Whatever stage of breast cancer you're in, it's sure to affect your partner, children, parents, and every one else in your immediate family.

Breast cancer is a family disease. According to the 2001 American Cancer Society Surveillance Research, each year, 239,300 women in the United States are diagnosed with in situ or invasive breast cancer. Nearly 57,000 of these women are under the age of 50 (and most have children that still live at home). Whatever stage of the disease a woman is in, one thing is certain: Ultimately her breast cancer will inevitably affect her partner, her children, her parents and every other member of her immediate family.

Although a woman coping with cancer deserves and often receives a great deal of support and attention, her family's needs can get neglected once she gets caught up in the urgency of researching information, keeping medical appointments, and making decisions. Instead of being allowed to complain and blow off steam, family members are expected to be supportive and helpful. But neglecting their needs can encourage a husband and children to withdraw, undermining the woman's support system and leaving her to not only deal with the cancer, but with family problems too.

The Ties That Bind
Martin felt helpless and confused when his wife was diagnosed with cancer because he felt he couldn't take care of her and protect her from the disease. Like Martin, many men feel helpless, frustrated and angry when their wives are diagnosed with breast cancer. In fact, in her book, Cancer and Emotion (1994, John Wiley), Jennifer Barraclough reported that half of all partners of people diagnosed with cancer experience significant depression and anxiety, because they are terrified they will lose their wives. Men's traditional way of responding problems is to try to fix things. But men cannot fix a diagnosis of breast cancer. This 'failure' can leave them feeling helpless, and they may withdraw or become overprotective, seriously undermining their partners efforts to take care of herself.

Because they can't find a positive way to help their wives, most husbands tend to avoid discussion of cancer and minimize its impact on their lives. Harold says, "Every time my wife talks about cancer, it makes me feel inadequate, like I need to do something to make her feel better. I simply change the subject because I don't want her to dwell on cancer and I don't know what to say."

Women often think this kind of behavior from their husbands means their husbands don't really care about them. They get the message they shouldn't talk about their fears; instead they turn to support groups or female friends.

Working It Out Together
There are ways for couples to deal with cancer by working together, instead of letting the disease pull them apart:

Do A Role' Call: Make sure your husband has a clear and important role in dealing with your cancer. He could deal with insurance forms, organize the children's activities, accompany you to chemotherapy appointments, or keep family and friends informed.

Talk the Talk: Your husband needs to understand it's important for you to talk about your cancer and its treatment, just as you need to understand that he might be reluctant to discuss the disease. You both need to be flexible enough to sometimes talk, and other times just sit quietly together.

Find Some Group Support: Men need to find their own sources of support, whether it is a friend, a brother, a counselor or a support group. They can also seek help from such organizations as Men Against Breast Cancer (www.menagainstbreastcancer.org or 866-547-6222) and Men's Crusade Against Breast Cancer (http://home.earthlink.net/~rkupbens/mcabc or 703-978-3336).

Take Ten: Men also need some time away from the breast cancer experience to exercise, go out for breakfast with a friend, or just watch television.

Kids Are People Too
Children react to their mother's diagnosis of breast cancer in many ways, depending on their age, gender, relationship with their parents, reaction of brothers and sisters, and how well they are coping with friends, school and other activities. Many young children get very upset and fear that their mothers may die. Other children think their parents are invulnerable and are not particularly upset by their mother's diagnosis. Some children are terrified by changes in their mother's physical appearance while others play dress up with her wigs and giggle at her bald head. All of these reactions are normal.

It's important to watch for signs of distress in children that shows they need help, such as acting out, withdrawal, excess crying, extreme irritability, refusal to attend school, and poor grades. Teachers should also be made aware of the situation at home. A study by Karen Greening, reported in the Journal of Psychosocial Oncology (1992), showed that most young children who have a parent with cancer have five needs: 1) A need for clear information on what is happening; 2) a need to be involved and to help out; 3) a need for realistic reassurance; 4) an opportunity to express their thoughts and feelings; 5) A need to keep up their normal interests and activities. Keeping those needs in mind can help a child deal with a parent's diagnosis in a healthy way.

Talking to Troubled Teens
Teens also react in a variety of ways to news of cancer. Gina, the 14-year-old daughter of a woman with breast cancer, rarely left her mother's side, while Gina's 16-year-old brother avoided his mother and refused to say anything in reaction to her diagnosis. Discussion of their mother's breasts embarrasses many boys, and they are likely to avoid their parents and spend more time with their friends (who they may not even tell about the cancer diagnosis). They may also withdraw and become quieter than usual. Other boys mature rapidly after their mother's diagnosis and become very helpful and protective.

Daughters may identify with their mothers and may also worry about getting breast cancer themselves one day. The best way to handle teens is to keep them informed, without providing too much detail. Give them lots of reassurance and support, don't pressure them to discuss their feelings until they're ready, and encourage them to keep up with friends and activities they enjoy. It's also helpful to give them a role in helping the family cope with cancer (i.e. helping their mother keep doctor's appointments, doing research), so that they feel like a valued and contributing member of the family.

The Family That Copes Together, Stays Together
Cancer does not occur in a vacuum. When Mary was diagnosed with breast cancer, her family was already dealing with a child with attention-deficit disorder and a grandmother with Alzheimer's disease. Overwhelmed by all their troubles, the family became immobilized and could not figure out what to do, which made it difficult for them to get the treatment that Mary needed.

The more stresses the family is already facing (financial difficulties, a child with behavioral problems, family conflict, another illness), the harder the family's ability will be to successfully cope with cancer. Coping with cancer can be especially trying for couples who have been recently married or who have young children and have not yet developed the personal resources they need to cope with cancer.

The good news: Most families do find a way to cope successfully with cancer. In fact, many couples become closer as a result of fighting cancer together. Sandra Haber, Ph.D, in Breast Cancer: A Psychological Treatment Manual (1993, Division of Independent Practice of the American Psychological Association), concluded that cancer pre-cipitated a divorce in only 7% of the marriages affected by it. Studies show it is usually people diagnosed with cancer who initiate talk of divorce in a marriage with long-standing difficulties, wanting life to be as rewarding as possible for their partner. Families can face the disease together by following these suggestions:

• Make time to talk, not only about cancer, but about other problems and triumphs in the family.
• Ask for help with the children, managing the home and other practical aspects of life that can get neglected.
• Try to maintain as normal a life as possible.
• Make time for enjoyment and relaxation and remember to express your love for each other.

Although breast cancer impacts the entire family, that impact can surprisingly lead to increased strength and closeness. Taking the time to listen, support and love each other and to accept different reactions, can go a long way toward helping the family triumph over breast cancer and lead fulfilling lives once more.