MedStar Health Blog

Most women with early-stage breast cancer discover the disease only after screening with a mammogram. Symptoms may not present in a dramatic or noticeable way, so women diagnosed with early-stage breast cancer are understandably shocked and unprepared as they begin their cancer journey.

If you or a loved one has been diagnosed with early-stage breast cancer, it would be rational and reasonable to jump to quick conclusions, some dire. But keep in mind that doctors are rethinking early-stage breast cancer treatment.

You or your loved one might benefit from recent research that allows doctors to prescribe treatment options that are more targeted, more focused and more effective than ever before.

The Three Types of Breast Cancer

Current research shows that breast cancer usually falls into one of three categories:

• Endocrine receptor-positive, wherein estrogen or progesterone receptors play a role;
• HER2-positive, wherein human epidermal growth factor receptor 2 plays a role; or
• Triple negative, wherein none of the above are involved.

This discovery allows doctors to identify the exact factors at play in your cancer diagnosis, thereby narrowing down appropriate treatments options to the most efficient and effective. Over-treating breast cancer can cause significant side effects for some women.

As much as doctors want to avoid a passive treatment regimen that doesn’t target or kill cancer, they also strive to eschew unnecessary treatments that might lead to other health problems. The ability to identify which type of cancer you have ensures that your treatment is balanced and purposeful.

Chemotherapy Isn't Always Useful

In the past, it was typical for doctors to surgically remove breast cancer tumors and to employ chemotherapy as a method for treating breast cancer, including early stage forms. Contemporary research indicates that chemotherapy doesn't always play a decisive role in early stage breast cancer treatment or in the prevention of recurrence.

Because research has proven that chemotherapy might not always be the best approach, cancer specialists might be less likely to use it as a treatment option except for when absolutely necessary. This discovery means that many women might be able to avoid the unwanted side effects of chemotherapy, including:

• Heart problems
• Osteoporosis
• Anemia
• Vomiting
• Memory loss
• Fatigue

No one wants to go through chemotherapy unless the treatment is essential. Doctors understand this, and they now have the information they need to make better decisions regarding your treatment.

If you have tiny tumors that are difficult to remove surgically, or if you have conditions that make it likely for tumors to return in the future, you may need chemotherapy. The side effects of this treatment plan will make life difficult for a while, but your cancer specialist should be able to prescribe a focused regimen that works specifically for your unique needs.

Final Thought

Your diagnosis of early stage breast cancer will be emotionally daunting and physically exhausting. However, you can find some reassurance in the fact that doctors know more today than ever before about identifying and treating breast cancer.

That way your recovery can happen with as few side effects and treatments as possible.

Cathy Kalimon comes from a family with a strong medical background. Her father was a physician, and Cathy herself spent more than 20 years as an ophthalmic technician. Having this background has always made Cathy aware of the importance of listening to her body and paying attention when certain medications were prescribed — such as narcotics, which always gave her bad reactions.

That’s why, when Cathy was diagnosed with breast cancer in December 2015, the thought of having to take narcotics again was one of her primary concerns.

“I developed uterine cancer in 2013 and asked for no narcotics, but for some reason, I received narcotics with anesthesia anyway,” she said. The second day after the surgery, Cathy continued to be ill. Knowing that Cathy historically reacted poorly to narcotics, her sisters stepped in to question her doctors.

They discovered that Cathy was prescribed oxycodone for post-operative pain management, the source of her prolonged nausea and illness.

Finding a Solution With Dr. Myers

It was with profound relief that when Cathy faced breast cancer surgery in 2016, she discovered a breast cancer specialist willing to listen and respond to her unique needs at MedStar Georgetown University Hospital.

“I am aware that doctors know more than I do — but I also know what happens to me when I get narcotics,” she said. “One of the first things I said to Dr. Tousimis, my breast surgeon, was: ‘Please don’t give me narcotics.’ I couldn’t imagine having my chest opened and then experiencing such terrible nausea afterward.”

Dr. Eleni Tousimis immediately introduced Cathy to anesthesiologist Joseph Myers, MD, who told her about ComfortSafe, a new technique he developed that uses few, if any, narcotics.

ComfortSafe utilizes a pyramid checklist characterized by a variety of medications, such as IV acetaminophen, nerve blocks and local anesthetics, all of which produce fewer side effects. Stronger medications are used only if needed; otherwise, patients receive milder therapies that are narcotic-free.

Cathy’s worries were eased— not only because her doctors and specialists listened, but also because she discovered possible alternatives to traditional narcotic therapy. “I just couldn’t believe that narcotics were the only way to put you out,” she said.

“Dr. Myers told me it was going to be painful, and I said, 'Not as painful as constantly throwing up' — and I was right,” she added. Cathy explained that there is a difference between pain and discomfort and didn’t feel narcotics would relieve “discomfort."

Looking Ahead to Her Renewed Life

Cathy considers herself fortunate because both her uterine and breast cancers were found early, thus negating prescription of radiation or chemotherapy. She advises anyone who gets a cancer diagnosis to ask plenty of questions from their doctors and to source a professional medical site where information is well-researched, accurate and balanced.

“As patients, we’re all different — and someone else’s awful experience was not my experience,” Cathy shared.

Cathy recovered fully from her uterine cancer. Her breast cancer is being treated with an aromatase inhibitor to lessen the chance of recurrence, and she looks forward to a continued good prognosis.

“I’m very lucky,” she said. “I’m not predicting the cancer will never come back — but I’m not worrying about it every day either,” she added.

One of the first thoughts many patients have after learning they have cancer is, “How do I tell my children?”

At first, you may be inclined to avoid the question altogether. This is understandable; you need time to understand the reality of your diagnosis and process your thoughts. And sometimes, your instinct to protect your children from sadness and stress can override the desire to help them prepare for the realities of the situation.

But discussing your cancer with your family is an important conversation to initiate. And believe it or not, just talking about your cancer can reduce stress while providing your children with the necessary information to help them adjust in healthy, age-appropriate ways.

Why You Need to Talk About Your Diagnosis

Many patients believe it’s better not to discuss a cancer diagnosis with young children. They worry that the children’s lives will be so negatively impacted that it’s better to pretend that life is continuing as it always has.

However, try as you might to hide your diagnosis, children can pick up on the pulse and tone of daily life in your family - and that includes the stress or anxiety you may be feeling about having cancer.

For example, your child may notice that their grandmother is visiting more often than usual, they are spending more time in childcare, or you are too tired to play the way you used to. When young children detect nuances within the home but are not informed about why things have changed - no matter how subtle the changes may seem - they quickly come to their own conclusions (which may be worse than the reality).

So even though you try to minimize their exposure to difficult emotions, children generally know that something is wrong.

They Need to Hear It From You

Children are great listeners, and often they overhear friends or family members talking in hushed tones about a parent’s illness. Or sometimes, well-meaning family members may talk to your child about your diagnosis before you’ve had a chance to clarify the situation. Talking to your children can avoid the possibility that they will learn about your diagnosis and treatment from someone else, which could impact your relationship with your child, and may lead to loss of trust.

A conversation like this is never easy. However, when children are provided with age-appropriate information about the disease, an understanding of how your treatment will impact their lives, and the ability to ask questions, they gain awareness of the healthy ways that families come together to support one another during difficult times.

Adult children, too, need to be considered. They may want to be involved in helping to support you through your treatment. Your kids will want to care for you. They will want to express their worry, as well as their love and care. Not telling your children about your cancer prevents them from acting on their concern for you and your health.

When your friends and family understand your diagnosis, your treatment options, and what cancer will mean for you, they will be better prepared to comprehend what it will mean for them as well. By talking about your cancer, you may be able to avoid adverse emotional outcomes and gain the family support you need.

How to Start the Conversation

Deciding when to have this discussion with your children is almost as important as what you say. In general, you may want to avoid times when your child is tired, stressed or hungry, or when you may be interrupted. If your family includes children of various developmental stages, you may want to tell the older children first, then allow them to take part in the conversation you have with younger children.

As you prepare for your conversation, keep the age of your child(ren) in mind. Because children – even children in the same family – develop at their own pace, determine in advance how to approach this discussion. Very young children (ages 3 to 6 years old) may be satisfied with generalizations, but older children may want specifics and an outline for a plan.

Along with thinking about your child’s age and developmental stage, you’ll also want to consider your child’s temperament. While some children’s anxiety is eased by your state of calm, others may need additional information and/or frequent check-ins. Even siblings can respond differently to the same information.

Tailor your conversation to the needs of your child. Some children will be reassured by more physical contact with you; others may need to have activities to help them process the information. Let your children know that any feeling they experience is okay, and that they can come to you with any questions they may have.

In this way, you can provide a positive forum for your children to develop their own set of emotions around your diagnosis, while letting them know they are a part of a family that works together to manage difficult problems and situations.

If you can only focus on the basics, the following three points are most important for children to understand:

• First, let your children know that cancer is not their fault. It’s not anyone’s fault; it just happens. It’s common for young children (ages 4 to 12 years old) to engage in “magical thinking,” therefore believing that they somehow caused the cancer to happen. Reminding them that cancer is no one’s fault can help them come to understand this.
• Cancer is not contagious. It’s not like a virus, the flu or a cold.
• And finally, let your family know that it's safe to ask any questions about your diagnosis.

Explain what your diagnosis might mean in your family’s daily life. For example, while you may be actively involved in your child’s favorite activities, you might not be able to have the same level of involvement during treatment. Clarify that you always want to be with your child to support the activities they love, but that you will need to do so now in a different, quieter way. Perhaps rather than coaching your child's soccer team, you observe and take stats.

Explain to younger children that the cells in your body are doing things that may make you more tired than usual so you won’t be able to play outside right now. So instead of rough housing, maybe you can read a book or watch a favorite movie. Children will appreciate knowing how your cancer treatment will affect them. And you can reassure your children – and yourself – that your cancer diagnosis doesn’t mean sacrificing quality time together.

Finally, if you have adult children, allow them to be a part of your journey by helping you. For example, your adult children can provide transportation, grocery shopping, meals or quiet, supportive conversation.

Final Thought

Your cancer diagnosis might be a shock that feels uniquely yours alone, but it also affects your family and friends, and that includes your children. When you are aware of your cancer diagnosis but your children aren't, you might be leaving them in the dark about a life-altering event. The one factor to remember when talking to your family about your illness is to keep the lines of communication open.

One sure way to reduce the stress of your circumstances, your children’s fear of the unknown, and anxiety about your diagnosis is to provide an age-appropriate explanation for your cancer, and look for ways your children can actively support you. For more information about this topic, check with the American Cancer Society or the Cancer Support Community. Both of these organizations offer online publications on helping children when a parent has cancer.

In addition, your oncology social worker is a great resource for these and other difficult situations that arise when undergoing treatment for cancer.

For many women, the fear of breast cancer is very real, due to certain risk factors - for example, a family history of breast cancers, being a member of a high-risk group or even aging. The presence of these risks, however, is no guarantee that a cancer will ever materialize; nor is the lack of these risks a guarantee that one will not.

The key to positive outcomes for breast cancer treatment is early detection, which is why annual mammograms for women starting at age 40 - when risk substantially increases - are so important.

In fact, according to the Society for Breast Imaging, one in six breast cancers occur in women aged 40 to 49 years, and 40 percent of all the years of life saved by mammography are among women in their 40s.

How Mammograms Help

A mammogram is an x-ray image taken of the breast, which is then used to screen for cancers. Often they are able to detect breast cancers in their early stages, even before a lump can be felt through self-examination.

“Despite common fears, the majority of women experience little to no discomfort while undergoing a mammogram," says Amy Campbell, MD, Chief, Division of Breast Imaging at MedStar Georgetown University Hopsital.

Given that 75 percent of women who receive a diagnosis of breast cancer in their lifetime do not have any apparent risk factors, it is important that all women go for an annual screening, once they turn 40 years old - otherwise most cases will be missed.

Other studies have shown there is a 30 to 40 percent lower mortality rate among women who engage in annual mammograms against those who do not.

And while there are other screening options available, such as magnetic resonance imaging (MRI) and ultrasounds, both of which can be utilized in women at an increased risk of breast cancer, mammography remains the cornerstone of screening.

But Are Mammograms Safe?

As with any procedure or screening involving radiation, there are risks involved. That being said, the benefits of mammograms in breast cancer detection far outweigh the minimal risk associated with the process. Meaning it is much less likely that a mammogram will cause cancer, rather than detect it.

In fact, you encounter multiple times the amount of radiation exposure from your natural surroundings in a single year than you do from a mammogram.

Take Charge of Your Breast Health

As the Society for Breast Imaging notes, mammography is by no means perfect. It detects the majority of breast cancers, but not all of them. There are also some downsides to regular mammograms, such as the necessity for a biopsy or additional imaging.

However, mammograms do unearth a large percentage of cancers in earlier stages, when there is a higher likelihood of being cured and before they increase in size.

Dr. Campbell shares, “Our goal as breast imagers is to save as many lives as possible with mammography and we can achieve that goal by starting annual screening at the age of 40.”

So if you are 40 years old, take charge of your health this National Mammography Day and schedule your annual mammogram today. And if you have concerns or other questions, reach out to your physician. Because sometimes the best course of action is to start with an open and honest conversation.