction.

Support for English speaking patients can be hard to find, but I've found a great group an hour away, and there's always the Internet. And my doctors all speak excellent English, having done specialty training in the US.

All in all, I'm quite happy with my treatment and level of care.

We've also had positive experiences with other health care issues within our family.
Top Answer by: member4321 (Survivor (1 year))
Patients of breast cancer who are receiving treatment are at an increased risk of bone loss also known as osteoporosis. Osteoporosis can lead to disfigurement, loss of self-esteem, and have significant morbidity and mortality. In women, screening for bone loss is done with dual-energy x-ray absorptiometry (DEXA scan). This test helps determine if they have low bone mass and help assess and individual patients risk for a fracture.
Top Answer by: NavneetDhillonMD (Physician - (Verified))
Weight control and exercise are the two related factors that are truly under our control and that might have a bearing on the outcome of treatment for early stage breast cancer.
Top Answer by: CliffHudisMD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Health, Reduce Breast Cancer Risk, Lifestyle Modifications, Reduce Cancer Risk, Lifestyle
All humans have a right to sexual health. just as much as any other aspect of health. Unfortunately, people dealing with cancer often have difficulty finding help for a sexual problem, even when they are assertive enough to ask. Of course a first step should be to talk with your oncologist, an oncology nurse or social worker, or if you are finished with cancer treatment, your primary care doctor. If you are lucky, one or more of these health professionals will be able to answer your questions, and if needed, refer you to get help for a sexual problem. Sadly, many health professionals who treat cancer know little about sexual side effects and are not skilled in discussing sex comfortably.

If you do not get the information you need, you may want to find a specialist yourself. This is not an easy task. If you do not have private health insurance or Medicare, finding any affordable treatment for a sexual problem is very difficult. A few major cancer centers have sexual health clinics, but they are usually in big cities like New York, Chicago, Houston, or Boston. Most only give care to people with insurance or to those willing to pay out of pocket. Most state Medicaid programs provide few or new services to help with sexual problems, whether or not cancer is involved.

Women often expect a gynecologist to be an expert in sexual health, but few GYN's have special training or interest in sexuality. Sometimes a gynecologist who specializes in menopause or pelvic pain can be helpful, but again, they tend to practice in large cities. Urologists often know about treatments for erection problems, but many are not very interested in this aspect of their practice. They may give you some pills with little advice or follow-up. Some urologists or sexual medicine specialists do focus on sexual problems, however. Look for someone who offers a full range of treatments. Some "male health" clinics that advertise in sport pages of newspapers operate like assembly lines, doing unnecessary tests and giving every man the same treatment in the end. Also, beware of buying pills for erection problems on the internet. Most are forgeries and some are quite dangerous. Get your pills from one of your real doctors.

What about sex therapists? In most states, anyone can use that title without coming under a licensing law. Look for a licensed mental health professional, such as a psychologist, social worker, or psychiatrist, who also has special training in treating sexual problems. But even if you have some insurance that covers mental health, it probably will not pay for psychotherapy related to a sexual problem, and you may only get reimbursed if you see a mental health professional who is on their list of providers—usually not the most senior and well-trained people in a community. Even mental health professionals who know how to treat sexual problems are not always familiar with the sexual side effects of cancer treatment.

Ideally, people need a treatment team that includes someone able to help with counseling issues and a physician who can treat physical damage that may be contributing to the sexual problem. I am very sad to say that around the United States, I could name only a very few clinics that offer such treatment for men or women. Because of my frustration with the system, I have been working on internet-based patient education/counseling tools on cancer and sexuality. They are not yet ready for the public, but we hope they will be available in a couple of years. At least we can help people understand why they have problems, what they can do on a self-help basis, and what medical options they have. I should mention that these are supported by small business grants from the National Cancer Institute, so there is a possibility in the future that they will be distributed for profit. So I may be biased, but I do not see many good resources currently on the internet either. Most are very superficial and do not suggest what you can do to make things better. The American Cancer Society does offer its booklets, Sexuality and Cancer for men and women. You can find them on their web site:
http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/sexualsideeffectsinwomen/sexualityforthewoman/sexuality-for-the-woman-with-cancer-toc

http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/sexualsideeffectsinmen/sexualityfortheman/sexuality-for-the-man-with-cancer-toc

Top Answer by: LeslieSchoverPhD (Researcher (Verified))
People who have had cancer often worry about their children’s health. Most of these concerns are needless, but there are a few situations that can pose a problem. Let’s look at three areas: children’s cancer risk, risk of birth defects related to a parent’s cancer treatment, and pregnancy risks.

Children’s Risk of Cancer: Only about 5% to 10% of cancers can be linked to a specific gene mutation that runs in a family. Most of these genetic problems can be passed down from a mother or father. Each child conceived by a couple has a 50/50 chance of inheriting the damaged gene, which usually creates a much higher lifetime risk of one or more cancers (such as breast cancer, colon cancer, etc.). Other genes may act together with each other or with dangers from the environment to create a mild increase in cancer risk. For example, if a mother has had breast cancer, her daughters have twice the average lifetime risk of breast cancer themselves. Families also share lifestyles and habits that contribute to the risk of cancer, including living in areas with radon or a lot of other pollutants, eating high fat diets, smoking, and not exercising.

What can you do as a parent? You can help your children be healthy by modeling and encouraging good health habits. If your children may be at risk for a family cancer syndrome, like familial adenomatous polyposis (early colon polyps that lead to colon cancer) or breast cancer at a very early age, make sure they get recommended screening tests. If you know you have a gene mutation that increases cancer risk, there are some options to avoid passing it down to your children, but they are only used by a few. When a damaged gene has been identified in a father or mother, embryos can be created using in vitro fertilization. Each embryo can be tested for the mutated gene, and only those without it are planted in the mother’s uterus to try for a pregnancy. This is called preimplantation genetic diagnosis. Most people choose to have children naturally, but a few may adopt or have a child with a donated sperm or egg to avoid passing on a mutation increasing cancer risk. These are difficult choices and counseling often helps to clarify feelings about them. One thing to consider: scientists estimate that every parent passes on several potentially harmful gene mutations to children!

If you suspect that cancer runs in your family, you can see a genetic counselor or a doctor who is trained in the genetics of cancer. Try the booklet: Making Sense of Your Genes: A Guide to Genetic Counseling (http://www.nsgc.org/Portals/0/GuidetoGeneticCounseling.pdf).

Birth Defects Linked to a Parent’s Cancer Treatment: Chemotherapy drugs used to treat cancer can also kill off sperm or eggs while they are developing, since these cells divide rapidly, like cancer cells. Some sperm or eggs survive, but their genes may have been damaged. If a child was conceived with a damaged sperm or egg, a birth defect could result (for example cleft palate, spina bifida, or heart or kidney problems). However, most embryos made with a damaged sperm or egg die during the very early days of a pregnancy, usually before a woman even realizes she was pregnant. Very few children are born who were exposed to chemotherapy around the time of conception or during pregnancy. For humans in general, about 3% of babies are born with birth defects. It takes studying a lot of babies to figure out if cancer treatment increases that rate. Some of the best studies have been done in Scandinavia, where countries keep excellent records of all births and all cancer cases, and researchers can link the databases. One recent study linked all men who had cancer in Denmark and Sweden between 1994 and 2005, and all births during those years. Children of male cancer survivors had a 3.7% chance of a major birth defect compared to 3.3% in other children. Although this difference is meaningful in terms of statistics, it is still quite small. Children born within two years of a father's cancer diagnosis had a 4% chance of a birth defect compared to 3.6% for all children born after that time period. Children conceived with the help of infertility treatment did not have more birth defects than children conceived through sexual intercourse. Studies of children born to women have had similarly reassuring results.

Sperm and eggs actually have some ability to repair their genes, but the process takes up to two years. It takes 3 months for a sperm cell to go from stem cell to mature sperm, and 3 to 6 months for an egg to ripen. Doctors often advise couples to wait for 6 to 24 months after the last dose of chemotherapy or radiation before trying for a pregnancy so that sperm and eggs that were exposed will be “used up.” If a man is on chemo and his wife is pregnant, he should use a latex condom to avoid any possible exposure of the fetus to drugs that can be present in his semen. In fact, it is generally a good idea to use condoms during chemotherapy so that a partner does not drug exposure and to avoid an unintended pregnancy. Men who have radiation therapy to the prostate with rods or seeds that are implanted permanently should also ask for guidelines if they have a pregnant partner. The normal period of avoiding close contact with another person just after the implant may need to be extended.

Some women are pregnant when cancer is found. After the first 3 months, organs have formed in the fetus and some chemotherapy drugs can be given to the mother without seeming to harm the developing baby. Chemo during pregnancy has mostly been studied in women treated for breast cancer.

There are a few cancer therapies that are known to cause birth defects in a developing fetus. If a woman is taking one of these drugs she should be extremely careful to avoid getting pregnant. Men taking them are generally advised to use latex condoms with any woman able to get pregnant, even if the man himself has had a vasectomy. Birth control should be used while taking the drugs and for 90 days after stopping them. These drugs include some of the new targeted therapies, iminatib, thalidomide, and lenalidomide. Women also should avoid getting pregnant while on the hormone therapy, tamoxifen because it also can cause birth defects.

Pregnancy Risks. Women who have been successfully treated for cancer can usually become pregnant without fear that pregnancy will cause a recurrence. Even women who have had breast cancer do not seem to have worse survival if they become pregnant after finishing treatment, although the high hormone levels of pregnancy remain a small concern. Women who had radiation therapy to the area near the uterus, especially in childhood or early teen years may have trouble carrying a pregnancy successfully because of damage to the uterus and its blood supply. Some babies miscarry or are born very prematurely. Women who have had chemotherapy may benefit from seeing a high-risk obstetrician before trying to get pregnant. Sometimes they have damage to the heart or lungs that does not show up without special tests, but could cause serious complications during a pregnancy.

Unfortunately, some cancer treatments damage men’s or women’s fertility, but for those cancer survivors who have children before cancer diagnosis or after their treatment, the chances are very high that their children will be of normal health.
Top Answer by: LeslieSchoverPhD (Researcher (Verified))
I recommend that health care providers use three approaches to initiate conversations about emotional health with survivors –1) Include emotional health in any medical history or intake form that patients complete before a visit; 2) Use a standardized screening measure as described above; and 3) Follow-up on the intake form and checklist directly with each patient. The medical history form may include 3-5 questions and gives a quick overview of how the survivor feels they are doing. The screening measure may have 10-20 questions and provides a more detailed view of how the individual survivor’s level of distress compares to other peoples. The in-person conversation allows the provider to ask follow-up questions, give clarifications, and provide reassurance, education, or referral for a mental health assessment if needed. Although this combination approach may seem redundant, it actually can save time since the health care provider can use the written information to direct their conversation and helps insure that psychological symptoms won’t be missed.
Top Answer by: ChristopherRecklitisPhD (Researcher (Verified))
Yes, sexual difficulties can lessen! But before talking about specific methods it is important to recognize some basic ideas about continuing your sexual life during or after cancer treatment.

1. Educate yourself. Talk with your doctor, nurse, etc. to learn about the effects of your cancer or your treatments on sexuality. For example, the American Cancer Society (http://www.cancer.org) has two excellent booklets available for a nominal cost: Sexuality for the Woman with Cancer, Sexuality for the Man with Cancer.

2. Keep in touch. Pleasure from touching is possible regardless of the type of cancer treatment one has had. As has often been said, the most important sexual organ is... the brain!

3. Leave routines behind and move forward. We can all have very narrow views of what is “normal” or what the “typical” sex life should be. Cancer is a life disruptor, but it can also offer new ways to experience life, new ways to give and receive pleasure. Often patients’ greatest need is not for sex (the ‘act’) but physical intimacy, such as being held, holding another, or cuddling. The most important step individuals and couple can make is to preserve personal and physical intimacy (touching) times when routines get disrupted.

4. Talk and share information. Good communication is the key to successful relationships, and good communication is essential to adjusting a sexual routine with a partner.

When addressing sexual problems it is important to first appreciate that sexual problems following cancer are common. In particular, the most frequent symptom is a loss of sexual desire. Fatigue can be a powerful contributor, as it remains a significant problem with full recovery taking upwards of 2 years after all cancer treatments end. As noted above, sexual educational materials can be quite important. For women, managing menopausal symptoms relevant to vaginal health should be done. The most common symptom is vaginal dryness, which is usually accompanied by diminished sensation and pleasure and possibly dyspareunia with partnered activity. Many such problems will be reduced if not eliminated with the regular use vaginal moisturizers, such as Replens® and the use of vaginal lubricants, such as K-Y jelly, during intercourse. For women who talk with their physician and learn that they can receive estrogen replacement therapy (ERT is contraindicated for those with breast or ovarian tumors), vaginal treatments (creams, tablets, estrogen-releasing ring) may be an option.

For men, surgical treatments for prostate or testicular cancer may result in significant problems of erection and/or ejaculation that may be permanent. Hormonal treatment for prostate cancer can reduce sexual desire further and cause menopausal like symptoms (hot flashes, sweats). Nevertheless, treatments are available including medication such as Sidenafil (Viagra), erectile injections with medication such as Papaverine, use of constrictive penile rings or vacuum devices, or penile prosthesis surgery (pump devices). All of these treatments can be enhanced with concurrent sexual therapy.

For those with pervasive sexual difficulties, discussion with a physician — such as a gynecologist for women and a urologist for men — is an important starting point to rule in or out physical sources of sexual dysfunction. There after, seeking counsel from a trained, licensed professional whose specialty is behavioral sex therapy is suggested. When seeking such counsel, ask the therapist the first session (or before hand) how many cancer patients with similar difficulties they have previously treated and with what success.
Top Answer by: BarbaraAndersenPhD (Psychologist (Verified))
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