Breast Cancer Awareness magazine 2020

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Breast Cancer Awareness

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Breast Cancer Awareness

2020 Publisher

Donna K. Anderson

Editorial Vice President & Managing Editor Christianne Rupp

Editor Megan Joyce

Contributing Writers Lynda Hudzick Barry Sparks

Art Department

Dear friends and colleagues,

Many of us know someone who has had breast cancer, or perhaps it is you who is facing it. For those who haven’t experienced this dreaded disease, many women wait, wondering if they will be next to hear the news. The incidence of breast cancer has either remained steady or has even slightly grown in recent years. Fortunately, the death rate from breast cancer has declined. Explanations for the reduction in breast cancer deaths includes not only the decrease in the use of hormone replacement therapies, but also increased education and awareness, extensive scientific research, medical personnel with specialized training, new equipment and instruments, and improvements in surgical and treatment options. Penn State Health Milton S. Hershey Medical Center, the sponsoring partner of this specialty magazine, is on the cutting edge of research and treatments. You can count on them through your entire journey. Their knowledgeable and experienced medical professionals offer their expertise so that anyone who is diagnosed with breast cancer can realize their best outcome. We would like to thank Shelly Vanderlaan and Linda Bair, two breast cancer survivors, for sharing their personal stories. They have been there and back — for Linda, twice. They realized they didn’t need to travel the journey alone, but rather could rely on their personal support system and medical team. Both women want to inspire and empower others to courageously face their breast cancer fight or help others through theirs. Please take a few moments to learn what Penn State Health Milton S. Hershey Medical Center is doing so they can serve you better.

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Copyright © 2020 On-Line Publishers, Inc. All rights reserved. All listings and advertisements have been accepted for publication on the assumption that the information contained in them is true and accurate and that all merchandise or services offered in the advertisements are available to the customer according to the conditions warranted therein. The appearance of advertisements or products or services does not constitute an endorsement of the particular product or service. On-Line Publishers, Inc. disclaims any and all responsibilities and liability which may be asserted or claimed resulting from or arising out of reliance upon the information and procedures presented in this guide.

Christianne Rupp Vice President and Managing Editor Inside:


Navigators play key role in breast cancer patient journey


Genetic testing available to more people than ever



Breast cancer screening guidelines


How location affects symptoms of metastatic breast cancer


Survivor story: Regular mammograms are key to preventing breast cancer

More women opt for breast reconstruction



Survivor story: Positive support fuels patient recovery



Using diet and exercise to prevent breast cancer

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Navigators play key role in breast cancer patient journey By BARRY SPARKS


he diagnosis of breast cancer can be an overwhelming experience. Besides the emotional and psychological impact, the diagnosis starts women on an unfamiliar journey through the health care system, which often can be confusing. Breast cancer patients, however, don’t have to make the journey alone. A nurse navigator will guide them through the process and help to remove barriers that hinder optimal care. A navigator’s background may vary from hospital to hospital, with some being nurse navigators and others patient navigators. What they have in common is that they must be well-versed in what breast cancer patients need and the barriers they must overcome. Additionally, they must possess extensive knowledge, specialized skills and good clinical judgment. “The goal of the service is to ensure patients receive timely, quality treatment for their breast health care issues,” says Lisa Spencer, a breast care patient navigator at Penn State Health St. Joseph Medical Center, who holds clinical licensures in radiation therapy.

Evidence shows that having a navigator available to assist patients can dramatically improve patients’ chances of receiving the best possible care. ““Allaying fear of the unknown is one of the first things we do to help patients,” says Sarah Sheetz, nurse navigator, at Penn State Health Milton S. Hershey Medical Center. “Most patients have no understanding of what’s involved when they are diagnosed. We help patients understand the process, the breast cancer health care team, the pathology of the disease, surgical options and much more.” Spencer adds, “I let patients know what’s going to happen and when. I tell them what the expectations are and try to put them at ease.” The relationship between a navigator and a breast cancer patient is usually very personal. “Undergoing breast cancer treatment is a very emotional process with a lot of ups and downs,” says Spencer. “Building relationships is very important.” Navigators serve a variety of roles. At times, they act as an educator, advocate, liaison, coach, coordinator, guide and problem solver. They are the central point person for breast cancer patients. Their effectiveness is increased because they are an integral part of the health care team. “I have a relationship with each member of the breast cancer health care team,” points out Sheetz. “I have direct access to them, making it easier for me to get information and answers to questions.” Navigators work with patients from diagnosis to treatment and recovery. At Penn State Health hospitals, all breast cancer patients are assigned one. Here are some of the services they provide: Find the information you need to make decisions. Your navigator can ensure that you have the most current and complete information on your treatment options. Answer questions about your care. You may ask your navigator any questions about your diagnosis and treatment. She will consult with physicians and other care providers as needed to help you find answers.

Lisa Spencer, breast care patient navigator at Penn State Health St. Joseph Medical Center

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Identify sources of financial support. If you don’t have insurance, or your insurance does not cover the entire cost of your care, your navigator can help you find sources of financial assistance.

Coordinate referrals to other support services within Penn State Health hospitals. These may include nutritional counseling, pain management, social work, spiritual care or physical therapy, all of which may benefit your cancer treatment and recovery. Locate additional resources in the community. Let you know what to expect during appointments and treatment. Your navigator can give you previews of what will happen during each appointment and help you keep track of questions you want to ask your care provider. Help you arrange transportation to your appointments. If you don’t have your own transportation, your navigator may be able to assist you in arranging transportation to and from your appointments. Arrange translation and interpretation services. Let your navigator know if you need translation or interpretation services at your appointments with care providers. Identify cancer research trials for which you may qualify.

Sarah Sheetz, nurse navigator at Penn State Health Milton S. Hershey Medical Center

Provide emotional support and understanding. Cancer treatment can be physically, emotionally and spiritually demanding. Your navigator can help minimize any distress by listening to your concerns and referring you to sources of helpful information and support. Coordinate any follow-up care at the completion of treatment. “Navigators will typically do whatever they can to make the patient’s journey easier,” says Spencer. “Many patients say they wouldn’t have been able to make it through the process without the help of a nurse or patient navigator.” Everyone in the health system works together for the patients, making the role of the navigator very satisfying, according to Sheetz. “I became a nurse to help people,” she says. “As a nurse navigator, it’s rewarding to help women through the process, see them improve their outlook and reclaim their lives.”

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Genetic testing available to more people than ever By BARRY SPARKS


bout 5% to 10% of breast cancers and 15% of ovarian cancers are thought to be hereditary, according to the American Cancer Society and the National Ovarian Cancer Coalition. Hereditary cancers result directly from gene changes (mutations) passed on from a parent. People who inherit mutations in these genes are at an increased risk of developing breast and ovarian cancers, as well as other types of cancers, compared to the general population. The most common cause of hereditary breast cancer is an inherited mutation in the BRCA1 or BRCA2 gene. In normal cells, these genes help make proteins that repair damaged DNA. Mutated versions of these genes can lead to abnormal cell growth, which can lead to cancer. “We can’t change the genes we inherit,” says Maria Baker, PhD, a genetic counselor and medical geneticist for the Cancer Genetics Program at Penn State Cancer Institute, Hershey. “You can, however, be proactive and consider genetic testing, which can determine whether you have an abnormal gene that increases your risk of breast or ovarian cancer.”

A genetic test most often involves a blood test but also can be done using a saliva sample. For the blood test, a technician inserts a needle into a vein in the arm and draws a blood sample. For the saliva test, the patient spits into a tube after refraining from eating, drinking or chewing gum for at least 30 minutes. The sample is then sent to a lab for DNA analysis. Who should consider genetic testing? Baker says there isn’t a clear answer to this question because professional organizations, as well as insurance companies, have developed their own guidelines, which sometimes tend to be different from each other. In general, however, they include two main groups of people, according to the American Cancer Society. The first group includes women who already have been diagnosed with breast cancer. Most doctors agree that not all women with breast cancer need genetic counseling and testing, but counseling and testing are more likely to be helpful, if: • You were diagnosed with breast cancer at a younger age, especially if you have triple-negative breast cancer. • You have been diagnosed with breast cancer a second time (not a recurrence of the first cancer). • You are of Ashkenazi Jewish descent. • You have a family history of breast cancer — especially at a younger age or in men – ovarian cancer, pancreatic cancer or prostate cancer. The second group includes people who are at higher risk for BRCA mutations (or mutations in other breast cancer susceptibility genes), including: • People with a known family history of a BRCA mutation (or mutation in another breast-susceptibility gene). • Women diagnosed with ovarian cancer or pancreatic cancer, or men diagnosed with breast cancer, pancreatic cancer, or highgrade or metastatic prostate cancer. • People with a family history of breast cancer at a younger age, more than one family member with breast cancer or breast cancer in a male family member. • People with a close family member with a history of ovarian cancer, pancreatic cancer or metastatic prostate cancer.

Maria Baker, PhD, genetic counselor and medical geneticist for the Cancer Genetics Program at Penn State Cancer Institute, Hershey

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Ideally, the first person to be tested in a family is someone with a diagnosis of breast or ovarian cancer. If this individual agrees to

genetic testing and doesn’t carry a mutation in any of the cancersusceptibility genes analyzed, then other family members may not benefit from genetic testing. Before undergoing genetic testing, you should meet with a genetic counselor who has specialized education and training in genetics and counseling, according to Baker. “A genetic counselor will take a detailed personal and family history to determine if genetic testing is appropriate,” she says. “They will assess your risk of developing cancer and discuss the risks and benefits of genetic testing, as well as genetic testing options available. After the test, they will help explain the results and what they mean, review your medical management options and answer other questions.” If you test positive for an inherited gene mutation, a genetic counselor will help you work through your feelings and concerns. It is typical to experience feelings of anger, anxiety, sadness or depression. Your test results may impact family members and strain relationships. Protection against genetic discrimination in the workplace and with insurance companies is another important topic of discussion. A positive result doesn’t mean you’re certain to develop cancer, and a negative result doesn’t mean you definitely won’t get cancer. Genetic-testing results are not always black and white. There is a gray area, known as a VUS or variant of unknown significance, as well as unanticipated findings involving different genes. “We don’t want patients to worry,” says Baker. “Ninety percent

of the variants of unknown significance will be downgraded to normal, but we prepare patients for the possibilities and potential risks.” Although most insurance companies cover genetic testing and counseling, Baker recommends checking with your insurance company before pursuing those courses. “Cost used to be more of a factor,” she says. “Testing, however, is much less expensive today. Many genetics labs offer patients a self-pay price that is significantly discounted, if their insurance company doesn’t cover testing. In addition, some labs offer financial assistance programs, particularly to patients with large deductibles.” What’s the future of genetic testing? Baker believes the tests will continue to evolve. Already, there is at least one lab that offers a panel of more than 600 genes, compared to the typical panel that examines from nine to more than 84 genes. Some companies and corporations are offering genetic testing to their employees through their health and wellness initiatives. Because of changing technology, if you underwent gene testing five or more years ago, you may want to ask your doctor about considering updated testing. If your family history has changed, such as another family member developing cancer, you may want to consider getting retested as well. Genetic testing is available to more people than ever. Working with a genetic counselor can help you navigate the process and better understand all aspects of testing.

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———— Survivor Story ————

Regular mammograms are key to preventing breast cancer By LYNDA HUDZICK “When you hear you have cancer, symmetrical,” Bair said. “I went in with your life changes forever.” perky and droopy and came out with More importantly, believes perky and perkier!” Linda Bair, a two-time breast Mammograms are no longer a cancer survivor, you learn that diagnostic procedure that works “you can’t change yesterday, for Bair due to the implants today is a gift, and God has in both of her breasts, but she tomorrow covered for me.” remains diligent when it comes So far, that motto has served to breast self-exams. her pretty well. “Check your chest wall when First diagnosed at age 50 and you shower, the same as you again when she was 63, Bair has would your breast tissue,” she a sister who also was diagnosed said. with breast cancer at 39. Not long ago, Bair felt a lump “We had no history of breast on her chest, near her sternum, and cancer in our family,” she said, adding wondered immediately if the cancer that both were diagnosed with ductal had returned. carcinoma in situ (DCIS), which “I went back to Lime Spring means the cancer is contained within Linda Bair and met with Dr. Daleela Dodge, the milk duct. “We were lucky, in Joni Sweigart and the team,” she that respect.” said. “They determined from an Doctors discovered the cancer ultrasound that it was an infected both times through a mammogram. cyst, which they surgically removed.” The second time was with a 3D Bair has been incredibly pleased mammogram, which is available with her medical team throughout at Penn State Health Lime Spring her entire experience. Outpatient Center, where Bair works as a referral specialist. “They were so positive all along. They alleviated my fears,” she Her experience has made her a strong advocate for regular said. “They all get five stars from me.” mammograms. In addition to her care team, Bair credits a strong support “A lot of people think mammograms hurt,” she said. “But, for system for her success. Although her husband was with her during a few minutes of discomfort, please do it for yourself and your her first diagnosis and treatment, he passed away before the second family.” diagnosis. At that point, her son stepped in to provide support. With both diagnoses, Bair elected to have reconstructive “He was more of a basket case than I was,” she said. “But he’s surgery. always been there for me.” “It felt right for me,” she said. Now that both she and her sister have experienced breast cancer, Bair’s first mastectomy and implant were on her left side. After Bair has made an effort to educate her family and friends about the the cancer was detected at age 63 on her right side, she decided importance of getting a mammogram. again to have a mastectomy with an implant. “Just a few minutes of time and personal awareness — even in “The surgeon said since the first implant was in for 13 years, the midst of a pandemic — may save you!” she said. why not take that out and put a new one in as well to be sure you’re

“We had no history of breast cancer in our family”

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———— Survivor Story ————

Positive support fuels patient recovery By LYNDA HUDZICK Even though Shelly Vanderlaan had a large portion of her breast removed due to cancer, she sees the physical change as a testament to her resilience. “I am a work of art, a Picasso,” she said. A breast cancer survivor, wife and mother of one, Vanderlaan recalls the stress she and her husband felt in 2018 when he lost his job and their health insurance coverage due to a company downsizing. “It had been at the time when all of my regular checkups were due,” she said. “I canceled them because we had no insurance.” When their health insurance was reinstated, Vanderlaan rescheduled all of her appointments — including a mammogram. It was during this appointment that the radiologist explained she would need a breast biopsy. “He was sitting in his chair looking at my mammogram, and he turned and said, ‘It looks like cancer; we need to do a biopsy,’” she said. “He said it so calmly, like it was just an average day in his life, giving average news to an average person.” After the biopsy, Vanderlaan anxiously awaited the results. “Every time the phone rang, I was torn between ‘answer it’ and ‘don’t,’” she said. When the call came confirming a diagnosis of stage 1 invasive ductal carcinoma, Vanderlaan decided to make a positive change in the care she was receiving and made an appointment at Penn State Health Lime Spring Outpatient Center. Throughout the process, her husband was by her side, ready with his questions. “The only one I had was, ‘Am I going to live?’” she said. Many tests followed, including another biopsy. “I met with Dr. Daleela Dodge and Joni Sweigart to make a plan,” Vanderlaan said. “They were very positive and upbeat.” In December 2019, Vanderlaan had a lumpectomy. In January, she began her radiation, finishing the day before going into lockdown. Although she was unable to see her physician in person, Vanderlaan had a few Zoom calls with her oncologist and his nurse. “I actually like them better,” she said. “I don’t have to stress about going into a medical office.” While her six-month, post-surgery mammogram revealed all margins were clear, Vanderlaan is still nervous about it coming back. “I am getting my feet back under me,” she said, adding that it is important to gather as much positive support as you can. “It’s lovely to be surrounded by so much hope, guidance and love.”

Shelly Vanderlaan

“I am a work of art, a Picasso.”

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Breast cancer screening guidelines ancer screenings are widely recognized as a vital component of personal healthcare. Catching cancer in its earliest stages greatly improves patients’ survival rates, and screening is often the most effective way to find cancer before it grows and spreads to other parts of the body. Women who recognize the importance of breast cancer screenings are also likely recognize just how conflicting advice about screening is. For instance, the Centers for Disease Control and Prevention lists breast cancer screening recommendations from seven different organizations on their website. These organizations include the U.S. Preventive Services Task Force, the American Cancer Society, the International Agency for Research on Cancer, and the American Academy of Family Physicians. Women who visit the site expecting consensus among these respected organizations might be surprised to learn that no such universal agreement exists. Breast cancer is a complicated disease, so it’s understandable why there would be differences of opinion within the medical community regarding when women should and should not be screened. But recognizing that breast cancer screening is a complicated issue won’t help women learn when they should be screened. Working with a physician they trust and being open and honest about their health and their family history of breast cancer can help women make the most informed decisions about when and how often to be screened. In the meantime, women can consider these screening guidelines from Memorial Sloan Kettering Cancer Center, whose cancer experts devised the guidelines based on their extensive experience treating breast cancer patients.


Women at Average Risk The MSKCC defines being at average risk as having: • No symptoms of breast cancer • No history of invasive breast cancer (breast cancer that has spread beyond the milk ducts) • No history of ductal or lobular carcinoma in situ (abnormal cells that are confined to the milk duct or lobule) 10 | Breast Cancer Awareness Month

• No history of atypia (atypical hyperplasia, a form of benign breast disease) • No family history of breast cancer in a first-degree relative (parent, sibling, or child) • No suggestion or evidence of a hereditary syndrome such as a BRCA mutation (evidence would be multiple first- and/or second-degree relatives with breast cancer or ovarian cancer) • No history of mantle radiation (a radiation therapy used to treat Hodgkin’s disease and some other conditions) MSKCC recommends women between the ages of 25 and 40 who are at average risk schedule an annual clinical breast examination. Women 40 and older should have an annual mammogram in addition to their annual clinical breast exam. Women with dense breast tissue may be advised to have an ultrasound as well. All women should consider performing monthly breast self-exams beginning at age 20. Doing so helps women become familiar with their breasts, and that familiarity may alert them to abnormalities down the road. Women at Above-Average Risk Women whose risk of developing breast cancer is above average face more complicated screening decisions. This includes women with: • A family history of breast cancer in a first-degree relative (parent, sibling, or child) • A history of atypical hyperplasia (a form of benign breast disease); history of lobular carcinoma in situ (abnormal cells that are confined to the milk duct or lobule) • A history of mantle radiation (a radiation therapy used to treat Hodgkin’s disease and some other conditions) before the age of 32 • A genetic predisposition for breast cancer (for example, women with a BRCA mutation). Breast cancer screenings are important, and women should speak with their physicians to determine the right guidelines for them.

How location affects symptoms of metastatic breast cancer Metastatic breast cancer diagnosis can be difficult to comprehend. Such a diagnosis means that cancer that initially began in the breast has now spread to other parts of the body. Many women who receive such a diagnosis have beaten breast cancer in the past and might not understand why it has returned and spread to other parts of their bodies. But the threat of recurrence is something all cancer patients must face, and taking steps to understand as much about their disease as possible can prepare people to fight it once again. The location of metastatic breast cancer will affect how women feel. Understanding the relationship between location and symptoms can help women identify problems they might otherwise write off as natural signs of aging, and that knowledge might compel them to seek treatment that can prolong their lives.

Brain notes that between 10% and 15% of women with metastatic breast cancer develop brain metastases. Symptoms that affect the brain can include headaches; changes in the senses, such as slurred speech or blurred vision; memory problems; mood or personality changes; seizures; or stroke or “brain attack,� in which the supply of blood to the brain has been cut off.


Symptoms of metastatic breast cancer vary depending on where the cancer is located. notes that metastatic breast cancer most commonly spreads from the breast to the bones, brain, liver, or lungs. Some symptoms of metastatic breast cancer may be mistaken for natural signs of aging, which might keep women from seeking treatment that could potentially extend their lives by a number of years. The following is a breakdown on the symptoms of metastatic cancer associated with parts of the body where the cancer is most likely to spread:

Women only rarely experience symptoms of breast cancer that has spread to the liver. Liverfunction tests are often how metastatic cancer that has spread to the liver is detected. However, some women do experience symptoms, which can include pain or discomfort in the midsection, fatigue and weakness, weight loss/poor appetite, fever, bloating, swelling in the legs, or a yellow tint to the skin or whites of the eyes.



What does location have to do with metastatic breast cancer?

Bones are the first site of metastasis for more than half of the women who develop metastatic breast cancer. Sudden, severe pain and an inability to move are the most common symptoms that cancer has spread to the bone. Pain in the back or neck, numbness or weakness in an area of the body, or difficulty passing urine or having bowel movements are other symptoms of bone metastasis. Fatigue, weakness, nausea, loss of appetite, and/or dehydration, each of which can be indicative of high levels of calcium in the blood due to bone breakdown, are other symptoms of metastatic breast cancer that has spread to the bone.

Breast cancer that has spread to the lungs also does not often produce symptoms and is often detected via imaging studies conducted during treatment follow-up sessions. If symptoms do appear, they may include pain or discomfort in the lung, shortness of breath, wheezing, persistent cough, or coughing up blood and mucus. When cancer spreads from the breast to other parts of the body, the location of the cancer cells can produce certain symptoms that should not be mistaken for innocuous signs of aging or other illnesses. Breast Cancer Awareness Month | 11

More women opt for breast reconstruction By BARRY SPARKS

“Women are concerned about their body image and how their clothes will fit. They want their appearance to be as close to normal as possible.”

Dr. Dino Ravnic, plastic surgeon at Penn State Health Milton S. Hershey Medical Center

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mastectomy can have a devastating effect on women. It can leave them with psychological problems, poor self-esteem, diminished sexual well-being and decreased overall quality of life, according to the Plastic and Reconstructive Surgery Journal. For these women, breast reconstruction is a vital surgical procedure. Advanced breast reconstruction techniques during the past decade have made it easier for plastic surgeons to rebuild a woman’s breast to appear almost normal. “More women are opting for breast reconstruction following a mastectomy. Their primary goals are to restore their appearance, develop a sense of completeness and gain personal satisfaction,” says Dr. Dino Ravnic, a plastic surgeon at Penn State Health Milton S. Hershey Medical Center. “Women are concerned about their body image and how their clothes will fit. They want their appearance to be as close to normal as possible.” Ravnic says he rarely sees mastectomy patients who don’t want to have breast reconstruction. “The breast reconstruction options are quite good,” he says. “Although a woman’s breast will not be exactly the same as before, there is a great sense of normalcy. There is a high degree of satisfaction among our patients, and most women are happy they went through the procedure.” Women with breast cancer have two options when considering breast reconstruction. The options include implants or flap procedures. There is no one best reconstruction method. There are pros and cons to each. Breast cancer patients should discuss what type of breast reconstructive procedure they will have with their breast surgeon, plastic surgeon and cancer oncologist. The surgeon can insert implants, which are made out of silicone, at the time of mastectomy or at a later date, placing them either below or on top of the chest wall muscle. Plastic and reconstructive surgeons who specialize in microsurgery perform flap procedures. During flap reconstruction, the surgeon recreates a breast using tissue taken from other parts of the body, such as the abdomen, back, buttocks or thighs, and then transplants it to the chest by reconnecting the blood vessels to new ones in the chest region. This type of procedure is called autologous breast reconstruction.

According to the Susan G. Komen Foundation, most women who have had breast reconstruction don’t regret the method they chose. “More than 80 percent of our patients opt for implants,” says Ravnic.”The type of procedure depends on the patient’s personal preference, risk factors, as well as the type of treatment used for the breast cancer.” Women also can select when to have breast reconstructive surgery. They have the option to have immediate reconstruction of their breast at the same time as their mastectomy. Physicians often advise women who require radiation therapy to have staged breast reconstruction. After a mastectomy, the surgeon will insert a tissue expander to keep the breast skin that was saved during the mastectomy procedure stretched and supple in preparation for final reconstruction, which will be done several months after the patient completes radiation. A woman may opt for delayed reconstruction if a plastic surgeon was not involved after her mastectomy or if she did not know her breast reconstruction options at the time of the mastectomy. When the decision is made to have breast reconstruction, a woman has many things to think about as she and her doctors talk about what type of reconstruction might be best. According to the American Cancer Society, some of the factors to consider include: • Overall health (including issues that might affect healing, such as smoking or certain health conditions) • Breast cancer size and location • Breast size • Type of breast cancer surgery (lumpectomy or mastectomy)

• Treatments needed other than surgery • Tissue available for reconstruction • Whether reconstructive surgery is on one or both breasts • Desire to match the other breast • Insurance coverage and related costs for the unaffected breast • Preferred recovery speed • Willingness to undergo multiple reconstructive surgeries • Bodily impact of different types of reconstructive surgery Federal law mandates that breast reconstructive surgery following a mastectomy is covered by insurance. Insurance not only covers the initial procedure, but also subsequent procedures, any necessary revisions and upkeep required, including replacement implants, according to Ravnic. “Breast cancer patients should expect their surgeon to review their medical history and overall health, as well as explain which reconstructive options might be best for them based on their age, health, body type, lifestyle, goals and other factors. Your surgeon should explain the limits, risks, and benefits of each option,” he says, adding that it is important to talk openly about your preferences. “Be sure to voice any concerns and priorities you have and, most importantly, find a surgeon you feel comfortable with.” Breast Cancer Awareness Month | 13

Resources Just Get Me Through This! By Deborah A. Cohen and Robert N. Gelfand, MD Narrated by Susan Boyce Length: 9 hrs and 39 mins Your doctor told you it was breast cancer. So now what? You’ll need plenty of essential advice, the kind that comes only from someone who’s been there. In Just Get Me Through This!, Deborah A. Cohen and Robert M. Gelfand, M.D., help you deal with the ups and downs of the breast cancer experience. From the shock of diagnosis to getting through treatment to getting on with your life, they pack it with plenty of straight talk and practical tips. This newly updated edition also includes advice from two prominent breast cancer surgeons. Each step of the way, this wise and witty companion will be there with unfailing inspiration and heart-to-heart support. It’s also simple to use, with an accessible format — to make even the toughest days a whole lot easier. Let Me Get This off My Chest By Margaret Lesh Narrated by Allyson Ryan Length: 2 hrs and 49 mins Tamoxifen hot flashes, mastectomy, reconstruction, breast cancer etiquette, Frankenboobs, bras with special attachments ... Margaret Lesh shares it all in her funny, heartfelt collection of essays, anecdotes, and life lessons from the perspective of a two-time breast cancer survivor. She’ll tell you when it’s OK to play the cancer card, what you should take to the hospital, and suggestions on how to cope in those dark moments of the soul. With practical tips sprinkled throughout, Let Me Get This off My Chest explores how breast cancer changed her outlook on life, offering honest insights, humor, and sensitivity as she looks for the silver lining in a not-so-great situation. Whether you are a woman diagnosed with breast cancer or whether you know someone with breast cancer, this book was written for you. Better By Amy Robach Narrated by Amy Robach Length: 7 hrs and 59 mins In September 2013, ABC producers asked Amy Robach, then anchor of Good Morning America, to get an on-air mammogram to highlight Breast Cancer Awareness Month. Robach’s first instinct was to say no — there was no history of cancer in her family, she was only 40 years old, and she felt strange drawing attention to herself when she had no personal connection to the issue. (She’d been meaning to get her first mammogram that year but had conveniently “lost” the prescription.) Her colleague, Robin Roberts, herself a cancer survivor, convinced her to do it with one simple sentence: “I can pretty much guarantee it will save a life.” To Robach’s surprise, the life she saved was her own: tests revealed malignant tumors in her breast, and she immediately underwent a bilateral mastectomy, followed by six months of chemotherapy treatments.

14 | Breast Cancer Awareness Month

All books are available for purchase on Better is more than a story of illness and recovery. Robach recounts the day she and her husband, Andrew Shue, got the terrible news; the difficulty of telling her two young daughters; and the challenges of carrying on with the everyday duties of parenting, nurturing a fledgling second marriage, and managing a public career. She lays bare the emotional toll of her experience and mines her past for the significant moments that gave her the resilience to face each day. And she describes the incredible support network that lifted her when she hit bottom. Anticancer — A New Way of Life By David Servan-Schreiber Narrated by Robert Fass Length: 8 hrs and 54 mins This updated edition of Anticancer draws on recent clinical studies and offers more tips on how people living with cancer can fight it and how healthy people can prevent it. The new edition of Anticancer includes: • More benefits of anticancer foods, including new alternatives to sugar and cautions about some that are now on the market • New information about how vitamin D strengthens the immune system • Warnings about common food contaminants that have recently been proven to contribute to cancer progression • A new chapter on mind-body approaches to stress reduction, with recent studies that show how our reactions to stress can interfere with natural defenses and how friendships can support healing in ways never before understood • A groundbreaking study showing that lifestyle modification, as originally proposed in Anticancer, reduces mortality for breast cancer by an astounding 68% after completion of treatment • New supporting evidence for the entire Anticancer program Breasts: The Owner’s Manual By Kristi Funk Print and Kindle Breast cancer surgeon Funk offers a comprehensive and empowering approach to breast care and breast cancer in this wellwritten manual. Although Funk spends a good portion of the book on breast cancer diagnosis and treatment, she also provides a wealth of tips on how women can decrease their risk of developing the disease. The extensive research she shares can be overwhelming, but she lightens things up with jocular comments and blunt asides (quit smoking now, she advises, or you will look “ugly at your own funeral”). While her subject is weighty, Funk’s voice is empowering and inspirational. She urges women to make lifestyle choices that will improve their odds for not getting breast cancer, including cutting out or limiting meat in favor of a plant-based diet. Though she produces numbers showing breast cancer on the rise worldwide, Funk asserts her goal is not to “scare” but to “incentivize” readers. This information-packed manual will be of value to women of all ages and all stages of life, and certainly to those who have been touched by breast cancer.

Using diet and exercise to prevent breast cancer When it comes to breast cancer risk, some things are beyond a person’s control. Women might not be able to do much in regard to their genetic makeup and family history, each of which can elevate their risk for breast cancer, but many risk factors are within women’s control. A healthy diet and routine exercise may help women reduce their risk of developing breast cancer, while poor lifestyle choices can increase that risk. For example, being overweight is a strong risk factor for breast cancer for women who are 18 and older, advises Stanford Health Care. Even a 10% weight gain (or 15 pounds on a 150-pound woman) increases breast cancer risk as well as the risk of recurrence. Diet and exercise can play a pivotal role in reducing breast cancer risk, and it’s important for women to understand just how much good, healthy diets and routine exercise can do for them in regard to fighting breast cancer. • Stanford Health Care says some studies suggest limiting dietary fats in the diet, particularly those that come from animals, to reduce breast cancer risk. These include butter, full-fat dairy, poultry skin, and fatty meats. Reducing intake of dietary fats, especially animal fats, may protect against diseases sensitive to hormones, like breast cancer. • Data from the Women’s Healthy Eating and Living study suggest that soy consumption from whole foods and soy milk for any breast cancer type is probably safe, despite public perceptions. Avoid soy supplements and concentrated soy that comes in many soy protein powders until more about their effects is known. • The American Cancer society links alcohol consumption to a higher How to Starve Cancer: Without Starving Yourself By Jane McLelland Print and Kindle After being given a terminal diagnosis with only a few weeks to live, Jane McLelland threw herself into research. Already medically knowledgeable as a chartered physiotherapist, McLelland dug up research, some decades old, in her quest to survive. Rather than aiming to cure cancer, which in many cases is unachievable, her approach was to stop it growing. Remarkably, it not only stopped it growing, it disappeared altogether. There are now clinics following her protocol, achieving remarkable successes. This book is a game-changing new dawn in the treatment of cancer. Breast Cancer Smoothies By Daniella Chace Print and Kindle The statistics are staggering. Breast cancer is the most common type of cancer among women — about 1 in 8 U.S. women (about 12%) will develop invasive breast cancer over the course of her lifetime. Second only to heart disease by a mere 1%, every ounce of prevention and every window of opportunity for healing is critical. In order to reduce the risk of developing this common disease, you need a targeted plan to

risk of various cancers, including breast cancer. The more alcohol a person drinks, the higher his or her cancer risk. The ACS recommends no more than one drink per day for women and two for men. A 5-ounce glass of wine is considered one drink. Susan G. Komen® says a high body mass index has been associated with increased risk for postmenopausal breast cancer. Exercise may help reduce risk by altering metabolism, hormones, and breast density. Inflammation is an immune system response to injury or illness. However, when inflammation is chronic, it can damage DNA and lead to cancer, advises the National Cancer Institute. Deep marine fish; dark, leafy, green vegetables; bright, multicolored vegetables; black teas; and spices like turmeric can help fight or prevent inflammation. The ACS recommends adults get at least 150 minutes of moderateintensity or 75 minutes of vigorous-intensity activity each week (or a combination), preferably spread throughout the week to keep body weight in check. Stanford Health Care says consumption of high amounts of sugar can increase insulin levels and result in weight gain, each of which can lead to breast cancer. Limit intake of sugary snacks and refined carbohydrates, opting for healthy alternatives such as fruit, vegetables, beans, whole grains, dairy, and soy milk.

Diet and exercise are vital to overall health and can help women reduce their risk for breast cancer.

protect yourself from common breast toxins and to strengthen your immune defenses. In her delightful new book, Daniella Chace breaks down the complex topic of oncology nutrition and the specific dietary needs breast cancer creates into simple recommendations for making delicious smoothies that support healing and a healthy lifestyle. Breast Cancer (2020) By Sattar Memon, M.D. Print and Kindle Breast Cancer (2020): 150 Latest and Illustrated Questions & Answers is one of the most complete and practical books on breast cancer treatment and survival. It is annually revised and updated, highlighting the latest and rapidly evolving breakthroughs. This edition explains advances in targeted treatments, hormonal therapies, safer chemotherapies, and immunologic approaches as well as new forms of surgery and radiation. Impressive progress has been made in the treatment of metastatic, triple negative (TNBC) and genetic (BRCA1/2) breast cancers. Whether you are premenopausal or postmenopausal, hormone receptor and HER-2 receptor positive or negative or triple negative, or BRCA1 and BRCA2 positive, and whether or not your tumor is of early stage or has spread into bones, lungs, liver or brain, the information you will gather from this book could be life-saving.

Breast Cancer Awareness Month | 15

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