Breast cancer catapults women into an unpredictable world, a place that often seems landscaped with prickly reminders of mortality and images of healthy breasts. It's also a place, many survivors say, in which each day can suddenly seem richer than ever.
And life after breast cancer is increasingly familiar to women in America: One out of eight will get the disease. Roughly 180,000 women will be diagnosed with breast cancer this year, according to the American Cancer Society. More than 150,000 will have one -- or both -- breasts removed.
As support groups and coping workshops proliferate, breast cancer survivors are sharing their experiences. More and more women are letting each other know what to expect and how to cope with the aftermath of cancer; and they are finding a forum for their own feelings as well.
"Things often happen so fast: You walk in without a symptom, then wham-bam you're in the medical system in this snowball experience," says Patty Wilcox, co-director of the Breast Surveillance Center at Johns Hopkins Hospital. "And, despite the odds of getting breast cancer, very few women are actually prepared for 'Well, what if it happens to me?' "
After surgery for breast cancer, many women undergo months of chemotherapy often followed by radiation therapy -- which may prevent them from dealing with the psychological aspects of their condition, she says.
"I've heard a lot of women say 'If I stop to think about this, I can't do it.' You can't afford to let go enough from the process to take care of yourself," she says. "When the patient finally begins to experience the reality of what has happened, many of the people around her think, 'You had your mastectomy a year ago, what's happening now?' Well, the woman didn't allow herself to feel her mastectomy a year ago."
The struggle to live through breast cancer, says Ms. Wilcox, can send a woman on an emotional journey similar to that experienced by someone who loses a loved one. Waves of denial, anger and grief often follow breast surgery as women come to terms with their new lives.
"Women will say to one another, 'Oh my God, you did that too?' Talking to other survivors helps women recognize that what they're going through, that what is happening to them, is normal."
Here are three women's stories:
The tale of how she discovered her cancer becomes as important to a breast cancer survivor as the story of how she met her spouse. For 48-year-old Jay Farmer, each moment of the event is still painfully vivid.
Ms. Farmer discovered a lump in her breast in November 1990. A woman who had had annual mammograms since she was 40, she was unalarmed and waited for her already scheduled mammogram the following week. The mammogram was negative. Ms. Farmer remained suspicious, however, and asked her gynecologist to check her breast.
The physician recommended she wait a month and try to treat the lump as if it were a cyst.
After the Christmas holidays passed and the lump was still there, Ms. Farmer got an appointment for a biopsy: Jan. 22. When the diagnosis of cancer came, she was rushed into surgery the next week. Breast reconstruction took until April. Then there was chemotherapy for seven months followed by radiation five days a week for another six weeks.
"The hardest thing I had to do was to tell my children," she says. "My youngest daughter, Molly, was still at home and she felt all the responsibility of Mom's health on her shoulders. The stress ,, on her was almost unbearable, that fear of abandonment."
A single mother of three, Ms. Farmer continued to work while being treated. She would schedule her radiation appointments at 7:45 a.m. in order to be at work on time.
Then, abruptly, the treatments were over.
"All of a sudden you start thinking about the future," she says. "You think, 'Is the future next week? Next year? Thirty years?' "
She began rebuilding her physical connections to life. An active woman who enjoyed sports, she discovered a year of treatment had severely weakened her. At first, each pulled muscle suggested her cancer had spread.
It also took a while for her longtime companion to feel comfortable with their physical relationship, she says, because he was concerned he might hurt her.
As a recent breast cancer survivor, Ms. Farmer has her blood tested for cancer every three months. To prevent recurrence, she is taking tamoxifen, a drug which makes her prone to hot flashes she treats with 49-cent fans from Pier One.
"The stage I'm at now with this is whether or not to make long-term or short-term investments," she says. "I do appreciate things like beautiful sunsets and a beautiful day a lot more. But you have a lot of highs and lows. Sometimes I feel as if I'm walking around with a grenade with a loose pin in my pocket. The pin could fall out 20 or 30 years from now -- or tomorrow.
"I'm spending a lot more time with my kids. I've made sure there were stronger bonds between my kids and my brother and my sister: This experience has really pulled our three families together."
When Suzanne Brace told her young son about the breast cancer she had suffered before he was born, he was puzzled.
"Don't all mommies have one breast?" he asked.
Now 12 years after her surgery, with no recurrence of her cancer,Ms. Brace has dedicated her career to helping other cancer patients. She is deep into interviewing program directors for the Wellness Community, a non-residential organization for cancer patients and their families which will open in Towson in November. Offering free programs, support groups and workshops, the Wellness Community fights cancer on the psychological front.
"When you go through cancer, you gain this incredible appreciation for everything in your life," Ms. Brace says. "But then it fades and you wish you could get that intensity back. I get renewed every day working with people who are struggling with life and death. Talking to someone about dying is an honor. They are letting you into their soul."
Ms. Brace, 44, has an elegant, gentle way of steering right to the heart of the matter. Perhaps the toughest part of her own recovery, she recalls, was making the decision at 39 to become pregnant. She had been warned that having children might increase the chance her cancer would recur.
"When you've had cancer, you live your whole pregnancy thinking the child you've wanted so much may also be killing you," she says.
She also speaks about wearing a prosthesis, an adjustment she did not find as painful as many other survivors have.
"At the time, it wasn't anything at all because I was young and happy to be alive and grateful my body was intact," she says. "I lived in California and didn't wear a bra very much, so there was that physical adjustment. But it was also that time, especially in California, when people had decided they were just going to be comfortable with their bodies. There had been that coming to terms with who you were as a person.
"I've always thought of it [breast reconstruction] as a real ageist issue. Women over 60 can get ignored because it's assumed that their body integrity isn't as important as it is. Often I think it's just the opposite, that it may be more important than when they were younger."
* Last June, Pat Brack discovered her cancer had recurred when she consulted her physician about a persistent pain in her sternum.
The news created much consternation among local breast cancer survivors. As head of Ruxton Country Middle School, author of "Moms Don't Get Sick," a book about cancer written with her youngest son Ben and a support group volunteer, 51-year-old Pat Brack has inspired hundreds of women determined to put their lives back together.
"People who are breast cancer survivors are really undone when people like me who are supposed to be past cancer have a recurrence," she says.
Mrs. Brack is taking tamoxifen. Monthly blood tests and periodic bone scans are monitoring the cancer. She has looked into a bone marrow rescue treatment program. And she radiates life. A stunning combination of optimism, wisdom, black humor -- "Don't ask my advice about a healthy diet!" -- and purpose spills out of her as she talks.
There's an immediacy to life for a cancer patient, once you've worked through that you're mortal. In this country we all run around thinking we can protect ourselves if we don't drink milk or do this or do that or whatever. I think it means we're terrified of death. That if we do everything right, we can live forever."
"Of course, I would have been willing to go along with that, too!"
After years of confronting her mortality -- she lost her first breast to cancer in 1985, her second breast in 1989 -- Pat Brack's emotionalperspective is well developed. She moves easily from humor to pain, from describing her supreme loneliness to describing her complete connection to the world.
When I was [first] diagnosed with cancer . . . my first thought every morning when I got up was 'Oh my God, I have cancer.' Now I get up and say, 'It's a beautiful day, I'm going to do my yoga.' Cancer may kill me, but it's not going to ruin my life."
Mrs. Brack takes "the seeds from the journal and write poetry," she says, pulling out a piece simply dated October, 1992.
live in a place past answers/Most of the time/Protected/From pain/uncertainty/From wondering too much.
"I'm here with flowers/sunlit days/small cats, a glass of wine/October fires and family/New songs to sing.
"I'm busy now and too alive/to contemplate/Not being here/The world's too full/For speculation/It's safer just to be/To be in this place past answers."
October is National Breast Cancer Awareness Month. Here are a few programs being held in the area:
* All-day breast cancer seminar. 8:30 a.m.-4 p.m. Friday at St. Agnes Hospital, 900 Caton Ave. Includes talks by Pat Brack, author of "Moms Don't Get Sick" and Connie Unseld, director of Bullets Wives Saves Lives Foundation. Breast cancer screenings will be available.
The seminar is sponsored by St. Agnes Hosptial and the American Cancer Society. Call 368-2962.
* Free screenings of the National Cancer Institute's film "Once A Year for A Lifetime," 3 p.m.-4:30 p.m. Oct. 26 and 7 p.m.-8:30 p.m. Oct. 27 at the breast cancer center of Baltimore County General Hospital, 5401 Old Court Road. A discussion of breast cancer follows. Call 521-5913.
* Breast cancer screenings sponsored by Project Awareness Partners for Baltimore for about 100 low-income women, Johns Hopkins Hospital. Women participants will also receive breast cancer education. Free for those who qualify. Call the YWCA, one of the project's sponsors, at 685-1460, ext. 203.
* Rebroadcasts of Soundprint's award-winning radio documentary series on breast cancer, "Reaching for Power Through the Pain," a look at breast cancer in the African-American community, will air on WJHU-FM 88.1 at 7 p.m. tomorrow and 7:30 a.m. Sunday. An updated version of "New Trends in Breast Cancer Research" will run at 7 p.m. Oct. 21 and 7:30 a.m. Oct. 25.
What age to begin
The National Cancer Institute recommends the followin guidelines for breast cancer screening:
Women aged 40-49 should get a mammogram every one to two years and have a yearly breastexamination by a physician.
Women aged 50 and over should get a mammogram every year and yearly breast examinations by a physician.
Adult women of all ages should perform monthly breast self-examinations.
* Women who have a family history of breast cancer should discuss with their physicians if mammograms should be performed more frequently or started at an earlier age. For more information or free publications, call the Cancer Information Service of Maryland at (800) 422-6237.