Coping with Cancer

Heart disease may be more common, arthritis more crippling, but no disease is more feared by women than breast cancer. Until fairly recently, women so dreaded it that they avoided discussing it, even among themselves; some, fearing the mutilative surgery required to control cancer, avoided examinations that could detect the disease.

But last week, in the wake of First Lady Betty Ford's operation for breast cancer, much of the reluctance, if not the fear, to face the disease seemed to have faded. Television Commentator Barbara Walters educated--and startled--her viewers by demonstrating a breast examination (fully clothed) on the Today show (see TELEVISION). Doctors' offices, hospitals and clinics found themselves inundated with requests for examinations. Telephone operators at the American Cancer Society in Manhattan lost count of the requests for information that poured into their switchboard.

This open attitude is one of the greatest advances made in the past 20 years in the fight against breast cancer. The disease will afflict some 90,000 American women and kill another 30,000 this year. But recent studies reinforce the doctors' insistence that early diagnosis can reduce both its fatality rate and the trauma of its treatment. The experience of survivors proves that most of those who develop the disease can learn to live with its aftereffects.

Despite the widespread occurrence of breast cancer, however, its treatment remains in dispute. A study released last week by the National Cancer Institute has added to the longstanding debate over the best surgical technique to combat breast cancer. The common procedure, and the one performed on Mrs. Ford, is radical mastectomy, a disfiguring and sometimes partially disabling operation that involves removal of the breast, the underlying pectoral muscle and the lymphatic tissue under the arm.

But a study conducted among 1,700 women at 34 institutions suggests that the operation, which can produce lifelong pain, weakness and periodic swelling in the affected arm, may be unnecessary in some cases. Doctors divided women whose cancers had not yet been found by clinical examination to have infiltrated the lymph nodes into three groups and gave one radical mastectomies, another total mastectomies (removal of the entire breast but no other tissue) coupled with radiation, and the third total mastectomies but no other treatment.

A two-year follow-up revealed no differences in the rates of recurrence among the three groups. Whether a ten-year follow-up will show similar results remains to be seen; doctors have found that a clinical diagnosis of no lymph-node involvement is subsequently proved wrong in 38% of all cases.

Another study, meanwhile, indicated that even axillary tumors--those that have spread to the lymph nodes--may be better controlled or prevented following surgery by treatment with a drug called L-phenylalanine mustard. Conducted at 37 hospitals, the study showed that L-PAM reduced the rate of recurrence among women who had already undergone surgery for breast cancer. Its effect on premenopausal women was particularly dramatic. Of 37 such women who received no drug treatment after surgery, eleven had recurrences of cancer; of 30 treated with oral doses of L-PAM, only one had a recurrence.

Reduced Trauma. Most doctors are likely to welcome the NCI's findings on L-PAM and make wider use of the drug. But, until ways other than surgery are developed to determine whether cancers have spread to the lymph nodes, few are likely to abandon radical mastectomy for the simpler operation.

Though such screening procedures as mammography and thermography can spot cancer in the breasts early, the American Cancer Society reports that 95% of all breast tumors are discovered by the women themselves. Of these, 60% have spread to the lymph nodes before detection.

In most cases there is little hope that amputation can be avoided. But some of its trauma can be reduced. The reason is an organization called Reach to Recovery. Founded in New York in 1953 by Terese Lasser and now operating in all 50 states, Reach is an exercise in self-help that uses women who have undergone mastectomies to counsel women who have just had the operation. Their approach is nothing if not direct. Volunteers visit patients three to five days after the operation, about the time that the worst post-surgical depression begins to set in. A few even point to well-shaped bosoms and ask jauntily, "O.K., kid, which one is real?" Most patients are unable to tell.

Once this gambit has broken the ice, the volunteers get down to business, telling patients about their own experience, assuring them that their femininity is undiminished, and offering practical advice on where to buy bras and breast prostheses. "I think that we help patients because we understand the feeling that something has been taken away --the sense of loss," explains Mrs. Renee Levine, 45, coordinator of the Reach to Recovery program in Brooklyn. "We can also help them to understand that breasts do not make a woman."

More Understanding. All women feel mutilated by a mastectomy. "It was the worst thing that could possibly happen," explained a 51-year-old California woman who had the surgery seven years ago. "I felt shattered for my husband, ashamed, degraded." A few find that their husbands or lovers feel deprived by their loss; some try to spare them from confronting their conditions by dressing and undressing in closets or bathrooms. But most women find their sex lives relatively unimpaired, and more than a few believe that their mates become even more understanding after the operation than before. "Most men are more tender and loving than ever," says Mrs. Hilda Aks, 56, of Washington. "Mine certainly has been."

Indeed, with a little help from their friends and families, the majority of women lose little tune getting back into the swing of things after their operations. Mrs. Aks swims and plays golf.

Mrs. Margaret Banks, 54, also of Washington, is even more active than she was before her surgery. She sings in her church choir and works with the Girl Scouts in addition to serving as a Reach volunteer. Many patients, in fact, become so sold on Reach to Recovery's message that they end up carrying it to others. Their evangelical spirit is understandable. Losing a breast to cancer is tragic, but not nearly so tragic as trying to ignore the disease and thereby losing a life to it.

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