ACIBADEM Breast Clinic

The major fear of women with breast cancer is about metastasis or recurrence of cancer, suffering from pain and death.

Women with breast cancer go through certain psychological stages after being diagnosed and throughout the treatment. You may also proceed to these stages. Usually, the first reaction to diagnosis is “denial.” You may not believe you have been diagnosed with breast cancer, since it is truly difficult to accept you have breast cancer. Many people initially go into shock and deny diagnosis. Denial may be replaced with anger. You may find yourself constantly asking “Why me?”

You may feel angry with people around you and express fury against them. You may try to rationalize the cause and you may think “I have breast cancer, as my family distressed me too much”. Next, you may proceed to other stage that is defined as “bargaining” by experts. You may start running internal bargains and you may have certain thoughts such as “I will beat breast cancer, as I quit smoking” or “It was me who caused this disease and it is also me who will defeat it”.

Bargaining is usually followed by “depression” and “grief.” You cannot deny you have the condition after a short while once treatment is started. Surgery and treatment may start to limit your daily life. You may feel hopeless and desperate. Once this stage is done, “acceptance” starts.

You will feel neither sad nor angry at this stage. Acceptance does not mean abandoning all hopes. You will be strongly holding on to your treatment at this stage. However, it is necessary to mention that not all patients with breast cancer go through all these stages. Also, not all patients experience these stages identically.

All these challenging consequences of being diagnosed with cancer will be psychologically wearing and sometimes, a psychological disorder may occur. Research reports that the risk of accompanying psychological disorder is 50 percent in breast cancer. Psychological disorders that develop most commonly in breast cancer are depression and anxiety disorders.

• If you are constantly feeling upset, anxious, sad, nervous or uneasy,
• If you believe you are unable to solve your problems,
• If you hesitate to share your problems with your physicians, family or social circle,
• If you experience difficulty in focusing your attention,
• If you cannot control your temper

We recommend you to seek counseling from a psychologist or a psychiatrist. Severing ties with life due to thoughts on your illness may affect your treatment. You should avoid taking such steps. Receiving psychological support, when required, will keep the aforementioned mood at bay.

If your finances do not allow this type of counseling, you should ask your physician all and every questions you may have, share feeling of restlessness with your physicians and all family members and loves ones and you also try to find your way out by cooperating with your physician. Sharing your problems will also alleviate your psychological stress.

• Increases quality of life by alleviating fear and anxiety,
• Makes you cope with your disease better and easier,
• Facilitates adaptation to your new life,
• Helps you cope with problems in various aspects of your life due to treatment and the disease,
• Guides you to see positive aspects of your life.
• Affects your physical health positively by boosting your immune system,
• Prevents risk of a more severe psychological disorder in the future, if you are at risk.

Our body is constantly communicating with our mind. Having a better mood affects our body positively. For example, if we get a headache when we are sad, we feel the ache more severely when compared to when we are happy. Thinking positively has positive effects on our immune system. However, this statement should not be misinterpreted: “I should never feel bad and I should never have negative thoughts”.

Everyone goes through bad mood with or without a cause. Nobody can constantly be very happy, anxiety-free, cheerful or energetic; therefore, you should not worry about negatively affecting your health when having bad thoughts. Minor mood swings do not affect your overall health.

Thinking positively and being constantly happy do not imply believing that everything will be nice; rather, it means facing realities of your disease, understanding your options and continuing to cope with your disease. Here, it is important to minimize periods of time you feel bad and strictly focus on your disease. Try to focus on other activities, notice your negative feelings and accept and express them to help manage such periods.

You can try to maintain most part of your life as usual and even to add new elements to your life, if possible. This approach ranges from visiting a new place to new hobbies or meeting new people. Remember that new activities boost the immune system.

Breast cancer does not only bring negativity. You will be a stronger person while fighting this disease, even if you do not recognize it. You will have a better insight about yourself, discover ways to reach your goals, recognize your strengths, overcome your limitations, experience living the moment as well as learn to cherish every moment of life and focus on beauty in your life. You will even see your quality of life has increased and your life has been enriched, once your treatment is completed.

Green tea: The polyphenol in green tea provides protection against breast cancer. Several studies show that breast cancer is less common in people who regularly drink green tea compared to those who do not. It reduces volume of tumor cells by helping the body burn fats.

Fish: The Omega-3 fatty acid and EPA lowers cancer risk. Experts recommended eating medium-sized fish once or twice a week.

Crucifers (radish, white radish, and Russian turnip), broccoli, and Brussels sprout: They contain isothiocyanate that reduces risk of breast cancer by affect the metabolism of estrogen especially in premenopausal women. Other effective ingredients are carotenoid, isoflovan and Vitamins A, C and E that reduce the risk.

Carrot, zucchini, and cauliflower: They contain lignan that reduces risk of cancer through anti-estrogenic effect especially in postmenopausal women. They are recommended to be consumed together with foods that contain Vitamin C. Whole grain foods, sesame seed, garlic, extra virgin olive oil, apricot, peach, pear, grape, winter squash and cherry are other vegetables and fruits that are rich in lignan.

Milk and dairy: Milk, cheese, yoghurt and dairy are rich in calcium. It is known that risk of breast cancer increases in women with low calcium intake. Considering consumption of milk and dairy, it is necessary to avoid the whole ones. Low-fat or skimmed milk and dairy help both weight control and protection against cancer. Experts recommend products that contain Vitamin D in calcium intake.

There is no food that prevents development or sudden-onset of breast cancer. Although it is known that certain foods increase risk, there are studies that report contrary findings. It is widely acknowledged that consumption of vegetables decrease risk of cancer by 25 percent.

Avoid fat-rich foods after treatment. Make larger rooms for green tea, fish, crucifers, milk and dairy, carrot, broccoli, zucchini and cauliflower in your diet.

It is necessary to avoid certain foods that trigger development of cancer through negative interactions with tissues. These foods that you should remove from your table are whole-fat foods, fried meals, smoked and salted meats as well as barbecued meat.

Rehabilitation should be started as soon as possible to strengthen weak muscle groups that have lost flexibility after surgery and to help flexibility and strength of affected joints. Rehabilitation focuses on muscles of shoulders, neck, chest, back and rotator cuff in the initial phase, while abdomen, low back and legs are prioritized in subsequent stages.

Posture muscles are trained again to correct posture disorders and ensure more appropriate body posture. Involved muscles are trained again to restore safer mobility of patients. Deep breathing is trained by rehabilitating muscles of chest, rib cage and back and thus, diaphragm and lungs gain more room for movement. Efforts are made to increase physical and general condition in order to accelerate postoperative convalescence and to tolerate chemotherapy and radiotherapy better.

Another important target of these exercises is to reduce weight gain during and after chemotherapy, radiotherapy or menopause, increase strength and boost or maintain fitness, body composition and bone density. Thus, individual can recognize own power and feel well.

Physical condition and healing periods are not same for everybody. Therefore, patients are evaluated in all phases of the program in order to create personalized plans. Exercises are always started with easy moves with minimal repeats. Next, they are gradually increased. Too quick advancement may result in injury and sickness. It is necessary to contact the physician who planned the program, if even minor problem is faced.

It is necessary to mobilize as earlier as possible after surgery. However, sudden and quick moves should be avoided.

• Arm should be elevated and supported with 2 pillows while lying or sitting in order to prevent swelling of arm after the surgery.
• Stretching exercise should be done several times a day for both halves of the trunk and each move should be repeated for 3 to 5 times.
• If pain and tiredness persist, it is wise to rest.
• Walking at short distances for several minutes twice of thrice a day may even restore strength after surgery.
• Lifting objects heavier than 1 to 1.5 kg should be avoided in early postoperative period especially by the affected arm.
• One should act carefully in order not to carry any object heavier than 2.5 kg in the long term in order to prevent swelling in arm.
• Shoulder bags should not be used, because shoulders straps may cause lymphedema by exerting pressure on shoulder.
• One should be sure that postoperative swelling regressed and surgical wounds completely healed before starting active exercise.
• One should focus on native rhythm of body and track own insight.
• In case of suspicion, one should consult to primary doctor, nurse or physiotherapist.
• It is necessary to make efforts every day even for a minor improvement. Being self-assertive is very crucial for improvement.

Stage 1: Early postoperative period. It is necessary to start basic exercises following surgery to decrease swelling, alleviate pain and tenderness and to achieve physical and mental recovery. Programs generally start with light stretching and strengthening exercises. The exercises should be performed smoothly and gently in several repeats twice or thrice a day. Deep breath exercises should be remembered to decrease pain and tension. These exercises are started as soon as possible after the surgery. Following moves are recommended for this period:

• It is wise to start with extending and flexing the elbow, rotating the wrists and opening and closing fists. Swelling regresses, if these moves are repeated several times throughout the day.
• They are continued in sets of 2 after they are performed easily and safely. One should rest after each set.
• Exercise session should not be prolonged in early postoperative period; it is wise to repeat moves several times in the day time.
• Upper extremity exercises should be performed in maximum 3 sets with 10 repeats.
• Program should always include mild warm up before the exercise and mild stretching after the exercise.
• Arms should be elevated above level of heart using pillows at night.
• It is necessary to walk short distances every day.

Stage 2: This period covers an interval up to 6 weeks after surgery. Slow and controlled movements prevent weakness and loss of flexibility in arms. Following moves are recommended for this period:

• Deep breathing exercises have a great role in this period as they alleviate pain and ensure relaxation along with relief of spasm in muscles of back and chest.
• Walking slowly at frequent intervals increases endurance and prevents muscle atrophy.
• Warm up before exercise and stretching movements afterwards are necessary.
• Duration of walk can be prolonged in this period.
• Resistance band exercises can be started, after surgical wounds heal.

Stage 3: This period of time extends from 6 weeks to 10 weeks after surgery.  It covers more advanced upper body exercises. Leg movements can also be started, when full recovery is achieved. Following moves are recommended for this period:

• It is rationale to start more active walks.
• Stationary bicycle and swimming are recommended to be started 6 weeks after surgery for arm and shoulder health.
• Frog style swimming is recommended in the early period. Free style and backstroke swimming should be avoided for 2 months after the surgery.
• Butterfly style should also be avoided, if lymph node is dissected or an implant is placed.
• Pilate’s ball, resistance bands and small weights can be used in this period.
• These exercises are decided in accordance with patient’s overall health and past experience of exercise.

Stage 4: This stage extends to >10 weeks after surgery and covers more active aerobic (endurance) activities. Exercises such as moderate-intensity walking, stationary bicycle and ascending stairs slowly can be started at this period. This stage focuses on increasing strength and flexibility. It is maintained with aerobic, strengthening and flexibility exercises in the long term. Jogging program is maintained. Patients should be evaluated by primary doctor before proceeding to advanced exercise program. Pilates ball, resistance bands and small weights can also be used in this period.

While breast cancer does not cause any symptoms in some patients, it is usually noticed when a solid lump is palpated in breast. Breast cancer is most commonly detected in self-examination of breasts or mammography and ultrasound screening. The lump is the most common complaint and the mostly noticed sign of breast cancer.

So, how is breast cancer noticed? Bloody nipple discharge, inversion or collapse on skin of breast and retraction or orange peel sign are the leading heralds for breast cancer. Moreover, sudden-onset redness, swelling and asymmetrical growth can also be seen. Another prominent symptom is crusting in nipple, leading to an eczematous appearance.

Breast cancer typically does not cause any pain. Women may notice the aforementioned symptoms in self-examination. However, patients may visit a doctor with complaint of pain at a location close to breasts. For such cases, your doctor may advise you a mammography screening.

One out of every eight women is diagnosed with breast cancer, which has constantly increasing incidence, in our country, as is the case with all other countries. On the other hand, new treatment options are recently developed to fight the disease thanks to technological advances in medicine. Women with breast cancer can beat the cancer, if it is diagnosed at early stage and the condition is managed with appropriate treatments. Therefore, it is crucial for women to perform self-examination one week after menstrual cycles.

In pregnancy, modified radical mastectomy which implies total removal of breast along with dissection of axillary lymph nodes is commonly preferred as standard surgery technique.

Chest wall or breast is not irradiated in pregnancy. Therefore, breast-sparing surgery can be considered only at terminal stages of pregnancy in order not the delay radiotherapy or otherwise, radiotherapy is postponed until delivery.

In the first 13 weeks, it is better to terminate pregnancy, as chemotherapy induces toxic effect on fetus and causes miscarriage.

Risk of fetal anomalies due to chemotherapy is 1.3 percent as of week 14. This rate is equal for a fetus that is not exposed to chemotherapy, which means that some chemotherapeutic agents like anthracycline (doxorubicin) can be safely used for pregnant patients.

Generally, it is accepted that chemotherapy can be used until week 35, but it should be paused 3 weeks before delivery to prevent potential resultant problems, as blood parameters of mother can be affected adversely.

Use of tamoxifen is also not recommended in pregnancy and it is postponed until delivery.

To prevent exposure of newborn infants to all chemotherapeutic agents or tamoxifen through breast milk, lactation is suppressed with medicines.

Women with breast cancer are advised to consult their physicians regarding future conceptions. Usually, a new pregnancy is not allowed for 5 years in women with stage II-III cancers. A patient with stage I cancer should wait for at least two years, unless tamoxifen is used.