Women's Bodies, Women's Wisdom (82 page)

Preventative chemotherapy (usually in the form of tamoxifen)

Taking estrogen-inhibiting drugs for the rest of your life (to presumably thwart tumor growth)

I’m saddened by these recommendations because they simply don’t take into account all the things a woman can do proactively. I don’t believe any woman should think of her breasts as lumps of tissue that are destined to kill her. And I wouldn’t want a woman to think these are her only three options for staying healthy. These protocols can create more problems and diminish a woman’s quality of life. And as already mentioned, frequent mammograms have been shown to increase your risk of cancer because of excessive doses of radiation.
¹⁰⁴

A Word About Genetic Profiles

With the completion of the Human Genome Project in 2000, an ever-increasing body of research is showing that certain gene mutations run in families and may predispose them to an increased risk of breast cancer, heart disease, and so on. These “genomic profiles” typically consist of tests for combinations of gene variants; the specific combinations are considered proprietary and are usually not disclosed in online or printed product information.

Genomic profiling for guiding individualized health promotion and disease prevention is in its infancy but becoming more popular by the day.
¹⁰⁵
This type of testing can be a very valuable tool if it is used proactively. For example, one of my medical colleagues has a mother who has had two different types of breast cancer. A practitioner of functional medicine who understands the link between our genes and our environment, she had her mother and herself tested for the type of gene mutations that are associated with some types of breast cancer. Sure enough, she and her mother had exactly the same genomic profile in the area of estrogen metabolism. But rather than feel as though she is a sitting duck for developing cancer, she used the data to spur her on to do what she already knew she should do: exercise more, increase her intake of indole-3-carbinol, decrease her consumption of sugar, and so forth. Increasingly, genomic profile blood tests—and the ability to change how our DNA gets expressed—will be the medicine of the future. If you work with a skilled health care practitioner who knows how to interpret a genomic profile and use it to help you improve your lifestyle, then getting one might be worth it. For the vast majority of people, family history is all the genomic profiling they need. The key is to make the changes that the family history—and common sense—tell them they should make. (To find a practitioner who is combining genomic profiles with specific lifestyle suggestions, check out the website of the Institute for Functional Medicine at
www.functionalmedicine.org
.)

Changing Your Legacy: Prevention from the Inside Out

Here’s the story of one woman, a social worker, who has engaged proactively with her family history. (Note the reference to her mother. Breast issues always go back to our mothers—the people from whom we learned our earliest and deepest lessons about self-nurturance.)

Life had been hectic for some time. Working as a social worker in a large Boston teaching hospital, I cov ered the oncology unit and the two intensive care units and had a beeper that went off nonstop. At home, I felt continuously assaulted by the noise from the street and from the huge radios that every kid on the block played. I vowed that by the age of fifty I would retire from the rat race and find someplace quiet where I could do some teaching and consulting and have a small private practice and a big garden.

I had been working in oncology for a few years. Initially, I felt somewhat compelled to do so, knowing that it had to do with my own mother’s death, at the age of forty, from breast cancer. It was something of a death-defying act. If I could learn as much as possible about can cer, it would never “get” me. All I had to do was get past the age of forty. In my own therapy, as I approached forty, I faced the issue of “having” to do oncology work. After some struggle, I finally decided that I did what I did because I was very good at it, and that when the time came to work in some other sphere, I could do it.

The age of forty came and went. And the angst remained.

In September 1990, I came to Maine for a vacation. I was having dinner with an acquaintance and we were talking about our dreams for the future. When I said that my dream was to retire to a place like this when I turned fifty, she challenged me with the question “Why not now?”

My answer was that I made good money for a social worker, I had a manageable mortgage, and I was vested in the hospital pension plan. Her observation that I was being held by the “golden handcuffs” irked me, because I like to think my values are elsewhere. “Besides,” she said, “what makes you think you’ll get to fifty?” Not only did my mother die young, but every day I was working with people younger than I who were dying.

At that moment I know that my life changed. I felt it in every cell of my body. And I
knew
there was no reason not to come to Maine. The next day I told a Realtor what I wanted, and on the following morning at nine a.m. I walked into the house that I now own. The first house that I looked at was just what I had dreamed about.

In January I moved to Maine and continued to work in Boston, never minding the commute, which was made easier by a flexible schedule. In March, Claudia, a young leukemic of whom I had become very fond, died. I had worked with Claudia and her family for four years. I dreaded her death. The morning she died, I experienced chest pains. Knowing that there was no physical problem with me, I paid attention and tried to figure out what my body was saying to me. By the end of the day, I had named the pain “collective heartbreak.” I realized that I knew more dead people than live people and decided that I needed a weekend away to think about things. A few Sundays later, I was sitting out on the rocks in front of a big resort, looking at the ocean. My thoughts were of Claudia, of many of the others I had worked with who had died, and eventually of my mother.

For some reason I was curious about exactly how old my mother had been when she died. Surprisingly, I had never done the arithmetic that would give me that information. Simple calculations told me that she had been forty-one and nine months old when she died. On that very day, I was exactly forty-one years and nine months old! And I had been working on the oncology unit for five and one-half years—the same length of time she had been sick with her breast cancer. I had done it! I had survived!

The next day I handed in my resignation. I took the summer off to think about what to do with my life. Those few months turned into a few more, and before I worked again, nine months had passed—an appropriate amount of time to be reborn.

During that time, I had the birthday my mother never had and began to rethink my identity and priorities. Eventually, I began what has turned into a very successful psychotherapy practice. I get to teach now and then, do a bit of consulting, and have that big garden. And I know for sure that although I’m my mother’s daughter, I never have to
be
her.

As part of my journey, I have come to believe in the strength of the body and spirit—a helper even in the most impossible situations. In the 1950s, when my mother had breast cancer, I know that there were few options for a Roman Catholic woman stuck in a bad marriage, even fewer if she had been physically disabled in childhood, as was my mother. I now believe that my mother’s breast cancer was her only way out of an impossible situation, a bad marriage, a stultifying existence of guilt and self-sacrifice. I regret that her escape cost her her life.

Breast Cancer Treatment

Treatment modalities for breast cancer are beyond the scope of this book and are not my specialty. Though the experts may disagree somewhat on the statistics, the data suggest that the overall mortality rate from breast cancer is going down. Though it is reported that the age-adjusted mortality rate for U.S. Caucasian females with breast cancer dropped 10 percent from 1975 to 2000, I’m not sure how meaningful this figure really is, given the large number of noninvasive ductal carcinomas in situ that no doubt have been included as part of these statistics. In some areas of the country, mastectomies are still being done, even though lumpectomy to preserve the breast has, in most cases, been proved equally effective. I urge every woman faced with breast cancer treatment decisions to seek a second opinion if mastectomy is the only option she is given.

One major advance in the surgical treatment of breast cancer is the sentinel node biopsy, whereby a surgeon is able to remove a single ax illary lymph node, the sentinel node, which is the first to process can cer cells. When this node is negative, no further nodes are removed. This prevents women from experiencing so much pain and subsequent lymphedema from removal of large numbers of lymph nodes.

Women now have as much access to information from other people, books, and the Internet as they could want. Some feel overwhelmed by it, while others welcome it. Every woman has her own unique decision-making process and should feel validated in using it. Everyone can read the same statistics and feel differently about them. Some want everything done even if the benefit is statistically very small (less than 5 percent). Others are more concerned about treatment risks and are willing to trust their own intuition. Different doctors can present statistics to patients in different terms. While doctors are rarely malicious, some oncologists (because they deal with so much death) can be quite frightening and full of doom and gloom. A woman should feel she has a support system of health care providers whom she can trust and who trust her.

One new online innovation is
AdjuvantOnline.com
. (Currently, you can only use the site with a password from a health care provider, so you might have to ask yours for one.) Women can plug in information such as tumor size and characteristics, and the site—using data from clinical trials and published studies along with the National Cancer Institute’s SEER (Surveillance Epidemiology and End Results) database—calculates a statistical estimate of their ten-year survival rates and ten-year relapse rates with different treatments or no options. The presentation includes easy-to-read colored graphs.

Another online resource I recommend is
The Moss Reports
by Ralph W. Moss, Ph.D., an expert on alternative cancer therapies. His reports, a periodically updated electronic library of more than 200 doc uments on various cancer diagnoses, contain information on the most successful treatments and most promising innovative therapies for various types of cancer, including breast cancer. (For more information, call Dr. Moss’s office at 800-980-1234 or 814-238-3367 or see Dr. Moss’s website,
www.cancerdecisions.com
.)

Whatever the form of treatment, women all over the world today are transforming their experience of breast cancer and healing at the deepest levels to go on to live full, dynamic, and creative lives.

Inner reflective work to change emotional patterns associated with breast cancer, certain types of support groups, and dietary improvement are important parts of treatment, regardless of whether one has a lumpectomy or undergoes mastectomy, radiation, or chemotherapy. Though the vast majority of women with breast cancer choose surgery, chemotherapy, or both for treatment, I’ve worked with several women whose choice has involved dietary change and inner healing work only—without any aid from conventional medicine besides the initial biopsy to make the diagnosis. After several years, some of these women now have clear mammograms and no evidence of cancer anywhere. One was called at home by her surgeon at the time that she first refused treatment and was told that if she didn’t have the recommended surgery she would die. She refused, and now ten years later she’s cancer-free.

Many women choose some, but not all, of the treatment options offered to them. Mildred was forty-three years old when her diagnosis of breast cancer was made. She was married to a university professor and lived in a midwestern college town. She had never worked outside of her home, having chosen instead to marry in her early twenties and raise three children. Shortly after she turned thirty-five, she realized that her husband had been having a series of affairs with students. For financial reasons, she chose to stay with him until their children were older. When her diagnosis of breast cancer was made, however, she left her marriage, went back to school, and got a job. She is now living happily and independently. She had a lumpectomy only. When her daughter asked her why she didn’t get a mammogram and exam every six months, Mildred replied, “I know why I got breast cancer. I know I will not get it back again.” She knew that she could not maintain her health and stay in a marriage with a man who was sexually unfaithful to her. After more than ten years, she hasn’t had a breast cancer recurrence.