Breast Cancer: The Complete Guide: Fourth Edition, Fully Revised Paperback - 2004

Book One

FROM SUSPICION TO DIAGNOSIS

Chapter One

How Can a Book Help Me?


The authors of this book are both physicians whose primary practices are in the field of breast cancer. Peter Pressman is a surgeon; Yashar Hirshaut, an oncologist. We share a philosophy about staying involved in all the phases of treating our patients, and in that sense we are both oncologists, one surgical, the other medical.

Both of us spend every day of our working lives with women who have breast cancer or fear that it lies before them. We have seen how they and their friends and families can sometimes be overwhelmed by this information, unclear as to how to proceed either in the practical matters or in the often devastating emotional ones.

The aim of this book is to provide you with a thorough, clear, step-by-step guide through the illness. More than that, we hope to act as “your brothers, the doctors,” as people who care about you and want to share with you what we’ve learned from years of study and experience.

Why can’t you get that kind of advice from your own physician? We certainly hope you can. But even the possibility of breast cancer poses problems so unusual that having an additional expert at your side may be of real help to you.

For example, if you’ve been told you have appendicitis, even though it’s an emergency, the course of treatment is pretty straightforward. You should try to find a competent, well-trained, and experienced surgeon who will do the procedure at a good hospital. But you don’t have to worry about the physician’s philosophy toward appendectomy. You don’t, in general, have to worry about which type of surgery he’ll perform. There are not several possible postoperative treatments to choose among.

More important, your survival chances after the removal of an
unruptured appendix–unless there are unusual and unforeseen
complications–are excellent. And unless you’re a belly dancer or a bodybuilder, your concern about a small scar at the side of your abdomen is probably minimal. To put it another way, losing your appen- dix doesn’t have much impact on your physical or social well-being, nor does it pose much of a threat to your self-image.

If, however, you’ve been told you may have breast cancer, you are facing all of those complexities–and more. It is our hope that this book will help women sort out such problems and approach them with as much confidence as possible.

As you may already have noticed, we are concentrating on breast cancer in women. We will not be addressing the illness in men, in whom it is rare, though the material on diagnosis and treatment would apply to them as well.

One other explanation: As a rule, we will use the first person singular “I” throughout the book, because that seems most comfortable for us. In fact, sometimes one of us will be the basic expert in a chapter, sometimes the other, and in some sections the material will be the result of a pretty evenhanded sharing of expertise and experience.

The book is sprinkled with stories about women (anonymous, of course) whom we have known in our daily work. We have used these anecdotes to help us explain the conditions we are describing, and also because we think it may be useful to you to read about other women who have “been there,” to hear what they felt and experienced, and how they coped. Much of our own insight into the illness has come from them.

The best understanding of breast cancer and its treatment will probably come from reading this book straight through. Doing that will also guide you, step-by-step, through any experience you may confront. If, however, you have a particular question to which you want an immediate answer, you can refer to the contents or the index and go right to the section that concerns you. There, if they are necessary, you will find cross-references to other pertinent material in the book.

Book I takes you from the time you first suspect a problem through the diagnosis of what it is. It helps you put into place the best possible personal and professional support system, including a team of doctors. It explains what may have gone wrong in your breast, whether it is a type of cancer or some other condition. In addition to diagnosis, Book I also covers pathology and provides guidance in making the best preparations for treatment after you’ve found out what’s wrong.

Book II has to do with prognosis–the probable course of the
illness–and treatment: describing the procedures and the side effects of surgery, radiation, hormone treatments, chemotherapy, and breast reconstruction.

Book III is a discussion of what happens after the initial course of treatment. It covers the appropriate medical follow-up as well as any recurrence of the illness. The last two chapters of this section describe what we know about the causes and prevention of breast cancer and the directions in which new research is pointing.

The final section, Book IV, relies heavily on the experiences of our patients in coping with the emotional impact of this disease, in understanding the reactions of others, and in the positive as well as the negative consequences of breast cancer that so many women have told us about.



While the continuing increase in the incidence of the disease during the previous two decades stopped in the 1990s, it has since begun to rise again, and with the exception of skin cancer, there are still more new cases of breast cancer among women than of any other cancer.

That is not good news. Clearly, we have to find out what is going on and why. But the fact is, we know more about the disease every day. The cure rate is definitely increasing; though 211,300 women a year continue to get breast cancer, a larger percentage of them are surviving.

We now know how to treat breast cancer without the devastation of women’s lives that was the norm a few decades ago. We also know that getting the right treatment from the right physicians can make all the difference. To help you do that is the purpose of this book.

"A definitive guidebook . . . in this highly regarded source, the authors—a medical oncologist and a surgical oncologist—provide both the support and every scrap of the information a woman needs to get the right treatment from the right doctor."—New York Times

"Both timely and current . . . [It] discusses the most common cancer in women in a precise, clear, and positive way, providing essential information in a warm, supportive fashion in a readable and understandable format."—Journal of the National Cancer Institute

"These experts demystify breast cancer in understandable and compassionate terms . . .. Should help hundreds of thousands of women."—James F. Holland, MD, Distinguished Professor of Neoplastic Diseases, The Mount Sinai Medical Center

"Comprehensive, up-to-date, and highly detailed . . . From selecting the best doctors to describing procedures and treatments, the authors answer all possible questions in a calm, rational manner . . . . Highly recommended."—Library Journal