Fertility Considerations in Cancer Treatment
Natural Mood Boosters When you are Feeling Down
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Christin Harless, M.D., Mayo Foundation for Medical Education and Research, Premium Health News Service
DEAR MAYO CLINIC: My sister was just diagnosed with breast cancer and will have a double mastectomy. What types of reconstruction could she have, and when can the reconstruction be done? Are there any new reconstruction options that she should be aware of? I’ve heard about 3D tattooing. Is that an option?
ANSWER: Breast reconstruction is a procedure that restores the shape of your breast after mastectomy, which is an operation that removes your breast to treat or prevent breast cancer.
Breast reconstruction can be performed with either an implant — silicone devices filled with silicone gel or saline — or a patient’s own tissue. Most people who undergo mastectomy tend to choose implantbased breast reconstruction, with a smaller portion opting for flap, or autologous, reconstruction Breast reconstruction with flap surgery involves taking a section of tissue — skin, fat and occasionally muscle — from one area of your body, most often your abdomen, and relocating it to create a new breast mound.
Each method has its benefits and drawbacks. For example, implant-based breast reconstruction involves a shorter operation and recovery, whereas flap surgery is a longer, more complex operation with a longer recovery time. Also, implants are temporary and will require removal or replacement on average every 10 years. With flap surgery, typically, no further operations are necessary. Breast reconstruction starts at the time of mastectomy. A team of breast oncologic and plastic surgeons working together to devise the appropriate plan for your needs is essential.
Depending on the location of the tumor and the patient’s breast size, they may be a candidate for a nipple-sparing mastectomy, which allows for a more natural reconstruction appearance. A nipple-sparing mastectomy involves the removal of the breast tissue, but spares the skin, nipple and areola, also called the nipple-areolar complex.
If the tumor is abutting the nipple-areolar complex, the patient will need surgical removal of the nipple. Nipple reconstruction can be done with a 3D nippleareola tattoo with or without the creation of a raised area of skin to reconstruct a raised nipple. 3D nipple tattooing is highly encouraged for all patients who have required surgical excision of the nipple-areolar complex. Data shows patients are more satisfied with reconstruction and can move forward from their cancer journey when reconstruction of the nipple is performed.
In the past, breast reconstruction would not provide the same sensations as before mastectomy. However, breast resensation is the new frontier
within breast reconstruction. This is a new technique of breast nerve repair during breast reconstruction that can potentially restore feeling after a mastectomy. This can be done in one of two ways.
First, suppose the patient is a candidate for nipplesparing mastectomy and is approximately a C cup or less at the time of mastectomy. In that case, we can identify the nerves on the lateral chest and bridge the gap beneath the nipple-areolar complex with a nerve graft. The nerve will then regenerate through the graft, providing sensation to the nipple-areolar complex. While this can take up to two years, it should restore light touch to the breast and nipple-areolar complex, but it will not fully return premastectomy breast sensation.
The second approach is pursued if the patient is undergoing flap surgery. We can identify a nerve on the tissue from the abdomen and connect that via nerve graft to a nerve in the chest. This can be an option for patients who have already had a mastectomy — and possibly implant-based breast reconstruction — and desire more sensation.
Breast reconstruction is an excellent option for many patients. It can give you a breast contour, provide symmetry to your breasts under clothing and help you avoid the need for an external prosthesis inside your bra. Many patients find that their self-esteem and body image improve after reconstruction, and it helps to erase physical reminders of their cancer journey. However, before breast reconstruction surgery, consult a plastic surgeon who is board-certified and experienced in breast reconstruction following mastectomy. — Christin Harless, M.D., Plastic Surgery, Mayo Clinic, Rochester, Minnesota
Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. This Mayo Clinic Q&A represents inquiries this healthcare expert has received from patients. For more information, visit www.mayoclinic.org.
Alicia Ogle, OB-GYN nurse practitioner, and Jessica Bleess, Mayo Foundation for Medical Education and Research, Premium Health News Service
DEAR MAYO CLINIC: I’m a 28-year-old woman recently diagnosed with breast cancer. My care team recommends starting treatment as soon as possible. While I’m ready to do the necessary treatments, I’m worried about the effect it may have on my ability to have children in the future. Are there options that can help preserve my fertility during cancer treatment?
ANSWER: When a person is diagnosed with cancer, the focus is often on immediate treatment and recovery. However, it’s important to consider the long-term effects of cancer and its therapies on fertility. These treatments can significantly affect a person’s reproductive organs, potentially altering their ability to have children in the future.
Cancer and its treatments can cause changes in your body. For some people, cancer damages a part of the reproductive process and affects fertility. For others, the necessary cancer treatments interfere with fertility. The likelihood that cancer treatment will harm
your fertility depends on the type and stage of cancer, the cancer treatment method and your age at the time of treatment.
Cancers with a greater risk of affecting fertility include breast cancer, uterine cancer, cervical cancer, ovarian cancer, colon cancer, prostate cancer, testicular cancer, thyroid cancer and blood cancers like lymphomas.
Certain cancer treatments can harm your fertility. The effects might be temporary or permanent. Cancer treatment and its effects might include:
• Chemotherapy. This common cancer treatment targets and destroys active cells in the body. The ovaries and testicles, which are vital reproductive organs, contain many active cells and are susceptible to damage from chemotherapy. This damage can affect the ability to produce viable eggs or sperm after treatment. Future fertility
depends on the type, duration, dose of chemotherapy, and the patient’s age.
• Radiation. This therapy also can affect fertility, primarily when administered in the pelvic area at high doses In some cases, patients may opt for surgery to reposition the ovaries from the radiation field, reducing the risk of damage.
• Surgery. Fertility can be harmed by the surgical removal of the testicles, uterus, or ovaries.
• Other cancer medications. Hormone therapies used to treat certain cancers, including breast cancer, can affect fertility. But the effects are often reversible once treatment stops.
Fertility preservation options may be available for cancer patients before treatment begins.
• Freezing. For women, egg freezing or embryo freezing are standard practices. These involve hormonal stimulation with injections, egg retrieval, and then either cryopreserving eggs or fertilizing with sperm to preserve embryos.
• Cryopreservation. Another option is ovarian tissue cryopreservation, which removes and freezes part or all of an ovary. This is especially suitable for young girls who haven’t reached puberty or women needing to start treatment immediately. Men may consider sperm cryopreservation, while testicular tissue cryopreservation may be used for boys before puberty.
• Suppression. Ovarian suppression uses medications to temporarily shut down ovarian activity, potentially protecting ovaries from chemotherapy’s effects. This method is not proven but may be considered.
During cancer treatment, radiation shields can protect fertility by placing lead shields over the ovaries or testicles. Proton radiotherapy can also help preserve fertility by delivering targeted therapy and minimizing exposure to nearby organs and tissues.
The diagnosis of cancer and the treatment process can be overwhelming. However, you have options if you’re concerned about how cancer treatment might affect your fertility. Don’t wait. Talk with your care team about fertility preservation methods before you begin cancer treatment to help you make an informed choice. — By Alicia Ogle, OB-GYN nurse practitioner, Mayo Clinic Health System in Eau Claire, Wisconsin, and Jessica Bleess, Reproductive Endocrinology and Infertility physician assistant, Mayo Clinic in Rochester, Minnesota
Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. This Mayo Clinic Q&A represents inquiries this healthcare expert has received from patients. For more information, visit www. mayoclinic.org.
DEAR MAYO CLINIC: My husband and I want to expand our family and are trying to get pregnant with our first baby. I’ve read about family planning couples can do before conceiving and learned about carrier screening. We don’t have a family history of genetic conditions, but we want to know if there is a chance of passing a genetic disorder to our child. What is carrier screening? And how does it help couples with family planning?
ANSWER: When planning a family, you and your partner may choose to have genetic testing before having children to determine if you have a risk of passing on specific genetic disorders
Genetic testing is available to people who are pregnant or planning a pregnancy. Carrier screening is important in family planning as it helps identify genetic conditions that can be passed on to children. Based on your family history or pedigree, a genetic counselor can advise:
• What type of genetic screening to consider, and whether your insurance coverage will apply to the cost.
• What genetic testing may or may not determine.
• Your potential risk of passing genetic disorders onto your children.
People should consider genetic counseling and testing regardless of their family history of inherited conditions such as cystic fibrosis, spinal muscular atrophy, or muscular dystrophy. Approximately 80% of children who develop a genetic disorder have no family history of the condition.
People receive two copies of each gene in their body — one inherited from the mother and the other from the father. Carrier screening determines if a person carries a non-working copy of a gene associated with a specific genetic condition.
People with one working copy and one nonworking copy of a gene are referred to as a “carrier.” They are typically not affected by the condition themselves. This is because carriers have one copy of the gene that functions normally, providing them protection against the condition. Most people are carriers of at least one genetic condition, and some are carriers of more than one.
Autosomal recessive conditions, such as cystic fibrosis, occur when a person inherits two nonworking copies of a gene — one from each parent who are carriers.
If a person is identified as a carrier, then their partner, egg donor or sperm donor is offered the same testing.
If both biological parents are carriers of the same condition, there is a 25% chance that their child may inherit two nonworking copies of the gene and be affected by the condition. Approximately 2% to 3% of couples are carriers of the same condition.
Although certain genetic conditions may be individually rare, collectively they account for more than 10% of pediatric deaths.
While carrier screening can be done during pregnancy, it is especially beneficial for preconception planning. Couples are empowered to make informed decisions about family planning, taking into account their carrier status. Based on findings, some people may opt for alternative reproductive measures, such as in vitro fertilization (IVF).
Carrier testing may look for a single genetic condition based on family history. Expanded carrier screening looks for many genetic diseases not limited to family history or ethnic background.
Carrier screening is now more accessible and affordable than ever before. Couples can ask their care team for a referral to genetic counseling. Self-referral also is available. Genetic counseling appointments can be conducted virtually, with testing done through a blood draw or saliva test
After testing, the genetic counselor explains the results and what risks have been identified. The information is shared with the patient’s primary care clinician or OB-GYN.
Carrier screening is a valuable tool in family planning, offering couples vital information about their carrier status for up to 500 genetic conditions and the risk of passing those conditions on to their children. It helps people make informed reproductive decisions and allows for early intervention and treatment if necessary. — Rebecca Jirik, Genetic Counseling, Mayo Clinic Health System, Eau Claire, Wisconsin
Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. This Mayo Clinic Q&A represents inquiries this healthcare expert has received from patients. For more information, visit www.mayoclinic.org.
It’s no secret that exercise has a long list of health benefits, and doctors and fitness experts recommend that adults engage in some form of physical, aerobic activity every week. However,
it can be unclear how to pair your food and diet with your exercise routine. Should we eat before a workout? And if so, what should we be eating? Find out here.
Glucose is of the utmost importance when it comes to boosting your energy before you exercise, says registered dietitian Brenna Larson.
Eating a light meal or snack before exercise provides the body with glucose, which is the primary source of fuel for muscles during exercise...This helps to improve energy and endurance during workouts.
If you find yourself feeling sluggish during your workout, this could be a clear sign that you’re not fueling properly before exercise.
“Eating before exercise prevents feelings of hunger and fatigue that might distract you during your workout,” Larson shares. And keeping your blood sugar levels stable ensures you won’t crash during the workout, especially key for morning workouts.
How does eating impact your workout?
Fueling your body before exercise also prepares your body for a faster recovery, according to registered dietitian Shelby Love.
“Properly timed nutrition not only mitigates muscle protein
breakdown during the workout but also facilitates more efficient recovery, promoting increased muscle growth and repair post-exercise,” Love explains.
Timing is important when it comes to fueling for your workout. Love advises to aim for a full meal about two to three hours before your workout, in order to give your body enough time to digest, break down nutrients and convert it all into fuel. If you need a quicker boost, eating a small snack rich in carbohydrates about 30 to 60 minutes before exercising will give you enough energy. The key, she says, is to listen to your body and adjust the timing of your meals and snacks based on how you feel during your workouts.
Pre-workout foods should contain a mix of carbohydrates and protein, while also being easy to digest without gastrointestinal discomfort. Larson explains that carbohydrates help maintain blood sugar levels, while protein prevents muscle breakdown during your workout. The amino acids present in protein can aid in muscle repair and recovery.
There are plenty of simple options for a quick fuel before exercise:
• Banana or apple with peanut butter. Quickdigesting carbs from fruit + protein and healthy fats from peanut butter.
• Greek yogurt with a drizzle of honey. Protein + carbs from yogurt, with a quick energy boost from honey.
• Dried fruit and nut mix. Quick carbs from fruit + sustaining fats and proteins from nuts.
• Oatmeal with banana slices and a dash of cinnamon. Complex carbs for long-lasting energy, banana for glucose, cinnamon to stabilize blood sugar.
• Smoothie with berries, banana and nut butter. Easy to digest, customizable, quick energy from fruit + protein from nut butter.
Real Simple magazine provides smart, realistic solutions to everyday challenges. Online at www.realsimple.com
DEAR MAYO CLINIC: I was recently diagnosed with cancer. Are there specific foods I should be eating or avoiding?
ANSWER: It’s not about any one food, and it’s not about one diet; it’s about a dietary pattern The dietary pattern that organizations such as the American Institute for Cancer Research and the American Cancer Society recommend is a whole-food, plant-predominant diet. The whole food component is very important to emphasize — eating foods as close to nature as possible is key, not ones made in a factory. Aim to arrange half of your plate with colorful vegetables and fruits, a quarter from whole grains, and the rest from healthy protein sources, especially plantbased.
The average American consumes at least 63% ultra-processed foods. Ultra-processed foods are factory-manufactured, packaged foods — frozen pizza, microwave meals, chips, pastries, cupcakes, muffins, processed meat, sugar-sweetened beverages, etc. These foods often have ingredients hard to pronounce. Studies show consumption of ultra-processed food is linked directly to premature mortality. Countries that eat fewer ultra-processed foods show that they not only increase the risk of cancer, but after a cancer diagnosis, these foods also increase the risk of mortality. Choosing ultra-processed foods means losing nutrient-dense foods rich in vitamins, minerals, phytonutrients, and fiber that help fight cancer and keep it away.
Processed meat is categorized as a Group 1 carcinogen by the World Health Organization Think hot dogs, sausage, pepperoni, bacon, deli meat, chicken nuggets. For people who eat processed meat, it is best to eliminate it. Instead, protein sources such as tofu, edamame, tempeh, fish, poultry, and pulses should be eaten more often than red meat.
What are pulses? Pulses are edible seeds from a legume plant. They include lentils, peas, beans (black, pinto, kidney, chickpeas, etc.). Eating pulses and soy not only replaces animal protein, but also provides fiber. In the U.S., there is not a protein deficiency but rather a fiber deficiency. Soy foods are safe for all cancer patients and are an excellent source of plant protein. Studies show soy may improve survival after breast cancer.
Fiber is an essential nutrient, but only 5% of Americans get enough. A recent meta-analysis from the American Institute for Cancer Research Global Cancer Update Program showed that for every 10gram increase in fiber, survival after breast cancer diagnosis improved by 13%. Benefits of fiber include improved cholesterol, blood sugar regulation, gut health, digestion, and weight control. Additionally, nuts and seeds provide healthy fatty acids, fiber, and protein. But they are caloriedense, so be mindful of serving sizes.
Aim to cut out ultra-processed foods and consume mainly whole, plant-predominant foods:
• A wide variety of colorful vegetables and whole fruit (not fruit juice).
• Whole grains such as steel cut oats, quinoa, brown rice, barley.
• Proteins from nonanimal sources.
• Foods not made in a factory.
• Drink water, not sugar-sweetened beverages.
You can have a role in your cancer journey when you think of food as medicine — and that’s exciting and empowering. — Dawn Mussallem, D.O., Integrative Medicine and Health, Mayo Clinic, Jacksonville, Florida
Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. This Mayo Clinic Q&A represents inquiries this healthcare expert has received from patients. For more information, visit www.mayoclinic.org
What are some natural ways to help boost your mood and energy when you feel stressed and worn out?
like painting, art, learning to play an instrument, or a new language can be a mood booster, as they provide a sense of accomplishment.
Practice gratitude. Identifying and writing down things you are grateful for can help offset anxiety or stress. Begin a journal to record examples of gratitude — from big-picture items (your ability to exercise, close friends) to small satisfying moments (a friendly exchange at a store). Provide details about why you are thankful and how it improves your outlook. You don’t have to write daily — even once a week can be helpful.
Lend a helping hand. You can reap emotional rewards through volunteering. A study of older adults found that people who volunteered at least two hours per week felt happier and more optimistic than those who didn’t. Volunteering can also boost self-esteem by providing a sense of purpose.
Make time to meditate. Practicing meditation can help you reduce stress by focusing on the present moment instead of ruminating on the past or future.
When to seek help. If your symptoms last for two weeks or longer or begin to interfere with daily life — for example, poor sleep, isolation, or losing interest in activities — you may be in the early stages of mild or moderate depression and should talk with your doctor.
visit www.health.harvard.edu
Jill Christensen, Mayo Foundation for Medical Education and Research, Premium Health News Service
I recently turned 45 and have been dealing with anxiety for several years. My feelings of worry, stress and fatigue have increased, leading me to avoid social events and limit activities I used to enjoy. My friend suggested I try something she called mindfulness meditation to help manage my anxiety. What is this technique, and how can I start doing it?
Anxiety is often described as sustained and excessive worry that a person cannot control related to the anticipation of a future threat, such as a traumatic event. At times, anxiety can significantly and adversely affect our daily lives, work, relationships and overall happiness. Anxiety also can manifest as an irritable, worried, restless and debilitating stress response lasting minutes to days. Most everyone has had anxiety surrounding a stressful situation.
Anxiety becomes an obstacle when it affects our day-to-day lives. Anxiety can negatively affect people at home, work, school and socially.
Emotionally, anxiety can appear as excessive worry, fatigue, irritability, panic attacks, paranoia, poor concentration, restlessness, or sleep disturbances. Left untreated, it can increase risk for depression, even suicide.
Physically, anxiety can appear as chest pain, diarrhea,
headache, increased heart rate, muscle aches, shaking, shortness of breath, or sweating.
Left unchecked, anxiety can further strain mental health, increasing the risk for poor communication and poor decision-making.
And for many people, anxiety is isolating, because people do not want to participate in normal activities. Anxiety can affect your willingness to take new steps or adventures in life due to fear.
People have many different approaches for coping with anxiety. Mindfulness meditation is a technique where you focus on being intensely aware of what you see and feel in the moment, without interpretation or judgment. Practicing this type of mindfulness involves breathing methods, guided imagery, and other practices to relax the body and mind to help reduce stress.
Recent research shows mindfulness meditation may be as effective as medication at reducing anxiety for some people.
Try this exercise the next time your mind is stuck on the worry setting. Sit quietly. Look around you and notice:
• 5 things you can see: Your hands, the sky, a plant on your colleague’s desk.
• 4 things you can physically feel: Your feet on the ground, a ball, your friend’s hand.
• 3 things you can hear: The wind blowing, children’s laughter, your breath.
• 2 things you can smell: Fresh-cut grass, coffee, soap.
• 1 thing you can taste: A mint, gum, the fresh air.
• This exercise helps you shift your focus to your surroundings in the present moment and away from what is causing anxiety. It can help interrupt unhealthy thought patterns.
In addition to mindfulness meditation, there are many tactics you can try to combat anxiety, including:
• Behavioral therapy
• Deep breathing
• Exercise
• Journaling
• Meditation
• Reading
• Socializing
• Speaking with your health care professional
• Spirituality
• Thought reframing
Try different things to see what works best for you.
A person with anxiety can seek support from a therapist, medical professional, family member, friend, community support person, crisis line resource, or a crisis center. Depending on severity, a behavioral therapy plan, anti-anxiety medication, and coping mechanisms may be recommended.
Regardless, it’s recommended you speak to a health care specialist if any of these situations occur:
• Your anxiety becomes an obstacle — difficulties in everyday living, often lasting six or more months.
• Your anxiety negatively influences relationships, creating barriers in life.
• Your anxiety leads to isolation — producing thoughts of hopelessness or helplessness.
• Your anxiety controls your life — when your emotional or physical response to excessive worry dominates daily functioning.
Recognition of anxiety is a key factor in dealing with excessive worry and moving forward in life. If you have any of the above symptoms or difficulty controlling worry, ask yourself if it could be anxiety. It’s important to share concerns with your health care team so they can help you identify ways to address anxiety and move past the adverse effects. — Jill Christensen, Family Medicine nurse practitioner, Mayo Clinic Health System, Waterville, Minnesota
Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. This Mayo Clinic Q&A represents inquiries this healthcare expert has received from patients. For more information, visit www.mayoclinic.org
DEAR MAYO CLINIC: I’ve always been a high achiever, both personally and professionally. But I struggle with a whirlwind of worries and thoughts, constantly second-guessing myself and pushing for perfection. I’ve heard the term “high-functioning anxiety,” and I feel like it is what I’m experiencing. How can I navigate and cope with this?
ANSWER: It’s normal to feel anxious sometimes, especially in stressful situations. However, for some people, excessive and ongoing anxiety can be a challenge to control and interferes with daily activities.
Linda Hubbard, Mayo Foundation for Medical Education and Research, Premium Health News Service
There are several types of anxiety disorders. The term “high-functioning anxiety” represents people with anxiety symptoms while maintaining a high level of functionality in various aspects of their lives. Often, they are successful in careers or other roles, yet internally struggle with persistent feelings of stress, self-doubt, and the fear of not measuring up. They feel extremely uncomfortable inside and struggle with significant self-criticism.
High-functioning anxiety isn’t recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM) but instead is a subset of generalized anxiety. Many emotional and physical symptoms are associated with
generalized anxiety disorder. The symptoms of high-functioning anxiety mirror many of these, but some may be more prominent.
Some symptoms of generalized anxiety disorder include overall nervousness and worry. Other symptoms that may point to high-functioning anxiety include internal struggles with:
• Fears of criticism or significant self-criticism
• Fears of looking inadequate or foolish to others
• Feeling on edge or on the verge of losing control
• Restlessness
• Sense of impending doom
• Significant stress
It’s important that you meet with a mental health professional to talk about your symptoms
and obtain an accurate diagnosis. Then, if it is determined that you have high-functioning anxiety, you can develop a care plan for the best quality of life.
Counseling and therapy play crucial roles in helping people with high-functioning anxiety manage symptoms effectively. Cognitive behavioral therapy (CBT) can help you reframe your thoughts about life and transform behaviors that may feed anxiety. Instead of being self-critical and looking for what could go wrong, you can learn to manage your thoughts, seek solutions, and guide yourself through anxious feelings.
In addition to therapy, other coping strategies to ease symptoms include:
• Creating a support network. People with high-functioning anxiety may believe they must deal with their behaviors alone. A
positive support network can help ease symptoms.
• Establishing healthy boundaries. Learn to say “no” to avoid overextending, and also embrace saying “yes” to opportunities that push comfort levels and build fulfillment.
• Forgetting comparisons. Comparison robs joy and contentment.
• Identifying core values. Instead of chasing society-defined success (job, car, house, possessions), work with a therapist to uncover what’s truly important and align with personal values.
• Learning to accept criticism. Instead of becoming defensive, learn to evaluate feedback neutrally with the help of a therapist.
• Practicing mindfulness. Focus purposefully on the present moment to increase calm and peace.
Medications can help some people with high-functioning anxiety, but should only be used with other coping strategies and under the care of a healthcare professional.
Talk with your healthcare team about how you are feeling. They can connect you to a skilled mental health counselor or therapist and assist with coping strategies to manage your anxiety and lead a fulfilling life. — Linda Hubbard, Psychotherapy, Mayo Clinic Health System, Eau Claire, Wisconsin
Mayo Clinic Q & A is an educational resource and doesn’t replace regular medical care. This Mayo Clinic Q&A represents inquiries this healthcare expert has received from patients. For more information, visit www.mayoclinic. org
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