Sam Bertenthal met his wife Anne Humphreys at a road race in 1986 -- he was dressed in an eighties-style running suit, beer in hand; she was long-legged and ready to run. They married in 1989, and settled into life in Pittsburgh. He worked at his family's business supplying cleaning supplies, she found a career path as a project manager at Carnegie Mellon and an adjunct professor in the English department.

Lake Fong, Post-Gazette Anne Humphreys' diagnosis of breast cancer changed the dynamics of her relationship with her husband, Sam Bertenthal. But both say it has brought them closer. Click photo for larger image. Race for the Cure    Komen Race for the Cure, May 8, Schenley Park, 8:35 a.m. start for the 5K run, 8:45 a.m. start for the 5K walk and 1-mile fun run. Early registration $20 for adults, $15 for survivors, $10 for those 18 and under. Register online at www.pittsburghraceforthecure.org by April 25. You can also download a mail-in application. Race day registration opens at 6:30 a.m.; $30 for adults, $25 for survivors and $20 for those under 18. For more information call 412 521-CURE (2873) or send e-mail info@pittsburghraceforthecure.org.

But when Humphreys, now 41, was diagnosed with cancer in 1999, their easy lives were disrupted. It was more than just the chemo, the nausea, the mastectomy.

On the day she called him with the news that her mammogram showed an abnormality, he ate lunch with his parents and returned to work, convinced that his young, healthy wife couldn't be sick.

He was concerned about her first round of chemo treatments, but knew she'd be fine in the hands of her mother and social worker. He went to the office.

When she was vomiting, sick from the chemo treatments, and needed him to run to the drugstore for some anti-nausea medications, he asked for her insurance card so he could get a discount. If she hadn't been so sick, she would have wrung his neck.

Bertenthal, 46, is by no means a bad husband. In fact, throughout his wife's cancer treatment, he has been a supportive partner. But he's learned how tough cancer can be on the emotional health of both patients and spouses, and that few spouses know how to deal with watching a loved one face off against a life-threatening disease.

Like Bertenthal, some spouses go through denial, others experience depression, bargaining and anger on the way to eventual acceptance that they play an essential role in helping their partners beat a terrifying disease.

The journey can be especially challenging for spouses of breast cancer patients, who are usually men. Many husbands must adjust to being a caregiver, something that can be especially difficult if they are shouldering a lot of responsibility without an outlet to talk about it.

Breast cancer husbands have been receiving more attention recently, from the book of the same name by journalist Marc Silver that helps husbands weather treatment and diagnosis, to a $1.1 million grant from the Centers for Disease Control and Prevention to Men Against Breast Cancer, an organization that supports men who are helping a family member or close friend get through the disease.

"There's a lot of support out there for women with breast cancer," said Judy Knapp, an oncology social worker at Magee Women's Hospital. "For the partner watching this, there can be an isolation that they feel as well, because everything is focused on the disease."

Many family members have an extremely difficult time when first hearing the breast cancer diagnosis, and think about death more than survival. Often men do not feel comfortable sharing such thoughts with their spouses; they feel they need to be supportive rather than negative.

"Death is usually the first place people go -- it's only natural that it's the first place husbands go," said Kathy Purcell, a social worker at Magee who works with breast cancer patients. "They think about plans they had made together, or about their children."

Even after diagnosis, there are horror stories about men's inability to cope with sick wives: the man who killed himself after learning of his wife's diagnosis, the man who ran away with another woman rather than face the sickness, the man who became angry with his wife for daring to be sick.

For many men, being a caregiver is a foreign role. Counselors stress that a husband should not be afraid to also seek treatment as his wife goes through hers.

"The husband needs to get help if he's not dealing with it, or distancing himself a lot," said Laurel Northouse, a professor of nursing at the University of Michigan who has studied the impact of cancer on families. "But we don't see that happening a lot. Cancer does not break couples up."

Two-part healing

While most research focuses on how cancer's toll on patients and improving their prognosis, Northouse has studied how cancer impacts couples.

"Cancer has both a physical and an emotional side, we often look only at the physical side," said Northouse. "If you look at the emotional side, you can see the importance of helping both."

Northouse has found that a patient's prognosis is affected by how her partner copes with cancer. If a wife is doing well in treatment, then a husband is usually coping well. If a husband acts upbeat and is supportive, a wife will often handle the treatments better.

Sam Bertenthal was scolded into dealing with his wife's cancer. She came home from a treatment and was feeling ill, and he acted down and mopey. She was sick of putting on a happy face.

"I shouldn't have to be the cheerleader here," she told him. "You're the cheerleader. You're the one who is supposed to be cheering me on."

"I'm going to be fine, I'm just going to have days when I don't feel well because of the treatment but I can't have you moping around on those days."

Those words were enough. He focused. But he made sure to find ways to take some time for himself to work through the emotional roller coaster. Always an avid runner, Bertenthal continued his exercise regimen every morning, rising before his wife to run for a few hours, or at the very least, take their dogs for a jog or walk.

"It helps me to put my thoughts together and stay relaxed," he said.

Spouses also need someone to talk to.

Some men find support groups or online chat rooms helpful places to share their grief. While there are few support groups for husbands of breast cancer patients, the national organization, Men Against Breast Cancer, can partner husbands with other local family members of cancer patients to provide support.

Many men seek to end their isolation by throwing themselves into hero mode -- researching ways to treat the cancer, getting second and third opinions.

"Guys feel that they can 'fix' cancer," wrote Silver. "We want to pull out a six-shooter and start firing away."

But this fix-it mode can be harmful, says Bonnie Shields, director of support services at the Burger King Cancer Caring Center in Bloomfield, especially since many husbands find there's not much they can do. Husbands may spend so much time searching for treatments and doctors and running errands that they avoid coping with the diagnosis.

Some of the toughest times come if the cancer returns. After putting all their energy into beating cancer a first time, couples find that the second time around can be more stressful and discouraging, said social worker Knapp.

Treatments can take their toll on spouses as well, said Victor Vogel, professor of medicine and epidemiology at the University of Pittsburgh.

"A good, caring husband is going to suffer a little bit," he said. "All the things we do, the poking with the needles, all the blood tests -- it's hard for anybody to see all of these things done to somebody we care about."

On the positive side, some couples know how to behave the second time around. And even if the cancer does not return, many relationships are made stronger.

After Anne Humphreys beat her cancer for the first time, she started a Web site, www.fightingspirit.org, to engage survivors in discussion. Bertenthal posted an essay on the site that talked about his experience "Surviving with the Survivor." He wrote about adjusting to having one-breasted wife, about the mistakes he made along the way, and how the cancer brought them closer.

Last summer, Humphreys discovered that her cancer had returned. And so began the treatments and chemo, the nausea and stress and moments of wondering if they could beat it once again.

But she and Bertenthal say that this time, they appreciate each other more, and have learned to work together in a way they hadn't before the cancer.

"I'm not Saint Sam and I haven't done perfectly, but I've tried to do the best I can," he said. The cancer "has helped bring us together . . . the adversity has helped to bond us a lot closer."