BREAST CANCER: FIGHTING BACK : Emotional Toll Can Be Harsh, but Some Fears Can Be Allayed : Reactions to threat or diagnosis vary, in part because of a perceived stigma. Information, awareness and support can alleviate anxiety.

More than most diseases, breast cancer takes an emotional toll on the women who contract it--and on the women who don't.

"Women can't pick up the paper and fail to find something about breast cancer," says Julia H. Rowland, an assistant professor of psychiatry at Georgetown University who specializes in psychological problems of breast cancer.

"They have good reason to be anxious. It carries more stigma than heart disease, which is a more common killer. Breast cancer is associated with mutilation and disfigurement. It affects a body part that has importance to women. It's associated with femininity, fertility, a woman's concept of self."

Rowland says that nearly 75% of breast cancer cases occur in women with no known risk factors, making it seem "to come out of the blue. You feel fine and healthy, and suddenly you find your body has betrayed you."

At this dark moment, a woman is faced with "a host of decisions. Breast conservation or mastectomy? Breast reconstruction or prosthesis?

"The period between diagnosis and treatment is probably the most stressful for a majority of women," Rowland says. During this wait, a woman can consult a seemingly unlimited number of specialists. Reams of information are available, some bewildering and even contradictory. "It is enormously taxing," Rowland says.

"Once a treatment plan is in place and she knows where she's headed, the anxiety diminishes," Rowland says. "When she understands what she has to cope with, a woman can gather her resources and get down to the challenge of being a cancer survivor."

But as treatment ends, anxiety usually increases once more, "and this is often underestimated by the family, medical staff and the patients themselves. A woman begins to think, 'Will the cancer come back? Will I ever be comfortable with my body again?'

"We no longer tell women that they're cured and it will never come back. We realize we can never be sure. This is a difficult burden for a patient."

And it comes at the same time that family and friends--the support network the woman has hopefully marshaled during treatment--are driving to have her well again. They are encouraging her to be a fighter and upbeat all the time, "and that's just unrealistic," Rowland says.

Following surgery, many women feel that they are "damaged goods," and problems with sex and intimacy can result, Rowland says. The reaction of the woman's partner may compound problems, Rowland says. "He or she may be reluctant to resume an active sexual life for fear of causing harm, but that often conveys the mistaken impression that the woman is no longer desirable."

A few partners are not able to accept the changes, "but that's fairly rare," Rowland says.

"The vast majority of women adapt well to the disease, and most of them resume their normal levels of activity."

"Some use their illness to embrace life more fully."

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