Showing posts with label women's health. Show all posts
Showing posts with label women's health. Show all posts

Thursday, December 21, 2017

Breastfeeding Lowers the Risk for High Blood Pressure and Other Problems in Mid-Life

Photo credit: La Leche League
A new study indicates that breastfeeding can lower the risk for hypertension in middle-aged African-American women.

Interestingly, the study did not find much protection against EVER getting high blood pressure, but it did find a modest protective effect of breastfeeding on getting high blood pressure in your 40s. In other words, it had a temporary but important protective effect as women approached menopause, when high blood pressure often develops. In addition, the longer the duration of breastfeeding, the more protection there was.

This seems to echo other studies in other groups that have found similar protective effects against blood pressure issues in early middle age (the 40s) but not as much difference in older ages (after 65 or so).

It's disappointing that breastfeeding doesn't have the long-term, permanent effect everybody hoped for, but even so, this delay in development of high blood pressure is very important because the longer you have high blood pressure, the more complications like heart disease or kidney disease develop. Even just delaying it can reduce the cumulative disease burden on the body.

Breastfeeding can hopefully help people minimize their risk for these diseases. This is especially important for African-Americans, who are particularly susceptible to early onset of hypertension and cardiovascular issues.

More support  is needed in helping African-American women initiate and breastfeed long-term because it could make a critical difference in their health, as well as their babies' health. Here are some resources that might be helpful:


And here are some general breastfeeding resources:
Implications Beyond Hypertension 

Photo Credit: Center for Disease Control
Breastfeeding has important lifelong benefits beyond the obvious immediate benefits to the baby.

One of these is the delay of development of hypertension in the mother. Research also shows the breastfeeding, especially long-term breastfeeding, helps prevent or delay diabetes and heart problems, and lowers the incidence of cardiovascular mortality (see studies in References below).

Biologically speaking, women evolved to have children and then breastfeed them for extended periods of time. When women have children but don't breastfeed (or breastfeed only briefly), there is inadvertent metabolic fallout. As one study summarizes:
Researchers hypothesize that pregnancy and lactation are part of a continuum, with lactation meant to "reset" the adverse metabolic profile that develops as a part of normal pregnancy, and that when lactation does not occur, women maintain an elevated risk of cardio-metabolic diseases.
This is not to shame or scold women who don't or can't breastfeed long-term. Not every woman can breastfeed fully, some women's situations prevent breastfeeding for long, and of course it's always up to the woman to decide how she will feed her baby.

But from an evolutionary point of view, breastfeeding, especially long-term breastfeeding, keeps women healthier longer. 

We need to do everything we can to help support breastfeeding women, and especially breastfeeding women of color.


References

Breastfeeding and Hypertension

Am J Epidemiol. 2017 Oct 15;186(8):927-934. doi: 10.1093/aje/kwx163. Cumulative Lactation and Onset of Hypertension in African-American Women. Chetwynd EM, Stuebe AM, Rosenberg L, Troester M, Rowley D, Palmer JR. PMID: 28535171
Hypertension affects nearly 1 of 3 women and contributes to cardiovascular disease, the leading cause of death in the United States. Breastfeeding leads to metabolic changes that could reduce risks of hypertension. Hypertension disproportionately affects black women, but rates of breastfeeding among black women lag behind those in the general population. In the Black Women's Health Study (n = 59,001), we conducted a nested case-control analysis using unconditional logistic regression to estimate the association between breastfeeding and incident hypertension at ages 40-65 years using data collected from 1995 to 2011... Overall, there was little evidence of association between ever breastfeeding and incident hypertension (odds ratio = 0.97, 95% confidence interval: 0.92, 1.02). However, age modified the relationship (P = 0.02): Breastfeeding was associated with reduced risk of hypertension at ages 40-49 years (odds ratio = 0.92, 95% confidence interval: 0.85, 0.99) but not at older ages. In addition, risk of hypertension at ages 40-49 years decreased with increasing duration of breastfeeding (P for trend = 0.08). Our results suggest that long-duration breastfeeding may reduce the risk of incident hypertension in middle age. Addressing breastfeeding as a potential preventative health behavior is particularly compelling because it is required for only a discrete period of time.
Am J Obstet Gynecol. 2013 Jun;208(6):454.e1-7. doi: 10.1016/j.ajog.2013.02.014. Epub 2013 Feb 7. Association between parity and breastfeeding with maternal high blood pressure. Lupton SJ, Chiu CL, Lujic S, Hennessy A, Lind JM. PMID: 23395924
...Baseline data for 74,785 women were sourced from the 45 and Up Study, Australia. These women were 45 years of age or older, had an intact uterus, and had not been diagnosed with high blood pressure before pregnancy...The combination of parity and breastfeeding was associated with lower odds of having high blood pressure (adjusted OR, 0.89; 99% CI, 0.82-0.97; P < .001), compared with nulliparous women...Women who breastfed for longer than 6 months in their lifetime, or greater than 3 months per child, on average, had significantly lower odds of having high blood pressure when compared with parous women who never breastfed. The odds were lower with longer breastfeeding durations and were no longer significant in the majority of women over the age of 64 years....
Breastfeed Med. 2015 Apr;10(3):163-7. doi: 10.1089/bfm.2014.0116. Epub 2015 Mar 18. Breastfeeding and maternal hypertension and diabetes: a population-based cross-sectional study. Zhang BZ, Zhang HY, Liu HH, Li HJ, Wang JS. PMID: 25785993
...A cross-sectional study was conducted in four urban communities of Beijing, China, with 9,128 parous women 40-81 years of age who had had only one lifetime birth...After the analysis was adjusted for the potential confounders...the odd ratio (OR) of hypertension was 1.18 (95% confidence interval [CI], 1.05-1.32) for women who did not breastfeed, compared with women who did. In addition, the ORs for >0 to 6 months, >6 to 12 months, and >12 months of breastfeeding were 0.87 (95% CI, 0.76-0.99), 0.83 (95% CI, 0.68-1.00), and 0.79 (95% CI, 0.65-0.97), respectively, compared with women who did not breastfeed. With adjustment for age, WHR, working status, educational level, family history of diabetes, and postpartum BMI, women who did not breastfeed increased the risk of diabetes (OR=1.30; 95% CI, 1.11-1.53) compared with women who did. Moreover, women who breastfed for >0 to 6 months (OR=0.81; 95% CI, 0.67-0.98) and >6 to 12 months (OR=0.46; 95% CI, 0.26-0.84) had a lower risk of diabetes, compared with women who did not breastfeed. CONCLUSIONS: Chinese mothers who did not breastfeed were more likely to develop hypertension and diabetes in later life.
Am J Epidemiol. 2011 Nov 15;174(10):1147-58. doi: 10.1093/aje/kwr227. Epub 2011 Oct 12. Duration of lactation and incidence of maternal hypertension: a longitudinal cohort study. Stuebe AM, Schwarz EB, Grewen K, Rich-Edwards JW, Michels KB, Foster EM, Curhan G, Forman J. PMID: 21997568
Never or curtailed lactation has been associated with an increased risk for incident hypertension, but the effect of exclusive breastfeeding is unknown. The authors conducted an observational cohort study of 55,636 parous women in the US Nurses' Health Study II... In conclusion, never or curtailed lactation was associated with an increased risk of incident maternal hypertension, compared with the recommended ≥6 months of exclusive or ≥12 months of total lactation per child, in a large cohort of parous women.
Breastfeeding and Diabetes

Obstet Gynecol. 2016 Nov;128(5):1095-1104. Breastfeeding Initiation Associated With Reduced Incidence of Diabetes in Mothers and Offspring. Martens PJ, Shafer LA, Dean HJ, Sellers EA, Yamamoto J, Ludwig S, Heaman M, Phillips-Beck W, Prior HJ, Morris M, McGavock J, Dart AB, Shen GX. PMID: 27741196
This retrospective database study included 334,553 deliveries (1987-2011) in Manitoba with up to 24 years of follow-up for diabetes using population-based databases... RESULTS: Breastfeeding initiation was recorded in 83% of non-First Nations mothers and 56% of First Nations mothers (P<.001)... With 24 years of follow-up or less, breastfeeding initiation was associated with a 17% lower risk of youth-onset type 2 diabetes in offspring (HR 0.83, CI 0.69-0.99, P=.038)... CONCLUSION: Breastfeeding initiation is associated with a reduced risk of diabetes among women and their offspring in Manitoba. The results suggest that breastfeeding might be a potentially modifiable factor to reduce the risk of diabetes in both First Nations and non-First Nations women and children.
Diabetes Care. 2010 Jun;33(6):1239-41. doi: 10.2337/dc10-0347. Epub 2010 Mar 23. Parity, breastfeeding, and the subsequent risk of maternal type 2 diabetes. Liu B, Jorm L, Banks E. PMID: 20332359
...Using information on parity, breastfeeding, and diabetes collected from 52,731 women recruited into a cohort study, we estimated the risk of type 2 diabetes using multivariate logistic regression... Among parous women, there was a 14% (95% CI 10-18%, P < 0.001) reduced likelihood of diabetes per year of breastfeeding... CONCLUSIONS: Compared with nulliparous women, childbearing women who do not breastfeed have about a 50% increased risk of type 2 diabetes in later life. Breastfeeding substantially reduces this excess risk.
JAMA. 2005 Nov 23;294(20):2601-10. Duration of lactation and incidence of type 2 diabetes. Stuebe AM1, Rich-Edwards JW, Willett WC, Manson JE, Michels KB. PMID: 16304074
...Prospective observational cohort study of 83,585 parous women in the Nurses' Health Study (NHS) and retrospective observational cohort study of 73,418 parous women in the Nurses' Health Study II (NHS II)...RESULTS: ...Among parous women, increasing duration of lactation was associated with a reduced risk of type 2 diabetes. For each additional year of lactation, women with a birth in the prior 15 years had a decrease in the risk of diabetes of 15% (95% confidence interval, 1%-27%) among NHS participants and of 14% (95% confidence interval, 7%-21%) among NHS II participants, controlling for current body mass index and other relevant risk factors for type 2 diabetes. CONCLUSIONS: Longer duration of breastfeeding was associated with reduced incidence of type 2 diabetes in 2 large US cohorts of women....
Diabetologia. 2008 Feb;51(2):258-66. Epub 2007 Nov 27. Duration of breast-feeding and the incidence of type 2 diabetes mellitus in the Shanghai Women's Health Study. Villegas R1, Gao YT, Yang G, Li HL, Elasy T, Zheng W, Shu XO. PMID: 18040660
...This was a prospective study of 62,095 middle-aged parous women in Shanghai, China, who had no prior history of type 2 diabetes mellitus, cancer or cardiovascular disease at study recruitment... RESULTS: Women who had breastfed their children tended to have a lower risk of diabetes mellitus than those who had never breastfed [relative risk (RR)=0.88; 95% CI, 0.76-1.02; p=0.08]. Increasing duration of breast-feeding was associated with a reduced risk of type 2 diabetes mellitus. The fully adjusted RRs for lifetime breast-feeding duration were 1.00, 0.88, 0.89, 0.88, 0.75 and 0.68 (p trend=0.01) for 0, >0 to 0.99, >0.99 to 1.99, >1.99 to 2.99, >2.99 to 3.99 and >or=4 years in analyses adjusted for age, daily energy intake, BMI, WHR, smoking, alcohol intake, physical activity, occupation, income level, education level, number of live births and presence of hypertension at baselines....
Breastfeeding and Cardiovascular Health/Mortality

Annu Rev Nutr. 2016 Jul 17;36:627-45. doi: 10.1146/annurev-nutr-071715-051213. Epub 2016 May 4. Lactation and Maternal Cardio-Metabolic Health. Perrine CG, Nelson JM, Corbelli J, Scanlon KS. PMID: 27146017
Researchers hypothesize that pregnancy and lactation are part of a continuum, with lactation meant to "reset" the adverse metabolic profile that develops as a part of normal pregnancy, and that when lactation does not occur, women maintain an elevated risk of cardio-metabolic diseases. Several large prospective and retrospective studies, mostly from the United States and other industrialized countries, have examined the associations between lactation and cardio-metabolic outcomes. Less evidence exists regarding an association of lactation with maternal postpartum weight status and dyslipidemia, whereas more evidence exists for an association with diabetes, hypertension, and subclinical and clinical cardiovascular disease.
Am J Obstet Gynecol. 2009 Feb;200(2):138.e1-8. doi: 10.1016/j.ajog.2008.10.001. Epub 2008 Dec 25. Duration of lactation and incidence of myocardial infarction in middle to late adulthood. Stuebe AM, Michels KB, Willett WC, Manson JE, Rexrode K, Rich-Edwards JW. PMID: 19110223
We assessed the relation between duration of lactation and maternal incident myocardial infarction. STUDY DESIGN: This was a prospective cohort study of 89,326 parous women in the Nurses' Health Study. RESULTS:... Compared with parous women who had never breastfed, women who had breastfed for a lifetime total of 2 years or longer had 37% lower risk of coronary heart disease (95% confidence interval, 23-49%; P for trend < .001), adjusting for age, parity, and stillbirth history. With additional adjustment for early-adult adiposity, parental history, and lifestyle factors, women who had breastfed for a lifetime total of 2 years or longer had a 23% lower risk of coronary heart disease (95% confidence interval, 6-38%; P for trend = .02) than women who had never breastfed. CONCLUSION: In a large, prospective cohort, long duration of lactation was associated with a reduced risk of coronary heart disease.
BMC Public Health. 2013 Nov 13;13:1070. doi: 10.1186/1471-2458-13-1070. A prospective population-based cohort study of lactation and cardiovascular disease mortality: the HUNT study. Natland Fagerhaug T, Forsmo S, Jacobsen GW, Midthjell K, Andersen LF, Ivar Lund Nilsen T. PMID: 24219620
...In a Norwegian population-based prospective cohort study, we studied the association of lifetime duration of lactation with cardiovascular mortality in 21,889 women aged 30 to 85 years who attended the second Nord-Trøndelag Health Survey (HUNT2) in 1995-1997. The cohort was followed for mortality through 2010 by a linkage with the Cause of Death Registry...RESULTS:...Parous women younger than 65 years who had never lactated had a higher cardiovascular mortality than the reference group of women who had lactated 24 months or more (HR 2.77, 95% confidence interval [CI]: 1.28, 5.99)...CONCLUSIONS: Excess cardiovascular mortality rates were observed among parous women younger than 65 years who had never lactated. These findings support the hypothesis that lactation may have long-term influences on maternal cardiovascular health.
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Tuesday, August 30, 2016

Mammograms: Getting Called Back for Additional Testing


At some point in a woman's life, she should start having regular mammograms. When she should do this is a matter of some controversy, but sooner or later, most women will have regular mammograms every year or two.

But what happens when you get a call back after your mammogram telling you that you need further imaging? What can you expect, and how likely is it that you will be diagnosed with breast cancer? How can you handle the anxiety while waiting for further results? Where can you get further support and information?

Earlier this year, this happened to me. I had my regular mammogram and got a call back telling me they had found two suspicious areas and I needed further testing. It was very unsettling. Even though intellectually you understand it's not an actual diagnosis of cancer, it feels like a sentence of doom. Your anxiety levels go through the roof.

Statistically, only a few women who get called back for additional testing after an "abnormal" mammogram result actually have cancer. Most are just fine, but many of those called back have fears about what additional testing entails.

Let's talk about what diagnostic mammograms are, what additional testing may be used, what to expect during the appointment, how to handle the waiting, and the latest screening guidelines. Then I'll share with you my diagnostic testing experience.

First Step: Don't Panic

Although it's deeply unnerving to get "the call" telling you to get more testing, the first step is to stay calm. Don't panic and start mentally going to worst-case scenarios. As one resource notes (my emphasis):
If doctors find something suspicious, they’ll call you back – usually within just 5 days – to take new pictures or get other tests. Getting that call can be scary, but a suspicious finding does not mean you have cancer. In fact, less than 10% of women called back for more tests are found to have breast cancer.
Although your mind will tend to automatically assume the worst, take a deep breath. Remind yourself that even when extra testing is required, you have a 90%+ chance of not having cancer. 

It's normal to cycle in and out of various "what-if" scenarios in the time before your diagnostic test, but the important thing is to focus as much as possible on the other business of your life. There's no need to panic when you don't know if there's something to actually panic over.

It's understandable to do some worrying, but don't let it consume you. Hard as it is, try not to focus on the uncertainty; let the future take care of itself. Focus instead on the everyday tasks of your life.

Screening vs. Diagnostic Mammograms

An important aid in avoiding panic is to remember that there is a major difference between a screening test and a diagnostic test.

A diagnostic test tells you for sure whether or not you have a certain condition. To get that kind of certainty, diagnostic tests are very involved, expensive, and time-consuming. Because of the time and expense, it simply does not make sense to order them for everyone.

Therefore, a simpler and less-expensive test is used on everyone ─ a screening test. Screening tests are designed to test a wide variety of asymptomatic individuals to look for problems that might need a closer look. These tests are slanted towards what's called "sensitivity" ─ a high chance of finding any existing problems ─ so as not to miss any potential disease. The trade-off is that many people (including many who don't have the disease) will require additional diagnostic testing, and that testing process can be unnerving.

Diagnostic testing looks specifically for disease or a high suspicion of disease. It is geared towards "specificity" ─ accuracy in ruling out disease. If something pops up on the screening test that is unusual or statistically outside of the norm, that person is called back in for further testing. [Of course, anyone with a distinct symptom of a disease goes straight to diagnostic testing.]

This arrangement of starting with a screening test and only going to a diagnostic test for a few people is a smart way to save time and money in an era of limited medical resources. But because most of the public doesn't understand the difference between a screening and diagnostic tests, many people automatically assume that a call-back means they likely have cancer. It doesn't.

Handling the Anxiety of Waiting

Even for people who understand screening vs. diagnostic testing, call-backs can still feel quite alarming. Human nature makes us emotionally jump to worst-case scenarios. That's why you have to keep reminding yourself not to panic. The best thing to do is simply to focus as much of your attention as possible on the tasks of everyday living and not dwell on the fear. Find ways to redirect your anxiety.

Of course, just telling yourself not to worry may be counterproductive; it may be easier instead to let yourself worry but to limit the amount of time spent on it. If you find yourself being taken over with worry, try writing down your worries, putting them into an envelope (physical or mental), and taking them out to indulge the worry only at specified times. When you do indulge the worries, let yourself do it in depth. Think of every worst-case scenario you can, weep and wail, write your good-bye letters, plan your funeral, etc. But then at the end of the specified time, stop and put those fears away until next time. By indulging your fears periodically, you lessen their emotional dominance the rest of the time. It's the rigidly suppressed fear that tends to multiply. Let yourself express your worries but it may help to put some limits on that expression.

Another thing that can help is to journal about why you are so worried. Do some stream-of-consciousness writing to explore your fears. Often the answers seem simple when you start, but the writing process helps uncover more subtle reasons that can give you insight. Journaling won't make the worry go away but understanding the true source of the anxiety may help diffuse its power so it is less emotionally overwhelming.

It's only natural to worry, but try to keep the worry in perspective, try to understand it, and find ways to deal with it that keep it from taking over your life. Soon you will have the answers that you need and can either relax or start developing a positive plan of action. If you need additional support, don't forget that many cancer organizations have 24 hour free phone lines for information and support.

Follow-Up Testing: What to Expect

 When you return for follow-up testing, what can you expect?

Basically, plan to devote about half a day to the appointment, give or take. Remember not to wear any powder or lotions to the appointment. Bring a book to help occupy yourself while waiting. The appointment will take several hours and quite a bit of this will be waiting.

You will start by having a longer and more in-depth mammogram. More images will be taken, using more angles, so they can really focus in on the area in question. Although longer than a normal mammogram, this process is usually less than an hour. Don't be afraid to ask questions about the process; technicians are limited in what they can say (and obviously can't give a diagnosis), but often can offer insight into what is being looked at and why.

Next comes the ultrasound. Although not mandatory, most mammography centers also do an ultrasound of the breast during follow-up testing. This process is also around an hour and will examine closely any areas of concern on the breast as well as lymph nodes underneath the arm.

Sometimes an MRI is also done. This is not considered standard-of-care and may not be covered by insurance so it is not part of most routine follow-up testing at this time.

You will be asked to wait on site while a radiologist reviews the results. This can take an hour or two more, so be prepared to wait, but you should get the results that day. The results are usually one of the following:
  • The suspicious area turned out to be nothing to worry about and you can return to your regular mammogram schedule
  • The area is probably nothing to worry about, but you should have your next mammogram sooner than normal – usually in 4 to 6 months – to make sure it doesn’t change over time
  • Cancer was not ruled out and a biopsy is needed to tell for sure
Remember, even if a biopsy is recommended, chances are you still don't have cancer. Often biopsy results are benign. This is hard to remember when you are told you need a biopsy but it's important to keep reminding yourself of this fact.

There are different types of biopsies. Most are done with a needle but some need a small incision. Biopsy results have to be sent away for analysis, which can take anywhere from a few days to a week or two. The wait is difficult. Find some emotional support but don't forget to keep your focus on normalcy during daily life.

If your biopsy results are benign, ask the doctor whether any follow-up is needed and when your next mammogram should be. Get the results and recommendations in writing for future reference.

If your biopsy results show cancer, then it is time to consult a breast specialist. People often report difficulty in recalling the information given at these consultations, so take a knowledgeable and supportive friend or relative with you to the appointment. Ask to record the appointment so you can refer back to it later. Take notes (or have your support person take notes) and ask for correct spellings of any words you don't know so you can research it further. You can find a list of questions to ask here.

Don't be afraid to ask for a second opinion about your options. You can you get completely different advice from another care provider so it really is worthwhile to get a second (or even third) opinion. You can also call the American Cancer Society for information and support at 1-800-227-2345. Many additional online resources for support also exist; don't be afraid to reach out to them. Many women find it helpful to be paired with someone who has been through breast cancer themselves and is trained in offering support to newly-diagnosed patients.

Reminder of Screening Guidelines

With all the anxiety that a positive screening test can generate, it's no surprise that many women opt out of yearly mammograms. They simply don't want to deal with the anxiety it produces. Others are concerned about over-treatment for non-aggressive cancers, false-positives, and the cumulative effect of the radiation from many mammograms.

Yet we know that statistically, mammograms save lives, especially as women age. So when should women start getting mammograms?

Unfortunately, even the experts can't agree on how often women should have mammograms. Some organizations suggest regular screening start at 40, some suggest 45, some suggest waiting till 50.

Once you do start regular screening, some suggest that every 2 years is enough, while others strongly push yearly screening. It's hard to know what to do.

From cancer.net, Dr. Connie Lehmen gives a summary of the controversy over screening guidelines:
At an absolute minimum, women should begin screening mammography no later than age 50 and get a mammogram every 1 to 2 years until at least age 74. All medical organizations agree with these minimum recommendations for screening...The areas of disagreement, and reasons for differences in the recommendations from different groups, center around the age to begin screening (40, 45, or 50) and the interval of screening (every year or every 2 years). These variations are due to different groups of people who interpret clinical trial data differently.
Bottom line, when you start and how often you screen really depends on your risk factors. Recommendations will vary from woman to woman.

How does "obesity" figure into recommendations? That's harder because it's not always clear. We do know that high-BMI women are less likely to get regular mammograms or follow-ups after abnormal mammograms, which may partially explain why we tend to be diagnosed at more advanced stages of cancer. Yet there is only limited research and recommendations specifically on the trade-off of benefits and risks of screening in obese women at different ages.

As women of size, it is clear that we are at increased risk for post-menopausal cancer ─ but authorities often neglect to mention that we are generally at decreased risk for pre-menopausal breast cancer (except triple negative breast cancer). But when does that initially decreased risk cross over to increased risk? Is it a hard and fast conversion right at menopause, or a gradual increase of risk as you approach menopause? I don't think anyone really knows for sure.

That means it's particularly hard to know what mammogram schedule a woman of size should follow during that in-between time in the 40s when women are peri-menopausal.

The short version is that mammogram decisions then really seem to boil down to your other risk factors (especially family history, breast density, and blood sugar status) and becomes a personal choice you decide in consultation with your healthcare provider.

Personally, not having access to much family medical history and having had a lot of fibrocystic lumps, I had a number of mammograms in my 20s and 30s. In retrospect, I think we did too much. After a lot of research, I opted out of yearly mammograms in my 40s, but did have a couple to establish a baseline. Now that I am past 50 I think it sensible to get regular mammograms (about every year or two) because high-BMI women really are at increased risk for post-menopausal breast cancer.

I still don't love mammograms but have found a center where the care is more sensitive and gentle than I've experienced in the past. It's still anxiety-producing but regular mammograms seem a sensible precaution at my age.

But that's just my choice, based on my own circumstances. Yours may be completely different.

 My Experience with Call-Back Testing

Needing a follow-up diagnostic mammogram really threw me. It just goes to show that having intellectual knowledge about a subject doesn't always have a lot to do with how you react to unsettling news.

Even though intellectually I knew that I probably didn't have cancer, I'm very good at "catastrophizing." It took quite a bit of effort to reel back my tendency to immediately go to the worst-case scenarios. Reading up about screening vs. diagnostic testing helped me scale back some of my fears. Education can be a powerful counter to fear.

When the anxiety elevated despite my reading, I made an effort to explore it. Obviously I was deeply concerned about leaving my children motherless, especially because I still have a young one at home. But upon further reflection, I realized that my fear was made worse by the fact that my husband had just been laid off. My big concern was that if I did have breast cancer, we'd run out of health insurance and I'd bankrupt the family and cause us to lose our house. We also have two kids in college, another in high school heading off to college soon, and the young one in private school; I was worried that my medical bills would derail their educations.

For me, handling the anxiety proactively while waiting needed multiple approaches. Research helped reassure my rational mind that I had a 90% chance of not having cancer. Emotionally, taking the time to explore why the fear was persistent helped me understand and diffuse a lot of its power. I was then better able to just focus on the everyday tasks instead of spending my days in constant fear.

In the end, I didn't have cancer, just some "asymmetrical lymph nodes" that the radiologist initially flagged but ultimately considered normal. I don't even have to go back for more frequent testing, just the normal screening.

Whew, what a relief! But oh, how difficult that waiting period is. Especially coming during a job layoff and time of great stress at my own work.

Sadly, there are no magical answers to getting through it; for me doing research and exploring my fears was vital in staying sane. In the end, though, it really boiled down to gritting my teeth and focusing on everyday tasks so I didn't go crazy.

It's totally normal to be anxious while waiting. But if that anxiety gets overwhelming, consider what is effective for you to deal with the worry. Consider developing some additional tools to help.

Has anyone else gone through a similar experience? What helped you get through the waiting period?


Resources
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