Breast Cancer Awareness • 7A
www.crossville-chronicle.com • Friday, October 9, 2015
Early intervention can make a difference in cancer treatment By Missy Wattenbarger Chronicle lifestyles editor
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On the morning of Sept. 29, Sheila Long walked out of a local cancer center a little drained, but full of optimism. She had just finished her last round of radiation, marking the end of a brief but frightening journey with breast cancer. “Oh, praise the Lord!” she said. “It’s been good, but you have a loss of energy, and that’s the big thing with radiation. After a few treatments, in the afternoon, you just go down hill and don’t have a lot of energy.” Long, who is 54 years old and has no family history of breast cancer, stays busy Monday through Saturday at Simonton’s Cheese and Gourmet House, 2278 Hwy. 127. Since 1994, she has spent her time handling the daily operations of the business, which she owns with her husband, Jim. Although the radiation sapped her energy, Long pushed through, counting her blessings that surgery and radiation were the only remedies needed to rid the cancer from her body. “They say it’ll take about six weeks or so before the radiation is out of my body, and once that’s all out of there, my energy should start to increase, at least I hope,” she said. Long’s cancer story begins with a missed mammogram, which is something she doesn’t recommend doing because it can make a difference in the type of treatment prescribed. Although it’s recommended for women to get annual mammograms starting at age 40, Long admitted she would skip a year or so between them. “And I had put off this one,” she said. “I should had went in like March or April, and things kept coming up and I kept putting it off. Then they called my mom [Selma Davis] because we went together last year and got our mammograms done at the [Knoxville Comprehensive Breast] Center to find out why I hadn’t been.” After some prompting from her mother, Long finally got around to getting a mammogram on June 3. The center also conducted an ultrasound as a precaution since her breast tissue is dense. This marked the second time that Long had to undergo additional imaging. “When I went back this year, I had my mammogram and it was fine. It came back fine. She did an ultrasound and that’s when she found a spot,” Long said. “They did a biopsy that day and I knew the next day that I had cancer,” she added. Long had to go back for a few MRIs, which picked up more spots. The biopsies of those, however, contained no cancer. By the end of the month, she was scheduled for surgery. Long was very concerned as it was her first surgery. She listed a great family and church family and “lots of prayers” for helping her get through it. “You can never have too many of them,” she said. On June 22, Long underwent a lumpectomy, which removed the cancerous spot, and some lymph nodes were removed as well
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Sheila Long, who recently finished radiation treatment for breast cancer, is looking forward to getting her energy back as her business, Simonton’s Cheese and Gourmet House, heads into its busiest season. as a precaution. Her doctor suggested she undergo 37 rounds of radiation as part of her recovery, but Long was reluctant. Because the surgery was a success and the lymph nodes showed no trace of cancer, she thought she would be fine without it. “My doctor advised me that doing the radiation with the lumpectomy was like doing a mastectomy. Your odds of it reoccurring is just about nothing, like three precent I think,” she explained. She pointed out that a test exists, called the Oncotype DX, that can analyze a
patient’s cancer tissue to see how it is likely to behave and respond to treatment. One of the other benefits of the test, which studies the activity of a specific group of genes, is that it also provides information about how likely (or unlikely) the breast cancer will come back. “They did a test to see… I think mine came back eight percent. So real low,” she said. Long opted to go to Cumberland Medical Center’s Regional Breast Center for radiation. She would arrive at the cancer center
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around 7:30 a.m. to receive her treatment, which would last about 10 minutes. Then she would head to work. She considers herself lucky that was her only commitment after surgery to keep cancer at bay. “It’s brutal,” she said about chemotherapy. “I have a friend who went through breast cancer and had a double mastectomy [and] See early page 9A
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8A • Breast Cancer Awareness
www.crossville-chronicle.com • Friday, October 9, 2015
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Breast Cancer Awareness • 9A
www.crossville-chronicle.com • Friday, October 9, 2015
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Tennessee Breast and Cervical program offers access to care By Heather Mullinix Chronicle assistant editor
Access to medical care can be difficult for women who are uninsured or under-insured, but there are programs available to help women get screening mammograms, diagnostic services and treatment. “This program is about prevention,” explained Candace Vaden, Cumberland County Health Department’s coordinator for the Tennessee Breast and Cervical screening program. “It would be surprising how many women we schedule their mammogram in their 50s and it is their first mammogram. We try to target women who haven’t had access to mammograms on an annual basis.” The program, offered through the Cumberland County Health Department, offers eligible women clinical breast exams, mammograms and pap tests. To get a free breast cancer screening, women should meet income guidelines and not have insurance, or insurance will not pay for the service; be 50 to 64 years of age; or be age 40 to 49 with a family history of breast cancer that includes a mother, daughter or sister, a personal history of breast can-
EARLY
• Continued from 7A had to take chemo afterwards. She went back and did the [breast] reconstruction and was doing great, but they found other places like a valve blockage and she’s going through chemo again. She’s been doing this going on three years and she’s just worn out. “That’s one reason I was anxious to get everything done. She had missed a mammogram and she has a family history… and she was having some issues and she waited too long and had so many problems,” Long continued. Long believes the key to her success and lack of major surgery or further treatment was early detection, and her advice to everyone is to be faithful about getting exams done and following up on the “least little thing to go wrong.” Although Long has thought back and wondered if the spot would have been
cer or a clinical breast exam result that is abnormal. Pap testing for cervical cancer is available free of charge if women meet income guidelines, do not have insurance and are age 40 to 64. Women age 18 to 39 who need further diagnostic services following an abnormal pap test are also eligible for services. Services are available on a sliding scale fee for those below age 40. Vaden works closely with Cumberland Medical Center’s Nurse Navigator Trish Vaughn, who works with women who have had a free mammogram through a program of the hospital. When an uninsured patient has a screening mammogram that finds a need for additional testing and exploration, the thought of how to pay for those services can cause additional stress. “We start where women who are uninsured and have that free screening mammogram find they need further intervention,” said Vaden. “Trish and I talk daily to coordinate care as a team. It’s really a collaboration between CMC, Covenant, physician’s offices and us.” Programs are offered that assist women with get-
ting a screening mammogram at no cost, through grants from Susan G. Komen of the Upper Cumberland, which also provides funding to Tennessee Breast and Cervical Program, and other organizations such as the Thompson Cancer Survival Center’s outreach services. “We will usually cover all diagnostic imaging and also any surgical consults they need to discuss breast biopsy,” Vaden said. The program is able to offer cover costs for breast biopsy so long as general anesthesia is not required for the procedure. Should a surgeon recommend an excisional breast biopsy, which is done under general anesthesia, patients can then be enrolled in TennCare. Then, if pathology confirms the presence of breast cancer from a breast biopsy, patients can be enrolled in TennCare, Tennessee’s expanded Medicaid program. Women must be uninsured and meet income guidelines. They also must follow a treatment plan. Patients are referred to an oncologist who will fill out the treatment plan specific for the patient that includes plans for surgery, chemotherapy, radiation therapy,
detectable in March, she is thankful that she did not put off her screenings any longer than she did. “They caught it early, and that’s the blessing of doing it every year and having someone who’s watch-
ing for something like that,” she said.
hormonal therapy or other treatments. “Once they have been enrolled in TennCare, they have it for the duration, unless they have a change in their financial situation or they decide not to pursue treatment,” Vaden explained. TennCare enrollment can help alleviate other barriers to treatment patients may have, such as transportation, because the program does offer coverage of transportation for treatments. For more information, contact the Cumberland County Health Department at (931) 484-6196. n Heather Mullinix may be reached at hmullinix@ crossville-chronicle.com.
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10A • Breast Cancer Awareness
www.crossville-chronicle.com • Friday, October 9, 2015
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Komen CEO sets priorities for research, metastatic disease and health equity Investing in early career scientists, increasing focus on metastatic breast cancer and improving health equity across the country are the top priorities of Susan G. Komen for the Cure CEO Judith Salerno, MD. “I hope, as the leading breast cancer organization, we can step up and make a difference,” Salerno said Oct. 5 at the Impact on Breast Cancer Research and Clinical Care seminar presented by the VanderbiltIngram Cancer Center and Susan G. Komen Greater Nashville. Komen has set aside about 50 percent of its 2015 grant awards for early career scientists. “There are a lot of blind alleys, but there are a lot of serendipitous findings, too,” Salerno said. “We have to go where the science leads us. That’s how we make advances.” Komen awards three types of research grants that can help bridge the funding gap recently graduated researchers and faculty may face as they start their breast cancer research: career catalyst research grants, postdoctoral fellowship grants and graduate training in disparities research. “You have a home in breast cancer research and we want to make sure you’re supported,” Salerno said. “I believe continuity in breast cancer research is critical to success.” Komen has funded more than $11 million in research grants for projects at Vanderbilt University, with the organization having invested more than $889 mil-
lion in research since it was formed in 1982. The 2015 research grants portfolio spans the cancer continuum from prevention to treatments for aggressive and metastatic disease. “We know that we have to help fill that gap,” Salerno said of the federal funding. “But we can’t do it alone.” Grant applications are evaluated by a panel of three scientists and a patient advocate. Salerno said, “We received hundreds of applications with good science from good scientists, but there are only so many we can fund.” Research is fundamental to Komen’s mission to end breast cancer forever, but that mission also includes community advocacy and public policy work. “Eighty cents of every single dollar goes to our mission program,” Salerno said. Local Komen affiliates, including the Upper Cumberland Susan G. Komen affiliate, keep 75 cents of every dollar raised in the community to support grants that offer an array of services such as screening mammograms for under-insured or un-insured patients, diagnostic testing, survivor support programs and support of nurse navigators at area hospitals. The remaining 25 cents is used only for national research grants. Since 1982, Komen has spent $1.95 billion in nonresearch services. “It’s because of the work people do in communities
that we see the impact of those funds and what the needs are,” Salerno said. “That’s what makes our organization, built on grassroots, so powerful.” That community involvement has shown there are disparities in health care for people among the general population and underserved communities, those who are under-insured or un-insured or those who have poor access to health care. For example, in Tennessee, African American women have a higher mortality rate from breast cancer than their white counterparts with the same stage disease. Nationally, the disparity is 44 percent. “While we know that we’re making great strides, we’re not there yet,” Salerno said. “But we know from the work that we’ve done that we can make a difference. In Chicago, through a program we funded, we’ve reduced the disparity gap by 34 percent in six years. That’s real lives saved.” Reasons for the disparity in health outcomes are complicated, Salerno said, pointing to issues of genetics, socio-economics, cultural issues and more. Further, each community’s issues will be unique. Salerno has launched a national health equity initiative that will include roundtable discussions with community leaders in the ten cities identified with the highest rate of disparity. Memphis, TN, leads the list. “We know that there are many folks who need services that will change those disparities, we are there and
we will be there,” Salerno said. “My goal with these roundtables is to listen to community leaders and find out what we can do in partnership in these communities to move the needle.” Salerno acknowledged that while October is often a time of celebration for breast cancer survivors, and that great strides have been made (the five-year survival rate for a patient with early stage cancer is at 99 percent), the number of women and some men who die from the disease every year remains at 40,000. “There are people who are dying of this disease, living with it every day knowing that there is no cure,” Salerno said of metastatic breast cancer. “We have to address their needs.” Over 33 years, Komen has invested $147 million in 400 grants focusing specifically for metastatic breast cancer. “We’re not limiting our commitment to the laboratory,” she said. “We have to do more. We have joined with 29 other organizations in the Metastatic Breast Cancer Alliance where we hope to address what are significant needs of dayto-day living with breast cancer and listening to the voice of women and their families who are telling us what we need to do.” Cumberland County is served by Susan G. Komen Upper Cumberland, komenuppercumberla nd.org. Since it was formed in 2006, the affiliate has invested more than $750,000 in local grants and $250,000 in research funding.
In addition to scheduling clinical screenings and mammograms, women should routinely examine and massage their breasts to detect any abnormalities. These breast self-exams can be an important part of early breast cancer detection. Although many women are aware that they should become familiar with their bodies, many are unsure about just how frequently they should conduct breast examinations. Experts at Johns Hopkins Medical center advise adult women of all ages to perform selfexaminations at least once a month. That’s because 40 percent of diagnosed breast cancers are first detected by women who feel a lump. Establishing a regular breast self-exam schedule is very important. Begin by looking at the breasts in a mirror. Note the size and appearance of the breasts, and pay attention to any changes that are normal parts of hormonal changes associated with menstruation. Breasts should be evenly shaped without distortion or swelling. Changes that should cause concern include dimpling, puckering or bulging of the skin. Inverted nipples or nipples that have changed position, as well as any rash or redness, should be noted. In addition, the same examination should be done with arms raised over the head. The breasts should be felt while both lying down and standing up. Use the right hand to manipulate the left breast and vice versa. Use a firm touch with the first few fingers of the hand. Cover the entire breast in circular motions. The pattern taken doesn’t matter so long as it covers the entire breast. All tissue, from the front to the
back of the breast, should be felt. The same pattern and procedure should be conducted while standing up. Many women find this easiest to do while in the shower. It is important not to panic if something is detected. Not every lump is breast cancer. And bumps may
actually be normal parts of the breast, as certain areas can feel different than others. But bring any concerns to the attention of your doctor. Breast self-exams are a healthy habit to adopt. When used in conjunction with regular medical care and mammography, selfexams can be yet anoth-
er tool in helping to detect breast abnormalities. Doctors and nurses will use similar breast examination techniques during routine examinations.
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