Breast Cancer Awareness

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Breast Cancer

Sponsoring Partner:

Cancer Institute

Breast cancer?

Never got in the way of her victory lap!

CAN-10575-17 59322 091316

Be inspired by Kathleen at InspiredTogether.org/Kathleen.

Cancer Institute

CAN-10575-17 59322 091316

Dear friends and colleagues,

As you probably know, statistics indicate that about 1 in 8 women will be diagnosed with breast cancer. And no matter what stage of the disease, those women are never the same after hearing that news.

Two breast cancer survivors have shared a snippet of their journey and offer a few words of wisdom within. After reading their stories, I was impressed by their resilience and positive attitude. And then I met them in person to take their photograph, and I marveled at how upbeat and positive they are about … everything! I thank these women for sharing their stories. It’s not always easy to put our personal lives “out there” for others to see.

These women faced a diagnosis that every woman fears and had to make some of the most life-altering decisions of their lives.

And after those difficult choices had been made, they entrusted their lives and the success of their breast cancer treatments to the expertise of their doctors.

That’s when you want to have the confidence that your provider is utilizing not only state-of-the-art screenings procedures and equipment, but also treatment techniques.

We would like to thank Penn State Health Milton S. Hershey Medical Center/Breast Cancer for sponsoring this special Breast Cancer Awareness insert. Learn how the Penn State Hershey Breast Center doctors and staff members coordinate efforts to ensure that patients have not only a positive experience, but also the best possible outcome.

From the initial 3-D mammogram screening to the support groups that are available during and after your final treatment, Penn State Health Milton S. Hershey Medical Center/Breast Cancer will give you the confidence to place your care in them.

Perhaps you would like to actively do something to make a difference. Find out more about the Making Strides Against Breast Cancer walk. It takes place in October, and the dates, locations, and information on how to become involved are included in the article.

Read, research, and learn what you can. As we all know, knowledge is power.

Christianne Rupp Vice President and Managing Editor

4

Inside:

10

Putting the Pieces Together Again

One More Cutting-Edge Tool: 3-D Mammography

6

12

Survivor Story: Attitude is Everything

Immediate Breast Reconstruction Surgery

7

14

Making Strides Against Breast Cancer

Survivor Story: No Hair? Don’t Care

8

15

Team Approach Welcomes Patients into the Fold

Resources

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Breast Cancer Awareness Month 3

Putting the Pieces Together Again

Women are creating mandalas in a mandala workshop led by artist Judeth Hawkins prior to the Moving Forward Breast Cancer Support Group meeting.

By LYNDA HUDZICK

W

omen who are diagnosed with breast cancer don’t have the luxury of putting their lives on hold to focus solely on their own treatment and recovery and on getting the support they need along the way. Studies have shown that a strong support system is key when it comes to keeping a positive attitude, something that has been proven to aid in the recovery process.

To help their patients who are fighting the disease, and the loved ones whose lives are also affected by a cancer diagnosis, Penn State Cancer Institute offers a variety of services that focus on taking care of the emotional, psychological, and physical needs that may have little to do with the nitty-gritty medical requirements of treating the diagnosis itself—but everything to do with a successful recovery.

Nichole Cook, a nurse navigator with the Penn State Cancer Institute, faced breast cancer at age 37 and feels that because she’s experienced it firsthand, she is “stronger, more patient, more empathetic to my patients and passionate about helping them get through their journeys,” she said. “I can’t take the cancer away, 4 Breast Cancer Awareness Month

but hopefully I can help make it a little easier for each woman I meet.”

Cook provides resource information for her patients about available programs, which include monthly support groups where she or another nurse navigator serves as a facilitator.

“They are very informal and candid,” she said. “We talk, laugh, and share tidbits of information with each other.”

There is also a support group designed specifically for children who have a parent with cancer called CLIMB, where the entire family is invited to attend.

Another important component to the healing process is to keep your body moving. The University Fitness Center on the Hershey campus offers classes that are designed especially for breast cancer patients.

“One program that has a lot to offer women is the Pink Ribbon Pilates Program,” Cook explained. “This program is instructed by a specialist trained to help women with post-op issues, such as lymphedema. There is also a special yoga class offered for stress and anxiety.”

Katie Schmitz, Ph.D., also believes in the power of staying active and, through the Schmitz Laboratory at the Penn State Cancer Institute, offers a number of exercise trials for breast cancer patients, including “Nurse AMIE for women with metastatic disease and ENACT for women undergoing chemotherapy,” she said.

“The most common symptoms during cancer are pain and fatigue … for fatigue, the No. 1 treatment is exercise, and we have many resources to help women get moving.”

A firm believer in leading by example, Schmitz said that “if I am asking someone who is going through cancer treatment to lift weights twice weekly, I have no excuse not to do it myself too!

Cancer patients and survivors are the inspiration for the work we do in my lab.”

As one patient shared in a testimonial about the exercise programs offered, “Having cancer and going through various treatments is tedious at times. This gym-related physical program has been for me a breath of fresh air. It has positively affected every aspect of my overall treatment process.”

Of course, it’s also beneficial to the overall state of mind for women facing breast cancer to feel as good as possible about how they look. One way the Penn State Cancer Institute helps with that is by offering the Look Good … Feel Better® program, where, according to their website, patients are taught hands-on beauty techniques to help them manage the appearance of side effects of chemotherapy and radiation treatments.

Additionally, free wigs are made available for patients undergoing treatments that cause hair loss.

For many women, forcing themselves to slow down and perhaps even try something new as a result of their cancer journey may lead to discovering a desire to be creative in whole new ways that become lifelong sources of joy and peace.

Providing women with those learning opportunities is the Center Stage Arts in Health program, with a mission of enhancing the entire healthcare community with art and music that is both nurturing and inspiring.

Keeley McCue, who coordinates all of the arts programs for the Penn State Cancer Institute, described the program as one that “offers a variety of free art making and live music programs for inpatients, outpatients, and their caregivers. We hire regional professional artists to teach these weekly workshops, perform, and live-paint on site,” she said.

Partnering with other established support groups at the Penn State Cancer Institute, McCue explained that they have been able to expand the reach and the scope of the programs offered, bringing a variety of arts workshops directly to the monthly support group meetings.

“Such classes include, but are not limited to, mixed-media arts, painting, pottery, yoga, movement, and music making,” she said.

Cancer patients participating in yoga class.

Their objective is to help those who participate to develop self-care habits and “to foster a greater sense of community through the arts,” McCue said.

The success of the programs is measured by feedback collected from the participants. As one participant in the Write from the Heart workshop shared, it was a “fun space to be in, freeing me from the trials of living with cancer in my body. [The workshop] helps me to identify the important things in my life, as I might stumble upon a writing I came up with in class that has more importance than I first thought. I enjoy this process of self-discovery.”

McCue gets great satisfaction from her participation in the Center State program and the opportunity it provides for spreading an atmosphere of creativity and positivity with the participants.

“I was drawn to all of the ways in which this program allowed me to share my array of creations with a community that has such a great need and appreciation for art,” she said.

As Cook put it, women often “don’t take the time from their responsibilities as mothers, wives, etc., to stop and address their own feelings and concerns.”

But she also emphasized just how important it is for women to force themselves to do so.

“Taking time for yourself is essential to healing and moving forward.”

Seasons duo Mary-Kate Spring Lee and Peter Winter provide soothing music as part of the Center Stage Performing and Visual Arts program.

Breast Cancer Awareness Month 5

Survivor Story

Attitude is Everything

By LYNDA HUDZICK

K

elly Hancharick Velesaris already knew a little something “I was informed that a lumpectomy may have been possible,” about facing challenges. A healthcare professional, a wife she said, “but I was hesitant because of the sheer number of small and mother of three young children, and a student working toward tumors surrounding the primary larger tumor. You have to do what completing a master’s program, not long ago Velesaris found herself is best for you.” faced with a whole new challenge when something happened that Velesaris is grateful for the services provided by Penn State forced her to slow down and take stock of her health.

Health Milton S. Hershey Medical Center/Breast Center, especially “For years, I was scheduling my yearly mammograms at another at the beginning when “your world has just been turned upside hospital, out of convenience from my home, and this year was no down,” she said. “They create an itinerary for you … a roadmap of different—until I received a phone call indicating that there was what is to come after being diagnosed.” an area of concern and the radiologist was requesting a Facing her journey with a positive attitude “from 3-D mammogram,” Velesaris said. the beginning was and still is key,” Velesaris said.

She contacted her physician and asked for a “Having a sound support system is imperative. referral to Penn State Health Milton S. Hershey As serious as cancer is, you have to find Medical Center/Breast Cancer. something to laugh at, even in your darkest “I initially had a repeat mammogram, moments, or it will eat you alive.” followed by a 3-D mammogram,” Because her children were so young Velesaris said. “The radiologist suggested when she was diagnosed, Velesaris an ultrasound, which was done also knew that there was “no time immediately.” to feel sorry for myself,” she said.

During the ultrasound, it was “They could not possibly wrap confirmed that the suspicious area their heads around the idea that did look like a cancerous mass.

Mommy was sick … maintaining “How in the world did I miss this a sense of normalcy was necessary mass during my monthly exams? both for myself and my family.”

How did I not feel it?” she said.

Velesaris credits her husband She was assured that it wasn’t for motivating her to keep going something she could have found every day, and she also said that because the mass was too deep in the staying active helped her to have an breast tissue. uneventful recovery.

“I had to make the dreaded phone “Moving keeps the body alive,” call to my husband,” Velesaris recalls. she said. “There was no time for sitting “I could not even utter the words … it’s around—I had a life to live!” like when you have a nightmare and you Being informed and advocating for cannot scream.” your own health are vital when it comes to The biopsy was done immediately, and the facing and beating a disease such as breast Kelly Hancharick Velesaris results confirmed the cancer. cancer, and Velesaris was no exception when it “My cancer was estrogen and progesterone positive/ came to learning all she could about how to help HERS2 negative,” Velesaris said. “Yes, I am a nurse, but herself through the process. She also learned to be aware now was not the time to play doctor. I refused to go on the internet of the needs of her own body. and research my diagnosis. I honestly believe this is the one time that “Your body will tell you when to stop and relax or when you did I ignored my very own words of living well and that is ‘knowledge is too much,” she said. “And remember: Keeping busy allows for both power,’” she said. physical and emotional healing.”

But she also knew that to do a job right, you need to understand Breast cancer affects women of all ages. Velesaris was only everything you can about it, and because fighting cancer was now her 42 years old when she was diagnosed, and she stresses how job, Velesaris said that she soon “realized I needed to hit this head-on important yearly mammograms are because early detection is and research everything I had coming at me in the weeks, months, often the key to survival. Yet, just as important is the attitude years to come.” that someone diagnosed with this disease brings to Because there were multiple tumors later found on a breast MRI, the fight.

Velesaris opted for a double mastectomy.

“Attitude is everything!” says Velesaris.

6 Breast Cancer Awareness Month

Making Strides Against Breast Cancer

By Jackie Chicalese

T

his year, it is estimated 11,300 new cases of breast cancer will be diagnosed, and 1,900 breast cancer deaths will occur in Pennsylvania alone, according to the American Cancer Society. Nationwide, 225,180 new diagnoses are predicted in 2017, along with 41,070 deaths from the disease.

Excluding skin cancer, breast cancer is the most commonly diagnosed cancer in women in the United States. It also remains a leading cause of cancer death in women, second to lung cancer.

Despite these statistics, the United States’ breast cancer death rate has decreased 38 percent since 1989, which amounts to 297,300 lives saved in almost 30 years. Through the Making Strides Against Breast Cancer program, the American Cancer Society hopes to see a continual decrease in breast cancer diagnoses and fatalities.

Kathryn Tucker, community development manager of American Cancer Society Inc., announced the ACS Making Strides Against Breast Cancer program will be celebrating its 25th anniversary this year.

Each MSABC event is a non-competitive 3- to 5-mile walk aimed toward raising funds for breast cancer research and education, awareness, and early detection, as well as promoting solidarity and commemorating those who have lost their lives to the disease.

Since the first event in Boston in 1993, Tucker noted that “more than 13 million walkers in the U.S. have raised more than $810 million in 300 communities nationwide, helping 3.1 million breast cancer survivors celebrate another year.”

Locally, another event will also celebrate its anniversary.

“The Making Strides Against Breast Cancer of Harrisburg event began in 1997, and we are excited to be celebrating our 20th anniversary this year,” Tucker shared.

This event unites the south-central region of Pennsylvania, rallying members of Cumberland, Dauphin, Lancaster, York, Adams, Juniata, and Perry counties.

Each year, the Harrisburg event attracts 6,000-8,000 community members for a display of solidarity and perseverance against the disease.

The communities’ support and determination to fight back against breast cancer raises anywhere from $700,000-$900,000 annually.

Proceeds from these events fund research, education, services, and programs both in south-central Pennsylvania and across the country, working toward a nation free from breast cancer.

“As of March 2017, the ACS is funding more than $64 million in breast cancer research grants,” Tucker said. “Through these grants, we’re investing in research to uncover strategies for more effective diagnosis, new treatments, and new options for patients who do not respond to

or become resistant to existing strategies, and more.”

In addition to research, funds have provided the ACS the means to ensure resources and programs are made available to those affected by breast cancer.

Remotely, the ACS national call center assists callers requesting cancer information, resources, and support, regardless of the hour. Proceeds raised from various events ensure the 1 million annual requests for cancer information are fulfilled through the 24/7 call center available at 800.227.2345.

Other programs that receive support include The Road To Recovery® program, which provides patients transportation to and from treatments and appointments; the Reach to Recovery® program, which creates a network of empathy and support by connecting recently diagnosed breast cancer patients with breast cancer survivors; and the Look Good Feel Better® program, which provides free wigs, accessories, makeup kits, and support programs for women struggling with appearance-related side effects of cancer treatments.

For readers looking to join the nationwide fight against breast cancer, they can begin in their own community.

“Readers can help make a difference by walking with us at our 20th anniversary event on Oct. 21 on City Island,” Tucker said.

The event will begin its walk at 8:30 a.m., with check-in opening at 7:30 a.m.

Those who participate in the event will learn ways in which the ACS can assist them, as well as how to become involved in creating a cancer-free nation.

No registration fee is required for the walk, though participants are encouraged to set a fundraising goal of $100, which will allow them to become eligible to receive an event t-shirt.

For those hoping to make a greater contribution, Tucker also suggests walkers recruit friends or family members to form a team.

To register for the Harrisburg event or make a donation, visit www.makingstrideswalk.org/harrisburg. For information on events, volunteer opportunities, and resources, visit www.cancer.org.

Breast Cancer Awareness Month 7

Team Approach

Welcomes Patients into the Fold, Places Them in Good Hands

By KIM KLUGH

P

enn State Hershey Breast Center, located at 30 Hope Drive in Hershey, integrates the dedication and expertise of its highly skilled breast-care specialists to meet the individual needs of every patient who walks through its doors.

It does so by welcoming patients (both men and women) into its care, working together as a team to quell the anxiety associated with the possibility of breast cancer and offering a variety of unique benefits, all under one roof.

This comprehensive approach enables the center to coordinate and tailor the overall experience for each patient—from initial screening to personal risk assessment, from multidisciplinary team meetings to immediate breast reconstructive surgery, from genetic counseling to wig fitting and onsite support groups.

Whatever the patient needs, the Penn State Hershey Breast Center is able to accommodate with a full range of services, all in the same building.

From the moment a patient enters the Penn State Hershey Breast Center, whether she arrives with challenging breast health issues, with a benign breast condition, or as an average patient scheduled for her

From left, Dr. Daleela Dodge, breast surgeon, and Dr. Julie Mack, breast imaging physician.

annual breast screening, she benefits from the collaborative team approach.

Dr. Julie Mack, breast imaging physician, and Dr. Daleela Dodge, breast surgeon, are two of those Penn State Hershey Breast Center team members who work closely together.

One of the center’s distinctive benefits is the face-to-face communication exchanges that take place seamlessly among team members as well as those that occur between team members and patients.

For example, Mack says that during a follow-up exam with her surgeon, a patient voiced concern about a new symptom, and a breast ultrasound was ordered. Mack, who had just spoken with the surgeon in the hall about the patient, performed the ultrasound and provided immediate feedback to both the patient and the surgeon.

Patients who receive their care at Penn State Hershey Breast Center experience a combined imaging and clinical center, and the center strives to make that combined care seamless for the patient.

Another benefit of team members being in close proximity: “If a patient’s image findings are complex and I want to show Daleela the

We often begin solving a problem on the same day a problem is detected.

area I’m concerned about— not just explain it to her on the phone or in writing—I can go down the hall and explain that I need to review the findings with her,” Mack says.

“If she’s in surgery, I can show it to her nurse coordinator, Lynn Fantom, who will then relay the key information as soon as possible.”

Mack explains that the same team approach occurs when an unexpected new finding is discovered on a screening mammogram.

The patient whose screening exam is abnormal is contacted by the breast imaging team and quickly scheduled for the required additional imaging. If the additional studies confirm an area that requires biopsy, the biopsy is frequently performed at the same visit.

“We often begin solving a problem on the same day a problem is detected,” Mack adds.

When a biopsy returns a diagnosis of cancer, “planning is already occurring with key team members behind the scenes,” says Mack.

Nichole Cook, R.N, one of the nurse navigators in the center, steps in to coordinate care and assembles key educational material for the day of the patient’s post-biopsy visit. Both Cook and the radiologist meet with the patient to explain and discuss the results of the biopsy.

“At the end of that visit,” says Mack, “I am able provide a warm handoff of the patient to the surgical team.”

Dodge explains that when Mack provides the warm handoff of a patient to her, her nurse coordinator, Fantom, becomes involved from the surgical side. Through a thorough intake process, she gathers personal information and relevant family history regarding all cancers of family members. In this position, she becomes familiar with the patient’s emotional status and personal concerns and can share them with the rest of the team when it meets.

“Surgeons by nature,” says Dodge, “have to operate. So that means we are not always available when results come back. This is where the nurse coordinator comes in—she can put the work orders in and speak to the patient while I’m still in surgery.”

Dodge says that they also have the internal support of plastic surgeons for breast reconstructive surgery, as well as genetic counselors to help with evaluations.

In addition to breast surgeons, breast imaging physicians, plastic surgeons, and genetic counselors, other team members include medical oncologists, radiation oncologists, integrative medicine, and nurse practitioners.

This “coordination of care” enables team members to explain information in a “cogent way” to their patients, Dodge says, which decreases the wait time for the next step in the process. Depending on

the circumstances, patients may even be able to leave the center with the story solved the same day.

The Penn State Hershey Breast Center also offers same-day readings where, “if patients choose to remain a little longer after a screening mammogram, they can receive the results before going home,” says Dodge. “We are one of the few centers that have that.”

The radiologists also offer evening diagnostic exams to assist with patient scheduling conflicts.

In the event that a patient becomes a candidate for breast-conserving surgery and chooses to have a lumpectomy or partial mastectomy, Dodge explains that the Penn State Hershey Breast Center offers an online tool called Nurse BEDI (breast education decision aid instrument) that has been developed to help breast cancer patients.

“This program,” says Dodge, “is a tool designed to personalize the information for the patient, given the specifics of her condition. As a surgeon, I used to be the sole educator for my patients. With tools like BEDI, they are already developing an understanding of their disease.”

Dodge notes that another benefit of the center is its high-risk assessment program. Although patients may not test positive for the BRCA1 or BRCA2 gene alteration, there are other factors that can increase a woman’s chances of developing breast cancer.

Should a woman discover she is at a high risk for getting breast cancer in her lifetime (20 percent or higher) through the Penn State Hershey Breast Center’s high-risk assessment program, she is then provided a detailed plan of care tailored to her specific risk level. This may include a schedule of periodic mammograms, physical exams, breast MRI, prophylactic surgery, or preventative anti-hormone therapy.

To help a woman along this uncertain journey, Dodge says, “We have a nurse practitioner who sees many of these high-risk patients long term.” It’s these additional pieces “that help us do the best we can for our patients—the care we are able to provide, all in the same place, and with a team approach is what makes the difference.”

And the more advanced the illness, as when disease is found in both breasts, the more important is that team approach.

“Information is power,” she says. “It saves time and helps with immediate problem solving. It also helps to alleviate fear for our patients.”

The Penn State Hershey Breast Center offers a comprehensive team approach, face-to-face communication, warm patient handoffs, and immediate problem solving, all under one roof.

Mack says, “Come into our fold—we will take care of you.”

Breast Cancer Awareness Month 9

One More Cutting-Edge Tool for Breast Cancer Screening:

By KIM KLUGH

T

Mammography

omosynthesis, often described as 3-D mammography, is an FDA-approved advanced technology that’s demonstrating its value as a screening and diagnostic tool in the early detection of breast cancer, including those cancers that are too small to be felt or are hidden.

Dr. Susann Schetter, division chief of Breast Imaging, comedical director, Penn State Health Breast Center, and associate professor of radiology, Penn State College of Medicine, says that after catching on more quickly in Europe, tomosynthesis has since grown in popularity in the United States.

She adds that Penn State Breast Center is entering its third year of using tomosynthesis as a screening and diagnostic tool.

“We think it’s a better mammogram, and we offer it to everyone ever since we rolled it out,” she says.

Given that every year there are more than 240,000 women diagnosed with breast cancer, screening remains paramount in the early detection of this highly treatable disease. She, along with the American College of Radiology and the Society of Breast Imaging, advocates for annual mammograms for women beginning at age 40 and earlier if there is an elevated risk.

“If the cancer is detected early at its earliest stage, there is an almost 100 percent rate of cure,” Schetter says.

How does tomosynthesis differ from a standard mammogram?

Typical mammograms provide a two-dimensional image of the three-dimensional breast.

Tomosynthesis is an innovative technology that Schetter says enables “the creation of a near-three-dimensional imaging data set of the breast taken with the sweep of the imaging tube in an arc across the breast.

“From the information obtained in the ‘sweep,’ individual, thin imaging slices of the breast are reconstructed, so that the radiologist can ‘page’ through the images, much like a CAT scan or MRI.” Studies have shown this technology results in earlier and easier detection of more cancers.

“We found cancers not previously found in a range of breast densities,” Schetter says.

Tomosynthesis is also more proficient in discerning the location, size, and shape of any abnormality identified at screening, which is especially beneficial to those women with dense breast tissue.

When relying on standard 2-D mammography, overlapping tissue can hide or mask tumors because dense breast tissue and

10 Breast Cancer Awareness Month

breast cancer have similar “whiteness” on the mammogram. With the multiple angles that 3-D mammography offers, radiologists can better detect the presence of an underlying abnormality.

The procedure for the patient is not that much different from the prevailing 2-D mammogram. As each breast is individually compressed, the patient is positioned for a 2-D image first. The tube then pivots to obtain the 3-D image.

The process lasts slightly longer than a traditional mammogram, but including the changing time, a patient should be ready to go in 20-30 minutes.

Women do receive a minimal amount of additional radiation during a 3-D mammogram, as compared to a 2-D mammogram; however, Schetter says, it’s a dose well below the FDA-regulated threshold for mammography—“an increased exposure, but not an increased risk.”

According to Schetter, in addition to improved breast cancer detection rates, one of the top benefits of 3-D mammography or tomosynthesis “is the decrease in the number of false positives, where women are called back for additional images.” (A false positive reading means that “something” appeared on the screening mammogram as a potential positive and warranted further imaging, but proved not to be cancer.)

In fact, she says there is a decreased call-back for falsepositive readings reported uniformly since the implementation of tomosynthesis.

Now, because tomosynthesis is more likely to identify a mass compared to a 2-D mammogram, instead of scheduling additional mammogram imaging as a follow-up, “they can often send a patient directly for an ultrasound when a 3-D screening determines there’s a mass,” Schetter says.

Ultimately, fewer women need experience the emotional rollercoaster of a call-back due to a false positive reading. Most importantly, if a mass is detected, the time between detection and appropriate diagnostic testing is improved with the use of a 3-D mammogram.

A more accurate screening can also lead to a decrease in the number of unnecessary biopsies and additional tests, since tomosynthesis delivers clearer results from the start.

The numbers tell the story: one in eight women living in the U.S. will be diagnosed with breast cancer in her lifetime. Seventy percent of women diagnosed will have no known risk factors.

Dr. Susann Schetter, division chief of Breast Imaging; co-medical director, Penn State Health Breast Center; and associate professor of radiology, Penn State College of Medicine, is shown with the new 3-D mammography system.

Twenty percent of women diagnosed with breast cancer are in their 40s, and “this,” says Schetter, “is a strong argument for consideration of screening for women in their 40s.” She also says that screening has led to a 15 percent decrease in mortality among the 40-49 age group.

What remains most critical for women, then, is to commit to screening.

“We have to somehow get to a point,” says Schetter, “where women accept this as something they need to do for their health—to overcome the fear and embrace a more positive outlook. Screening is not a prevention of cancer and should not be perceived that way, but it’s the best shot of finding breast cancer at its more treatable stage.”

She adds that there has been a 35 percent decrease in mortality since mammograms have been in use.

“We have to better our understanding of a woman’s risk,” Schetter says. “Because not one science fits all, we need to move toward a personalized approach to screening by stratifying a woman’s risk for developing breast cancer.”

This would take into account specifics such as age, personal breast issues, breast density, and family history— an approach that could potentially lead to safer and less costly breast healthcare in the long run.

As with any new medical procedure, the question arises: Will insurance cover tomosynthe­sis? Schetter says in Pennsylvania, “It’s the law.”

For anyone with insurance, mam­mograms are covered—that means 3-D mammograms are covered for all those who are insured within the state of Pennsylvania.

“Out-of-state coverage, however,” says Schetter, “where the insurance originates someplace else—many deny it, although that’s

beginning to change.”

As breast-imaging technology continues to evolve, new state-ofthe-art screening and diagnostic tools will be added to the toolbox for breast-health assessments.

For example, Schetter says, “We adopted whole-breast-screening ultrasound as a supplemental screening option for women with very dense breast tissue and an elevated risk of developing breast cancer.”

Statistics confirm that screening for breast cancer saves lives.

And at the moment, Schetter says, “Mammograms are the gold standard for screening and remain our best tool.”

Breast Cancer Awareness Month 11

Exploring the Option of Immediate Breast Reconstruction Surgery

A

fter a woman receives a breast cancer diagnosis, she has surgical options that her breast surgeon will discuss with her.

Dr. Melody Paulishak, breast surgeon at Penn State Hershey Breast Center, says, “She may be a candidate for breast-conserving surgery—as in a lumpectomy or a partial mastectomy—or she may need a mastectomy. Or due to high risk factors, even without a breast cancer diagnosis, she may elect to have a bilateral mastectomy (preventative mastectomy).”

Whatever surgery she chooses, she is then left with decisions regarding breast reconstruction. And on many occasions, Paulishak says the Penn State Hershey Breast Center makes it possible to schedule, in tandem with breast cancer surgery, immediate or sameday reconstructive breast surgery performed by a board-certified plastic surgeon.

Dr. John Potochny, medical director of the cosmetic surgery division at Penn State Hershey Breast Center and associative professor of surgery, explains that it’s called immediate breast reconstruction surgery.

“It’s an immediate start to reconstructing the breasts,” Potochny says.

Although breast reconstruction may be scheduled to begin at the same day/time as the breast cancer surgery, it is often completed later, after healing or a treatment program occurs.

However, he says that depending on the patient’s situation, there are instances when reconstructive breast surgery is carried out start to finish during that single scheduled surgery.

Unless their patients will be receiving radiation treatment after breast cancer surgery, both Potochny and Paulishak agree that same-day or immediate breast reconstruction is preferable for their patients.

Potochny explains that breast cancer patients who require radiation therapy after surgery are not good candidates due to the “collateral damage to the good tissue in the area.” They usually need a year to heal before becoming candidates for delayed reconstruction.

Both doctors say that immediate breast reconstruction is favorable in most circumstances because of the emotional impact a breast cancer diagnosis carries.

“Even for the gene-positive patients who have elected to receive prophylactic surgery (preventative mastectomy) and don’t have cancer,” Paulishak says, “having their breasts removed is a big decision. Immediate reconstructive surgery gives them the chance to wake up with some semblance of what they had before.”

Potochny says women facing a breast cancer diagnosis bear the weight of a huge emotional toll.

12 Breast Cancer Awareness Month

By KIM KLUGH

“Especially if they’ve opted for a bilateral mastectomy—they have to adjust to a significant change in their body image. Immediate reconstructive breast surgery gets a woman to the point of feeling whole again—at least the start of having breasts again,” he says.

Another advantage the doctors point out is that simultaneous

Dr. John Potochny, medical director of the cosmetic surgery division at Penn State Hershey Breast Center and associative professor of surgery.

surgeries save the patient from a second surgery at a later time, thus reducing time spent under anesthesia.

Potochny says that working simultaneously on a patient with a breast surgeon could eliminate one and a half hours of surgery for the patient and could mean a possible five hours’ total surgery for a bilateral mastectomy with reconstructions, with the potential to be home the next day.

Both Paulishak and Potochny say that the collaborative team approach that the Penn State Hershey Breast Center offers is what makes immediate breast reconstruction surgery possible for their patients.

“We meet with our patients in separate appointments—I go over the options for treatment and surgery, such as lumpectomy or mastectomy, and from there, the patient meets with the plastic surgeon and discusses the reconstruction options,” says Paulishak.

When she sees who’s scheduled to be the plastic surgeon, she meets with him/her in advance so that the patient’s appointment with the plastic surgeon is better Dr. Melody Paulishak, breast surgeon at Penn State Hershey Breast Center. tailored for her personal situation.

“Then we start coordinating surgery dates immediately, since it’s usually a time-sensitive situation mastectomy with the nipple removed is another option. Nipple for the patient,” she says.

Potochny says the team approach allows for immediate reconstruction can then be coordinated with the plastic surgeon, if collaboration among surgeons, oncologists, radiologists, patients, the patient chooses to have it reconstructed.

Paulishak says there are also specialized tattoo aestheticians who and ancillary staff so they can provide seamless movement for the can tattoo the nipple onto the breast, should the patient choose patient from one stage to the next.

“We have an advantage at the Penn State Hershey Breast not to have it surgically reconstructed. They are able to match the Center—we have the same operating schedulers, which makes appropriate pigmentation and create a 3-D effect, complementing the communication flow a lot better with surgeons and other the remaining nipple in appearance.

Although there are a variety of breast reconstruction techniques providers. In a community hospital, it requires a lot more work to make that happen—plastic surgeons’ schedules don’t match up, so available, plastic surgeons use two main types of procedures. The many reconstructive breast surgeries need to be delayed, rather than first is called autologous or flap reconstruction, “where the patient’s own body tissue is taken, most commonly from one of two sites for immediate,” he says.

As for the types of reconstructive breast surgery offered, tissue reconstruction—either from the belly area or the muscle of Paulishak explains from her end there are more options possible with the back—in order to create a breast form or mound.”

The second technique Potochny describes is a tissue expander a specialty called oncoplastics, which she describes as “performing a cancer operation while also paying attention to the cosmetic or implant reconstruction, where a saline-filled implant is used to outcome.” This is achieved by integrating plastic surgery techniques expand the tissue to “create a temporary space or a babysitter” for a permanent implant later on. into breast cancer surgery and, again, requires a team approach.

Potochny explains that although immediate or same-day For example, women with large, heavy breasts can elect to have a reduction incision to make the breasts symmetrical after one reconstructive breast surgery is not new, it is not available breast is altered as a result of cancer removal. This procedure, everywhere, due to the scheduling challenges it presents.

Not only does Penn State Hershey Breast Center “offer a whole which Potochny says “might require a lift or reduction” from a plastic surgeon to complete the symmetry and achieve balance, is array of reconstruction options, we also provide four ABPS-certified coordinated with the breast cancer surgery, limiting the patient to (American Board of Plastic Surgeons) plastic surgeons dedicated to breast reconstruction surgery. We are capable of coordinating the one time under anesthesia.

Another breast surgical technique is a nipple-sparing whole experience and can accommodate our patients, in most cases, in a few days with scheduling appointments and setting up surgery mastectomy.

“This is a technique that removes all of the breast tissue but dates.”

Potochny encourages anyone facing breast cancer surgery to plan conserves the skin, including the nipple,” Paulishak says.

This procedure leaves an envelope of skin that can then be filled ahead by scheduling a consultation to discuss breast reconstruction with an implant or tissue from the patient’s body. A skin-sparing options.

Breast Cancer Awareness Month 13

Survivor Story

No Hair? Don’t Care

By LYNDA HUDZICK

L

eonila Strouse leads a full and busy life. She was born in the Philippines, has lived in Germany (where she met her husband of 27 years), raised two successful daughters, and has enjoyed being a stay-at-home mom and also having a rewarding career.

It was for all of those reasons that Strouse decided when she was diagnosed with breast cancer that she was going to fight, and fight hard.

“Only you can fight your cancer,” she said. “No one can fight this battle as well as you can.”

It was in February 2014 that Strouse was doing her own breast self-exam and felt a lump in her lower right breast.

“I immediately called my family doctor,” she said.

Strouse was sent for further testing and re­ members exactly how she learned her diagnosis.

“The radiologist called me at work—really bad place to receive bad news—and confirmed I had cancer,” she said.

“I thought I died that day.”

Her cancer was a multifocal invasive ductal carcinoma, stage zero.

“At first I thought stage zero is not that bad,” Strouse said.

But the tumor grew very quickly.

“I had a lot of questions,” she said.

“What’s going to happen to me? What about my children and my husband— Leonila who’s going to take care of them?”

Strouse chose to have a bilateral mastectomy on April 9, 2014. She recalls thinking that although the surgery was over, “the fight is far from over.”

After visiting her oncologist, she was told that the recommended treatments would make her bald.

“I almost backed out,” Strouse said. “I asked myself again: ‘Do you want to live or die?’ I chose to live, and my attitude was: ‘It’s only hair; it will grow back. No hair, don’t care.’”

14 Breast Cancer Awareness Month

I chose to live, and my attitude was: ‘It’s only hair; it will grow back.’

Six months of chemo­ therapy followed, causing her to become quite ill. She remembers telling herself that “I need to fight this battle, not just for me but for my husband, whom I love very much … and my two daughters, they need me … they are the reason I am alive today.

Strouse I have a lot of friends and family that I want to be with for a long time. They made me strong,” she said.

Strouse is grateful for the words of encouragement she received from her boss, also a cancer survivor.

“The words she gave me were, ‘I promise it will pass; it will be better tomorrow,’ which it [was],” she said. “It’s been three years and I am doing well. I live my life like today is my last day here on Earth.”

Resources: The Mayo Clinic Breast Cancer Book By the breast health experts at Mayo Clinic Center Publisher: Da Capo Lifelong Books From the breast health experts at Mayo Clinic comes a guide to the many aspects of breast cancer—from prevention, to care and coping, to survival, to living with hope. The Mayo Clinic Breast Cancer Book is the trusted resource for anyone wanting reliable information about this dreaded disease. Mayo Clinic set out to provide comprehensive and up-to-date facts in easy-to-understand language. They’ve succeeded in this handbook for those who’ve been diagnosed or for those who want to give sensitive and helpful support to someone with breast cancer.

Available in Kindle and print editions Uplift: Secrets from the Sisterhood of Breast Cancer Survivors

By Barbara Delinsky Publisher: Atria Books With Uplift, bestselling author Barbara Delinsky, whose life has been shaped by her mother’s breast cancer as well as her own, created a resource she wished she’d had for herself during her own treatment: one that is filled with all the helpful advice that only the women who have already been there can tell us about—from tips on even the smallest details of daily life to inspiring personal anecdotes that amuse, comfort, and instruct. Here, readers can find answers to all the questions they were afraid to—or never even knew how to—ask: What kind of deodorant can I use during radiation? Are there certain foods that really satisfy on treatment days? How do I address my surgery with my coworkers? Will I still feel feminine? And what about a sex life?

Available in e-text and print editions The Buoy Projects: A Story of Breast Cancer, BucketLists, Life Lessons, Facebook and Love

By Lorna J. Brunelle Publisher: AuthorHouse Wanda Stairs Howard was many things to many people, but first and foremost, she was a mother, grandmother, and wife. Her daughter Lorna’s book is an account of how Wanda took what was left of her life and squeezed it until the pips squeaked, how she and her tireless Team Wanda celebrated her life while she was still living it, and how eventually they set her free for the ultimate journey. This book was written because so many people responded so strongly to her story as it played out through the medium of Facebook, and many of those people asked Lorna to put her mother’s story into print so that she could inspire others who weren’t lucky enough to know her personally. By the end of the book, readers will feel like they knew Wanda and will take comfort and inspiration from her life and death.

Available in Kindle and print editions

Chicken Soup for the Soul: Hope & Healing for Your Breast Cancer Journey: Surviving and Thriving During and After Your Diagnosis and Treatment

By Dr. Julie Silver Publisher: Chicken Soup for the Soul A support group from breast cancer diagnosis through treatment to rehabilitation and recovery, this book combines inspiring Chicken Soup for the Soul stories written just for this book and accessible leadingedge medical information from Dr. Julie Silver of Harvard Medical School. Patients and survivors will find comfort, strength, and hope.

Available in Kindle and print editions Breast Cancer (2017): 150 Latest & Illustrated Questions & Answers

By Sattar Memon Sold by Amazon Digital Services LLC Breast Cancer (2017): 150 Latest & Illustrated Questions & Answers reveals the breakthroughs that can save your life and extend it meaningfully and functionally. Whatever your cancer type or stage, the information you will gather from this book—containing the latest questions and most up-to-date answers regarding risk factors, screening, diagnosis, and novel, cancer-targeted treatments—could be life-saving.

Available in Kindle only Headscarves, Head Wraps & More: How to Look Fabulous in 60 Seconds with Easy Headwrap Tying Techniques

By Kaye Nutman Publisher: Kaye Nutman This book will teach you how to tie complimentattracting head wraps in no time at all. It can be so easy! The styles look amazing in much less time than it would take you to curl (or straighten) your hair. Headscarves can boost your look in seconds.

Imagine walking out the door, feeling great: confident, covered and chic!

Available in Kindle and print editions Breast Cancer Smoothies: 100 Delicious, ResearchBased Recipes for Prevention and Recovery

By Daniella Chace Publisher: HCI The statistics are staggering. Breast cancer is the most common type of cancer among women: About 1 in 8 U.S. women will develop invasive breast cancer over the course of her lifetime. Second only to heart disease by a mere 1 percent, every ounce of prevention and every window of opportunity for healing is critical. To reduce the risk of developing this common disease, you need a targeted plan to protect yourself from common breast toxins and to strengthen your immune defenses.

Available in Kindle and print editions

All books are available for purchase on Amazon.com.

Breast Cancer Awareness Month 15

From brain surgery to a full sprint; there’s no stopping Bindi now!

Be inspired by Bindi at InspiredTogether.org/Bindi.

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