Very often the drugs administered during chemotherapy will cause the suspension of your monthly periods. During chemotherapy, if your periods continue, they are very likely to be different from your usual periods in duration and flow. Some women experience an increase in flow, accompanied by fairly heavy cramping, during the first month or two; other women notice a decrease in flow that precedes cessation. Depending on your age and how close you are to naturally occurring menopause, your menstrual cycle may resume or it may not. Although there has been a great deal of attention directed to the experience of passing through menopause, you may find, as many of us did, that when you are coping with cancer, menopause pales in comparison; it is simply not that big a deal.

Yet, in spite of the understanding that being alive is much more important than unexpectedly having an early menopause, it is also true that some of us really hate it. Women who have not completed their families may have the most painful adjustment. Even if they would have decided not to have (more) children, having the choice taken away can be devastating. We often feel out of control and victimized or “done to” because of the cancer, and this can be one more significant example of what we have lost.

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? Again, you may bring and listen to a Walkman.

? You will spend time after undressing in a waiting room. Bathrobes are provided, but you may bring a jacket or wrap of your own. You can also wear a regular button-down-the-front blouse.

? Talk with other women in the waiting room. You will see the same people there each day; lifelong friendships have been formed in this environment.

? Consider bringing a friend. It can be a good time for a visit.

? Let the technicians know if you like to chat or prefer silence.

? Apply your moisturizer immediately after treatment and before you get dressed.

If you have moderate or worse burning on your skin (which is unlikely), ask your doctor if you can use goat’s milk soap or Radia Care, a cream available at medical supply stores.

If you are using special creams or ointments on your skin, it may be helpful to wear a thin paper diaper liner between your breast and your bra to prevent stains on your clothing.

? Even if you generally take showers, try warm baths during radiation. They are very soothing.

? Cotton athletic bras and cotton camisoles are the most comfortable. There are pretty ones, and this is the time to splurge. Try searching through the natural fiber catalogs as well as the stores.

* Plan your daily radiation treatment as something you do on the way to somewhere else—not as the main event of your day.

? Parking may be a concern. Ask about places to park and the possibility of a reduced parking rate.

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Either of the surgery options is likely to include an axillary node dissection, in which some of the nodes under your arm are removed by your surgeon to be studied by the pathologists). The pathologist’s examination of these tissues gives information about the stage and prognosis of the breast cancer. This information is considered in making additional treatment decisions, such as chemotherapy and hormonal therapy and possible radiation treatments to the axilla (armpit) and breast or chest wall. Side effects of an axillary dissection vary among individual women, but may include discomfort, numbness, and/or swelling.

In order to minimize the surgery to be done in the axilla and to diminish possible, unpleasant physical changes, a less invasive surgery has been developed. This procedure is called selective lymph node dissection (SLND) and resection of the sentinel node. This smaller surgery has been offered in some hospitals for several years and has been found to provide all the same important information as the more invasive standard axillary node dissection does.

The sentinel node is the first draining node of a regional lymph node basin. For women with breast cancer, this is most commonly the axilla or underarm area. The theory is that the sentinel node is the first node where cancer cells would lodge if they have traveled through the lymphatics. By removing and testing a sentinel node for cancer cells, your medical team can determine if further surgery is necessary. This is done at the time of definitive surgery for breast cancer. There are two ways the sentinel node can be located. Some surgeons perform one technique or the other, and some use a combination of the two. The first technique uses a radioactive material called technetium (the same tracer used for bone scans), which is injected at the site of the breast tumor. The tracer is then taken up into the lymphatic channels and accumulates in the sentinel node. The surgeon then uses a handheld probe that detects signals from the tracer to locate and identify the node.

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Women from nonwhite middle-class cultures bring their own experiences and expectations to breast cancer. For example, in the Haitian community, it is still sometimes considered inappropriate to even talk about breasts and quite shameful to have cancer, especially in the breast. The main reason for the higher mortality rate from cancer in minority communities is later diagnosis. This is due to less good access to medical care, poor or no medical insurance, less information about self-care and health, and less comfort in general with talking about cancer or sexualized body parts.

If you are from a minority community, you have the same rights as anyone else to the best care and best support services. You may not feel comfortable being an assertive health care consumer if you have been raised to believe that any authority figure, and especially a doctor, is always right. You may find it harder to ask questions or go after a second opinion. Remember that your first responsibility is to yourself and that you deserve the very best care you can find.

There are intrinsic supports in the community that can be helpful to you now. Many African-American churches have support groups for cancer patients or women’s alliances that can help with transportation, child care, meals, or whatever you need. Call the local office of your American Cancer Society and ask what is available in your own community.

If you do not feel comfortable and respected in your hospital or doctor’s office, speak up. Bring a friend or family member with you and ask for what you need. You might also want to contact the National Black Women’s Health Project in Washington, D.C.

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Consider the following possible treatment settings:

? Academic or teaching hospitals are likely to have the biggest names in your community on their staffs and to have access to current clinical trials.

? Community cancer centers may be located closer to your home and may also participate in some research programs.

? Private oncology practices may be the most convenient, and you may prefer the small size of the whole operation. This would feel comparable to going to your regular doctor’s office.

? Combinations of the above exist in many areas. For example, you may be able to meet with your oncologist in her/his private office away from the hospital and receive your chemotherapy either there or in a hospital-based unit.

Breast cancer care varies in complexity depending upon the clinical circumstances. Most situations require an integrated approach involving a number of specialists:

? A breast surgeon, who does the initial biopsy (unless that has already been done by another surgeon) and then the second surgery of either wide excision/partial mastectomy (also referred to as a lumpectomy) or mastectomy. Both of these definitive surgeries are likely to include an axillary node sampling.

? A plastic surgeon, if you are having a mastectomy and considering reconstruction.

? A radiation oncologist, if you are having a lumpectomy followed by radiation. Some women also have radiation following a mastectomy.

? A medical oncologist, who plans and delivers your chemotherapy or hormone therapy.

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