Discussing Breast Cancer

Survivors often find themselves in the midst of depression. They’re facing their own mortality, for one. They’re tired, sick, sore … it’s tough to pick yourself up mentally when you don’t feel good physically. It’s been said that hormone fluctuations affect our mood - chemotherapy and hormone therapy reek havoc on your natural hormone levels. And it’s wintertime (here in the Northern Hemisphere at least) … and these cold, dreary days are for the birds.

You’re not alone. Up to one-third of women diagnosed with breast cancer face mood disorders of some type.

Here’s what I need to tell you: it’s important to get help. If not for yourself, for your children: Research indicates that children of depressed breast cancer patients are more likely to be concerned or anxious about their mother’s cancer and its implication for their families.

My recommendation:

(1) Talk openly about your disease with your children — the positive spin you’ll likely want to put on it for their sakes will benefit your own psyche as well.

(2) Talk openly about your disease with whoever you have around you — it’s therapeutic to share those negative emotions. Purge them, get them out, so you can put all the energy you can muster up towards your treatment. Got nobody? Comment here or on an online support site like breastcancer.org.

(3) Talk openly with a medical professional. They can prescribe medication to help manage your mental distress. This is not the time to be too proud, or too vain. Get help. Nobody should go into battle without a fully loaded arsenal. If you already take something, tell them it’s not working. They need to know.

Don’t deal with depression alone.

Whether or not a survivor even questions the presence of her ovaries in her body depends on the results of her pathology and the answer to one specific question: is her cancer estrogen receptive?

If she is, and the cancer in her body ‘feeds’ on estrogen, there are treatment options to consider that will either (1) suppress her estrogen production with pharmaceuticals (Tamoxifen tablets) (2) chemically stop her estrogen production (Zolodex shots) (3) remove her estrogen production (Oopherectomy).

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Let’s go back to 2003 … after my partial mastectomy and radiation therapy I was considered cancer free. The question on the table was would I be able to stay that way?

I was 36 years old. The pathology from my surgery determined my cancer cells were estrogen receptive (ER+). I hadn’t started menopause which meant I had a good amount of estrogen running throughout my body. I had a choice to make: do nothing or start hormone therapy, another adjuvant therapy, and that meant taking Tamoxifen.

Now Tamoxifen was supposed to be a pretty great drug (the FDA touted its benefits when it approved it back in 1998). I was told it would prevent whatever cancer cells I might have had left in my breast from feeding on the estrogen my body produced. I was told it would reduce my risk of recurrence by around 50%.

I was told that my risk of recurrence within five years was maybe around 10%. Taking Tamoxifen would take that number down to around 5%. I liked the lower number, that’s for sure.

Of course, there were some side effects to consider — mostly menopausal symptoms like hot flashes and vaginal dryness — also some risks: blood clots and endometrial cancer.

My oncologist felt the benefits far outweighed the risks. When asked point blank if she would take it if she were me she said, ‘yes.’

There was one potentially big problem, however, from where she stood. If my husband and I wanted a third biological child she could not ethically prescribe the drug for me because it could cause fetal harm were I to conceive while taking it. If we were done having kids, however, she’d write the script that day.

My husband and I looked at each other and smiled. No, we weren’t done having children. Yes, we wanted a third child. But we agreed immediately that she should write the prescription. See, we knew that God’s plan for our lives was to bless us with a third child, a little girl, whose biological parents in China could not raise her. We knew we’d adopt child number three so taking Tamoxifen was not going to be an issue in that regard.

I started taking Tamoxifen the week after my radiation therapy had ended. I experienced no side effects at all while taking the drug. But there was one big problem. Tamoxifen was supposed to keep me cancer free. Remember the numbers? It was supposed to reduce my risk of recurrence by about 50%. It was supposed to bring my personal risk of recurrence within five years from 10% down to 5%.

The cancer cells in my body didn’t listen to the numbers that day in my oncologist’s office. They had their own plan and it didn’t involve me staying cancer free for long.