Kaelin Carolyn M. - Living through breast cancer: what a Harvard doctor and survivor wants you to know about getting the best care while preserving your self-image

Copyright 2005 by the President and Fellows of Harvard College. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

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To Bill, Kathryn Grace, and Tripp with love. Thank you for all your support.
And to my mother, who put a year of her life on hold to be with my family and me
during this very unique year of ours.
C.M.K.

To Kate, Emma, and Andrew with love.
F.A.C.

To women everywhere who share their stories and to those who so generously
shared theirs with us.

Part I
GETTING YOUR BEARINGS: DIAGNOSIS, TREATMENT, AND DRAWING TOGETHER YOUR MEDICAL TEAM

Part II
PRESERVING YOUR SENSE OF SELF: RESPONDING TO TREATMENT CHALLENGES

Part III
REGAINING YOUR BALANCE: EXERCISE, NUTRITION, SEXUALITY, AND MORE

MANY WOMENS LIVES are touched by breast cancer, either through their own diagnosis or that of a friend or loved one. If you have picked up this book, chances are you are one of those women. As a breast cancer surgeonand as of last year, a breast cancer patient as wellI, too, am one of those women.

Recent advances have greatly pared down the cosmetic and emotional impacts of breast cancer and its treatment. Breast cancer is being diagnosed earlier and tissue sampling is more precise and less traumatic, thanks to new biopsy techniques. Emerging therapies have extended and improved the lives of women faced with this disease, and improved surgical and radiation procedures leave less of an imprint than older treatments. Most importantly, today women are less likely than ever to die of breast cancer.

Still, from up close, breast cancer can seem as frightening and overwhelming as it did thirty years ago. Not only is your life suddenly on the line, but so is your way of life. And your sense of self.

I wanted to offer women facing breast cancer information based on my work as a breast cancer surgeon and some hard-won insight drawn from my experiences as a breast cancer patient. Francesca Coltrera, an exceptional health writer, worked with me to present this information in an accessible way and helped bring these pages alive. I also drew upon the invaluable expertise of many colleagues at Brigham and Womens Hospital and Dana-Farber Cancer Institute, as well as the knowledge of many others who spend their days supporting women with breast cancer. Much of the information on surgery and reconstruction was developed in concert with clinical staff working on the Brigham and Womens Hospital booklet Breast Surgery: A Guide for Patients and Families.

It is our hope that Living Through Breast Cancer will serve as a valuable guide through a challenging time and help you anchor your sense of self during treatment and afterward. By providing up-to-date and clear information, it will help you understand your diagnosis and think through your treatment options. Its pages also detail ways to ease or erase lingering aftereffects.

While any errors and omissions in the book are our responsibility, we would like to gratefully acknowledge those who shared their expertise and very valuable time.

At Brigham and Womens Hospital and Dana-Farber Cancer Institute, Ann H. Partridge, M.D., M.P.H.; Julia S. Wong, M.D.; and Eric P. Winer, M.D., were especially heroic. Elizabeth S. Ginsburg, M.D.; Charles A. Hergrueter, M.D.; Jennifer A. Ligibel, M.D.; Stacy Kennedy, M.P.H., R.D./L.D.N.; Darrell N. Smith, M.D.; Janet Kunsman, R.N., N.P.; Barbara Silver; Peter Mauch, M.D.; Sanaz Ghazal; Larry Raymond; and Julie L. Durmis, director of Friends Boutique, were enormously helpful as well.

Cheri Bishop, D.M.D., of Hammond Pond Dental Associates, and dermatologists Lynn Baden, M.D., M.P.H., and Leslie Lucchina, M.D., graciously shared their time and expertise. We also owe a debt to the expertise of Walter C. Willett, M.D., Dr. P.H., Chair of the Department of Nutrition at the Harvard School of Public Health, for the nutrition information provided in this book.