Q&A with Cindy Papale, Author of "The Empty Cup Runneth Over"

by Jennifer Minar-Jaynes

Having survived a July, 2000 diagnosis of a stage I, left multi-focal invasive breast cancer, Cindy Papale decided to embark on writing a book to educate young women and men on the many facets of her often misunderstood disease. Within The Empty Cup Runneth Over (Dorrance Publishing Company, 2008), Papale chronicles her journey from diagnosis, treatment and beyond—discussing the many hurdles she faced and the lessons she learned along the way.

What’s more--within the book--she and co-author Sabrina Hernandez, collaborate with a brilliant group of specialists who contribute special chapters that provide much professional insight into this illness, further demystifying a disease in which most Americans know little.

We recently had the pleasure of speaking with Papale. Here’s what she told us.

What was the most difficult part of being diagnosed with breast cancer?

The most difficult part of being diagnosed with breast cancer for me was losing my breast. I wondered how my husband at the time would react to my having one breast (I had the other removed 3 months later).

Most men are visual and breasts are definitely a part of a woman's body they look at first. The biggest challenge for me now after my divorce is whether someone will love me after having had breast cancer, which I discuss in the last chapter of my book.

Dating is very difficult because during your first date do you let him know you had breast cancer or tell him later on in the relationship if it continues. This is hard for me because when you meet for the first time you talk about what you do for a living, etc. my book always comes up, and then the big question they ask is "are you a survivor?"

Then, surprise -- there is no second date. How I deal with this is if a guy just wants me for my breasts then he is not worth getting to know. However, I do understand at times some men just cannot handle knowing a women had breast cancer for fear of losing them if their cancer returns.

What are some of the most common misconceptions you think women have about breast cancer?

Below are ten myths from www.breastcancer.org, one of the many resources referenced in my book.

1) That breast cancer only affects older women.

2) If you have a risk factor for breast cancer, you're likely to get the disease.

3) If breast cancer doesn't run in your family you won't get it.

4) Only your mother's family history of breast cancer affects your risk.

5) Using antiperspirants causes breast cancer.

6) Birth control pills cause breast cancer.

7) Eating high-fat foods causes breast cancer.

8) A monthly breast self-exam is the best way to diagnose breast cancer.

9) I'm at high risk for breast cancer and there's nothing I can do about it.

10) A breast cancer diagnosis is an automatic death sentence.

How prevalent is breast cancer in younger women?

One in thirteen women in the nation will develop breast cancer. As per the American Cancer Society Facts & Figures 2007-2008, the five-year survival rate is slightly lower among women diagnosed with breast cancer before age 40 (82%) compared to women diagnosed at ages 40 and older (89%).

Tumors diagnosed in younger women may be more aggressive and less responsive to treatment.

What are the signs to look for?

Swelling of part of the breast, nipple pain or nipple turning inward, redness or scaliness of the nipple or breast skin, nipple discharge other than breast milk, or a lump under the arm. Breast cancer lumps vary and may be hard or soft. It is important to note that any of these signs or symptoms do NOT necessarily mean that you have breast cancer. However, you should see a physician to have them checked.

How long did it take you to write this book? Also, please explain the writing process.

Well, this is a great question and one many ask me. It took me a total of five years to write The Empty Cup Runneth Over. I did not want to rush writing this book because I knew that it was very important to give up-to-date information. Medical research is ongoing and as a matter of fact while I was writing the chapter on ultrasound and mammography the next thing I knew digital mammography was developed. While not all institutions use them, and it is not the only method of diagnosing breast cancer, I still needed to write about it.

Lots of research, interviewing, transcribing interviews with women who shared their stories, and speaking to high school and college students all took time and a huge part in my writing this book.

The writing process was not easy. I had writers block at times, distractions with personal family issues, getting in touch with people I needed to interview, selecting the best physicians to contribute important chapters for my book. As many of them see patients and do surgery weekly, this was a challenge and frustrating time for me. Also, finding young women to share their stories was not an easy task. Luckily, many of the physicians had young women interested in sharing their stories to help others battling the same disease. Not every woman wants to talk openly about their breast cancer.

Also, choosing chapters based off of what the young wanted and needed to know was another challenge for me. I feel it is important when writing for the young -- or anyone for that matter -- to have the most up-to-date information available.

Once the book was complete came the real challenge. Writing a proposal letter and to find a publishing company to publish my book. I must have sent out over six proposal letters, and that really is not a lot compared to what others send out. Rejection, you bet I got many of those. Rejection is really hard to take but you have to be tough.

More specifically, what was it like writing with a co-author?

Writing [with] and selecting a co-author is very important. You both need to be on the same page and you should encourage each other especially when one is overwhelmed, which does happen. It is important for a co-author to be just as committed and understands what you would like to accomplish writing your book.

My co-author [Sabrina Hernandez] had lots of juggling to do. She had her own private practice, her business to run, and taking care of her son and husband. Talk about juggling, she truly is amazing. When we first spoke I told her that I read a quote once by Wentworth Dillon who said choose a co-author as you would choose a friend. After meeting several times to discuss The Empty Cup Runneth Over, we knew we would make a great team together.

What's the first advice you would give a woman who has just been diagnosed by breast cancer?

That there are many treatment options, to choose a physician she is comfortable with, be proactive, and that it is not the end of her life but the beginning of a new one, which will make her stronger and empower her more.

If you could impart just one thing to your readers, what would it be?

As I mention in The Empty Cup Runneth Over, having the upper hand: being educated about breast cancer, performing self breast examination, and being proactive is critical for early diagnosis.

Where can we find The Empty Cup Runneth Over?

Through Dorrance Publishing Company at http://www.dorrancebookstore.com/emcupruovana.html.

I understand you give lectures to young women and men on breast cancer awareness. Do you have an event schedule online?

There is a schedule of our upcoming events listed on our web site at http://www.theemptycuprunnethover.com.

Author's note: I would like to encourage all women who discover any abnormality in their breast to discuss any changes or pain with their physician. Education and being proactive is important, and The Empty Cup Runneth Over will help promote a better understanding of the many issues involved in dealing with breast cancer.