Breast Cancer on a Backdrop of Domestic Abuse

Breast cancer and domestic abuse share the month of October as their awareness month.

It  is not something we want to think about very much, if at all…women newly diagnosed with breast cancer who are already suffering in abusive and many times violent living  situations.  A survey of the literature turned up few studies on the subject with limited findings. However, the findings carry a message for all of us who come in contact with women in treatment for breast and other cancers. It is a simple but powerful message. If you suspect abuse, do whatever is in your power to intervene without jeopardizing a woman’ s access to treatment and her personal safety.

For the purposes of this post the term domestic abuse encompasses not only spousal, domestic partner and significant other abuse, but elder abuse and parent abuse of adult dependent children living with them.

I can still feel my frustration, anger and sadness, when, as a navigator, I would meet with women suffering from breast cancer and domestic abuse.

It was so wrenching to meet women, who even when well, could not extricate themselves from an abusive relationship. Knowing that now, when they needed support the most, they were most vulnerable. For many, breast cancer played second fiddle to the abuse in their lives. Almost all of these women had advanced breast cancers by the time they sought medical help.

Dr. S., Director of the Breast Clinic, asked me to meet with Mrs. Y and her physician husband.  Mrs. Y had just been told that the results of surgical biopsy indicating that she needed a mastectomy for a 4 cm malignant tumor in her right breast. Dr. S. was concerned, as Mrs. Y registered little emotion after being told and kept stealing glances at her husband who was asking all the questions. When we met, Mrs. Y kept her head hung low and Dr.Y negated all my attempts to offer the free services of the American Cancer Society (ACS) and its community partners, saying that services were not needed as he knew what was best for his wife. I kept directing my conversation to Mrs.Y, who would begin to answer me only to have her husband jump in and say, “You can tell me and I will decide if this is something I want her to have.” When I suggested that Mrs. Y might benefit from having a volunteer from Reach to Recovery, a breast cancer survivor, call her on a regular basis to offer support her husband responded by saying, “The volunteer can speak to me and I will tell my wife what I want her to know.” I assured Dr. that unless and until he got breast cancer that would not be possible  as the program was a survivor to survivor program. At first he objected, saying that he didn’t want his wife taking calls when he was home or talking on the phone when she needed to be caring for the children and their home. I assured Dr. that a volunteer could and would call during his work hours and the hours their children were in school.

Dr. S. Director of the Breast Clinic, requested that hospital Social Services follow up with Mrs.Y and alerted the chemotherapy staff to the situation, asking them to be vigilant. ACS  Reach to Recovery Program Director arranged for a volunteer to call during school hours and her husband’s work hours. The feedback on these calls…Mrs. Y welcomed the calls and they went on for months.

Missy was referred to me having come to the breast clinic for a pre-surgical exam  prior to her bilateral mastectomy. She came across as a meek, frightened woman who lived with and took care of her father.  Her father was with her. He complained loudly, to anyone who would listen, about how this surgery was going to effect him and his bad back. During our visit, Missy sat quietly with tears running down her face as her father asked if this surgery was really necessary; couldn’t the doctor just give her some medication and avoid surgery so she could continue taking care of him? He wanted to know if it were a same day surgery, would she be well enough to come home in the evening and cook his dinner.

The surgeon arranged for Missy to staying in the hospital for two nights despite her father’s protests. Social Services was called in to meet with Missy and explore ways of improving her living situation.  it was arranged that Missy’s received in-home care while she recuperated from surgery. ACS Reach to Recovery program arranged for a volunteer to call on a regular basis.  God’s Love We Deliver, a community meals program, delivered meals for Missy and a local  meals on wheels program delivered meals for her father.

Unfortunately, I encountered  many more situations where women were living a nightmare of breast cancer and domestic abuse.

Some were being physically as well as emotionally abused. Elderly women were being neglected by drug addicted children, wives were denied life-saving treatments, others were the object of a husband’s rage because they could not be productive during treatment.

I was always grateful for the support of American Cancer Society social workers and administrators in trying to help women living in these situations. I cannot say enough good things about the medical, nursing and social services staffs of the NYC hospitals where I navigated. Despite their  heavy patient loads, they remained watchful of their patients and offered interventions as needed.

This year, when October rolls around and the world goes pink, I hope there is a little purple along with the pink. We need to raise awareness about women who are living the double whammy of breast cancer and domestic abuse.