'Boomers' Show Distinct Style of Coping With Cancer

NEW YORK--When diagnosed with breast cancer, "women havevery different coping styles," Amy Langer said at a mediabriefing on molecular diagnostics in breast cancer, sponsoredby Pharmacia Biotech.

"What we see at NABCO [National Coalition of Breast CancerOrganizations] are three basic types: the mostly older passivepatient, the information seeker, and what we call the 'new patient,'mostly younger women," said Ms. Langer, NABCO's executivedirector.

A patient's reaction to the diagnosis of breast cancer dependson a number of factors, including personality, culture, and priorexperience. "For example," she said, "if everyoneyou know who had breast cancer died from it, you have a very differentconcept of the disease than do those of us who have seen womenwith breast cancer live and prosper."

Other important influences include the patient's access to thehealth care system and to information about treatment options,and available support from family, friends, and health professionals.

An Outdated Model?

The passive patient "is in shock, in denial," Ms. Langersaid. "She leaves decisions up to others, asks the doctor,What would you do? or What would do you do for your wife?"Her model for perceiving breast cancer may be outdated. For example,40 years ago, people didn't talk about breast cancer, and mortalityrates were much higher.

These patients may also be fatalistic, believing that the diseasewill take its predetermined course regardless of interventions."There are certain cultures and belief systems that encouragethe idea that cancer is in the hands of others, and it may bedifficult to get that woman to partner with us in guiding hercare."

The information seeker is more likely to contact NABCO or otherorganizations. "She sees information as a way to get backinto control," Ms. Langer said. "She partners with themedical team in making decisions about her care. She stays current.She probably knows about p53. She hires and fires. She reallydoes want to assemble the best team, and will redo her team ifit isn't working."

The so-called new patients are women in their 30s or 40s who have"grown up in the women's movement, who may be more comfortablebeing advocates for their own care."

Even though the average age of onset of breast cancer in the UnitedStates is 64, Ms. Langer noted that physicians will be seeingmore of these new patients. "This is not necessarily a functionof the breast cancer rate, but rather the post-War baby boom,"she said. In 1996, of the 180,000 women who will be diagnosedwith breast cancer, some 33,000 will be in their 40s, more thanare predicted to be in their 50s (31,000).

Ms. Langer said that breast cancer advocates are frustrated withcurrent technology, calling both mammography screening and availabletreatment 'blunt tools.' She noted, "We really can't customizeeither or use either in a way that is targeted to the individualpatient."

Ms. Langer notes that early detection with mammography is oftennot early enough. "Some women do everything right. They havemam-mograms when they're supposed to, have clinical breast exams,perform self-exams every month, find breast cancer, and die ofit at an early age."

Treatment for early stage breast cancer is a continuing challenge."We vastly overtreat some women in this group and undertreatothers, because we can't predict who will have aggressive disease,"she said.

Recurrence often cannot be detected early enough for effectiveintervention, and must be fought with the same tools used uponinitial diagnosis, "so we're back to the customization problem,"she said.

Ms. Langer urged physicians to continue their research into methodsto detect breast cancer at the molecular level, "so thataberrant cells can be destroyed as cells, and 2-inch tumors--theaverage size in this country--which are composed of billions ofcells, become a thing of the past."