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Breast Cancer Awareness • 3B

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Early detection saves lives

Know what’s normal for you and get regular screenings based on your risk factors. Talk to your doctor about appropriate screenings Heather Mullinix/Chronicle

Sherry Stanish found great support throughout her breast cancer treatment from her husband, Jerry. The couple live in Fairfield Glade with their Airedale Terrier, Shannon.

‘Be brave’

Stanish keeps spirits up, health in check with exercise and healthy eating

By Heather Mullinix Chronicle assistant editor

The thought that she would be among the thousands of women diagnosed with breast cancer each year had been in the back of Sherry Stanish’s mind for some time. The Fairfield Glade woman was the fifth woman in her family to be diagnosed with the disease. But even with her strong family history, the realization of her diagnosis earlier this year took some time to sink in.

“I didn’t process it right away. I kept thinking, ‘What are these people doing to me? Do they have the right patient?’

And then one day I was in Lisa [Morris’] office and I asked, ‘Can I see my pathology report?’” Stanish said. “She brought them in and I looked at them and I said, ‘Yep, that’s my name on there.’

Then it really hit me.”

Stanish found a lump in February and immediately contacted her gynecologist who referred her to The Women’s Center at Cookeville Regional Medical Center. There, she had a mammogram that revealed the presence of a tumor and was referred to a surgeon.

She also met Nurse Navigator Lisa Morris.

“I call her my guardian angel,” Stanish said.

“This lady went to doctor’s appointments with me. She held my hand. She helped the doctor aspirate my breast. We got very personal, didn’t we?”

Morris also made sure Stanish had the information she needed as she went through the diagnostic procedures and then moved forward into determine which treatment options she would choose.

“People need to understand what’s available to them for the recovery, and Lisa provided all of that for me. Cookeville has a gem in her,” Stanish said.

“From the time she had her mammogram on March 7, she went to surgery on March 24,” Morris said. “Not that we rushed, but that’s the beauty of having navigation along with a comprehensive center to decrease timelines for the patient.”

Stanish initially elected for a lumpectomy, and the tumor was removed.

The surgeon and pathologist were surprised to find the tumor was larger than originally believed from imaging testing. Pathology also found it was filled

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with ductal carcinoma in situ [DCIS] cells were close to the margins.

“Virtually the entire specimen was filled with the DCIS cells,” Stanish said.

A breast MRI followed.

“The other breast was fine,” she said. “There was nothing there. But, they were concerned about recurrence.”

Stanish’s case was reviewed by a team that included surgeons, oncologists, the nurse navigator, radiologists, tumor registry and others who complete the breast cancer care team. The team reviews all breast cancer cases twice a month, Morris explained, to bring collaboration to patient care.

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A few basics on preventing, diagnosing and dealing with the disease

BY SALLY DADISMAN McClatchy-Tribune

hether it’s your grandfather who developed lung cancer after smoking for 50 years or your mother who found a lump in her breast, chances are you know someone who has battled, or is still battling, cancer.

The National Cancer Institute describes the disease as one “in which abnormal cells divide without control.”

Those cells can spread to nearby tissue, the bloodstream and other parts of the body.

Here, we provide some basic information about the survivability, risk factors, screenings, treatments and resources related to cancer.

CANCER Q&A How common is cancer?

Almost one in every two men and one in every three women in the United States will get some type of cancer at some point in his or her lifetime, according to the ACS. While young people are still susceptible to cancer, 77 percent of cases occur in people 55 years or older.

Also, the rates of cancer vary in different racial and ethnic groups.

How does someone get cancer?

According to the ACS, cancer is caused by damage to DNA. This damage could be passed on through genetics or caused by human behavior, like tanning or smoking.

In regular cells, the body is able to repair damaged DNA, but that is not the case for cancer cells, which due to their doubling outlive normal cells.

Can it be prevented?

Some forms of cancer can be prevented.

Activities such as alcohol consumption, smoking, increased exposure to sunlight and eating high-fat foods can all provide higher risk of cancer.

According to the ACS, eating fruits and vegetables as well as getting screening tests are helpful preventative measures.

What are the symptoms?

There are specific symptoms accompanying each type of cancer, but there are more general ones as well.

Unusual weight loss of 10 pounds or more, tiredness, fever and changes in skin tone can all be signs of cancer. Obviously those who have one or all of these symptoms do not necessarily have cancer, but they are important early warning signs.

According to the American Cancer Society, prostate and breast cancers top the list of sites of new cancer cases among men and women in the United States.

TOP 10 CANCER SITES FOR WOMEN Cancer location Breast Lung and bronchus Colon and rectum Uterine Non-Hodgkin lymphoma Melanoma of the skin Thyroid Ovary Bladder Pancreas

PREVENTION

Perhaps the best way to keep cancer away is to catch it before it develops.

Screenings such as mammograms, pap tests and other blood work can help prevent many common types of cancer.

WOMEN Breast: A mammogram — an X-ray of the breast — can help catch breast cancer early.

The NCI suggests women over 40 years old should have a mammogram once every one to two years.

The ACS also urges women who have been diagnosed with cancer in one breast to have an MRI to ensure there is not a tumor in the other breast as well.

The group’s study published in the New England Journal of Medicine notes that more than 3 percent of new breast cancer cases have had one breast diagnosed, but cancer is also lurking in the other, which was undetectable through mammograms or physical testing.

The Susan G. Komen Breast Cancer Foundation also recommends that women over 20 should do monthly breast self-exams and have clinical breast exams every three years.

After age 40, clinical breast exams should be conducted annually.

Cervix: Called both pap tests and pap smears, these screenings can help prevent cervical cancer.

By taking a sample of tissue around the cervix, the test can show whether cancer cells are present.

The NCI says pap tests should occur every three years after a woman becomes sexually active or when she turns 21, whichever comes first.

MEN Prostate: The cancer that affects men the most can be treated through a blood test and digital rectal examination, according to the ACS. All men should begin annual testing at age 50.

Black men and those with a family history of the disease are considered at high risk and may begin testing early as 40 to 45 years old.

BOTH

TOP 10 CANCER SITES FOR MEN Cancer location Prostate Lung and bronchus Colon and rectum Bladder Melanoma of the skin Non-Hodgkin lymphoma Kidney and renal pelvis Oral Leukemia Pancreas

Colon and rectum: There are a number of tests that can be done to prevent cancers in these areas of the body, including rectal exams and colonoscopies.

The NCI advises people 50 and over to get screened.

TREATMENTS

Once cancer has been diagnosed, there are four main treatment options, according to the American Cancer Society: surgery, radiation, chemotherapy and biological therapies.

SOURCE: AMERICAN CANCER SOCIETY

RISK FACTORS

Tobacco Sunlight Ionizing radiation (X-rays, radioactive substances and other sources) Certain chemicals and other substances Some viruses and bacteria Certain hormones Family history of cancer Alcohol Poor diet, lack of physical activity or being overweight

It’s no surprise that smoking a pack a day puts you at higher risk for lung cancer or that lying on the beach for hours gives you a greater chance of developing melanoma. But there are natural and uncontrollable factors that can lead to cancer as well.

According to the National Cancer Institute, the most common risk factors are Growing older

Surgery: Most cancer patients will undergo some surgery since it is the most effective way to eliminate cancer that hasn’t spread yet to multiple parts of the body.

There are less invasive options available in some cases, such as laser surgery.

Surgery can be used as a preventative or diagnostic step, and also to remove or reduce tumors.

Radiation: Radiation uses of waves or high-energy particles to kill cancer cells and prevent them from doubling. Radiation is a local treatment and only affects the part of the body being treated.

Chemotherapy: Often given by simply

GLOSSARY

Here are some common words associated with cancer, with definitions from the ACS. Antibody: A protein produced by immune system cells and released into the blood. Antibodies defend against foreign agents such as bacteria.

Benign: Not cancer; not malignant.

Biopsy: The removal of a sample of tissue to see whether cancer cells are present.

Bone marrow transplant: A treatment that restores blood-forming stem cells that have been destroyed by high doses of chemotherapy and/or radiation therapy. The bone marrow may come from the patient or a donor.

Carcinoma: A malignant tumor that begins in the lining layer of organs. At least 80 percent of all cancers are carcinomas.

Doubling time: The time it takes for a cell to divide or for a cancer to double itself in size.

Cancers vary in doubling time from eight to 600 days, averaging 100 to 120 days, so a cancer may be present for many years before it can be found.

Lymph nodes: Small beanshaped collections of immune system tissue such as lymphocytes, found along lymphatic vessels.

They remove cell waste, germs and other harmful substances from lymph. They help fight infections and also have a role in fighting cancer, although cancers sometimes spread through them.

Malignant tumor: A mass of cancer cells that may invade surrounding tissues or spread to distant DENNIS BALOGH/AKRON BEACON JOURNAL areas of the body.

Oncology: The branch of medicine concerned with the diagswallowing a pill or having an injection similar to the flu shot, nosis and treatment of cancer. chemotherapy has been used to treat cancer since the 1950s and is one Red blood cells: Blood cells of the oldest forms of treatment. that contain hemoglobin, the subUsually distributed through the veins, chemotherapy, unlike radiastance that carries oxygen to all of tion, affects the whole body, not just the cancerous areas. Common the cells of the body. side effects include hair loss, sickness, change in bone marrow and Remission: Complete or parfatigue. tial disappearance of the signs and Biological therapies: Unlike other treatments, biological thera- symptoms of cancer in response to treatment; the period during which pies don’t treat the cancer directly, but instead try to help the weaka disease is under control. A remisened immune system. They work to block cancerous cells and sion may not be a cure. strengthen healthy ones, and can also help treat side effects of other White blood cells: Help treatments, such as chemotherapy.

Treatment options can have different levels of effectiveness due to defend the body against infections. the patient’s overall health and the stage of the cancer. Treatment can Certain cancer treatments such as chemotherapy can reduce the numalso vary depending on if the goal is to cure, treat symptoms or simber of these cells and make a perply to control the spread of the cancer. son more likely to get infections.

S O U R C E S : A M E R I C A N C A N C E R S O C I E T Y, N AT I O N A L C A N C E R I N S T I T U T E

ACS working to end the CANCER fight against breast cancer MCCLATCHY-TRIBUNE

The American Cancer Society invests more in breast cancer research than any other cancer and is doing the most for people with breast cancer today to end the disease tomorrow. While significant progress has been made in the fight against breast cancer, more needs to be done.

With more than 230,000 new cases of invasive breast cancer and more than 40,000 deaths from breast cancer estimated in 2014, breast cancer remains the most common cancer among women

in the U.S. other than skin cancer, and second leading cause of death after lung cancer. During National Breast Cancer Awareness Month, the Society urges you to join the fight to end breast cancer once and for all.

“The American Cancer Society has played a role in nearly every major breast cancer research breakthrough in recent history. We encourage all women to take steps every day to reduce their risk from breast cancer by maintaining a healthy weight, get-

ting regular exercise, and limiting alcohol intake,” said Brandise Layne, Relay for Life specialist with the American Cancer Society. “Thanks in part to the progress we’re making together, death rates from breast cancer have dropped by 34 percent since the early 1990s. This translates to 203,000 lives saved that would have otherwise been lost to breast cancer. In short, more Birthdays for patients with breast cancer.”

The Society helped establish mammography as the standard

to find breast cancer early, and recommends that women 40 and older have a yearly mammogram and clinical breast exam. Also, the Society recommends that women ages 20 to 39 receive a clinical breast exam at least once every three years.

Breast cancer is the number one reason people call the American Cancer Society. The Society provides help and support 24 hours a day to anyone facing a breast cancer diagnosis through its roundthe-clock call center at 1-800-227-

2345 and on the web at www. cancer.org, and is doing the most to help people with breast cancer today while working tirelessly to find cures to end the disease tomorrow.

Here are a few ways to join the Society in the fight to finish breast cancer: • Get started at cancer.org/fightbreastcancer.

• Register, fundraise and walk in one of our nearly 300 Making See ACS page 5B

Breast Cancer Awareness • 5B

www.crossville-chronicle.com • Friday, October 3, 2014

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Part of fighting breast cancer is finding and diagnosing cancer in the earliest stages, when it is most easily treated and before it has spread to other areas of the body.

Of the screening and diagnostic tools available, mammography is the “gold standard” of medical imaging for early stage breast cancer, said Amanda King, director of medical imaging at Cumberland Medical Center.

“You have the ability to see extremely small areas,” King said.

CMC’s Regional Breast Center utilizes digital mammography, with two units available at the CMC location and one unit available at the CMC Medical Arts facility in Fairfield Glade. This technology offers advantages over previous mammography technology, including faster imaging, less radiation exposure and faster results.

Also, because the files are digital, the radiologist can enlarge areas for closer scrutiny and can file them away with the patient’s medical records to use for comparison in future years.

“It offers the radiologist the ability to manipulate the image, level the image, darken it, contrast it, without having to call the patient back for extra imaging,” Kind explained. “We can magnify those images, too.”

Women can get a baseline mammogram as early as 35.

Women should consult with their physician on when to begin regular mammograms based on risk factors and family medical history.

“You don’t have to have a physician referral to have your screening mammogram at either facility,” King said.

While the Fairfield Glade imaging center offers screening mammogram services, the CMC Regional Breast Center is able to offer a variety of tools and procedures to aid in the diagnosis of breast cancer and other diseases. This includes diagnostic mammograms and ultrasound.

ACS

• Continued from 4B Strides Against Breast Cancer events across the U.S., or participate virtually at MakingStridesWalk.org.

• Make a donation.

• Volunteer to help people with breast cancer in your community.

• Take action to help make fighting breast cancer a top national priority at acscan. org/makingstrides.

The American Cancer Society is a global grassroots force of more than three million volunteers saving lives and fighting for every birthday threatened by every cancer in every community. As the largest voluntary health organization, the Society’s efforts have contributed to a 20 percent decline in cancer death rates in the U.S. since 1991, and a 50 percent drop in smoking rates. For more information, to get help, or to join the fight, call us anytime, day or night, at 1-800227-2345 or visit cancer.org.

Mammography Questions

What is mammography?

Specific imaging using low-dose X-ray to examine breasts.

A mammogram is used to aid in the early detection and diagnosis of breast disease in women.

Why should I have one?

A mammogram can find breast cancer even when it is too small to be felt.

Who should have a screening mammogram?

Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health. Screening mammograms are for women without breast symptoms. Women who have had breast cancer and those with a genetic history of breast cancer should seek expert medical advice about when to begin screening.

Who should have a diagnostic mammogram?

Diagnostic mammograms are used to evaluate a patient with abnormal clinical findings such as a breast lump or lumps found by the woman or her doctor. Diagnostic mammography may also be done after an abnormal screening mammography in order to evaluate the area of concern.

What screenings should I have before age 40?

Women in their 20s and 30s should have a clinical breast exam as part of a regular health exam by a health professional. A woman should also conduct breast self-exams and familiarize herself with what is normal for her body. Any breast changes should be reported to a health professional right away. A breast self-exam should not take the place of routine clinical breast exams and mammograms.

What if I have breast implants?

Women with breast implants should also have mammograms, though implants pose special challenges. You will need additional imaging during a screening mammogram.

It is important to tell the mammographer you have implants before your mammogram. Screening guidelines are the same as for women without breast implants.

-American Cancer Society “Having that capability within the breast center makes it more convenient for the patient,” Kind said. “The ultrasound technicians at the hospital are trained in breast ultrasound, as is one of our mammographers is credentialed, as well.”

All of the mammographers at CMC are credentialed in mammography imaging through the American Registry of Rediologic Technologists. It shows mammographers have met a recognized national standard which includes completion

of clinical experience, ethics standards and successful completion of the mammography examination.

Ultrasound imaging can differentiate solid lesions, identifying the borders of lesions. It isn’t effective with calcifications, however, so it isn’t the first choice for screening images.

“We want to start with effective screening so that we don’t do unnecessary tests, but yet we don’t want to leave any stone unturned,” King said of the methodology in employing various

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diagnostic tools.

CMC Regional Breast Center also works with surgeons to help in biopsy and treatment through stereotactic breast biopsy and placement of wires to guide surgeons. Stereotactic biopsy uses two images to provide almost three-dimensional images to guide surgeons during biopsy procedures.

“It’s a GPS. We know exactly where we need to go to biopsy,” King said. “We can use it with wires, as well.

If you need an excisional biopsy or have a definitive diagnosis, we’ll put a wire in to serve as a guide for the surgeon. It lets him know exactly where that area of concern is so that he goes right to it.”

As a member of Covenant Health, patients at Cumberland Medical Center benefit from the collaborative efforts of the health system’s many See diagnosis page 6B

Dr. David Tabor Cumberland Medical Plaza, Suite 340 Crossville, TN 38555 931-707-8808

Breast Cancer Awareness • 6B

www.crossville-chronicle.com • Friday, October 3, 2014

BRAVE

• Continued from 3B “It’s a team approach,” Morris said. “All patients are reviewed for clinical trials because we do offer clinical trials and we follow the NCCN guidelines, as well as standards of care.”

Stanish said, “It’s not just one person making a decision. It’s many people.”

In Stanish’s case, the team worried about the possibility of recurrence of breast cancer and recommended a mastectomy. Stanish agreed and opted for immediate breast reconstruction.

Testing revealed her breast cancer was hormone receptor-positive, meaning it grew in response to hormones. Because of this, she did not need to follow surgery with chemotherapy or radiation treatment, but she was prescribed daily medication to stop estrogen production and help prevent recurrence of the disease.

She’ll be on medication for at least five years, and perhaps longer.

“It takes over your life.

It never leaves your head.

It’s with you all the time,” Stanish said. “I just thank God every day that I didn’t have a stage IV triple negative breast cancer.”

Because of the number of breast cancer diagnoses in her family, Stanish was offered the opportunity to undergo genetic testing with a doctor’s order.

“I was fortunate. My BRACA 1 and 2 were negative,” Stanish said.

Morris noted that when there is a strong history of breast cancer in a family, a negative genetic test doesn’t mean a person is at the same risk as the general population, and those individuals need to watch closely and get appropriate screenings for breast cancer.

Throughout it all, Stanish has kept her spirits up, and just months after diagnosis she says she feels great. She attributes that to the support of her husband, Jerry, who was with her at every appointment and by her side throughout her treatment.

“Be brave,” Stanish said to other women who have been diagnosed with breast cancer. “Have a good support system. I leaned on Lisa. I called her many times. My husband was right there.”

Morris said a healthy lifestyle before her diagnosis, and continued healthy living during her treatment, helped keep her positive.

“She walks, walks, walks. She eats well. Those are all positive things for her in her treatment and her continued success,” Morris said.

Stanish said, “I’ve been exercising for quite a few years now, and I can do the things I do because exercise changes everything.

You really feel good.”

She has a goal of 30 minutes of activity each day.

“It gets the endorphins going. That happy chemical is running all over your body and you feel good!” she said.

She also eats lots of vegetables and fruits and lean meats, limiting treats like pasta. Because she lost three lymph nodes in the surgery, she is paying more attention to her healthy habits so that she can keep her immune system in tiptop condition.

Moving forward, she will be watching her cholesterol and bone density, as her medication could affect those things, and will be scheduling regular mammograms with checkups every few months for a while.

And she’s going to keep on walk, walk, walking with her husband and their dog, Shannon, and enjoying every day to its fullest. n Heather Mullinix may be reached at hmullinix@ crossville-chronicle.com

Breast cancer facts and figures An estimated 51

new cases of invasive breast cancer are expected to United States, accounting for nearly 29 peroccur among women in Cumberland cent of newly diagnosed cancers.

County.

• An estimated 232,670 new cases of Mortality invasive breast cancer are expected • Except for skin cancers, breast cancer is the most common cancer among women in the

to occur among women in the U.S. during 2014.

• An estimated 2,350 new cases of breast cancer are expected to be diagnosed in

men in the U.S. in 2014.

• Breast cancer is second only to lung cancer in cancer deaths among women in the U.S. • An estimated 40,000 women in the U.S. are expected to die from breast cancer in 2014.

245 new cases of • Breast cancer is the most common invasive breast cancer are expected to cause of cancer death for women occur among women in Tennessee.

40-59 in the U.S. • An estimated

• Early detection and effective treatment have resulted in a 34 percent decline in breast cancer mortality in the U.S. since 1990.

Information from the Upper Cumberland affiliate of Susan G. Komen for the Cure. The Upper Cumberland Affiliate was founded in 2006 and, since that time, more than $730,000 has been granted by the affiliate to non-profit organizations in the Upper Cumberland region to provide free mammograms, diagnostic services, survivor support and educational resources. Since 2010, the affiliate has granted more than $68,000 to Cumberland Medical Center to provide free mammograms, continuing education opportunities for nurse navigators, and other services. To learn more about the Upper Cumberland affiliate, visit komenuppercumberland.org.

DIAGNOSIS

Missy Wattenbarger/Chronicle

Beth Cunningham, massage therapist with the CMC Wellness Complex in Crossville, gives a patient a massage during the Sept. 30 Ladies Day Out event at the CMC Regional Breast Center. A second event will be held at the Fairfield Glade Medical Arts imaging facility Oct. 7.

CMC invites women to Ladies’ Day Out Annual mammograms can save a woman’s life.

October is Breast Cancer Awareness Month, so there is no better time to schedule a screening mammogram. The benefit of annual screening mammography is earlier detection and lower risk that the breast cancer will have spread to other areas. Ladies’ Day Out is a free event hosted by the CMC Regional Breast Center to promote awareness and encourage ladies to get their mammograms. Two separate events are scheduled to allow ladies to bring their friends with them in a casual and fun environment to receive their screening. The next event will be held Oct. 7 at the Fairfield Glade Medical Arts Building beginning at 1 p.m.

Bring friends and enjoy a fun time with local musicians, samples from local businesses, and lots of

chocolate and desserts.

Two opportunities, one thing in mind – saving lives, one mammogram at a time.

Call in advance and schedule a mammograms for the event, or schedule an appointment during the party. A physician referral is not needed to schedule a mammogram. So gather some friends and encourage neighbors to come have a good time, meet our new Obstetrics & Gynecologist Dr. Andrew Szaflarski, view new products from local merchants, get a massage, have their fingernails painted, and listen to the soothing music of Tony Zarola and members of the Children of Crossville Chamber Orchestra – did we mention that we will have lots of chocolate and desserts?

Call (931) 459-7040 today to schedule a mammogram and encourage other ladies to do the same.

SMHS sets Pink Out Oct. 10

Stone Memorial will be having special nights during October.

The SMHS football team will be playing their annual pinkout game to help raise awareness for Breast Cancer on Oct. 10 against Sequatchie County.

T-shirts, “Paws for the Cause,” will be on sale this week and next at the school.

Buckeye carries a full line of turbans, wigs and mastectomy bras for our patients undergoing cancer treatments. Feel like your beautiful self with the latest styles designed just for you!

• Continued from 5B facilities.

“We work closely with our sister facilities,” King said.

“We use their resources and they use ours to ensure that all patients throughout Covenant get the best care possible.”

CMC works with Thompson Cancer Survival Center’s Comprehensive Breast Center and Thompson’s Cancer Outreach Services. Partnerships with Susan G. Komen and the Tennessee Department of Health also help ensure care for those who are uninsured or underinsured.

The center also takes donations to assist with the needs of uninsured or underinsured individuals.

While offering good diagnostic and screening tools to patients was a top priority, patient comfort was not far behind. Both the CMC Regional Breast Center and the Medical Arts at Fairfield Glade facility kept patient privacy and comfort in mind, with private dressing areas, private waiting areas and segregated facility areas for women only. Even plush robes were brought in to add to patient comfort.

“We want to make it as positive an experience as we can,” King said.

CMC is encouraging women to get their annual mammogram, and offering a Ladies’ Day Out event Oct. 7 at the Fairfield Glade Medical Arts Building. A Ladies’ Day Out was held Sept. 30 at CMC. Women are encouraged to bring their friends and enjoy music, samples from local businesses and lots of chocolates and desserts while making a positive choice for their breast health.

For more information or to schedule a mammogram, call 459-7040.

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