ANDREW:
Hello, and welcome to the American Cancer Society's Cancer Survivors' Network, a service created by and for cancer survivors. I'm your discussion leader, Andrew Schorr. I'm joined by our co-host, medical broadcaster Gina Tuttle. Gina, thank you for being with us.

GINA:
I'm very glad to be here, Andrew.

ANDREW:
Today's topic, breast cancer and cancer recurrence for women between the ages of 35 and 45. On the phone with us are four breast cancer survivors from across the country, women who are all between the ages of 35 and 45. They are in treatment or recently completed it, and have had a cancer recurrence. Over the next few minutes we'll discuss issues such as: the importance of support from other women with young children; dealing with sexuality after survival; sorting through information to make your own treatment decisions; being your own advocate; and dealing with depression and chronic pain.

LINDA:
That's correct.

ANDREW:
And I also know you had a mastectomy, chemo, a stem cell transplant, and radiation. You're married with two little girls, ages 3 and 6, at home. Now, you were nursing when you were first diagnosed with breast cancer and had to go cold turkey, if you will, when you found out about your disease. You just dropped that right away. That must have been really difficult, almost an insult, for you and the baby. One thing that you feel is important we talk about is getting support for women going through this disease who have younger children. How did you do that? How do you do that now, with the recurrence, with little girls who are still so young?

LINDA:
Well, initially part of my problem was my age. You know, we're generally not considered high-risk. I was nursing, and for a month and a half everyone was treating the lump as a nursing-related problem. I had heard information otherwise and had to keep saying, "You know, I don't think this is a nursing problem." But I didn't have, at the time, the authority behind me, or really the knowledge, to put my foot down and say, "Look at it!" So finally when it was discovered it was almost like, "Oh, my gosh! We've got a real problem here!" Everything was rush, rush, rush, and I never really had a chance to fully comprehend it until I was already in chemo.

ANDREW:
And the breast feeding over...just stopped.

LINDA:
Oh, my last breast feeding episode, it was really hard for me. My youngest had some medical problems and I had been very faithful to nurse her through the whole thing so that she would stay healthy until she was able to have corrective surgery. So we had a bond there. And the day chemo started, I had gone over on my lunch hour to do the final feeding. Then they were late getting me started that afternoon, so my husband had to go get the girls and bring them back over to the infusion center. I think part of me was just thinking, "Oh, how dare these children should have to come into this evil place." But then it was like, "Well, if she's here I'm getting one last feeding in." Literally, I fed her for the last time about two minutes before they started injecting me with my first dose of chemo.

ANDREW:
Now, your 6-year-old is probably pretty aware of things. She's seen all the stresses you've been under. The things that happened with the little baby, her younger sister, and now again. So how are you dealing with this? What support do you get, and what would you recommend for other young women with little children? How do you talk to your kids about the issues that come up, beyond simply the logistics of where they go when you need treatment and all those sorts of things?

LINDA:
Right. I've been very lucky in that my job continued to pay me even while I was off with the chemo and surgery and so forth. So we were able to keep the girls in a constant daycare situation with people that they trust, with their friends. So probably that part wasn't as traumatic. We made the decision to do that just to have that constant when everything else was in flux. As far as support, I had a very good support group at church. Though there were women that were able to support me because they had children, not because they necessarily understood what I was going through. That kind of support, I got more from a support group at the hospital. Most of whom were older, but they were able to provide me the breast cancer support. So I kind of had to get my support in bits and pieces and put it together for a whole.

ANDREW:
So there's often more than one source, at least in a larger community, for support. Are you saying you need to sort of shop around to find the one that is truly supportive of you?

LINDA:
You really do. You have to talk to other survivors and that's kind of hard sometimes. I tend to be somewhat shy, but I've come out of a lot of that with this thing. I mean, we've gone around bald for almost a year. You tend to lose a lot of shyness. Just talking to people, I think, is the big thing. And talking to your nurses that are taking care of you. You have to be very proactive about going out and looking for the support. Generally, it's not just going to fall in your lap.

GINA:
Linda, did they also help you figure out how to talk to your 6-year-old about this? Because it's an ongoing issue, I assume.

LINDA:
No. I haven't gotten a whole lot of help. That's been mainly through reading a lot of parenting books. They talk about how you tell your child that grandma's died, or something like that. Just pulling in pieces that aren't related to cancer, necessarily, but are related to some type of trauma, to how to help your child cope with it. I felt that probably being open with, particularly the 6-year-old...The 3-year-old at the time was only 15 months, so there wasn't an understanding there. Other than she knew that something was wrong because she couldn't nurse anymore and I was sick. She wasn't able to understand. But my oldest was 4 and 5 and she could see. She knew something was wrong and I knew I had to be open with her. You can't hide it from them when you're going bald, and when she knows you're in the hospital on and off, and when you're sick all the time.

ANDREW:
Linda, I have a question. I've heard that some women who've been in the hospital with breast cancer have made efforts to call home at bedtime to read a story, or say goodnight to the kids, or maintain some kind of normalcy to the routine even in a remote way. Did you make any effort to do that?

LINDA:
When I was in the hospital a couple times for the surgery, and then for one really short chemo, my husband brought the girls up. They didn't have me in the hospital long because I was safer at home than I was in the hospital, being nutripenic and so forth. But we didn't keep them out of the treatment. They were there at the hospital many times. They were up at the infusion center, if it happened that he had to come pick me up. We made them a part of it. So because there wasn't the big mystery to it maybe it was easier for them to accept it.

GINA:
You are, exactly. Very difficult decisions to make. And some things are just not black and white.

LINDA:
No, they're not. And it'd be a whole lot easier if they were.

GINA:
I'd like to bring into our discussion now Lisa, from Meriden, Connecticut. Lisa, you've also got a 6-year-old, right? A daughter. You're 39. You were initially treated for breast cancer in 1994. Then you had a recurrence of breast cancer. You've gone through a lot. A lumpectomy, radiation, chemotherapy, then a mastectomy and more. Is that right?

LISA:
Yes, and in a lot of ways my story is very similar to Linda's. I was nursing, and nobody in my family had ever had cancer. I was 34, you know. I didn't have to worry about that. And I had some difficulty. I really thought, "Well, it's a plugged duct." I went in and had it checked out, and guess what, folks?! We had a three-centimeter tumor on our hands. I had to do the lumpectomy and CAS. I was very sick with the chemotherapy, following the radiation. There were a lot of childcare issues that came into play with that that were quite difficult.

GINA:
What kind of issues, and how did you deal with them?

LISA:
Well, for instance, I live in Connecticut. I grew up in Michigan and my family now lives in Washington state. I had worked up until the day before I delivered my daughter. All of my friends worked. I did not have the support group to help me take care of my child. I was on my own. They told me that I had to drive down to New Haven to get my radiation treatments every day. It was a half-hour drive down there, and that was no big deal. But I didn't have anybody to look after my daughter. And I couldn't get her into any daycare programs because I only needed them for a couple of hours every day. It was a hurdle.

GINA:
Did they have any resources at the treatment center?

LISA:
Well, if they didn't, they do now! You know, you always have a hospital social worker come around and ask you what you need help with. And I said, "I need help taking care of my daughter." And they said, "Well, we'll call the Cancer Society." Well, they could get people who were willing to drive me down there. But no one was willing to look after my daughter. And I was told, basically...In fact, I actually had the social worker say to me, "You mean to tell me you can't find someone to look after your daughter?" And I said, "No. Or I wouldn't be asking you." I was really incensed and I went straight to the hospital vice-president and I said, "Look, you've got a daycare here. Why don't you open it up to cancer patients who have young children who don't have any kind of facility to take them to?" I am not alone in this. More and more young women are being diagnosed with breast cancer. A lot of us have young children, and the way that the society is mobile today, this is a need. And because I kicked and screamed and fought, it's now open to anybody who needs to use it.

GINA:
Good for you. You helped a lot of people.

LISA:
I hope so. The clincher was that once I got into the radiation treatment, they assigned two techs to each machine. They said, "Oh, you don't need to do that. We'll look after her. One of us will give you the treatments and the other will look after her. It's only 15 minutes." So, while I was getting the treatment, my daughter would take her little dolly carriage and walk around the hospital halls. It was really interesting because all the other cancer patients loved to see her. It gave them a moment when they didn't have to think about what they were doing there, and why, because here was this little bundle of sunshine. So that was an interesting thing. And I admit, even though I didn't like it, I became the video queen when I was undergoing chemotherapy. Because basically the only thing I could do was sit on a sofa and read to her or watch videos. So you know, you go through a period where you do what you have to do.

ANDREW:
Lisa, I have a question about that. For the women listening who maybe are not as outspoken as you, what do you think the message is if they find something in the system that is not helping them? They're told, "Well, this is the way it is." What would you recommend? It sounds like rattling cages can produce results.

LISA:
Absolutely. You just need to ask more questions and ask them of more people. Because you might find out that it's not exactly as it's presented. The other thing that is really important goes back to support groups. I belong to a support group now. I joined as soon as I could. A lot of times the people in the support group will have suggestions, or experiences that they have gone through, that can help you. I could say, "Well, this is what I did. Why don't you try this?" And that might be some help.

GINA:
Let me ask you about your husband, Lisa. Were you married at that time?

LISA:
Yes.

GINA:
And was he able to help with some of this?

LISA:
He was able to help somewhat but he didn't really clue in. Like most men, what he did is he stuffed his feelings deep down and he didn't want to look at them. The only time that I really knew that it did affect him and that it was hard on him... There was one time in my first treatment, when I was extremely sick, and we got an obscene phone call, only I didn't know it was an obscene phone call. This person called, got me on the phone, and identified himself as Bob. He asked to speak to my husband. My husband does have a friend named Bob, so I handed over the phone. And the fellow went on to say that he was having an affair with me, and went on. And my husband said, "Yeah, right. In between which chemo treatment?" So that was the only clue that I had that it really did affect him.

GINA:
How about now?

LISA:
Well, the second time around I got smart. I had gotten pregnant. I was carrying twins and I miscarried. I immediately started asking questions about what happened, and found out that I had a low progesterone count. I then pushed to have an early mammogram, and here I am four years out. I found out I had microcalcifications-no big deal. Except that I knew at that point it was cancer. But still I thought, "Okay, they're going to take the breast off and we're gonna be in like Flint. No problem, we'll take care of it. It's early." Blah, blah, blah. Well, what had happened was it that it didn't show up in the mammogram. My entire breast was involved in cancer and the microcalcifications were actually a secondary form of breast cancer that was taking place. I came back and said, "This is what the results are." My husband's response-he was sitting in a chair with his arms crossed, and he looked at me and he said, "Well, I'm sorry to hear about your bad news." I was furious at that point. I walked out of the room and I sat downstairs. And finally I pulled myself together, went back upstairs and looked at him, and I said, "You know, this is what you would say to your neighbor. This is not what you would say to your wife. I understand that you're scared. I understand that feelings are very difficult for you. But I can't go on like this. I was mad at you before, when I went through this the last time, even though I understood it was difficult for you. It wasn't the way you were raised. You're getting help or we're not going through this." And so, at that point I got the two of us into therapy. And we've been doing much better. He actually is beginning to really get in touch with his own feelings. He literally had no clue that this was not an appropriate response.

ANDREW:
Lisa, before I bring in the other members of our discussion group, I just wanted to ask you...Sexuality is an issue between you and your husband, too. Tell us a little bit about working through that. I mean, with the change in your body, how do you work through that? What would you say to other women about it?

LISA:
It's interesting because actually, when I first started out, appearances were not all that important to me. You know, I often don't put on makeup to go bopping out and so forth. I basically said to myself, "Oh, a breast...what's that? Who cares?" And yet, when the breast came off and I looked at it it was like, "Oh, this is not what I thought it was going to be like." There are all these scars, and I felt like I looked somewhat like a freak. You've got this one breast and this kind of indentation on the opposite side. And in the back of my mind, I kept on thinking about the fact that my husband had always said that he was a breast man. You know, it's...it's difficult.

GINA:
Even if he's not having a problem with it, you are. Regardless of how he feels?

LISA:
Yeah, and then you put that together with the fact that I've had a hysterectomy. I've had an ovarectomy, so I don't have the estrogen. I'm on tamoxifen, my sex drive is almost nothing, I have hot flashes out the wazoo, you know. It makes sexuality extremely difficult. And the good guy that he is, he keeps on saying, "You're still you. I still love you. You're still desirable to me because it's you. I'm not married to a breast. I am married to a human being, and that's you."

ANDREW:
I'm glad to hear you say that. I was wondering about your husband earlier.

LISA:
It's just that, like most men you know, they're not equipped with the right kind of experiences in the way they're raised to actually get in touch with some of those feelings. Especially when you're looking at the issue of death. And I had always wanted to have more children, and that is no longer a possibility. Trying to raise my daughter, being fearful for my daughter's health. She's also dealing with the fact that somebody told her that I was pregnant. So she knew, and then we lost the babies, and she was there when that happened. And having to go through this, dealing with her comments of, "Mama, I'm sick and tired of cancer. I just want it to go away."

ANDREW:
Lisa, let's bring in another member of our discussion. Millicent is joining us from Columbus, Ohio. Millicent, I know you're 41 and married, with an 11-year-old son, right? And you were diagnosed with breast cancer initially back in 1988 when that 11-year-old was just a little tiny baby. And then you had a recurrence in 1995. The first time you went through a mastectomy, chemo, and radiation. The second time, a lumpectomy in the other breast, and radiation.

MILLICENT:
Yes, it's very important. My maternal grandmother had breast cancer when she was approximately my age. So when I came along my grandmother was in her 50s or 60s. She didn't pass until she was in her early 80s and she didn't die of cancer.

GINA:
Did she ever talk about the breast cancer?

MILLICENT:
No.

GINA:
Why do you think that was?

MILLICENT:
It was just taboo. You just didn't talk about it. Cancer was just not a subject that came up in a family discussion, or even in a secret discussion. It just was not talked about. My mother knew and my uncle, her brother, knew. And funny as it was, I was speaking with my uncle shortly after I was diagnosed and was starting my treatments, and he said, "Well, you know, your grandma had that." And I said, "You're kidding." He said, "No. Didn't your mother tell you?" And I said, "No." My mother had even forgotten. She said, "You know, I knew it but it happened so long ago that I didn't even remember."

GINA:
Do you think they would have caught it earlier if you'd said you have this family history?

MILLICENT:
I'm not sure. I'm not sure. I had had no other problems. I did not have fibrocystic disease or anything that would have indicated that to me. I did my breast self-exams monthly. I was very good at doing that. I don't think it would have had any effect. I really don't. Because I was already checking my breasts. The only thing I didn't do was mammograms, but that was not something that at my age, 30 years old, they would have gone for anyway. I don't think the doctor would have promoted that. I don't think. I don't know, because that was over ten years ago.

ANDREW:
Millicent, I have a question for you. I've been told that you have a view that women in the African-American community are not always as willing to talk about this.

MILLICENT:
Exactly.

ANDREW:
Why do you think that is, and what have you been doing to help change that?

MILLICENT:
I'm not too sure why they don't talk about it. I really don't know. I'm not of that generation. So I really don't know what the cause was. It was just fear, I think, more so than anything.

ANDREW:
Are you pretty outspoken about it?

MILICENT:
I'm very outspoken. I've participated with "Race for the Cure," just like Linda spoke of, for many years. I was the keynote speaker one year. I'm also heavily involved with the African-American cancer support group here in Columbus, and we have a lot of members. Since we've started in '92, we have had 400 people come through our support group. And we do a lot of outreach in that manner. We do outreach to churches, young women's groups. Anyplace that we can, actually. And I myself am on my own campaign of just talking to my friends.

ANDREW:
I'm going to ask for a paragraph out of your keynote speech. What do you want to say to women, African-American or not, who are dealing with a recurrence, or metastatic breast cancer? What is your view, as you now have had it twice? What do you want to say to other women?

MILLICENT:
That it's your attitude that makes the difference. And going through my experience, the one thing that has stuck out the most is the number of people that I've met who've had cancer. The most impressive thing was a gentleman that I met doing a commercial for the American Cancer Society one year. He had had cancer seven times in different places in his body. He was in his 70s. I said, "Well, do you take any medication or anything?" He said, "Yeah, I have to take B12 because my body won't absorb it anymore." I said, "You're kidding."

ANDREW:
So, there is an example that life goes on.

MILLICENT:
Exactly. And when he said he had had it seven times, that was so inspirational to me. That one or two times is almost nothing, you know? It's just your attitude. It's how you deal with it. Like Lisa, I believe, said that she had a childcare issue and she dealt with it. She dealt with it courageously. I'm sure that that's what it takes to make it through the whole thing.

GINA:
Great advice. Great help for us. I want to bring into our discussion one more person. This is Susan, from Spring Valley, California. She's 42, and had breast cancer when she was 34. Then two years later a recurrence of cancer in the spine. Susan had a mastectomy, chemotherapy, and then, for the recurrence, chemotherapy again and radiation.

SUSAN:
It was interesting listening to Millicent talk about the barriers for African-American women in even talking about the disease. I coach here at the Intercultural Cancer Council, which is a national organization that addresses the disparity in incidence of survival and mortality for minority and medically underserved populations. One of the things that we find out is that even though our communities are different, there are some issues that are very similar. The cultural barriers for talking about cancer, even addressing the issue, even thinking about it, are very similar. In many Asian and Pacific Islander communities, women don't want to think about it. In fact, they believe if they do think about it or if they do talk about it, it will happen to them or somebody in their family. It's a big stigma.

GINA:
So they don't even want to hear about it, I assume.

SUSAN:
They don't want to hear about it, they don't want to talk about it, nothing. There are a number of reasons. One is that they believe that cancer is contagious, so they don't want to talk to someone who has it because that means that they're going to get it.

GINA:
That's very isolating.

SUSAN:
Another thing is, as I said, if you talk about it, if you think about it, it will happen to you. It's sort of a karma thing. And if you do get it, there's nothing you can do about it. So it doesn't do any good to talk about it. Another issue is that a lot of people believe that you get cancer because you've done something bad, and this is your punishment for it. So there are a lot of similarities. I know, in talking with people from different communities, that these issues do come up often. So we really have to try to dispel a lot of those myths that are out there in the community. Just to get people to talk about it.

GINA:
Susan, you bring up issues that might make a woman feel guilty. Oddly enough, we hear from a wide range of women that there's an element of guilt for some of them. Any suggestions on dealing with that? Obviously it shouldn't be there but for some women it is.

SUSAN:
Right. You know, one of the things that different cultures do have in common is that the woman in the family is considered the nurturer. She's the one that has to take care of people. She's the one that deals with the family issues, deals with the family health issues. So one way that we try to approach women in our communities, and I think other communities have done this as well, is to point out that if you're not there, who's going to take care of your family? Telling women that by taking care of their own health, and addressing the issues for their own health, that they will be helping their families. And that we're the last person we'll think of in terms of our health, and the things that we need, because we're so good at providing everything for other people. That's one of the things I think that we have to try to do.

ANDREW:
I have sort of a nitty-gritty question for the group, especially when you talk about working on your own health for your family. Where you stand now, with a recurrence of breast cancer, what is your view of the future? Your feelings as to whether you will be there? Lisa, you kind of alluded to this when you were talking about the interaction with your husband. You were acknowledging that there was a possibility that you could die. Millicent, on the other hand, was talking about all the examples of people who've had cancer more than once who go on for a long time and live a very full life. Hopefully so. Anybody? Where's your head at now as far as what you think of your future?

LISA:
There are a couple of things with me. I keep on saying, cancer is not a death sentence. But when I was first told that I had a recurrence, and that it was a very serious recurrence, it was very difficult for me because I didn't know anybody who had had a recurrence and survived. You became sort of a pariah, because people said, "I don't want to get near you. I don't want to talk to you because you're scaring me. I'm now looking at you and knowing that I could be there." Even some of the people within the breast cancer support groups.

SUSAN:
When I was told that I had a recurrence in my spine I was given 10 months, maybe on the outside 24 months, to live, and it was really devastating. I dealt with a whole lot of issues. First of all, when I'd gone through my mastectomy and my chemotherapy the first time, I was told that I was cured. Of course, all of us know that there really is no such thing as a cure for breast cancer. It's one of those diseases that can come up at any time.

LINDA:
I had a real problem with my recurrence. I had already had the big guns pulled out, so to speak, last year with the stem cell transplant, because the cancer was so aggressive. They said if you don't have this treatment, you have an 18 percent chance of making it to five years. So I thought, "Well, there's obviously not much decision in that. Yeah, we'll go for it." But then it comes back and you look at your doctor and you say, "Well, what do you do now? You've already done the biggest, brightest treatment there is." And then you find out, no, there are other treatments. One of the other ladies in my support group, who has also been through stem cell transplant, and I were kind of joking. Sometimes you feel like you just need to survive the one treatment. If you can just live another year or two before they have the next new treatment.

ANDREW:
Linda, do you consider that there could be a day when what they said was not bull? And how you would prepare yourself? Or do you ever think about that?

LINDA:
I have, and I've made some changes. Part of this is I'm trying to get my life a little more organized . When my mother-in-law passed away, it was very unexpected. Nothing related to cancer. I remember my father-in-law's frustration at not knowing where things were, at having to go through years of accumulated junk. I thought, I don't want my family to go through that. I know that the possibility exists. And even if I don't die, my house will be much nicer. So it's kind of been an impetus to do some things I've put off.

ANDREW:
Millicent, any comments from you about all this?

MILICENT:
I totally agree, especially with the attitude thing. I know that our family members mean a lot to us. Not only do they mean a lot to us but we mean a lot to them, and we have to make sure that they are taken care of just like we are, too. I think that it is important to take care of your body, though, and take care of your own health. Who else is going to do it, as you mentioned earlier. So, that's a big thing for me.

GINA:
You talk about taking care of yourself. One of the things is having to make decisions about your treatment. Lisa, you went through a lot. And as you're trying to make these decisions the doctors don't even always agree. It's not like they can say, "Well, this one will work and this one won't." How do you go about staying informed and making decisions?

LISA:
It's hard. Especially when a lot of the information that you get is partial information. And it's also kind of annoying. You feel like you're trying to keep yourself patched together so the next treatment that comes down the pike, you'll be eligible for. And it's very frustrating when you read magazines and it says, "Gee, do you have cancer? Call this 800 number. You can be in this trial." And I actually did. And they said, "Well, you're not currently in treatment." Well, I'm on tamoxifen but, no, that doesn't count. And you get a bit frustrated. Then when you find out something you have to go to your doctor and say, "Look, am I eligible for this?" And really you sometimes have to push. I had to push a little bit to have a hysterectomy. I had this letter from Washington.

MILLICENT:
I agree with that, too. My frustration came because I wanted to have more children. I kept going to my doctor, and telling my oncologist, and my gynecologist, that I wanted to have more children after the five-year period. They were very discouraging and telling me that I had one child and I needed to stay healthy to raise him. While I understood that and agreed with that, at the same time I wanted to know why it was unadvisable to have more children. So they gave me an answer, and I kept it in my head, and then I went to the medical library. I did all the research on women who either had had children after breast cancer or who were pregnant and discovered they had breast cancer. And the research that I read came back that there was no data!

GINA:
Well, at least the doctors weren't withholding anything.

LISA:
The funny thing...When I went to my oncologist and said, "Hey guys, guess what? I'm pregnant!" Of course their jaws hit the floor and I said, "Hey look, you guys said that after you went through all the stuff with me the first time, the chances are, I was clean! I was going to be fine. So you can't cut it both ways." And the funny part about this was that when we discovered I had the recurrence, of course I knew the first thing that my oncologist was thinking was, "Well, she shouldn't have gotten pregnant, ha, ha, ha." And once we got into it, he actually turned to me and said, "Your pregnancy had nothing to do with this. It had been there all along." In fact, I lost the pregnancy because of the cancer. So it's kind of interesting. But I think the important thing is is that you find an oncologist who meshes with you. The first oncologist I went to I fired, too.

ANDREW:
Susan, did you have a comment?

SUSAN:
Yeah. I just wanted to say that what both Linda and Millicent said, I've been there, done that. Both in terms of firing the oncologist and also this issue about having children. And this is a group of women that are still in our childbearing ages. Some of us are approaching the end of it, and having children was always a really big thing. I wanted to have five kids, and unfortunately my infertility problem preceded my breast cancer. After I'd had the breast cancer I wanted to try to have children, and the only way that I would possibly do that was to have in vitro fertilization. And I was discouraged to the hilt about even trying to get pregnant.

ANDREW:
Having kids is certainly life-affirming.

LINDA:
I was never given the option. I wasn't even told that I could maybe have children later. We really wanted to have more but I was told as soon as I went on chemo that I needed to make sure that I didn't ever get pregnant again. That if I got pregnant again it would probably kill me. And I just thought, "Okay, yeah. I've got this horrible cancer. That must be true." And part of me now regrets that decision. I went ahead, when I had my mastectomy, and had my tubes tied at the same time. Let's just get it all over with, and I think that probably bothered me more.

ANDREW:
Well, we do need to wrap up our discussion. I want to give each of you a chance to leave women who are listening with a final thought. For women who have found they have breast cancer again, or a recurrence of cancer that has spread. For women like you, who are younger. What would you like to say to them above all else? Linda, let's start with you.

LINDA:
I think you just have to approach it very positively. And that now you at least know what's in store for you somewhat. You've been through the initial treatments of chemo, radiation, surgery, whatever it's been, and as a whole you're probably much better prepared to handle this. You know what to expect. It's no longer this big mystery.

GINA:
Millicent, what would your recommendations and thoughts be to women in the same situation?

MILLICENT:
Well, I totally agree with what Linda has said. But also, it's good for you to put your faith in something and believe in it and believe strongly that it will take care of you. Whether your god is Allah or Jehovah or Christ or whoever it may be. Or the stars in the sky above, it doesn't matter. Just continue to believe that you are here for a reason and the cancer happened to you for a reason. It's not your fault. It's just that there is a reason for it and you should learn and live from it.

ANDREW:
Susan, what about you?

SUSAN:
I think the most important thing is, number one, educate yourself. Whether that means making phone calls, talking to women in your support groups, over the Internet, whatever it is. Educate yourself about the possibilities, and know that research is happening all around us. It's happening all the time, and there are things coming up that are more hopeful. Things that five years ago we would have never thought were possible. Educate yourself. Know that there's something out there. Talk to your doctor about it. Don't let him be the master of your health care. You have to take that ownership for yourself and trust yourself on doing that.

GINA:
Lisa? Your turn. What would you say to a woman who is going through a recurrence of cancer?

LISA:
Well, in some ways we have to look at it as kind of a gift. Because there's a lot of people who haven't gotten a wakeup call until they were much older than we are. A wakeup call, as far as being able to look at things, and live life to the fullest that you can at that time. Take things as they come day by day, and do things that you want to do and that fulfill you. When we talk about having a good attitude, that does not necessarily mean that you are cheerful and happy and bouncy all the time. There are times to cry, and there are times when you are absolutely petrified. And that doesn't mean that something's going to come up and snap you, and that will be the end of that.

ANDREW:
Thank you so much for this very rewarding, personal, insightful discussion. I know it will benefit many others. And thanks to my co-host, Gina Tuttle, for helping.

GINA:
It's been a privilege to meet these women.

ANDREW:
For the American Cancer Society's Cancer Survivors' Network, and from our Healthtalk Interactive Studio in Seattle, I'm Andrew Schorr.