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time, your parents complain they never see you, and you rarely have an adult conversation with your spouse these days. Save yourself the worry. This is the one nonnegotiable in your schedule over the next six to twelve months. Accept the fact that cancer will take its place front and center in the midst of your hectic schedule. And hopefully, all those people placing all those demands on you will rise to the occasion and help you manage that schedule.

      REACTING TO THE NEWS: IT’S ALL IN YOUR ATTITUDE

      You Didn’t Cause This . . . and If You’ve Got to Get One of the C’s . . .

      Let’s make one thing clear. No matter what your lifestyle, nutritional habits, exercise regime, family history, or anything else that you’ve read about that might contribute to cancer, there is nothing you did that caused this. You did not ask for it. It’s just one of those mysteries in life that happened. And while you might consider yourself one of the unlucky one-in-eight women that gets breast cancer, it’s not as if the other seven escape “home free.” There is not one person in this world who will escape having to deal with some type of disease in the course of his or her life. So, the other seven will end up with something else. This cheery idea was pointed out to me by one of my doctors as an attempt at encouragement in one of my tearier moments. Furthermore, as one of my friends rationalized to me, “If you’ve got to get one of the C’s, it’s not a bad one to get . . . because it’s completely treatable!”

      Paternal Genetics: Does He or Doesn’t He?

      In your quest to come to terms with why you got breast cancer, you’ll hear many different opinions on the role of genetics. Is breast cancer hereditary? From whom? While there seems to be consensus and a predominant focus that a history of breast cancer on your maternal side—grandmother, mother, sisters, aunts—places you in a higher risk category, paternal genetics can play an equal role in determining your predisposition to breast cancer. Look for patterns in your father’s relatives as well.

      Ten Leading Risk Factors

      It seems like everything you do, or don’t do, eat, or don’t eat, or even breathe in can cause cancer these days. Until now, you probably haven’t organized your life around how to avoid cancer, and you might have had no risk factors, but you still got it anyway. So, going forward you might want to be aware of the risk factors that you can control so you can manage them to prevent a new breast cancer:

      Some Basic Factors You Just Can’t Change

      1. Family history. If it’s in your genes, there’s not much you can do, except regular monitoring to catch any recurrences or cancers in the other breast in the earliest stages. In the extreme, you might consider prophylactic mastectomy if you carry the genes (see the discussion in Chapter 8, “Five-Year Follow-Up Visits” for overview of genetic testing).

      2. Early menstruation or late menopause. If you started menstruating before age 12, or went through menopause after 55, the many years of estrogen surges from your monthly cycle may trigger breast cancer, as some types grow and flourish on estrogen.

      3. Childbirth after age 30 or no children. Hopefully you haven’t done your family planning around whether you might get breast cancer, as there are much more important decisions around bringing a child into this world. But late childbearing or not having children is a risk factor because of the continuous exposure to monthly estrogen cycles, without an interruption for pregnancy.

      4. Exposure to radiation. If you’ve ever received any form of radiation to the chest area before age 30, say for Hodgkin’s disease, you are more susceptible to breast cancer.

      5. Use of estrogen / progesterone. This increases risk, mostly for lobular cancer.

      And Those Over Which You Have Control

      6. Smoking. If you ever have, just don’t, not ever again. You want your life—not breast, lung, or many other types of cancer. Enough said.

      7. Obesity. Fat cells produce estrogen, a potential nutrient source for breast cancer cells. If you’ve always wanted that lean, healthy body, now is the time to make it happen, not just for cosmetic, but for very real health reasons.

      8. High-fat diet. Again, fat consumption boosts estrogen, and the last thing you need after breast cancer is more estrogen. So, stick to a diet low in saturated fats (some monounsaturated fats are fine). You’ll also prevent obesity (see the discussion in Chapter 9, “Nutrition: Looking at Food in an Entirely Different Way”).

      9. Lack of exercise. You’ve been bombarded, ad nauseam, by information on the health benefits of exercise. So you don’t need me to tell you any more about how regular aerobic exercise strengthens the immune system to rid your body of bad cells before they turn cancerous (yes, everyone has bad cells; cancer just forms when your immune system can’t eliminate them from your body properly). But I will tell you that a review in the Journal of the NCI (1/21/98) evaluated a range of studies on the effects of exercise on breast cancer, and reaffirmed its risk-reducing effect in healthy women of all ages.

      10. Alcohol. There is a growing body of evidence linking alcohol intake to breast cancer, especially heavy use.

      Remember, You Are Not a “Cancer Patient.”

      “You are not a cancer patient. You are most likely a healthy person who has had some cancer that was removed and are now fine. Remember that. There is a difference.” These were the first words of the first oncologist I went to visit for an opinion. While I didn’t ultimately choose him for treatment, I found this extraordinarily helpful mental model to keep me positive and focused. According to him, “cancer patients” are those unfortunate people who must manage cancer until it ends their life at some point. With early-stage breast cancer, the theory is that most women are cured from surgery alone, and they will go on to have long, healthy lives. However, any and all the follow-up treatment recommended is purely “insurance”—or “adjuvant” treatment—so you will hopefully never have to become a “cancer patient.”

      You Haven’t Been Robbed of Your Youth. You’ve Been Granted Incremental Wisdom.

      If, like me, you are young—I was just 35 when diagnosed—one of the emotions you might experience in the initial days of coming to accept your new reality is a feeling that you’ve been robbed of your youth. Yes, rationally you understand all the doctors’ optimism about 90+ percent survival rates for early-stage diagnoses, and you fundamentally believe that you will grow old and live a full life. However, on an emotional level you can’t help but think that you have been robbed of your youth, your invincibility. Your body, which you have always taken for granted and considered immortal, has betrayed you. From now on, you must defer to it, honor it, even make promises and negotiate with it. Now you will always remember what it feels like to have had a brush with mortality. Whenever you are contemplating a major life event—your wedding, the birth of your child, watching your children grow up, etc.—never again will you be able to ignore that little voice in the very back of your mind whispering, “Will I be alive to experience it?”

      Instead of feeling shortchanged, robbed of your youth, consider that you’ve been granted a premature wisdom and perspective on life that many women twenty to thirty years your senior haven’t grasped yet. You will cherish and appreciate those special life events even more, and remember where they rank in your ever-competing life priorities. It’s a gift. Use it wisely. And don’t ever lose it.

      It’s a Very Tough Way to Find Out You Don’t Control the World.

      It’s your diagnosis alone, and try as you might, nobody else’s. As many times as you might say, “No, this isn’t happening to me,” it’s not going to walk away from you anytime soon. Just accept it. Then get going at gathering information and making decisions regarding your treatment plan. That, at least, is something you can control. No matter what your occupation, if you work, you get paid every day for making decisions. So, make decisions about your own life with consideration, courage, and conviction. At least you’ll feel like you’re back in charge.

      It’s Okay to Have an Occasional Panic Attack.

      By the end of the first month into this whole breast cancer ordeal, you will probably

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