Dr. Marisa C. Weiss on Breast Cancer

Marisa C. Weiss, M.D. is the author of several breast cancer books including, most recently, Taking Care of Your "Girls": A Breast Health Guide for Girls, Teens, and In-Betweens. A breast cancer oncologist with 20 years of practice, Weiss currently serves as director of Breast Radiation Oncology and director of Breast Health Outreach at Lankenau Hospital in Philadelphia. She is also the founder and president of Breastcancer.org. Here, she addresses practical aspects of breast cancer treatment like emotional support, whether supplements and complementary treatments are safe, and what to do about weight gain during chemo.

What are the initial weeks after a breast cancer diagnosis like?

Well, first of all, you're hit by a stun gun. After hearing the words, "You have breast cancer," people assume the worst. They enter into this zone of fear and uncertainty, which is debilitating, and at that point they are grabbing onto whatever they can to resolve some of those fears and move forward. They enter into a zone of another language that they have to quickly get to know so they can understand what the doctor is saying, and feel in charge. Not only that, these women have trouble thinking straight. You're marinating in anxiety, and when you're in an anxious state of mind, it interferes with the ability to take in information.

So how can women get through this?

You have the resources to help you through it. At Breastcancer.org, we have over 4,000 pages of information, all searchable; ask the expert conferences once a month; and an online community. Many of these women have never been to a chat room or discussion board. But right now, maybe they're too busy to go to a support group. Women are working in the home, community and office, and no one has time to deal with breast cancer. Once you put the kids to bed, it's too late for any organized care, but discussion boards are open 24/7. You must be supported throughout the process.

How is psychological help an important component of breast cancer care?

Psychological support is underutilized. As a medical system we focus on the physical, medical things that are happening. We don't do enough to support people emotionally. In my hospital here we have a support group. We have nurses who are professionally trained, and we have a psychiatry department. I find my patients end up using the discussion boards extensively. Someone's day is another person's night. When you're waiting to get a test result back, waiting to get a call back, waiting for whatever, it can just drive you crazy, and that's when those chat rooms are very helpful.

Is it easy to find a medical team that effectively communicates with one another?

It really depends. Every doctor in breast cancer oncology today knows that coordinated care is the best care, and that each of us has to be committed to that to avoid fragmentation. But even with the best intentions and the best coordinated setting, things can fall through the cracks, so you definitely as a patient must be proactive, by making sure that each test result is circulated amongst the doctors, otherwise one of them might be in the dark.

How do you feel about holistic or alternative treatments for breast cancer?

I'm in favor of meditation, acupuncture, massage, yoga, energy therapy, and Reiki. The area where it gets complicated is in the herbs, vitamins and supplements that are out there. Even if they are natural and seem to be simple and appealing, they are not regulated by the FDA. They can contain powerful chemicals that occur in nature, like DHEA. It's a hormone that can be extracted from yams, and it can have a hormonal effect on women with breast cancer. There are some plant derivatives that can thin the blood that can be unsafe to use. So I don't feel comfortable with my patients taking pills and potions and powders. You also want to be careful about vitamins because some can interfere with your treatment. The antioxidant vitamins can protect against free radicals, which is what we're using to destroy the cancer.

Is it true that most women gain weight during chemotherapy?

Up to 25 pounds. It's from a combination of things such as decreased physical activity, eating the same or more and seeking out foods that are higher in calories. Exercise three or four hours a week is key. In terms of a diet, you want to follow a Mediterranean one-lots of fish, olive oil, fruits and vegetables. Avoid fried foods. Your taste might change during chemotherapy and you might seek out comfort foods. You want to be careful with that, because it's unhealthy to be overweight when you've had breast cancer, and it's a mean side effect.

How does treatment affect a woman's fertility?

It depends entirely on the treatment. If you are premenopausal, surgery does not affect your menopausal status. The closer during chemotherapy that you are to age 40, the higher your risk of becoming infertile and going through menopause. There are medications that we give to intentionally put a women in menopause. If she has a cancer that grows in the face of estrogen, that's hormone receptor positive, we're going to give her an anti-estrogen therapy to block the effects of estrogen. Tamoxifen is another drug we use that can mimic menopausal symptoms, but that's only temporary.

SIGNATURE QUESTIONS

What is the belief you personally go to at times of change?

Question your assumptions.

The best thing about change is...

It refreshes hopes for tomorrow.

What's the best change you have ever made?

Becoming a mother deepened my ability to care for my patients' holistic concerns.

For more information on Dr. Marisa C. Weiss, visit www.breastcancer.org.