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Breast Cancer Awareness Blogging through breast cancer Easing the transition from active treatment to active survivorship Becoming a caregiver at 15 years old Is genetic testing right for you? TrueBeam represents a quantum leap forward in radiation therapy Meet Chester County Hospital’s breast surgeons

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Thursday, october 17, 2013

Blogging through breast cancer

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By CARLA J. ZAMBELLI

ne of life’s little realities is life is never quite as you expect it to be. For example, if you had told me a few years ago that today I would be a breast cancer survivor, I would have told you that was crazy. Yet here I am. Survivor is a weird word to describe getting through even one round of a disease such as breast cancer. Using the word survivor means some days you picture yourself at the end of a reality show, and I suppose that could be a good analogy: dealing with breast cancer is like starring in your own personal reality show. Only you don’t get hair, make-up, a fabulous wardrobe, and designer shoes. Am I being glib? I don’t mean to be, as breast cancer is serious stuff. But a simple truism exists that God never gives you more than you can handle. I am not being hyper- religious saying that, but I do have faith. Or I should say I learned to have more faith: in myself and things beyond my control. I still remember vividly the day I received the news that I had breast cancer. April 28, 2011: the day before my 30th high school reunion weekend began. The room spun around for a minute or two. What do I do? What do I think? How do I feel? Will I live? How will I tell people? Why me? I made a decision on that day that I would be open about having breast cancer and I would be positive. I forced myself to acknowledge that like it or not, at least for a while, this was something front and center in my life. I wanted to live, so I would have to fight. Two days later I started my breast cancer blog. Writing is and always has been cathartic, so I decided I

Carla Zambelli was turning 47 years old when she was diagnosed with breast cancer. Blogging about her experience helped her get through the ordeal.

Writing about how I was feeling and the maze of tests, emotions, forms and new headspinning medical terminology helped me stay positive. Writing was like exorcising the demons of breast cancer: putting it down in black and white made it less terrifying and more manageable.

for people in my life to stay connected to me as I went through this and it would give them the ability to know exactly how I was doing. Writing about having breast cancer was not and is not easy some days. It’s very personal and breast cancer hits immediately and hardest at the core of each woman’s femininity. I still fight those feelings today, two years into a five-year prescription of a breast cancer drug known as Tamoxifen. Getting out the emotions and thoughts combined with an amazing support network helped me stay the course of treatment. Soon, I was not only through the surgery but through seven weeks of radiation as well. By the time it was my turn to ring that bell on the last day of radiation I was exhausted, but I had done it. I had indeed survived. My world had tilted for a while, but I was alive and cancer-free. Two years and four months later, I am still writing my breast cancer blog. Not as frequently as before, but I am still writing. Breast cancer doesn’t define me per se, but it is part of who I am. If I could give advice to women on the precipice of this crazy roller coaster ride called breast cancer I would tell them to be open and positive, not be afraid to talk about it and to just get through it one day at a time. Don’t give yourself a death sentence because you have a breast cancer diagnosis. Fight. You can do it. You just have to believe.

Carla Zambelli lives in Chester County. You can read more on her two was going to write my way through ing and the maze of tests, emoblogs ihavebreastcancerblog (www. this thing happening to me. tions, forms and new head-spinning ihavebreastcancerblog.me) and chesI remember some people were medical terminology helped me stay tercountyramblings (www.chestervery critical when I decided I would positive. Writing was like exorciscountyramblings.com). Some of her be blogging through breast cancer, let ing the demons of breast cancer: photography can be seen at Simple alone speaking about it openly. You putting it down in black and white Shots Photography: The Magic of Orsee, for some women breast cancer made it less terrifying and more dinary Days (www.simpleshotsphois one of those deep, dark secrets. manageable. tos.com). Her writing can also be Many women will tell you if they get To me, writing about it was like found in “The Pink Moon Lovelies: Botox, a tattoo, cheat on their spouse journaling, which if you ask most Empowering Stories of Survival by or partner, or get a breast augmenta- psychologists, they will tell you it is Nicki Boscia Durlester.” This book tion, but not if they have any kind of a very effective self-help tool. I am of breast cancer survivor stories is cancer. also a fairly practical person and I available on Amazon.com and barneWriting about how I was feelthought a blog would be an easy way sandnoble.com.


Thursday, October 17, 2013

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Transitioning from active treatment to active survivorship

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eaching the end of cancer treatment is a monumental event, but the end of treatment can leave a patient wondering what’s next. The transition from active treatment to cancer survivor can be wrought with physical, psychological, and financial concerns. This is where Survivorship Nurse Navigator Sandy Camarota comes into the picture. She is at the forefront of Penn Medicine Chester County Hospital’s cancer survivorship initiative “Many patients feel like they don’t have the tools to find their new normal,” Camarota said. What the survivorship program aims to do is, “Give them the support and tools they need to be able to move forward feeling empowered, not in fear,” she said. Photo by Jeff Hoagland The Survivorship Nurse Navigator is Sandy Camarota, RN, BSN, OCN sion) when providing follow-up working initially with Sandy is the Survivorship Nurse Navigator at care. Stage II breast cancer Chester County Hospital. Sandy received her Camarota also utilizes a patients, with plans to Bachelors of Science degree in Nursing from psychosocial distress questionexpand the program Thomas Jefferson University and started her career naire to help assess a patient’s to include survivors of in the Oncology Unit of Pennsylvania Hospital. While specific stressors — physical, other types of cancers. raising her two children, she worked in Medical/ psychological, financial, etc. A key component Surgical and Intensive Care hospital units, as well — to help guide the patient to of the survivorship as Home Care and a large family practice. In 2001, resources to assist with decreasprogram is a treatment Sandy returned to her first love, Oncology, when she ing stress. summary/care plan joined Chester County Hematology/Oncology SerCamarota is no newcomer to tailored specifically vices (CCHOS) as a chemotherapy nurse; CCHOS cancer patients. She has worked to each patient. The later became an outpatient department of Chester at Chester County Hematology treatment summary/ County Hospital. Sandy received her Chemotherapy Oncology for 13 years. Chester care plan chronicles a Certification from the University of Pennsylvania County Hospital is also workpatient’s cancer treatin 2001 and her Oncology Certification from the ing with colleagues at Penn’s ment and also includes Oncology Nursing Society in 2003. In 2013, Sandy Abramson Cancer Center to bena follow-up plan. “This became the Survivorship Nurse Navigator at Chester efit from experiences gained from can be a road map County Hospital. cancer survivorship initiatives for follow up care,” that have been launched there. Camarota said. And in From her experiences as an addition to the detailed oncology nurse, Camarota has medical information, it plan will also be a resource to the a great understanding of what also helps to educate the patient on physical and psycho- patient’s team of medical providers, patients go through during treatwho will be able to review the inforlogical changes they may experiPlease see SURVIVOR on A18 mation (with the patient’s permisence. The treatment summary/care

The Cancer Program of Chester County Hospital offers both support groups and programs to help patients deal with the often overwhelming emotional effects of cancer and to celebrate life and survivorship. Cancer Transitions: Moving Beyond Treatment This FREE 2½-hour, six-week workshop is designed to help cancer survivors make the transition from active treatment to post-treatment care. This program offers education and support to cancer survivors who have finished treatment within the last 2 years. Cancer Transitions was developed as part of a partnership between the Cancer Support Community (CSC) and the Lance Armstrong Foundation. Education, group discussion, exercise and nutrition activities and tools and resources are provided to help participants form a plan for survivorship. Art Therapy Held monthly at the Chester County Art Center, this group meets weekly to explore through art ways to use the challenges presented by their cancer diagnosis as a stepping stone to personal growth. This ongoing program uses expressive art as an outlet for coping. No artistic ability is necessary - just an adventurous spirit! Coping with Cancer This 8-week group was created to provide a safe space for newly diagnosed cancer patients to connect, share, and learn from one another as they cope with cancer treatment, stress, relationships, and emotional turmoil. Together the group will discuss a wide range of topics and will offer a consistent, safe, hopeful support Please see SUPPORT on A18


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Thursday, october 17, 2013

Becoming a caregiver to her dying mother At age 15, Michelle Donia-Martin was told that her mother had just 3 months to live By KIERSTEN MCMONAGLE For 21st Century Media

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ichelle DoniaMartin was only 15 years old in 2005 when her mother, Jane Donia, was diagnosed with Stage 3 breast cancer and told she had only three months to live. With no other family to perform the day-to-day task of caring

for Jane, Michelle and her 9-year-old sister, Krystal, became the caregivers for their mother in their home in Parkesburg in a battle that would last the next three years, rather than three months. The transition to caring for their mother was not difficult for Michelle and Krystal, as their father had passed away six years earlier when Michelle was only 9 years old. “By the time she was diagnosed, we were used to being the three people taking care of each other,” said Michelle, recalling that the task of handling her mother’s health

was not as daunting or surprising as the disease itself, which came as the last thing they were expecting. Jane’s diagnosis came after several months of ignoring what she believed was simply muscle pain under her arm. When she did seek medical attention, an MRI found a lump in her breast. The MRI was followed by a mammogram and then came the diagnosis of Stage 3 breast cancer. The cancer had already spread to her ribs and stomach, causing the doctors to reason she had just months to live. Despite the bleak diagnosis though, Jane’s doctor immediately started her on weekly rounds of chemo. Each round was performed in the hospital and allowed In 2005, Jane Donia was diagnosed with Stage her to go home by the end 3 breast cancer. Her two young daughters had of the day. The treatments to become her cargivers. left her bedridden for two to three days each week and this left 15-year-old Michelle in charge. tor… He inspired her to fight harder,” Although treatment was never able Michelle said, adding that at every to destroy what cancer had already check-up, Jane’s doctor would stop to taken over Jane’s body, it was able to hug her, and promise that everything prevent further growth. This was a would be all right. success that many women in Jane’s For Michelle, the optimism rubbed position do not experience, and which off. She recalls that, because of her her doctor took as a positive sign. age, she spent the first several months Throughout the entire ordeal, Miafter her mother’s diagnosis believing chelle recalls that her mother’s doctor that she was simply sick, and would was always very hopeful. “I think one bounce back. Even when her mother of the biggest reasons she fought for so long was she had an amazing docPlease see CAREGIVER on A5

During some of the time she was battling breast cancer, Jane Donia kept a journal. It wasn’t until after her death that her daughters learned of its existence. Dated Nov. 27, 2007, this entry reads: “My stomach has been feeling a little bad. The nurses got my medicine approved. I feel so much better than before the medicine. I was trying to find out more information on my medicine. It said it doesn’t help you live longer. I wish I wouldn’t have read that page. That’s why I don’t. I never did get the info I wanted.”


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Michelle Donia-Martin, wearing glasses, and her sister Krystal, far left in the front row, pose with members of The Pink Giraffes. Katie Ensell, standing second from right, founded the group to raise money to fight breast cancer.

Caregiver From A4

tried to bring up the subject of death, Michelle recalls asking her to talk about something else. “I was very naïve,” she said, admitting that although she knew what cancer entailed, she never believed it would affect her family that way. Still, Michelle said that she and Krystal never knew what they would come home to. “You never knew what was going to happen…she went through stages where one day she would be great and fine, and then she would be really sick the next. I had a constant fear that something would be wrong,” she said. Despite her mother’s failing health, Michelle said that one of the most important things for her family during that time was keeping a positive view of their situation. “You have to stay strong,” she said, explaining that she believes it got them through a lot of rough times, and helped her mother to live for as long as she did. It was three years later, in 2008, when Jane passed away. Most of Jane’s last year was spent going back and forth between the hospital and home. By that time, the doctors had started her on an experimental treatment of chemo, which she could take at home in pill form.

For the last three months of her life, Michelle said that her mother was bedridden. The cancer had left her immune system weak, and she was suffering from pneumonia which rarely allowed her to leave her room. By that time Michelle was 17, and Krystal 12. After their mother’s death, Michelle became her sister’s legal guardian, and the two attempted to stay in their mother’s home for about a year. When it became clear that they could not afford to continue living there, they moved in with close family friends in Atglen. Through it all, and especially during the last several months, Michelle said that the most important thing she and her sister could have done for their mother was just to be there. “Even for caregivers,” she said, “the biggest thing that is important during this time is having family support.” The three women had a small family, but Michelle remembers that during those three years, what family they did have always tried to help. After her mother’s diagnosis, Michelle learned that her great aunt had also died of breast cancer. Today, at 23 years old and with a daughter of her own, Michelle is making a family tree and undergoing genetic testing to determine whether or not she carries the BRCA 1 and BRCA 2 gene mutations which are inherited from the

mother or father and can increase the likelihood of contracting breast cancer. Early identification of having the mutation allows for treatments which can greatly reduce the chances of getting breast cancer. Since her mother’s death, Michelle said her outlook on life has completely changed. “You don’t think about it…but I’ve learned to appreciate every moment,” she said. “The biggest thing for me now is how important it is to support this cause.” In August, Michelle joined her friend Katherine Ensell in creating a group in memory of her mother and other women in their lives who have been affected by breast can-

cer. Their group – The Pink Giraffes – is now one of 317 teams set to participate in the American Cancer Society’s “Making Strides against Breast Cancer” walk in Philadelphia on Oct. 19. Within a month of the team’s formation, the women had raised 100 percent of their $1,000 goal. Since then, the team has worked tirelessly to go above and beyond that first milestone. To join The Pink Giraffes, or to help raise money for the American Cancer Society, visit the team’s website at http://main.acsevents.org/ goto/pinkgiraffes2013, and find them on Facebook at www.facebook.com/ PinkGiraffes2013.

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Thursday, october 17, 2013

A Medical Choice: Cancer genetics counseling and testing All men and women have two copies of the BRCA 1 and BRCA 2 genes. One copy of the gene is inherited from each biological parent. The BRCA 1 It is estimated that approximately and BRCA 2 genes are called “tumor 5-10% of women who develop breast suppressor genes” and help prevent cancer and approximately 10% of cancers from developing from a single women who develop ovarian cancer cell. However, some people are born have inherited an alteration, or mutawith a mutation in one of these genes tion, in one of their genes that prethat causes it to not work properly. disposes them to these cancers. The most common genes that predispose to These individuals have a significantly breast and ovarian cancers are the BRCA increased risk to develop cancers, mainly breast and ovarian cancers, 1 and BRCA 2 genes. The BRCA genes and these cancers typically occur at and the potential of genetic counseling younger ages (under age 50). have been in the spotlight lately since Mutations in the BRCA 1 and BRCA actress Angelina Jolie wrote a New York 2 genes run in families and are passed Times op-ed piece entitled “My Medion from generation to generation. cal Choice.” Jolie announced that she Genetic testing for the BRCA 1 and carried a “faulty” BRCA 1 gene, placing BRCA 2 genes can be performed using her at a significantly increased risk to a blood sample and can determine if develop breast and ovarian cancer.* By KIM MCGREEVY MS, CGC, Certified Genetic Counselor

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an individual carries a mutation in one of these genes. Not every individual who has a personal and/or family history of cancer needs to consider genetic testing. Cancer genetic counselors are medical professionals who specialize in hereditary cancer conditions and can help determine if genetic testing is appropriate. If testing is appropriate and performed, the genetic counselor can assist with interpreting the results and can recommend cancer screenings and preventative actions based on guidelines established by the National Comprehensive Cancer Network (NCCN). Individuals concerned about their personal and/or family history of cancer may benefit from cancer genetic counseling. The following are indications for cancer genetic counseling:

Cancer genetic counselors are able to help educate patients about hereditary cancer conditions, interpret genetic testing results, and discuss options for cancer screening and prevention according to guidelines established by the NCCN. The Genetic Counseling Program of the University of Pennsylvania of • Individuals diagnosed with cancer Chester County Hospital, offered at the Women’s Specialty Center, is specifiat an early age (younger than 50); • Women who have been diagnosed cally designed for women who want information about their personal risk with ovarian cancer at any age; • Individuals with two or more close for breast and ovarian cancer. The program provides participants assisrelatives on the same side of the famtance in understanding risk factors; ily with the same or related types of cancer (for instance breast and ovarian a review of family history, personal medical history and lifestyle risk faccancer, or colon and uterine cancer); tors; an explanation of genetic testing • Individuals who have had more than one primary type of cancer (bilat- and determination if it is a reasonable eral breast cancer or women with both option; a written summary of level of risk ; an outline of a plan for continued breast and ovarian cancer); monitoring; and an evaluation of eligi• Individuals who have a family bility to participate in research studies member who has been found to carry Those who may benefit from cancer a mutation in a cancer predisposition risk assessment include: gene; • Women who have been diag• Individuals of ethnicities that are nosed with breast cancer at an early known to have a higher risk to carry mutations in the BRCA 1 and BRCA 2 Please see CHOICE on A19 genes (Ashkenazi Jewish).


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Is genetic testing right for you? Kim McGreevy, certified genetic counselor at Chester County Hospital, helps patients through all phases of genetic testing, from determining if it’s appropriate given their family history, to what steps they can take if they do in fact carry the BRCA mutation.

By JEFF HOAGLAND jhoagland@dailylocal.com The average American woman stands a 13 percent chance of contracting breast cancer in her lifetime. Women who carry the BRCA 1 or BRCA 2 gene mutation face a 60 to 80 percent chance of contracting breast cancer in their lifetime. While the presence of the gene mutation is low among the population, the fact that its presence so drastically increases the likelihood of contracting breast cancer has led to more and more women getting genetic testing to determine if they carry it. When a woman wants to know if she carries the BRCA 1 and BRCA 2 gene mutations, they see someone like Kim McGreevy, certified genetic counselor at the Chester County Hospital. McGreevy can help in several ways. She can determine if the test is even necessary by assessing family history and she can determine the exact type of testing that should be performed. She can look at a patient’s health insurance to determine coverage – the test can cost as much as $4,000 - and she can counsel on the options a patient has if a test comes back positive. While McGreevy is not a medical doctor,

Photo by Jeff Hoagland

she works alongside a gynecological oncologist who makes medical recommendations. “Most cancer is not hereditary,” McGreevy said, “but if you’re concerned about your history, a genetic counselor can look at your family tree

“These gene mutations make the average age of onset of breast cancer much earlier,” McGreevy said. Women who carry the mutation often develop the cancer in their 30s or early 40s. and determine if testing would be helpful.” The gene mutation can be passed on from the mother or father. “If a parent has it, their kids have a 50-50 chance of getting the mutation,” McGreevy said. Having

the mutation doesn’t mean you have cancer. It means that something has gone wrong with the BRCA 1 or BRCA 2 genes which are tumor suppressor genes that everyone has. Having the mutation does mean that you are at an increased risk for cancer. A child who does not inherit a BRCA mutation from parent cannot pass on a BRCA mutation. McGreevy, who has been counseling at Chester County Hospital for the past 2 ½ years, has seen an uptick in the amount of women seeking the test ever since actress Angelina Jolie had a double mastectomy after learning that she carried the mutation. Since January of this year, McGreevy has had 60 women screened with 10 having a positive result. For those 10 women who received the positive result, McGreevy’s next step was to counsel them on their options. As far as ovarian cancer, which is also tied to the BRCA mutations, there aren’t

many options, she said. So it’s typically recommended that they have the fallopian tubes and ovaries removed. “For

breast cancer there are a lot more options because screening is more effective,” she said. These options are increased screenings, medication or prophylactic mastectomies. The prophylactic mastectomies are the removal of both breasts before any cancer develops. “Most women choose the prophylactic mastectomies,” McGreevy said. “This reduces the risk by 90 percent because

there are breast cells in the chest wall and axilla (armpit) and you could still get breast cancer in these places.” Another option is increased screening. This means starting mammograms and MRIs at age 25 with the screenings staggered so every six months the patient has a mammogram or MRI. “That doesn’t prevent it, but it lets us catch it at a stage that is treatable,” McGreevy said. The third option is medication – Tamoxifen and Raloxifene. “These can be used to prevent Please see GENETIC on A19

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Thursday, october 17, 2013

Cancer took her career, but it gave her a new outlook on life Since she was a child Steidler had wanted to dance. She “grew up” in Sharon Steidler’s haron Steidler’s diagno- Harrison Dance Studios discovery of having in West Chester and was sis of Stage 3C breast breast cancer came cancer came just weeks able to make dancing her by accident when career. In 1991 she was after she turned 39 in she was bumped by on the dance squad for 2007. Now, six years another dancer durthe 76ers. From there she on from surviving the ing a rehearsal. continued to dance and disease, she’s still dealsing professionally. In ing with breast reconthe mid-‘90s she landed struction surgeries and a job in Branson, Mo. for lymphedema (see blue “Legends in Concert,” a box at right), a condition that causes stage show featuring impersonators of she was performing in two shows six severe swelling in her left arm. days a week. She was living the life she For Steidler, who lives in Downingtown, famous musicians. Dancing was her life. She was in phenomenal condition. always wanted. Her co-workers and felbreast cancer took from her both breasts, low dancers were like a big family. At the time just before her diagnosis, her independence and her career. The first sign that something wasn’t right happened while she was rehearsing a dance routine and was elbowed in her left breast by another dancer. The impact caused her a lot of pain and later that day as she was feeling around the area she discovered a pea-size lump. “The doctor told me that cancer doesn’t hurt,” Steidler says, recalling her first visit. “But then the doctor said, ‘but if in fact it is cancer, it’s advanced stage.’” This was a lot for her to swallow. She was young, athletic, she wasn’t a smoker or a drinker and there was no family history of the disease. A mammogram detected a mass and then a biopsy led the doctors to believe she had Stage 2 Invasive Ductal Carcinoma. “They pretty much told me to pray,” Steidler says. “I didn’t cry that much. I was kind of numb. I called my family and asked them to be supportive and as positive as possible.” A second opinion confirmed her fears. Steidler left Missouri and her dancing career and went to Florida to live with her sister and begin treatment. Even though no cancer was detected in her right breast, she opted for a bilat38 E. Gay St eral mastectomy (the removal of both Autumn in the Pacific Northwest Wine Dinner West Chester breasts). “I chose bilateral because Tues, Nov 12th • 7pm I couldn’t imagine having it happening again,” she says. The date of her $99 per person By JEFF HOAGLAND jhoagland@dailylocal.com

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According to WebMD, “Lymphedema is an abnormal buildup of fluid that causes swelling, most often in the arms or legs. The condition develops when lymph vessels or lymph nodes are missing, impaired, damaged, or removed. Lymphedema develops after breast surgery because there is an alteration in the pathway that drains the fluids involved in the immune system. It may occur at any time after the surgery.” Breastcancer.org defines Stage 3C invasive breast cancer as: • “there may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast AND • the cancer has spread to 10 or more axillary lymph nodes OR • the cancer has spread to lymph nodes above or below the collarbone OR • the cancer has spread to axillary lymph nodes or to lymph nodes near the breastbone” A breast tissue expander makes room for a more permanent implant by stretching the skin and muscle. The tissue expanders are inflatable and are slowly enlarged through the injection of a saline solution.


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Accelerated Diagnostic Breast Evaluation Questionable Lump. Unquestionable Service. A suspicious lump can create worry. In an effort to be responsive and reassuring to our patients, the Chester County Hospital’s Radiology Department has established a rapid appointment program, where patients who notice a lump at home can call and be scheduled for an appointment quickly. After your primary care physician or gynecologist has seen you and performed a physical exam, call the Radiology Department and you can be seen within 24 hours. Urgent appointments for diagnostic mammograms are held aside each day for these types of requests. Patients will need to bring with them a prescription for the mammogram from their physician. Once at the Women’s Imaging Center, the patient will have the benefit of our digital technology, results that will be read immediately, our Breast Care Coordinator’s assistance, and the new spectrum of services offered at the Women’s Specialty Center. For urgent appointments, call 610.738.2611.

Dance From A8

surgery, April 23, 2007, is marked upon her back within a tattoo of a butterfly and the pink ribbon that has come to signify breast cancer awareness. It wasn’t until the surgery that the doctors could define exactly what she had. Now they learned it was Stage 3C (see blue box on page 8). Twentyfour lymph nodes were removed and 12 were cancerous. Next up was a tough, four-month bout with chemo. She lost her eyebrows, eyelashes and when her hair started coming out in clumps she had it shaved. Suffering the effects of chemobrain, Steidler says her memory of that time is blurry, but she does recall being encouraged by the other patients she would see in the infusion room. “I realized I didn’t have it so bad after seeing a guy younger than me who had to hold a bucket and had two kids in strollers with him,” she says. After the chemo she had to undergo 50 radiation treatments and this led to complications with the breast tissue expanders (see blue box on page 8) that had been implanted at the same time as the mastectomies. The expanders had to come out. Eventually she left Florida and went back to Missouri. She got a job in a chiropractor’s office and found some work teaching dance lessons. In 2010, she moved back to Downingtown, where she grew up, to live with her mother. She now works at Nordstrom’s and teaches at Harrison Studios, the same studio where she

spent so much time as a kid. “It’s good to teach, but I miss performing,” she says. “I didn’t choose to end my career. Because it was taken from me, I have a lot of ill feeling toward that,” she says. The lymphedema, which causes severe swelling in her left arm, is a complication from having so many lymph nodes removed. This condition, she says, is almost harder to accept than the cancer was. It makes her prone to infection and it makes buying clothes very difficult. And it’s this swelling, along with scar tissue from the mastectomies, which makes her unable to dance. Steidler stresses that early detection is key with this disease. “I tell that girl who elbowed me, you saved my life,” she says. Because she didn’t get annual mammograms, it was that elbow that detected the cancer. Early detection applies to men as well. “It doesn’t discriminate,” Steidler says. “I know men who have it.” She also advises women not to go online and attempt to self-diagnose if they find a lump. “It will drive you crazy,” she says. And while October is for breast cancer awareness, Steidler says it should also be about kindness awareness. “Every day everybody is going through something. Be aware and be kind to people,” she says. “I used to look away when people who were sick would pass me.” Then she had the experience of people looking away when she was sick. “Just look at them. Say hello.” Through it all Steidler has emerged with her spirit intact. “I didn’t consider myself a positive person until the

diagnosis, but something clicked and I got really strong and I don’t know how. I have a better outlook. I’m not perfect, I’m still working on it, but I know that I beat something huge,” she says. “It wasn’t just medicine that got me through it. I do pray. I thank God for giving me a second chance. I want to make a difference. I was put here for a reason.”

Recently, Steidler underwent a TRAM-flap, a grueling, eight-hour procedure to reconstruct one breast where fat is taken from the stomach and moved to the chest. Her doctor told her that by the end of this year she should be done with the second reconstructive surgery. “I hope it’s done. Hopefully,” she said. “I just need to move on.”

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Thursday, october 17, 2013

A POWERFUL PARTNERSHIP

Thursday, october 17, 2013

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Transforming how we treat cancer

Chester County Hospital is now part of Penn Medicine. Now, the power of Penn Medicine is behind all that we do, bringing the best of both worlds to our community: high-quality, personalized care and direct access to the most advanced treatments and technology.

YOUR LIFE IS WORTH PENN MEDICINE.

TrueBeamTM radiation therapy signals the beginning of a new era. We continue to accelerate our investments in lifesaving technology, including the TrueBeam system— a high-precision radiation treatment that’s a quantum leap forward in cancer-fighting technology. What does that mean to you? Greater accuracy in far less treatment time, tighter targeting—even if the tumor is moving— and a decreased level of radiation exposure. It’s all part of the multimillion-dollar improvements we’ll be making for you. Learn more about the TrueBeamTM technology and our Radiation Oncology Program at ChesterCountyHospital.org/TrueBeam

Chester County Hospital

Learn more at ChesterCountyHospital.org/Penn


A12 / Daily local News

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Thursday, october 17, 2013

BRINGING TRUEBEAM TO THE COMMUNITY Leading-edge technology of the future In September, Chester County Hospital officially began treating patients on the Varian TrueBeam™ linear accelerator.

T

tions of radiation delivery systems. Previous and many current models he scene looks futur- rely much more on human intervention and istic, like manual control, whereas something the TrueBeam has born in the imagination built-in capabilities that of a science- enable it to automatically and specifically target fiction and destroy tumors with writer. A maximum doses of radiacancer pation while protecting surtient lies still on a radiation treatment couch, as rounding healthy tissue. The Chester County what looks like space-age machinery starts circling Hospital recently purchased a new TrueBeam around them to deliver linear accelerator for its precise radiation treatRadiation Oncology proment with a remarkable level of control and syn- gram, bringing the highchronization. The couch est level of cancer care also moves to reposition to the community. The TrueBeam can deliver the patient as needed. Called TrueBeam™, this various forms of radiation therapy; including advanced cancer treatimage-guided radiotherment technology repapy (IGRT), intensityresents a quantum leap modulated radiotherapy forward in the speed, (IMRT) and Volumetric accuracy and safety of Modulated-beam Therapy radiation therapy. The TrueBeam system (VMAT) like RapidArc® radiotherapy. The Truemakes it possible to aggressively, accurately and Beam at Chester County will additionally feature safely attack tumors in the lung, breast, prostate, a fast Gated RapidArc® - allowing it to deliver soreproductive organs, phisticated and complex head, neck, brain and treatments accounting elsewhere with greater for patient respiratory precision and in far less time than earlier genera- movements. By Beth eBurn

the Chester County hospital recently purchased a new trueBeam linear accelerator for its radiation Oncology program, bringing the highest level of cancer care to the community. the trueBeam can deliver various forms of radiation therapy.

According to Medical Physicist Andre Kalend, PhD, the TrueBeam far surpasses its predecessors with its onboard digital ability to synchronize all the different components involved in

radiation therapy - including imaging, treatment delivery as well as patient positioning, and breathing and motion detection. “TrueBeam is much more than cutting-edge

technology; it is the leading edge of radiation therapy. It goes beyond what is considered stateof-the-art today. Having the TrueBeam means we have secured the stateof-the-art radiotherapy technology of the future,” said Dr. Kalend. “Radiation Oncology is complex technology-driven medicine. With this purchase, Chester County Hospital is poised to stay ahead of the innovation curve of

radiation oncology in the region.” Indeed, the level of precision with which the TrueBeam delivers radiation treatment is unprecedented. The system is able to target cancers with sub-millimeter exactness as it continually monitors more than 100,000 points of patient live images and data. Another key to the system’s Please see TRUEBEAM on A13


Thursday, October 17, 2013

TrueBeam From A12

pinpoint accuracy is that it includes sophisticated user-friendly imaging tools that physicians and therapists can use to generate various anatomical views 60% faster than previous accelerators. These advances also reduce overall imaging radiation exposure by 25% and offer greater patient comfort by shortening their treatment duration on the delivery couch. Typical irradiation duration that took 10 to 15 minutes takes a mere 1 to 2 minutes on TrueBeam. According to Radiation Oncologist Ann Marie Siegal, MD, the increased precision of the TrueBeam has significantly fine-tuned an often-challenging treatment delivery process. Many tumors are located in places that are affected by the body’s slightest movement. With the TrueBeam, radiation fields can be tailored tightly, directly targeting the cancer or area at risk. “When we are treating some of the more challenging cancers - where tumors are in areas exposed to lots of organs and healthy tissues - we have to be very careful. Movement is inherent to the human body and can’t be avoided, so precision is absolutely paramount when targeting a tumor. The slightest shift in the patient’s position or movement in the body, even the lungs as they expand during breathing, can throw off radiation targeting,” explains Dr. Siegal, who is also a Clinical Assistant Professor at the University of Pennsylvania Health System. She adds, “The TrueBeam can detect the smallest movements during a treatment session. It has the ability to automatically adjust where the delivery beam is directed; allowing radiation to hit its intended target, protecting healthy organs and tissues.” As the patient breathes and the lungs inflate and deflate, tumors are pushed in different directions, becoming both moving and shape-changing targets. TrueBeam contains a respiratory-motion management feature that is specifically designed to track movement of tumors as the patient breathes. The system ensures that radiation is only delivered when the tumor is within the beam’s line of sight. It even recognizes unplanned disruptions in the patient’s breathing cycle, such as coughing or sneezing. The added safety of the TrueBeam does not end with precision when tar-

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geting the tumor. The TrueBeam also has an internal collision protection and avoidance component that protects the entire patient while the linear accelerator’s gantry (the head of the machine) moves around their body, which means safeguarding patient positioning does not solely rest on the professionals operating the equipment. The system itself continually monitors where the patient is located throughout treatment, using special sensors to detect where the patient couch is in proximity to the machinery circling around the patient. “As treatments become more complex, it is essential that we have accelerator systems in place that monitor patient safety,” said Dr. Kalend. “TrueBeam has its own GPS-like capabilities that check itself to make sure the gantry never encroaches into the patient’s space. If there is ever an issue, the machine will immediately stop, move the patient out of the gantry path and then bring the patient back again to the treatment position. Prior to the True- Beam, machines were ‘blind’ to the location of the patient and the couch when the beam was on. Only the operator was aware of the patient’s location.” The advances in the TrueBeam system have significantly shortened the duration a patient has to spend on the couch undergoing treatment, even for those requiring high doses of radiation. The length of time needed for radiation sessions is always determined by the type of cancer a patient has, what dose of radiation is needed, and the individualized treatment plan. However, in many cases, delivery time will now be reduced by 50% or more with the TrueBeam. For example, treatments for patients with prostate cancer or

some of the more difficult head and neck cancers that may take up to a half hour or longer with conventional linear accelerators can now be delivered in just 2 to 7 minutes with the TrueBeam. “Faster treatments make the whole experience much easier for our patients,” said Dr. Siegal. “And the True-

Daily lOcal News / A13

Cancer Network since 1995. Because of the Hospital’s long-time connection to Penn Medicine, radiation oncology and medical oncology patients seeking treatment in Chester County will benefit from direct and immediate access to the resources of the university health system - including the latest

Chester County Hospital’s Radiation Oncology Team. Beam has a two-way communication system so therapists are in constant contact with patients and vice versa. That is very reassuring to patients.” The purchase of the TrueBeam linear accelerator is a significant milestone for Chester County Hospital, expanding the services provided by its Radiation Oncology Department and opening the door to new possibilities for treating cancers that are more complicated closer to home. A new vault for the TrueBeam was incorporated into plans for the Hospital’s Tower Project, a $45.2 million expansion. The Radiation Oncology Department is a key component of the Hospital’s comprehensive Cancer Program, which has been part of the Penn

oncology clinical trials. Patients can feel confident they are being treated by experts from one of the top academic institutions in the country, while being cared for close to home at the Chester County Hospital. Bringing the TrueBeam to Chester County Hospital dramatically expands its clinical treatment capabilities, and it demonstrates its firm commitment to expanding services and adding the future of technology to treat a broader spectrum of cancer patients with the most sophisticated program between Philadelphia and Lancaster. This article was originally published in Synapes 2013, Vol. 1.


A14 / Daily local News

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Thursday, october 17, 2013

Chester County Hospital’s breast surgeons

D

rs. Pamela Scott and Catherine Plzak are proud to welcome fellow breast surgeon Catherine Porter, D.O. to Chester County Hospital’s Women’s Specialty Center.

Under the care of these three exceptional women, area residents have access to the diagnosis, treatment and follow up of breast conditions in a personalized setting. The Women’s Specialty Center was conceived, designed and developed by women for women. At the Center women are provided with timely scheduling, consultation, diagnosis, and surgery, if needed. For more information about Drs. Porter, Scott and Plzak and the Women’s Specialty Center, visit www.TheWomensSpecialtyCenter.com or call 610-423-4556.

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Meet the Breast Health Team Catherine Porter, DO For Catherine Markle Porter, DO, coming to The Chester County Hospital means coming home. Dr. Porter was born at and later served as a candy striper for the same hospital that she now returns to as a Fellowship Trained Breast Surgeon. This local talent attended St. Agnes School and Henderson High School before studying at Delaware County Community College and completing her undergraduate degree in microbiology at Humboldt State University in California. Dr. Porter returned to the area to attend the Philadelphia College of Osteopathic Medicine, interned at Christiana Hospital in Delaware and completed her surgical residency at Cooper Medical Center in Camden, New Jersey. She then earned a surgical fellowship in Breast Oncology at Stanford University in California, where she received specialty training in treating breast cancer and high risk populations. Dr. Porter has also served her country as a member of the AmeriCorps, where she was stationed in Denver. She has a husband and two young children and is happy to have returned to the West Chester area to become a part of The Women’s Specialty Center.

Catherine Porter, DO

Pamela Scott, MD

Pamela Scott, MD

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Dr. Scott graduated from Mount Holyoke College and the Medical College of Pennsylvania. After completing her surgical residency at the Medical College of Pennsylvania, she joined their staff as the Director of Trauma Service and the Please see SURGEONS on A15

Catherine Plzak, MD


Thursday, October 17, 2013

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Surgeons From A14

Surgical Intensive Care Unit before moving to West Chester where she became a member of the medical staff of The Chester County Hospital. She has been an active member of the medical community for 25 years. Currently she serves on the hospital’s executive committee and is the Secretary-Treasurer of the Medical Staff. She is a member of the Breast Task Force and is the cancer liaison physician for the hospital to the American College of Surgeons. Formerly she was chief of the General Surgery section and a member of the credentials committee. Dr. Scott is a fellow of the American College of Surgeons and a charter member of the American Society of Breast Surgeons. Dr. Scott has been recognized by other doctors and has been awarded Top Doc in the Mainline in 2000, 2005, 2007, 2008, 2009, and 2010. She has been recognized by the March of Dimes as a Chester County Woman of Achievement. The Commission on Cancer (CoC) provided Dr. Scott with the Cancer Liaison Physician (CLP) Outstanding Performance Awards. This award is in recognition of her outstanding leadership and guidance as a physician champion in The Chester County Hospital & Health System’ Cancer program. The provision of comprehensive breast care has been a professional passion of Dr. Scott’s since joining The Chester County Hospital Medical Staff in 1984. Catherine Plzak, MD Certified by the American Board of Surgery and the American College of Surgeons, Dr. Plzak previously served as founding Medical Director of the Breast Center at Chesapeake regional Medical Center in Chesapeake, Virginia. Under her leadership, the center became a model of one-stop care for breast cancer patients. Dr. Plzak is a fellow of the American College of Surgeons. She received her medical degree from Jefferson Medical College in Philadelphia, and went on to complete an internship in general surgery at Bryn

Mawr Hospital and a residency in general surgery at Thomas Jefferson University Hospital in Philadelphia. She has served as attending surgeon/ trauma surgeon and Director of the Short Procedure unit at the Medical College of Pennsylvania in Philadelphia and was in private practice at Bryn Mawr Hospital. In addition, Dr. Plzak was an assistant professor of surgery at the Medical College of Pennsylvania and a clinical assistant professor of surgery at Thomas Jefferson University Hospital. Dr. Plzak’s experience adapting a multidisciplinary team approach to treat breast cancer complements the compassionate patient care practiced at the Women’s Specialty Center. Dr. Plzak works closely with talented colleagues from Surgery, Pathology, Radiology, Medical Oncology, and Radiation Oncology. Together, the team develops integrated treatment plans that are specialized to meet the individual needs of each patient. Dr. Plzak believes that caring for individuals with breast concerns requires an organized approach by a team of medical professionals in multiple specialties. Her goal is to promptly provide the highest quality care and compassion to guide and help patients become knowledgeable, active participants in their journey through this complex health challenge. She has a particular interest in the genetics of breast cancer, male breast cancer, and the use of neoadjuvant chemotherapy and has worked with Medecins sans Frontieres/Doctors Without Borders in Liberia, and have a commitment to providing medical care to underserved populations in the USA and abroad.

For more information or to schedule an appointment with one of these exceptional physicians, please call 610-423-4556.

Daily lOcal News / A15

Free Breast Cancer Screening The Cancer Program of The Chester County Hospital, in conjunction with The Linda Creed Breast Cancer.Org and La Communidad Hispana, presents a free Breast Cancer Screening. This program is FREE and open to women over 40 with no insurance coverage for mammograms. The screenings take place Sat., Nov. 9, 2013 from 9 a.m. to noon at The Chester County Hospital Radiology in the Kennett Square Medical Office Building, 402 McFarlan Road, Suite 204, Kennett Square, Pa. 19348. The screening includes a mammogram, physical breast exam and education. Refreshments will be served. Interpretation services are available. The screenings are a service of the Chester County Hospital and Health System and the Penn Cancer Network and could not happen without the support of the Linda Creed Foundation (lindacreed.org). To schedule an appointment, please call 610-444-7550 ext. 207.


A16 / Daily local News

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Thursday, october 17, 2013

Anatomy of a Mammogram What is a Mammogram? A mammogram is an x-ray exam of the breast that’s used to detect and evaluate breast changes. The x-ray machines used for mammograms produce lower energy x-rays that do not go through tissue as easily as those used for routine chest x-rays or x-rays of the arms or legs. This improves the image quality and exposes the breast to much less radiation.

What Happens? When you show up for your mammogram appointment, please proceed to the registration desk to register. Please bring with you your insurance card, your driver’s license or another acceptable form of identification and a script from your physician. After you

register, you will be taken to a dressing room and be given a gown. You will have to undress above the waist to have a mammogram. A technologist will come to escort you into the exam room for your mammogram. You and the technologist will be the only ones in the room during the imaging. The technologist will position your breasts between 2 plates attached to the mammogram machine—an adjustable plastic plate on top and a fixed x-ray plate below. The machine will compress your breast to keep it from moving and to make the tissue thinner. This reduces x-ray exposure and creates a sharper image. This compression may be uncomfortable and even painful, but it only lasts a few seconds and is necessary for good image. It is important to have open communications with your technologist. Let them know if you are in pain. He or she

can reposition you to make the pressure as comfortable as possible. The whole procedure takes about 20 minutes. The actual breast compression only lasts a few seconds. All mammogram facilities are now required to send your results to you within 30 days. In most cases, you will be contacted within 5 working days if there’s a problem with the mammogram.

have found that these types of mammograms are more accurate in finding cancers in women younger than 50 or with dense breast tissue.

Reading the Images

The digital image is interpreted (or “read”) by a board certified radiologist. This type of physician has special training in diagnosing diseases by Digital Mammograms looking at pictures of the inside of the body produced by x-rays, sound waves, Mammograms produce a black and magnetic fields, or other methods. white x-ray picture of the breast tissue. Reading mammograms is challengThe Chester County Hospital uses all ing. The way the breast looks on a digital mammogram machines, so the mammogram varies a great deal from picture is captured in a digital format woman to woman. And some breast that can be looked at on a computer cancers may cause changes in the screen. With digital mammograms, the mammogram that are hard to notice. original pictures can be magnified and looked at in many different ways on Please see IMAGE on A17 the computer screen. Several studies

Exceptional care for exceptional women Women’s Specialty Center Chester County Hospital

915 Old Fern Hill Road Building D, Suite 503 (2nd Floor) West Chester, PA 19380

728 West Lincoln Highway Exton, PA 19341

610.423.4556

Catherine Plzak, MD Catherine Porter, DO Pamela Scott, MD

TheWomensSpecialtyCenter.com • • • • •

Breast Care Gynecologic Oncology Genetics Counseling Pain Management Plastic Reconstructive Surgery

Chester County Hospital

Breast Surgery

Waleed Shalaby, MD Gynecologic Oncology


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Daily lOcal News / A17

Mammograms produce a black and white x-ray picture of the breast tissue. The Chester County Hospital uses all digital mammogram machines, so the picture is captured in a digital format that can be looked at on a computer screen. With digital mammograms, the original pictures can be magnified and looked at in many different ways on the computer screen. Several studies have found that these types of mammograms are more accurate in finding cancers in women younger than 50 or with dense breast tissue. The image on the left is a traditional mammogram. The image on the right is a digital mammogram.

Image From A16

It is important that if you have had previous mammograms you provide your radiologist with the most recent images. This way they can be compared with the new images, assisting the doctor in finding small changes and detecting cancer as early as possible. After comparing images, the radiologist decides whether there are any potential abnormalities. If there are any areas of concern, additional imaging of the breast will be needed. If you are asked to return for a diagnostic mammogram, don’t panic! This does not mean that you have cancer. In fact, less than 10% of women called back for more tests are found to have breast cancer. Being called back occurs fairly often. It usually just means more pictures or an ultrasound needs to be done to look at a suspicious area more carefully. Only 2 to 4 screening mammograms

of every 1,000 lead to a diagnosis of breast cancer. During the diagnostic mammogram appointment, a radiologist will be present to interpret your images and answer any questions that you may have. You will be informed of the results that day before you leave.

When Should You Have a Mammogram? The American Cancer Society breast cancer screening recommendation suggest that women age 40 or over, should have a mammogram every year. A reminder to schedule your mammogram should be sent to you from your primary care or ob/ gyn physician’s office. Some women schedule the next year’s mammogram while still at their appointment and ask to be reminded of the appointment a few weeks ahead of time. From the American Cancer Society

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A18 / Daily local News

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Survivor family during treatment,” she said. “Patients get accustomed From A3 to having a lot of help during treatment and when they’re ment and the bonds that are done, sometimes they feel lost. formed between patients and I’ve seen people have panic staff. “We almost become like attacks.” Helping patients after treatment “is a very real but often unmet “Many patients feel like need,” she said. they don’t have the tools The survivorship program will help to find their new noraddress that need. mal,” Camarota said. Camarota sees her role as a SurviWhat the survivorship vorship Nurse Naviprogram aims to do is, gator starting when the patient is having “Give them the support their final meeting and tools they need to with the doctor upon completion of be able to move forward their active cancer treatment. “I’m here feeling empowered, not to help them transiin fear,” she said. tion to their ‘new’ normal.”

Thursday, october 17, 2013

Support

share their concerns with others having similar experiences and to design ways to cope with the challenges that arise from a system as each individual explores his or her cancer journey. cancer diagnosis. Guest speakYour facilitator will suggest some ers include professionals in the basic topics, but there will also be field of cancer management. In addition, videos, print materials, plenty of time to delve into other and class discussion provide uptopics of interest to the group. to date information for patients, family, and friends. I Can Cope From A3

An educational program offered in collaboration with the American Cancer Society (ACS) for adults facing cancer – either personally, or as a friend or family caregiver. Knowledge is power, and the more you know about what is happening during cancer diagnosis and treatment, the better equipped you will be to handle each step of the journey. The I Can Cope program gives participants an opportunity to

Association (PBA | NCA).

There is no charge for any of the above programs. Preregistration is required. For more information, including dates and times for these programs, please call 610.738.2300 or visit ChesterCountyHospital.org/Wellness. Meetings are held at the Chester County Hospital and other sites. The format varies from Look Good...Feel Better an open forum of discussion to planned educational presentaA program created to help tions. In addition, patients also individuals with cancer improve are welcome to attend suptheir self-esteem and manage port groups sponsored by the their treatment and recovery with Abramson Cancer Center for greater confidence. Look Good… areas such as bone marrow transFeel Better is offered through a plant, brain tumors, lung cancer collaboration of the Personal Care and advanced cancer care. Products Council Foundation, the Additional cancer-related American Cancer Society (ACS), support groups and events can and the Professional Beauty Asbe found at www.penncancer. sociation | National Cosmetology org/events.

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FAUNBROOK SUPPORTS THE FIGHT AGAINST BREAST CANCER. JOIN US AT THE HARVEST EVENT ON OCTOBER 24. WWW.UNITEFORHER.ORG/HARVEST 699 W. Rosedale Ave. • West Chester, PA 19382 • 610-436-5788 • www.faunbrook.com


Thursday, October 17, 2013

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Daily lOcal News / A19

Choice

Genetic

The Genetic Testing Program at Chester County Hospital is age (younger than 50) or provided as a part of ovarian cancer. their membership in • Women with two the Penn Cancer Netor more close relatives work. The Abramson (siblings, parents, chilCancer Center of the dren, grandparents, aunts, University of Pennuncles), on the same side of sylvania is a national the family, with the same or related types of cancer (for leader in the field of breast cancer genetics instance breast and ovarand has been selected ian, colon and uterine) by the National Can• Women who have had more than one type of cer Institute as one of eight institutions cancer nationally to form • Families that have a its Cancer Genetics known cancer predisposiNetwork. tion gene.

people from having it done. But a Supreme Court ruling earlier this year that determined genes cannot breast cancer. They block estrogen be patented might help the cost to from binding to breast cells,” Mcdrop from its current $4,000 range. Greevy said. But these medications “Until recently there was only one tend to have a lot of unpleasant side lab in the country that could do the effects. testing,” McGreevy said. The Supreme If a person is considering having Court ruling means other labs can the genetic screening — which has perform the genetic screen and posbeen available since the late 1990s sibly cause the price to drop. and is performed through a simple While some people might not blood test — it’s best to have it done want to know if they are carrying when they are in their early to midthe mutated gene, that’s their right. twenties. “These gene mutations And even if they possess a strong make the average age of onset of family history with cancer, nothbreast cancer much earlier,” Mcing says that they have to undergo Greevy said. Women who carry the the genetic screening. But people mutation often develop the cancer in should be aware that this mutation their 30s or early 40s. can be passed from the mother or For some, genetic testing may raise father to a son or a daughter and a ethical concerns over how the infor- parent with the BRCA mutation has mation could be used. The Genetic the ability to pass it along to all of their Information Nondiscrimination children, some of their children or none Act of 2008 outlaws employers and of their children. “Most patients are health insurers from discriminating grateful to have the information,” based on genetic predispositions to McGreevy said. And that informadeveloping a disease in the future. tion is something she encourages Ethical concerns aside, the cost her patients to share with their of the genetic screening can prevent families.

From A6

From A7

If you feel that you may be a candidate for the Genetic Counseling Program, please contact The Women’s Specialty Center at 610-423-4556.

This article was originally published as part of the Daily Local News Medical Column on July 26, 2013. *In a New York Times op-ed piece entitled “My Medical Choice,” actress Angelina Jolie announced that she was found to carry a “faulty” BRCA 1 gene, which places her at a significantly increased risk to develop breast and ovarian cancer. In this piece, Jolie discussed her personal experience of losing her mother to ovarian cancer at the age of 56 and her decision to undergo a prophylactic (preventive) mastectomy to reduce her breast cancer risks. Jolie indicated to other sources that she also plans to undergo a prophylactic salpingo-oophorectomy to remove her ovaries and fallopian tubes in order to reduce her risks of ovarian and fallopian tube carcinomas.

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A20 / Daily local News

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Thursday, october 17, 2013

our Family

eNdocriNology Family practice

taking care of

geriatric mediciNe

your Family

iNterNal mediciNe

Gateway Medical Associates, in Chester and now Delaware County, has been serving our community since 1996. Gateway strives to provide the highest quality primary and specialty care with a focus on our patients’ wellbeing and health.

New patieNts always welcome.

You can now schedule appointments online! visit our patient portal at

gatewaydoctors.com

Our 39 physicians and nurse practitioners provide quality care from any of our 9 convenient locations throughout the County.

610.423.8181

meet our New physiciaNs:

Visit our New practice:

Katherine Chin, M.D. Internal Medicine of West Chester 610.430.8200

Gateway Family Practice Newtown Maria DeMario, D.O. Newtown Business Center 4667 West Chester Pike Newtown Square, PA 19073 610.356.7870

Neema Chokshi, M.D. Endocrinology Associates 610.431.7929 Charles Catania, M.D. Myers, Squire and Limpert 610.431.1210 coatesVille

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