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Living with Breast Cancer

Thanks to earlier detection and advanced treatment options, more women are surviving breast cancer today than ever before. In fact, according to the National Cancer Institute, nearly 90 percent of women diagnosed with breast cancer today will survive their disease at least five years. These cancer survivors find themselves dealing with a host of new issues, both physical and psychological. In this month’s column, radiation oncologist Dr. Laurie Herscher takes a look at some of the challenges that face today’s cancer survivors.


On November 10, Suburban Hospital will host the 9th annual Living With Breast Cancer Symposium from 8 a.m. to noon. The symposium, “Humor and Healing,” will feature discussions on finding humor where you least expect it, bringing laughter into your life, and drawing on your inner strength.


Admission to the symposium is free, but seating is limited, so anyone interested in attending is encouraged to register early. To reserve your seat, call Suburban On–Call at 301.896.3939 (select option 2), or send an email to soc@suburbanhospital.org and leave your name, contact information, and the program name, date, and time.


What are the major areas of concern for breast cancer survivors?

With the increase in the number of women who are surviving breast cancer — most women who are undergoing multiple modalities of treatment — there are a number of issues that arise over the long term, including both physical and psychological issues. In terms of physical issues, the long-term side effects of treatment are a big area of concern since some of these side effects may occur years after initial treatment ends. There are long-term effects of chemotherapy and radiation, as well as the prolonged risk of lymphedema, which is mostly a side effect of surgery.


What are the long-term effects from chemotherapy?

Women who undergo chemotherapy are at risk for a constellation of long-term side effects, the most common of which are fatigue and premature menopause. Some women who have undergone chemotherapy complain of prolonged memory problems and confusion. Recent studies have also linked certain chemotherapy drugs to an increased risk of heart disease. It’s important to work with your doctor on ways to mitigate these and other potential long-term side effects.


Are there long-term effects from radiation therapy?

There can be. The side effects of radiation therapy are generally localized to the site of the radiation. The most common long-term side effects are minor cosmetic changes in the treated breast. Some women experience some shoulder mobility problems and there can be an increased risk of lymphedema in certain situations as well. Much rarer side effects include the increased susceptibility to future rib fractures or damage to the heart or lung, and the remote possibility of secondary tumors years later, although newer radiation techniques have made these side effects extremely uncommon. Breast cancer survivors who smoke, however, are at increased risk of developing lung cancer after radiation therapy, so it’s extremely important to stop smoking. Because the long-term side effects of radiation therapy can be difficult to make more tolerable, it’s important to minimize the risk of these effects as much as possible with modern treatment techniques.


What exactly is lymphedema and how can it be avoided?

Lymphedema results when excess fluid collects in the tissue, causing swelling. With breast cancer survivors, lymphedema can occur after removal of the lymph nodes or as a result of radiation therapy. At Suburban Hospital, patients work with the Physical Therapy staff, utilizing such treatments as massage therapy, to decrease their risk of developing lymphedema. For women most at risk, it’s important to baby the affected arm. Don’t allow blood draws in that arm, avoid cuts and scrapes, and make a special effort to guard against any type of infection in the arm. When traveling by air, use a compression stocking. The key is to try to keep the arm from developing edema for any reason and to seek medical attention at the first sign of a problem.


How might support groups help breast cancer survivors?

There are a couple of questions that are posed frequently by cancer patients. The first is, “Now that I’m done with treatment, what do I do?” The second is, “Am I cured?” Support groups can be very helpful in dealing with these kinds of questions.


For many women, it’s difficult to make the adjustment from being a patient to being a breast cancer survivor. They don’t know how to start living their lives again. For these women, support groups can be a big help. These groups offer an opportunity to connect with other women who have experienced the same thing, to gain knowledge, share common concerns, and get needed support. While there are many of these programs available, patients don’t always avail themselves of these opportunities. Some just don’t want to be reminded of their breast cancer. Others may have difficulty opening up about their experiences. But support groups can really help the cancer survivor deal with some of these bigger psychological issues.


The question, “Am I cured?” is a difficult one to answer right after treatment. It’s a matter of watching over time and learning to live with uncertainty. The fear of recurrence is normal and there’s no one answer to this question. Any cancer survivor lives with a heightened sense of mortality. Again, being able to connect with others who have lived through it can make all the difference.


How do women deal with the fear of recurrence?

With breast cancer in particular, dealing with the fear of recurrence is a real challenge. Unlike with some other forms of cancer where you may be declared cancer-free several years after treatment, breast cancer can recur as many as 10, 15, even 20 years after the initial treatment. So this particular fear is extremely normal. It’s important to maintain a general follow-up schedule. Many women get particularly nervous just before that first follow-up mammogram. This is a time when a support group can help, as can talking about your fears with your oncologist. For someone who is feeling overwhelmed by fear and that fear is impeding her ability to function, talking with a social worker or other mental health professional or joining a cancer support group is strongly encouraged.


Along with their fears, some breast cancer survivors find that they experience feelings of liberation as well. They decide not to waste time on the things that aren’t so important and they make life changes that they have always wanted to make. Any cancer survivor will tell you that having cancer changes everything.


What are some lifestyle changes that breast cancer survivors can make to favorably impact their risk of recurrence?

That’s a question that comes up frequently. There are things women can do that can make a difference in the long term. In fact, recent data suggests that certain lifestyle choices do have a positive impact. Physical exercise and diet are extremely important. Exercise can help ameliorate treatment-related fatigue. Exercise and a low-fat diet can impact favorably on recurrence. Taking charge of your exercise regime and your diet has a positive impact psychologically as well. Cancer can make you feel out of control. Diet and exercise are two areas where you can take charge, giving you back some sense of control.


What is Suburban Hospital doing to support breast cancer survivors?

Suburban Hospital has an active breast cancer support group that meets monthly and is open to all breast cancer survivors, their families, and friends. The group meets the second Monday of each month, from 7 to 8:30 p.m. at the hospital, and drop-ins are welcome.


In addition, women are encouraged to attend Suburban Hospital’s 9th annual Living With Breast Cancer Symposium on Saturday, November 10, from 8 a.m. to noon. Admission is free, but seating is limited. To reserve your seat, call Suburban On–Call at 301.896.3939 (select option 2), or send an email to soc@suburbanhospital.org and leave your name, contact information, and the program name, date, and time.


About Dr. Herscher

Dr. Laurie Herscher is a board-certified radiation oncologist with the Suburban Hospital Radiation Oncology Center. A graduate of Stanford University, Dr. Herscher received her medical degree from George Washington University and completed her fellowship and residency training program at the National Cancer Institute, where she also served as a senior investigator and clinical director of the Radiation Oncology Branch.


Dr. Herscher is a member of the American Society for Therapeutic Radiology and Oncology and the American College of Radiation Oncology. She joined Suburban Hospital in 2002. Suburban Hospital’s Radiation Oncology Center is located in the Suburban Outpatient Medical Center at 6420 Rockledge Drive in Bethesda. The phone number is 301.896.2012.

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