NEW YORK--Caring for a mother with advanced breast cancer can be a
lot to deal with for a daughter. She has the tricky task of reversing
roles with her mother. She may have a family of her own to care
for--and there is the fear that she is at risk for cancer herself.
Patricia Spicer, CSW, coordinator of Cancer Care, Inc.s Breast
Cancer Program, and Karen Antman, MD, director, Herbert Irving
Comprehensive Cancer Center, and chief of medical oncology, Columbia
Presbyterian Medical Center, offered support to these daughters
during a Cancer Care teleconference.
Ms. Spicer said that one of the most difficult roles an adult child
is asked to assume is that of caregiver to a parent. "It is
important to recognize that many mothers and daughters have
unresolved issues between them," she said, "and,
unfortunately, cancer and the rigors of treatment do not usually turn
the patient or family member into saints."
Mothers who are ill can become demanding, irritable, and angry, and
their daughters can get angry, too. The daughter may feel that
nothing she does is good enough--but feeling angry will also make her
feel guilty, Ms Spicer said. "It is important to accept your
feelings, whether they are positive or negative," she said.
"If you try to suppress them, the anger may turn to rage, and
the fear may turn to terror." She encouraged daughters to seek
help by joining a caregivers support group or getting counseling.
Even though a mother may be irritable, "Mom still needs to feel
that shes important in your life," Ms. Spicer said.
"That means hugging her when you come in the door or simply
holding her hand or kissing her to reassure her that shes still
important to you." A mother should also be allowed to cry and to
talk about death, and it is also okay for the daughter to cry with
her, she said.
Ms. Spicer warned daughters against putting pressure on their mother
to eat. "Sometimes we confuse love with food. If she is losing
weight or does not want to eat, talk to the doctor," she said.
And daughters must also take care of themselves. Ms. Spicer urged
them to take vacations and to ask for help when they need it.
"When someone asks you what they can do, tell them. Ask them to
come in for a couple of hours so you can out and shop or just sit in
the park and get away from life with cancer."
Dr. Antman took on the question of a daughters cancer risk. The
daughter is at significant risk, she said, if her mother was very
young when she developed breast cancer, even more so if other close
relatives had breast or ovarian cancer before age 45. But if the
mother had cancer at age 65 or over, the daughters risk is
probably not significantly increased.
High-risk women should consider genetic testing and counseling, Dr.
Antman said, as they may have a BRCA1 or BRCA2 gene mutation. These
genes account for about 5% of breast cancer cases.
Some experts feel that mammography screening for high-risk women
should begin before the age at which the youngest family case
occurred, or by age 40. Dr. Antman noted that MRI, which avoids
radiation exposure, is being studied for screening of women under 40
who have a strong family history of breast cancer.
Regarding prevention, she recommends eating ample vegetables and
using olive oil on salads. Women who use a nonfat salad oil may
actually be dispensing with something that could be protective, she
said. She advised avoiding alcohol and margarine, and not gaining
more than a few pounds over ones weight at age 18, since
estrogen is stored in fat cells. She also advised women whose mothers
have had breast cancer to carefully discuss the use of birth control
or hormone replacement with their physicians and not to use them for
more than 5 years.