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Breast Cancer, Beyond Convention
by Mary Tagliaferri, Isaac Cohen, Debu Tripathy
Pocket Books, 2002

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Chapter One: A Diagnosis of Breast Cancer: Taking Your First Steps

Susan Love, M.D., M.B.A.

SUSAN LOVE, M.D., M.B.A., is a researcher, author, activist, surgeon, and founder of LLuminari,SM a multimedia women's-health content company, and As author of Dr. Susan Love's Breast Book and Dr. Susan Love's Hormone Book, she has gained the trust of women worldwide. She is currently the medical director of the Susan Love, M.D., Breast Cancer Foundation, a nonprofit organization dedicated to the eradication of breast cancer, an adjunct professor of surgery at UCLA, a member of the National Cancer Advisory Board, and a director of the National Breast Cancer Coalition.

Hearing the words "you have breast cancer" is shocking. The shock can last for minutes to hours, and it is soon followed by questions: "How can this be?" "What does this mean?" "Am I going to die?" "What should I do?" Many people close at hand will try to answer your questions and direct you on a path of treatment. But over the years I have learned that treatment is not enough for most women. Most of us need to be healed as well. Treatment is pretty easy to get and pretty standardized, but to feel healed, you must put together a different plan that is unique to you. This often includes what some people term alternative and conventional therapies.

With a diagnosis of breast cancer you enter the world of the "sick." Your modesty goes first. Your dignity is also left at the exam room door as you walk around in a short hospital gown with your bare bottom exposed to the world. You reveal intimate details about your body to perfect strangers, over and over again -- but they never once ask you questions about who you are as a person, who you love, and who loves you. You have ceased to be a unique contributing person in the world and have become a "case." The treatments of breast cancer, which I have called "slash, burn, and poison," are depersonalizing and cold: "one size fits all." They may well improve the statistics of survival, but they don't empower the woman who has to undergo them. In order to reclaim the process you have to take control of your treatment and control of how you are treated. You need to find ways that work for you to heal yourself as well as treat this disease. You need to find your own way through the maze of breast cancer, its practitioners, its standard therapies, and its complementary treatments and form your own unique path to healing.

All this takes time and energy, of course; neither is plentiful when you have just been diagnosed with breast cancer. That is okay. You don't have to do everything at once. Besides, a diagnosis of breast cancer is not an emergency. Most breast cancers have been present for eight to ten years by the time you can see them on a mammogram or feel them. They have either spread microscopically, or not spread, by the time of diagnosis. Although you shouldn't spend the next six months studying the problem, you do have time to catch your breath, get a second opinion, and search out the options.

It is important to start with an understanding of the current hypothesis of breast cancer. Most breast cancer starts in the lining of the milk ducts. The breast consists of approximately six to eight ductal systems. The ductal system consists of lobules that make the milk and ducts that are the pipelines, carrying milk to the nipple. We think that breast cancer is the result of a series of steps. First there are an increased number of cells in the lining of the milk ducts, almost like rust. This is called hyperplasia. The cells then become "funny looking" and are then called atypical hyperplasia. After a time the cells actually resemble breast cancer cells, but they are completely contained by the ducts. This is called ductal carcinoma in situ, or DCIS (a similar progression can be outlined in the lobules). Finally the cells invade outside of the ducts into the surrounding fat and become invasive ductal cancer.

This is what we commonly call breast cancer. Once breast cancer is invasive, it has the ability to cause new blood vessels to grow in order to feed the tumor. Soon after, cancer cells have the ability to invade the blood vessels and travel throughout the body. The cells find a comfortable environment in other organs and form new colonies of breast cancer cells. In fact, it is the breast cancer cells elsewhere in the body that are life threatening. If they start to grow they can interfere with vital functions in the liver, lungs, or brain and finally lead to death.

This whole process does not take place very rapidly. In fact, it is estimated that the average breast cancer has been present for eight to ten years by the time it can be felt as a lump or seen on a mammogram. It is also true that cancer cells and colonies of cancer do not grow continuously in the body; more likely they rest and grow over the years, depending in part on the environment in which they find themselves. What triggers cancer cells to grow and become detectable at one time rather than another? We really don't know, but we suspect that this is where such factors as stress and the immune system may act. Women often speak of getting cancer after a particularly stressful period of time, and wonder whether the stress caused the cancer. This is unlikely, as it takes a long time for the process to evolve. What is more likely is that the stress alters the hormonal balance of the body and possibly depresses the immune system. This imbalance may lead to stimulation of a quiescent colony of breast cancer cells, causing them to multiply, divide, and possibly spread to other parts of the body. This is what happens when a tumor reemerges after a period of dormancy. What were those cells doing for ten years? They were asleep. What put them to sleep? What woke them up? It is highly likely that the general status of health and vitality in the person will have a major impact on the status of those cells.

Our belief that all cancer cells have to be killed may not be a good one after all. This notion of killing comes in part from thinking about breast cancer as a foreign invader that gets into the body and grows continuously until it takes over. In fact, breast cancer starts in your own cells, which develop mutations, allowing them to replicate without limit and invade outside their own territory. These cancer cells are not in isolation. The cells around them, and the general state of the body, influence their capacity to thrive. A criminal analogy might work here. Some criminals have severe character defects that cannot be changed, but many can be rehabilitated if they are put into another environment. Cancer cells may also be able to be rehabilitated, reversed, or controlled if the environment of cells, hormones, and the immune system around them is changed. This becomes important in our approach to treating breast cancer. When I first started in this field twenty-five years ago, we did not have chemotherapy. Instead, if a premenopausal woman was diagnosed with breast cancer, we would take out her ovaries. Interesting new studies have monitored these women, and it turns out that taking out a woman's ovaries is as effective as chemotherapy in premenopausal women with estrogen receptor-positive cancers. Why would putting a woman into menopause treat her breast cancer? It does not kill cells the way that chemotherapy does. What it does do is change the environment for the cells by changing the hormonal milieu. The cells are probably "put to sleep" and stay asleep unless something comes to wake them up.

All of this becomes important in the way we approach breast cancer therapy. Our current therapies of chemotherapy, surgery, and radiation therapy, albeit the best we have, are crude ways of dealing with the disease. They have been shown to make some difference in survival from breast cancer, but they are focused on killing cancer cells rather than changing their environment. Hormonal therapies, immune approaches, mind-body techniques, nutritional treatment, and other alternative treatments focus on strengthening the body and altering the immune system to make important changes in the internal environment.

With this understanding, it becomes obvious that we need to address newly diagnosed breast cancer on three different fronts. The first is to do something that will prevent breast cancer from recurring in the breast. This is called local therapy and usually involves surgery to remove the cancer, in combination with radiation therapy to clean up any microscopic cells that have been left behind. The surgery is usually a lumpectomy or wide excision around the original tumor, but it can be a mastectomy if the mass is so large that it cannot be removed any other way. It is very interesting that chemotherapy will not always take care of this bulk of cancer cells in the breast. It seems that systemic therapy, regardless of whether it is chemotherapy, hormone modulation, or alternative medicine, works better on microscopic cells than on chunks of cancer. In all of these situations, surgery still appears to be the best way to debulk, or remove, the chunks of cancer. Local therapy can be curative if -- and it is a big if -- the body has either taken care of all the cells that may have gotten out or reversed them.

The next phase is systemic therapy. We presume that cells from most cancers have escaped through the bloodstream and "gotten out." These cells will seed other organs, and they can grow and affect these distant organs later on. Systemic therapies are those which are given by mouth or vein, get into the bloodstream, and therefore have a chance of affecting these cells. The most common systemic therapy is chemotherapy, with drugs that interfere with cell division and, as such, poison cancer cells as well as some normal cells. Hormonal therapy with agents such as tamoxifen, by contrast, changes the environment of the cell and probably acts more to control or reverse cancers.

The third aspect of treatment is to strengthen the body and immune system so that they can better reverse or control the cancer cells. This is where nutrition, exercise, meditation, visualization, support groups, and other alternative techniques come in. They are as important as the drugs. We all know women who have small cancers, with good prognoses, who get all the standard traditional therapies, yet rapidly succumb to the disease. By contrast, some women whom we expect to do poorly live -- to everyone's surprise. There is no question in my mind that these results are in part attributable to holistic approaches to disease. Data from new studies are showing that women who are overweight have a higher rate of recurrence than women who are not overweight. Exercise has been demonstrated to prevent breast cancer and may well help prevent recurrence. David Spiegel has demonstrated that women with metastatic disease who participated in support groups lived 18 months longer than women who did not.1 Can alternative therapies cure cancer by themselves? I don't know, but I would not personally risk it. On the other hand, can standard therapies cure cancer by themselves? I don't know, but I certainly would not risk doing one without the other.

And what about metastatic disease? Metastasis occurs when the cancer has been treated and then returns in other organs of the body: lungs, liver, bones, or brain. Again, the standard therapies are limited. We try different hormonal and chemotherapy drugs as well as radiation in an attempt to get the cancer back into remission, but we are not generally able to cure breast cancer at this point. Can we control it? We certainly try -- and again, it is here that complementary therapies are important. If we believe that a change in the environment of the body is what causes the cancer to wake up, then we certainly need a change in the environment of the body to put it back to sleep.

In addition to facing the shocking news of breast cancer and choosing specific treatment options, you still have to deal with the many debilitating side effects. In some ways, this is the most important time for women, since this is frequently when healing takes place. Tissues that have been damaged by chemotherapy, surgery, and radiation can be healed by nutrition and exercise. Acupuncture has been used successfully to treat postsurgical pain, chemotherapy-related nausea and vomiting, and the fatigue induced by radiation. Traditional Chinese medicine, herbs, and other therapies have been used to help women with breast cancer deal with the symptoms of premature menopause and the side effects of tamoxifen. The body clearly needs to be rebalanced after the assault from cancer therapy. Nutritional, physical, and spiritual rebalancing will make the difference.

How can a woman put together the best approach to treat her disease and heal herself? When she is newly diagnosed with breast cancer or discovers a recurrence, she needs to first put together a team of experts that includes a breast cancer specialist she can trust and work with, who will help guide her. This could be a surgeon, an oncologist, a radiation therapist, or even a primary care physician. It is important that each person feels comfortable with her care providers and acts as a partner in her team. This may mean shopping around.

Many medical doctors are scared of alternative therapies, probably because they don't know much about them. Many of their criticisms do not hold water when examined closely. Although they often cite an absence of scientific studies of alternative therapies, they will often suggest drugs that have yet to be proved effective by the "gold standard" of randomized controlled clinical trials. The recent experience when thirty thousand women underwent high-dose chemotherapy with stem cell rescue before studies demonstrated that it was not better than standard chemotherapy is a perfect example of how modern medicine is not always based on science. Some doctors complain that alternative therapy is not standardized; yet, these same physicians will argue that modern medicine cannot be dictated by insurance companies because it is not standardized. Finally, they suggest that alternative therapy is too personality driven, but at the same time, we often search for the "best" surgeon or oncologist with the understanding that the person delivering the care is as important as the care. In reality, these physicians are uncomfortable because they have not been trained in that tradition and do not feel knowledgeable about its use. By explaining to your physicians what you are doing, you can often educate them. Ask your alternative practitioners for information that you can share with your medical team. Your experience may well pave the way for the next woman with breast cancer who wants to explore a broader range of healing.

Not only is it important to find the right team of medical doctors, but you must find the right team of alternative practitioners as well. There is no advantage to walking into a health food store and picking herbs and supplements off the shelf and combining them willy-nilly. Different herbs have different effects and may or may not lend themselves to combinations. It is important that you see a trained herbalist, naturopath, or traditional Chinese medicine doctor who can guide you in this approach. Ask for their credentials and training; talk to people whom they have treated. Nutritionists and personal trainers will also be important in helping you revise your lifestyle in a more healthy manner. Look for a counselor experienced with breast cancer survivors and/or a support group to help your emotional healing. Find the best approach for your spiritual healing, whether in traditional religion, yoga, meditation, or your own personal journey. All of this is important. After a diagnosis of breast cancer, your life will never again be the same. But it can be better as you put together your approach to therapy and healing from this disease.

This is an individual journey -- one that is unpredictable. We all desire magic: "If I just eat this, take this herb, and do this exercise, the cancer won't come back again." There is no magic. One of my patients had a very small tumor, with prognostic factors that were all good. She begged us to give her chemotherapy even though we had no statistical evidence that the medicine would benefit her. She just "felt" that she had a bad tumor and needed it. We finally gave in and treated her with our most aggressive regimen. She changed her life, but within two years she was dead of metastatic breast cancer. On the other hand, one of my very first patients was a young woman with a very aggressive type of breast cancer. Not only was the tumor large, but also she had twenty positive lymph nodes. She underwent standard chemotherapy and radiation before revamping her life. She left her husband, moved to Hawaii, and started a nutrition and spiritual program that completely changed her life. She is still alive and well twenty years later.

I tell these stories not because I think that we can control all cancers with alternative approaches, but rather because I think they demonstrate how little we understand about this disease. We do what we can with standard therapy, but we base our therapies on statistics and large randomized studies, which tell us very little about any one woman, her body, and her cancer. There is no right or wrong way to treat breast cancer. There is only your way. Whatever happens to you is 100% yours, regardless of the purported statistics. Putting together your own personal prescription for treatment and healing will ultimately be the best approach for you. This magnificent collection of chapters will help you with that journey.

Excerpted from Breast Cancer, Beyond Convention: The World's Foremost Authorities on Complementary and Alternative Medicine Offer Advice on Healing by Mary Tagliaferri, Isaac Cohen, Debu Tripathy. Copyright © 2002 by Mary Tagliaferri, Isaac Cohen, Debu Tripathy. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

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