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FREE A M AG A Z I N E F O R W O M E N ' S H E A LT H
IRON WOMAN Mika Kume
BREAKFAST HAS BENEFITS
CONTENTS
2
IRON WOMAN
2
Mika Kume
5 6 8 9 12
Share your story in PiNK!
16 18 20 21 23
Q&A: Fertility after Cancer Treatment
FA LL 2 014
Run for the Cure® News Improving Bone Health? To Supplement or Not to Supplement? Medical Decision-making: What Cancer Treatment Is Right for You?
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Cancer Prehab Breakfast Has Benefits Are You Listening? Healthy Diet, Happy Bladder
FROM TH E FO U N DATIO N (Follows English section) 1. PiNK Readership Offer 2. Monthly Self-Examination 3. RFTC Products 4. Pick up your free copy of PiNK 5. How you can help 6. Dear Survivor 8. Lemon Project 11. Resources Cover photograph © Zandy Mangold
Run for the Cure ® Foundation is a registered NPO with the Tokyo Metropolitan Government since 2004. Our mission is to eradicate breast cancer in Japan as a life-threatening disease through education, timely screening, and treatment. Through our activities, the Foundation funds education initiatives, clinical examinations and mammography machines; donates funds to organizations that promote activities specific to the mission of the Foundation; and develops and executes community outreach programs. We have donated six mammography machines to six clinics in areas where women are underserved, more than 18,000 women have benefited from mammograms, with over 3,700 funded screenings. The Foundation holds three annual events open to the general public to raise funds in support of our cause. PiNK is Japan's one and only magazine dedicated to breast cancer. Some 18,000 copies of this quarterly magazine are distributed free-of-charge nationwide through medical institutions, cooking studios, sports shops, libraries and sponsoring companies. Please contact inquiries@runforthecure.org for subscriptions. ®
For more information about how to donate, become a sponsor, and/or volunteer for Run for the Cure Foundation, please visit www.runforthecure.org
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Iron Woman U
Mika Kume
I
could barely see the finish
me: âNext time, please do not come
dedicated triathlete and long-distance
line because of the tears in my
alone. Bring a family member if
runner. I have done 11 Ironman
eyes. I was in incredible pain,
possible.â I replied that I am a single
competitions, 18 full marathons and
yet so, so happy. After 250km
woman, my brother is always busy,
eight ultramarathons, along with
and seven days in the Gobi
and my elderly mom lives far away.
countless other races over the past 15
Desert, I had finally crossed the finish
The doctor explained: âThere is a
years. Did I really have to bury my
line. It was a battle from beginning to
90% chance you have cancer. When
passion and love of endurance sports
endâbut after what Iâve been through
a patient is diagnosed with breast
for the rest of my life? Nonetheless,
this year, one of the most enjoyable
cancer, even if they look OK, they
I ended up pulling out of the Roth
battles Iâve fought to date.
are often in shock and do not listen to
Challenge, an Ironman distance race
what they are being told.â So I asked
in Germany; a 250km ultramarathon
2001 and 2011. Even though some of
one of my best friends, Taeko, to come
race in Iceland; and the Las Vegas 70.3
my best friends had been diagnosed
with me on the next appointment.
half Ironman World Championship
with breast cancer, I had always put off
After it was confirmed I had cancer,
that I had entered.
having a checkup myself. I returned
Taeko wasn't listening to what the
to Japan in 2012. My friend was
doctor was saying either!
I had lived in Singapore between
surprised Iâd never had a mammogram
couldn't possibly get any worse, I was diagnosed with breast cancer.
even after I entered, and won, the Run
being diagnosed with cancer was
for the Cure® 10km in Nozawa Onsen
not as traumatic as what I had been
now? Why so many mishaps in a
that year.
through a month before. I had a
row? " I became a little depressed, but
One of the prizes for winning was a
Initially, I asked: "Why me? Why
terrible bike accident on my way to
then I eventually started thinking in
free subscription to PiNK magazine.
work. A careless taxi driver opened the
a different way. âHold on. Maybe it is
Reading each new issue I became
passenger door as I was passing, and I
better the bad news coming altogether
increasingly more concerned about
ended up smashing my face against the
rather than things happening
breast cancer, especially being a
doorframe. The impact shattered my
separately. I will focus 100% on having
middle-aged woman whose family
cheek and orbital floor bone. During a
treatment and recovering from cancer
members had a history of various
six-hour operation, a titanium mesh,
and injury this year, and will bounce
forms of cancer. When I turned 52 in
bolts and plates were inserted in my
back even stronger eventually.â
2013, Ota ward of Tokyo sent me a
face. While the bolts and plates were
letter offering me a free mammogram.
removed a half-year later, the titanium
not just in Tokyo, but also from
They found a suspicious shadow in my
mesh will remain for life.
doctors in Singapore and Bangkokâ
right breast. After a further biopsy,
The surgeon informed me that I
I decided to seek a second opinionâ
for both my injury and breast cancer
they said the tissue contained some
could no longer do endurance-type
prognoses. It was fortunate that I
cancerous matter and asked me to
sports, because in extreme conditions
always was in good company when
return to discuss the next steps.
there is a greater risk of infection.
visiting these doctors. Taeko was with
As most of my friends know, I am a
me in Tokyo, Geraldine accompanied
My young female oncologist told
2
To be honest, the fact that I was
Then, just when I thought it
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I have done 11 Ironman competitions, 18 full marathons and eight ultramarathons, along with countless other races over the past 15 years.
Taken at Nozawa Run for the CureÃÅœ/ Walk for Life
PiNK â€Ë FALL 2014
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me in Bangkok, and JJ was by my
diagnosed at stage one. It was HER2-
also was having to take tamoxifen every
side in Singapore. I appreciate these
negative, a less aggressive type, and
morning, so I may have been more
ladies for standing next to me when I
had not metastasized to my lymph
fatigued than the othersâand feeling
desperately needed some support.
nodes. After a partial-breast removal
hotter in the 45°C conditions because
operation and subsequent 16 days
of hot flashes that are a side effect of
Singapore to see oncologists was
of radiation therapy, I am now only
tamoxifen. There were about 10 ER
because I was still covered by private
receiving hormone treatments, which
doctors in the race, and I mentioned
insurance there, whereas I was only
will probably last for about another
to them about taking tamoxifen. They
covered by national insurance in
four years.
kindly monitored me to ease my worry.
One of the reasons I went to
Japan. It would also be comfortable
It has been over one year since
I was enjoying walking and running
in Singapore because many of my
the accident and diagnosis, and I
in the spectacular scenery, and really
friends still lived there. However, since
have managed to restart my fitness
appreciated thatâdespite all that
my work was now based in Japan and
regimen. I completed another
had happenedâI made it through. I
the national insurance system here is
100km ultramarathon in April in a
couldn't have done it without the many
good, I decided to stay for the whole
new personal best time of under 12
friends and family members who were
treatment.
hours. Next, I finally completed the
always encouraging and supporting me.
I started reading books, articles,
250km self-supported Gobi March,
I am happy now to share my
searching the Internet and listening to
from the 1st to 7th of June. For this
experience and try to motivate others
stories from cancer survivor friends
ultramarathon race, I raised funds for
who are facing similar difficulties. Life
and from specialists. Many friends
breast cancer research while coming
will throw you constant challenges, but
were so helpful, thoughtful and
in 65th out of 109 competitors. It was
by facing them head on and dealing
generous to share their experiences
a good result, considering I was the
with them, they can be overcomeâ
and knowledge.
second-oldest woman in the race and
and you can battle on to your next
the 10th female finisher out of 23. I
adventure.
Luckily, my breast cancer was
Mika Kume Originally from Yokohama city, Mika is a Japanese tax accountant and a partner in KUME Tax Accountants, Kanda, Tokyo. She went to the UK for seven months in 1996 to learn English. There she enjoyed milky British tea and biscuits so much that on her return to Japan she needed to do something about the weight she gained and started running. To date, she has completed 18 full marathons, eight ultra marathons and 11 Ironman triathlons. She is also a very accomplished skier. In 2013 she had both a major bike accident and was also diagnosed with breast cancer. These incidents didnât stop her taking part in new sporting adventures, but just slowed her down a little. She now takes a less competitive and more relaxed approach to these events. Her recent health scares reminded her once again that life is just too short not to enjoy it to the fullest. In what little spare time she has, Mika enjoys good quality craft beers, making sashimi, singing & dancing, and drawing.
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Share your story in PiNK! Healing Power We have been publishing a âSurvivor Storyâ in the Japanese section of PiNK ever since the quarterly magazineâs launch in 2007. We continue to receive a lot of very positive feedback from both writers and readers. There is the special healing power of writing that allows survivors to open up, reflect back and share their personal journey â sorting their thoughts and embracing their feelings. Readers have commented on how the stories are reassuring, helping them to move forward and providing timely support. Run for the Cure® Foundationâs founder and chairman, Vickie Paradise Green, shared her personal journey as a breast cancer survivor in PiNK fall 2013.
Please keep in mind some basic requirements. In Word format (or similar) and at 800 â1,100 words, please include how you found out you had breast cancer; whether you had annual mammography screenings and if so from what age; whether you regularly self-examined; at which stage you were when diagnosed; whether you had a mastectomy or lumpectomy; what sort of treatment you underwent; and the types of drugs you used if any. Be sure to include your name, age, address, phone number and email. We reserve the right to edit your story for consistency in style regarding PiNK magazine, and crop or resize the photography you submit to fit our layout. The photography should be high resolution, at 300 dpi or more, as you will be on the English cover! You must confirm there is no copyright infringement for photography submitted and/or direct quotes you include from other sources. Please be reassured that we will not use your personal information for any other purpose without your prior consent. There is no compensation for the story you submit. We look forward to hearing from you! For any queries and submissions, email pink@runforthecure.org
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RUN FOR THE CURE® NEWS
Run for the Cure Foundation
Photos © Richard Grehan
@RFTCtokyo
Casino Night 2014
O
n October 17th, Friday, there will be more than just the rustling of color-changing leaves to mark the arrival of Autumn. Come to The Westin Tokyo in Ebisu for the welcoming sounds of Casino Night in Japanâs capital city. Chips hitting velvet Blackjack and Poker tables, pink balls circling Roulette wheels, dice rolling across crap tables, shouts of âRound and round she goes, where she stops nobody knowsâ at the Big Six Wheel â and the promising clunk of those one-armed bandits. Everyoneâs a winner, as proceeds will go to Run for the Cure® Foundation in its fight against breast cancer as a life-threatening disease in Japan.
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While the stakes are high when you consider that 1 in 12 Japanese women are diagnosed with breast cancer, your participation in Casino Night in Tokyo will make the odds tilt in favor of a life without breast cancer. Join us for an evening of great entertainment that includes authentic, one-of-a-kind Cajun food prepared by Bourbon Street, Guest Chef Sohan, whoâll bring The Big Easy hospitality to his buffet spread. Hurricane cocktails, beer and wine will be in generous supply on the casino floor. There will be live jazz and blues music played throughout the evening. All attendees also have an open invitation to join in the live
auction, silent auction and raffle with unbelievable prizes to take home. Book now since tables are limited. Date: Friday, October 17, 2014 Time: 6:30 p.m. â 0:00 a.m. Venue: The Westin Tokyo, Galaxy Ballroom & Star Junior Ballroom Games Available: Blackjack, Texas Holdâem Poker, Roulette, Big Six, Craps and Slot Machines Participation Fee: 15,000 yen (Buffet Dinner & Drinks Included) Please see our website for details! www.runforthecure.org
Run for the Cure ® News
Run for the Cure®/ Walk for Life 2014
G
reat entertainment, food trucks and much more! Top three winners of the runs (menâs and womenâs) will receive amazing prizes. Raffle tickets sold at 300 yen each or 1,000 for 4 gives you the chance to win some fantastic Raffle prizes that will include round-trip tickets to Guam by UNITED, round-trip tickets to Saipan by Delta Air Lines and accommodation at PIC Saipan resort, and tickets to enter the Saipan Marathon! Join us with friends, family and work colleagues for a 10K/5K Run, 5K Walk around the Imperial Palace!
Date: Saturday, November 29, 2014 Time: 9:00 a.m. â 1:00 p.m. Place: Hibiya Park / around the Imperial Palace Events: 10K/5K Run and 5K Walk Participation fees: 5,000 yen (adults), 2,500 yen (children 6-12 year-old), Free for children 5 and below Online registration and details available on our website http://runforthecure.org/en/tokyo-run/
Tokyo Bosom Buddies Survivor Group in Tokyo for foreigners and English-speaking Japanese. Gatherings at Franciscan Chapel Center in Roppongi once a month. For details, please email pink@runforthecure.org From left to right: Yuki Hirayama, Brenda Bohn, Sarah Smith, Nora Koiwai
For more photos of any of the events, please visit www.runforthecure.org!
Run for the Cure® Partners (Alphabetical order)
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I M PROV I N G B O N E H E A LTH?
T
here has long been a debate about whether older women benefit from calcium and vitamin D supplementation, but new research indicates that one group might: those taking hormone replacement therapy (HRT). The study, published online by Menopause, the journal of the North American Menopause Society, found that the supplements combined with hormone therapy protected women against hip fractures compared with placebo. Hormone Changes and Bone Loss Osteoporosis is a disease of the bones that is characterized by reduced bone mass and bone quality. Hormonal changes later in lifeâlike the drop in estrogen production that occurs during menopauseâcan contribute to bone loss. Osteoporosis leaves bones more fragile and susceptible to fractures. In fact, nearly half of women over the age of 50 will have an osteoporosis-related fracture in their lifetime, according to the US Preventive Services Task Force (USPSTF). Coping with Menopause Many women cope with uncomfortable symptoms during menopause, such as hot flashes, night sweats, vaginal dryness, moodiness, and difficulty concentrating. Some women choose to use HRTâeither estrogen alone or estrogen plus progesteroneâto reduce these
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symptoms. HRT comes with its own set of risks and benefits and, while not right for everyone, some women may benefit from it. HRT, Supplementation, and Bones Calcium is an important component in bone growth, and vitamin D helps the body absorb calcium. To evaluate the relationship between bone fractures and HRT and calcium and vitamin D supplementation, researchers evaluated data from the Womenâs Health Study, which included more than 30,000 postmenopausal women between the ages of 50 and 79. Many of the women in the study were taking HRT (estrogen alone or estrogen in combination with progesterone). About 16,000 women participated in a portion of the study dedicated to calcium and vitamin D. They were randomly assigned to receive either a placebo or 1,000 milligrams (mg) of calcium and 400 international units of vitamin D each dayâabout 8,000 women took supplements, while 8,000 took placebo. These 16,000 women came from all three hormone groups in the studyâestrogen alone, estrogen plus progesterone, and placebo. The researchers then analyzed the rates of hip fracture among women who took hormones and supplements, those who took hormones alone, and those who took neither. The results indicated that the hormones and the supplements appeared to have a synergistic effectâworking together
to protect against hip fractures and bone loss. The results indicated that women taking HRT who also took daily supplements of calcium and vitamin D experienced a 40 percent reduction in the rate of hip fractures compared with those who took HRT and placebo. In fact, women using both HRT and supplementation had a much greater protection against hip fractures than with only HRT or only supplementation. Overall the use of HRT and calcium and vitamin D supplementation together reduced the risk of hip fracture by 57 percent. Because calcium and vitamin D were taken together, the researchers were not able to identify whether one supplement had an edge over the other. Whatâs more, they were unable to identify an optimal dose for preventing hip fractures, though it appeared that women with a calcium intake of 1,200 mg or higher (from diet and supplements) and those with a higher vitamin D intake might reap more benefits. The researchers concluded that postmenopausal women may benefit from the combination of HRT and calcium and vitamin D supplementation as a strategy for fending off hip fractures. Because HRT carries some risks, women are encouraged to discuss the best proactive bone health strategy with their individual physicians. Right now the USPSTF does not recommend calcium and vitamin D supplementation in older women, but that could change as a result of this study.
TO SUPPLEMENT OR NOT TO SUPPLEMENT? By Paulette Lambert, RD, CDE
A
glance at the vitamin and supplement aisle in any grocery or drug store is proof: the nutritional supplement market is booming. More than half the American population takes supplements in some form, and we are spending $27 billion annually on a wide array of products that includes everything from mineral and vitamin capsules to herbal remedies and protein powders.
So why the rush to supplement? Many people believe that supplements can improve health, protect against disease, and, at worst, do no harm. But many of the claims made by manufacturers cannot be supported by science, and consumers are often unaware of drug interactions and other potential risks of using these products without a physician̢۪s supervision.
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Food First What many people seeking to improve their health with nutritional supplements may not know is that a balanced diet is adequate to provide most of us with the nutritional support we need. Supplements are not the same as food; they cannot replace a well-rounded diet made up of real food that includes a large volume of fruits and vegetables. And while many of us pop supplements to counter poor food choices, the fact is that no supplement has all the properties found in real food; there are more than 8,000 known bioactive compounds in fruits and vegetables alone, offering a treasure trove of protective benefits. More Is Not Always Better While it may seem like a good idea to boost our health by adding more of a beneficial nutrient, problems, including cellular toxicity or poor absorption of other nutrients, can arise when you take a higher concentration of a particular nutrient in supplement form. A nutritional compound that may be beneficial as one component of a food can have a potentially negative impact in a higher, concentrated dose. It is a double-edged sword: a supplement we take in an effort to do our bodies good may actually interfere with protective processes that occur naturally. More is not always better. Questionable Science When a supplement is recommended, a specific scientific study will often be cited that describes the purported benefits of the supplement. But the studies referred to are not always based on sound science. For example, if we were to examine the fact that Japanese men have a much lower rate of prostate cancer and assume that it is because they
When Supplements Make Sense
consume a large amount of soy, that may not be correct. They also consume large amounts of fish, vegetables, and fruitâall which may be factors in the lower prostate cancer risk. One reason for the jump to attribute scientific studies to various supplements is the potential financial returns on supplements in the lucrative US market; manufacturers want to cite studies to help market the supplements, so they push the results of studies that are sometimes incomplete, lack outcome data, and are not based on the rigorous human studies needed. For studies to be valid in nutritional science, they need to be complete and conducted over a sufficiently long period to offer results that can actually make a valid claim as to benefit or harm. Even the rather prolific research on multivitamins does not show a direct correlation to greater longevity. The bottom line: donât assume that the studies used to market supplements are reputable or rigorous; think critically about any scientific claims made, and always discuss supplements with your physician. Be a Savvy Consumer As with claims about scientific studies related to various supplements, other marketing approaches should also be evaluated with a critical eye. When you see a claim on a package that states something like âsupports breast health,â ask yourself, What does that actually mean? In all likelihood, at this time, there is no good evidence that it can lower the risk of breast cancer. The nutritional supplement market has our attention, but research does not necessarily support the marketing claims about these products. Until we have more sound scientific proof that taking supplements provides real benefit, it
While most of us can get the nutrients we need by eating a balanced diet that includes a high volume of fruits and vegetables, the following individuals may benefit from nutritional supplements:
⢠Those who have a medical condition that restricts the intake of a healthy diet or that interferes with the absorption of nutrients, such as food allergies, gastrointestinal disease, or liver disease ⢠Those on calorie-restricted diets, generally below 1,500 calories per day ⢠Women who are pregnant or planning to become pregnantâa prenatal vitamin ensures adequate intake of certain nutrients ⢠Those with very little exposure to the sun who may need vitamin D ⢠Those over 50 who may need a vitamin B12 supplement due to reduced absorption with age
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may behoove us to focus more on the most optimal diet possible. Using real food instead of searching for a âmagic pillâ will likely provide more long-term benefit for our overall well-being. Moderation and variety in the diet give us the nutrition we need. If you do feel the need for a supplement, consult your physician to avoid harmful interactions with other drugs you may be taking. If your physician approves, keep
Nutrition Through Real Food
supplementation to a level that is found in food, avoid the âmegaâ levels often seen in nutritional supplements, and stay within the bounds of the daily recommended intake. Do not base your decisions on retailers; even more importantly, focus on what we do know about nutrition: a lifestyle that includes a high intake of fruits and vegetables and regular exercise to maintain a healthy weight is generally the best choice.
Look to the garden for foods that offer vital nutrients easily absorbed by the bodyâand great taste. Eating a large volume of a variety of vegetables and fruits ensures adequate intake, promoting health and longevity.
FARMERSâ MARKET SALAD WITH BUTTERNUT SQUASH Arugula is a leafy green that provides many powerful nutrients. Approximately 3 cups of arugula (three small handfuls) offers 16 percent of the recommended daily intake of calcium, 79 percent of vitamin A, 25 percent of vitamin C, 90 percent of vitamin K, and 24 percent of folate. Dressing 1 tablespoon olive oil Pinch of red pepper flakes Âœ teaspoon sea salt 2 tablespoons orange juice 2 tablespoons pomegranate juice 1 tablespoon walnut oil or olive oil 1 tablespoon water Âœ teaspoon sea salt Âœ teaspoon freshly ground black pepper Salad 4 cups butternut squash, cut into Âœ-inch cubes and roasted 1 bag arugula salad mix Âœ cup feta or goat cheese, crumbled ÂŒ cup walnuts, chopped and toasted Âœ cup pomegranate seeds (dried cranberries are an alternative)
3 tablespoons pomegranate molasses Preheat oven to 400°. Toss squash cubes with olive oil, red pepper flakes, and salt. Spread squash in a single layer on a baking sheet and roast for 30 to 40 minutes, until tender and golden. Set aside to cool. (Squash can be prepared a day in advance.) Whisk juices, oil, water, salt, and pepper in a small bowl. Set aside. When ready to serve, toss arugula with dressing, place on platter, and arrange squash on top. Sprinkle with cheese, walnuts, and pomegranate seeds, then drizzle with pomegranate molasses. Note: If pomegranate molasses is unavailable in your area, place one cup pomegranate juice in a saucepan and reduce over low heat for 20 minutes until thick and syrupy. Watch carefully to avoid burning. Yield: 6 servings Nutritional information per serving: calories 195; calorie equivalent: 1 carbohydrate, 2 fats, 2 vegetables
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MEDICAL DECISIONMAKING: WHAT CANCER TREATMENT IS RIGHT FOR YOU? By Kari Bohlke, ScD
A
diagnosis of cancer can raise a long list of questions: Whatâs my prognosis? What are my treatment options? Should I get a second opinion? Where should I receive treatment? How will I feel during treatment? By seeking answers to your questionsâand by understanding some of the factors that influence treatment decisionsâ you can work with your healthcare
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team to choose a treatment plan that is right for you. As you go through this process, keep in mind that each person with cancer is different. Some people want very detailed information about their diagnosis and treatment options, and others do not. The extent to which people want to play an active role in treatment selection also varies. There is no single right approach, so communicate openly with your
healthcare team about your needs and preferences. UNDERSTANDING THE DIAGNOSIS As research has advanced, it has become apparent that cancers show tremendous variability in how they grow and respond to certain treatments. Even a single type of cancerâsuch as breast cancerâ can vary dramatically from one woman to the next in ways that affect
treatment decisions. By talking with your doctor about the characteristics of a particular cancer, you may develop a better understanding of why certain drugs or procedures are recommended. The stage of the cancer is important for many cancer types, and tests may also be available to assess factors such as hormone receptor status, patterns of gene expression, or the presence of certain gene mutations. Stage and Grade The stage of the cancer captures information about the size and the extent of spread of the cancer. For many types of cancer, stage is assessed using a TNM staging system. This assesses the size of the primary tumor (T) and the extent to which it invades nearby tissues; the spread of cancer to the lymph nodes (N); and metastasis (M) of the cancer to distant sites in the body. Stage may range from 0 to IV, with a higher stage indicating larger or more extensive cancer. Cancers that have a different staging system or a different way of being described include many of the hematologic (blood) cancers and cancers of the brain and the spinal cord. Your doctor can help you
understand the important features of a particular cancer. Stage can guide treatment decisions in many ways: it may help the doctor decide whether the cancer can be surgically removed, for example, and whether whole-body therapies such as chemotherapy are necessary. The grade of the cancer may also be important to assess. Grade refers to how abnormal the cancer cells look under a microscope. Different types of cancer can have different grading systems, but in each case high-grade cancers have cells that appear very abnormal (very different from normal cells). High-grade tumors may be more aggressive than low-grade tumors and may therefore require different treatments. Patterns of Gene Expression For certain types of cancer, patterns of gene activity within the tumor provide information about how the cancer is likely to behave. The Oncotype DXÃÅœ breast, prostate, and colon cancer tests, for example, assess the activity of several genes in a sample of tumor tissue and provide information about the likelihood of cancer recurrence or cancer aggressiveness. Cancers that have a higher likelihood of recurring
(coming back) may require moreaggressive treatment than cancers with a low likelihood of recurring. Gene Mutations Certain gene mutations also affect cancer behavior, and a large and growing number of targeted therapies have been proven effective against cancers that contain these mutations. Many advanced melanomas, for example, contain mutations in the BRAF gene and can be treated with drugs known as BRAF or MEK inhibitors. Similarly, advanced non– small cell lung cancers that contain abnormalities in the ALK gene tend to respond well to a drug that targets this gene abnormality. In some cases the presence of a certain gene mutation within a cancer may provide information about which treatments will not be effective. Certain targeted therapies for colorectal cancer, for example, are not recommended if the cancer contains a mutation in the KRAS gene. Other Features of the Cancer Many other features of the cancer may also be important. In the case of breast cancer, for example, cancers are typically tested for their
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Seeking a physician who specializes in the type of cancer you haveâand who treats large numbers of patients with that type of cancerâ may help you receive the best possible care.
hormone receptor and HER2 status. The results of these tests provide information about whether the cancer is likely to respond to hormonal therapies such as tamoxifen and the aromatase inhibitors and to HER2targeted therapies such as Herceptin® (trastuzumab). Choosing a Treatment Team As you consider where to receive cancer care, it can be helpful to start by talking with trusted healthcare providers in your area. Your primary care provider or a local oncologist, for example, may be able to refer you to an expert who specializes in the type of cancer you have. Or if you have already received some type of cancer careâsuch as surgeryâthe physician who provided that care will often be able to advise you about sources of any subsequent care you may need. Seeking a physician who specializes in the type of cancer you haveâand who treats large numbers of patients with that type of cancerâmay help you receive the best possible care. This may be particularly important if you have a very rare type of cancer or if you require complex or highrisk treatments, such as stem cell
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transplantation. Depending on where you live, finding a physician who specializes in a specific type of cancer may require you to travel to a large cancer center. Once your treatment plan is developed, however, it may be possible to receive much of your care closer to home, with only periodic travel to see the specialist. Choosing a team that makes you feel comfortable can also ease the process of cancer treatment. Cancer care providers differ in their communication styles and general approaches to health and healthcare, and you may wish to consider these characteristics in addition to the teamâs other qualifications. Some patients appreciate a blunt, businesslike approach to medical care; others prefer a more nurturing environment. UNDERSTANDING TREATMENT OPTIONS Depending on where and how they act, cancer treatments are either local (intended to treat cancer in a single area of the body) or systemic (wholebody). Surgery and radiation are local therapies, and many of the drugs used to treat cancer are systemic.
Depending on your situation, you may receive only local treatment, only systemic treatment, or a combination of these approaches. As you and your doctor develop a treatment plan, consider the types of information that you would like to have. You may have questions about your prognosis after treatment, the duration of treatment, where treatment will be delivered, short- and long-term side effects of treatment, and how side effects are managed. Some cancer treatments may reduce or eliminate your ability to have children; and if you have not yet completed your family, you may wish to talk with your doctor about options for fertility preservation. Answers to these questions can be helpful even if there is only a single standard approach to the particular type of cancer you have; and they become even more important if you have more than one treatment option. For example, one type of treatment may produce a somewhat lower risk of cancer recurrence than another, but this treatment may also have a higher risk of serious side effects. Once you have this information, you can decide what matters the most to you.
It may also be important to consider the goals of treatment. For earlystage cancers, the goal is often to cure (completely eliminate) the cancer. Goals for later-stage cancers will depend on the specific characteristics of the cancer: some may be treated with the goal of eliminating the cancer, but this is not always possible. Other goals of treatment may be to slow the cancer growth or to alleviate symptoms and maximize quality of life. Discussing treatment goals with your physician may help you decide what treatments and what side effects you are willing to tolerate. During this discussion keep in mind that the decision to have any treatment is up to you.
field. Second opinions are a common practice in any area of medicine that is complex and that has multiple treatment options. Getting a second opinion allows you to become more informed about the cancer and your treatment options and can also provide reassurance. If two experts in the treatment of the type of cancer you have agree on a treatment plan, it may help you feel more comfortable with your treatment choice. And if the experts disagree, it opens the door for additional discussion and a deeper understanding of the available options. You can then choose the treatment plan that you are most comfortable with and receive the care from the doctor who offered it.
ENLISTING SUPPORT Bringing along a friend or family member to your appointments can be very helpful. If you assemble a list of questions for your healthcare team prior to an appointment, your support person can ensure that the questions are asked and answered and can help you keep track of any new information your healthcare team provides. Family members or close friends may also be able to help you explore and manage the financial and insurance implications of a cancer diagnosis.
CONSIDERING CLINICAL TRIALS A clinical trial is a research study designed to evaluate potential new treatment options. Clinical trials test the safety and the efficacy of new or modified cancer drugs, new drug doses, unique approaches to surgery or radiation therapy, and varied combinations of treatments. In the United States, all new cancer treatment products must proceed through an orderly clinical trials evaluation process to ensure that they have an acceptable level of safety and demonstrate benefit to helping patients with a specific cancer before they become commercially available to other patients. Clinical trials are available for most types and stages of cancer and
SEEKING A SECOND OPINION Another step that many cancer patients take when selecting a doctor or treatment plan is to get a second opinion from another expert in the
can be particularly important for cancers that have poor outcomes with current standard therapies. A good source of information about ongoing clinical trials is the National Cancer Institute (cancer.gov/clinicaltrials). The potential benefits of participating in a clinical trial include close monitoring, the potential for early access to a promising treatment, and the knowledge that you are contributing to the advancement of cancer care. On the downside, it is possible that the new treatment will not prove to be as effective as hoped or will be found to have unexpected side effects. If you are considering participating in a clinical trial, your treatment team may be able to help you weigh the risks and the benefits. DECIDING WHAT ELSE MATTERS TO YOU Cancer can be an overwhelming diagnosis, but it doesnât define you as a person. Talking with your healthcare team about the other important aspects of your lifeâwhether it is your work schedule, your responsibilities at home, or your recreational pursuitsâmay help you plan how to integrate cancer treatment and cancer survivorship with the rest of your life. During this process, take the time you need to make the decisions that are right for you. In some cases it may be important to begin treatment immediately, but in other cases it will be less urgent. Talk with your treatment team about how much time you have to consider your options.
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Q&A FERTI LIT Y AF TER C AN C ER TR E ATM ENT Women who survived childhood cancer have a good chance of getting pregnant, but it might take longer By Lisa Diller, MD, Chief Medical Officer, Dana Farber/Boston Children's Cancer and Blood Disorders Center
Q A
What is the link between childhood cancer and fertility?
We have known for a long time that individuals who had childhood cancer may have limited fertility as a result of treatment. For boys, cancer therapy may lower sperm count. For girls it̢۪s more complicated. They need functioning ovaries and a functioning uterus. They need their hormonal paths to induce menstrual cycles. All these functions can be adversely affected by treatments for childhood cancer. For example, many types of childhood cancer require radiation therapy. Radiation to the pelvic area might affect the ability of the uterus to grow during pregnancy, or it might affect the ability of the ovaries to produce eggs. Radiation to the brain can affect hormones produced there that tell the ovaries to cycle.
Q
What do we know about the likelihood that a woman who had cancer as a girl will be able to get pregnant? How does this compare with other women?
A
New research from DanaFarber/Boston Childrenâs Cancer and Blood Disorders Center as well as from Brigham and Womenâs Hospital gives us valuable information about the fertility of women who were treated for childhood cancer, went through puberty normally, and are menstruating like any other woman. What we wanted to find out was What are the chances that these women will get pregnant? We looked at women of childbearing age, in their twenties and thirties, who had a history of childhood cancer. To find the women whose ovaries were not functioning normally, we asked if they were in menopause. If they were not in menopause, we asked whether they had ever tried to get pregnant for 12 months without success. Approximately 16 percent overall had some form of infertility, compared with about 11 percent in a control group composed of sisters of cancer survivors. This translates to roughly a 50 percent higher risk of infertility among women who had been treated for childhood cancer. About 3 percent of the cancer survivors were in menopause. About 13 percent were menstruating and appeared to have functioning reproductive systems but had not conceived after trying for a year. About two-thirds of these menstruating women eventually got pregnant. That is roughly the same rate of eventual conception found among all women who have tried unsuccessfully for one year to get pregnant. This tells us that women who survived childhood cancer have a good chance of getting pregnant, even though it might take them longer.
Q
Are certain women who were treated for childhood cancer at particular risk of infertility?
A
Women who had been treated with alkylating agent chemotherapy (drugs like cyclophosphamide and nitrogen mustard) or who received radiation to the abdomen or pelvis were most likely to experience infertility. They were more likely to experience early menopause and clinical infertility and not get pregnant at all following clinical infertility. The biggest risk of infertility for any woman, whether she has had childhood cancer or not, is older age. Fertility rapidly declines after age 35. This was true among the cancer survivors as well. In fact, they didnât look all that different from their siblings when they entered their late thirties. It was really at the younger ages that we saw a significantly elevated risk of infertility among the women who had been treated for cancer as girls, compared with women who had not had childhood cancer.
Q
What advice do you have for women who had childhood cancer and want to get pregnant?
A
Physicians generally advise women to see a fertility specialist after trying to get pregnant unsuccessfully for a year. With women who were treated for childhood cancer, we recommend that they see a fertility specialist after six months. If you have irregular menses, received pelvic or abdominal radiation or alkylating agents, or are not sure of your treatment or fertility status, you may want to seek a specialistâs guidance as soon as you are ready to start trying to conceive. In addition, a 20-something young woman who had alkylating agents or radiation may want to have children at some
point in the future but is not yet ready to conceive. She should make an appointment with a reproductive specialist to get information about egg preservation.
Q
What advice about fertility preservation do you have for parents whose child is diagnosed with cancer?
A
It is often very hard for a parent to deal with a new diagnosis of cancer in a young child and at the same time imagine a future when the childâs fertility becomes an issue. It is important to talk with a professional about various options so that you have the information you need to make a decision about fertility preservation. With postpubertal boys it is worth collecting their sperm because it is so easy. For adolescent girls itâs more complicated. Preserving eggs can delay cancer therapy for one to two weeks. It involves taking hormones and a minor procedure to harvest the eggs. It is more invasive than collecting sperm, so we reserve it for adolescent girls who are receiving therapies that we suspect will limit ovarian function. In addition, if a girl is being treated with radiation, we can sometimes move the ovaries away from the area where the radiation is being delivered. Whether it is a newly diagnosed child or a young woman who survived childhood cancer, parents and patients alike are best served by asking questions to help them make decisions about fertility and fertility preservation. Likewise it is important for caregivers to provide patients and parents with the information they need to make those decisions. Our research strengthens cliniciansâ ability to do so by filling in some gaps in our understanding of the complex relationship between childhood cancer and fertility.
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C AN C ER PR EH AB Patients benefit from physical and emotional preparation for cancer treatment. By Julie K. Silver, MD
M
ore than one in three women in the United States today will hear a doctor say, âYou have cancer.â What will happen next is changing for the better, due to an emerging medical field called âcancer prehabilitation,â or cancer prehab. Prehab itself is not a new concept; it is used to improve the health and the endurance of patients in anticipation of surgery or other major medical treatment, and it improves patient outcomes. For example, someone with severe arthritis who elects to undergo a knee replacement may be advised to attend a prehab program, sometimes called âjoint camp.â The goal of joint camp is to improve the likelihood that the surgery will go wellâand literally get the patient back on her feet as soon as possible. Before surgery she would be taught various strengthening exercises, how to use a walker and a cane (as she transitions from one to the other after surgery) and how to recognize, and hopefully avoid, postoperative complications. Fortunately for cancer patients, prehab is becoming integrated into cancer care, with the goal of preparing patients for rigorous treatments and decreasing the likelihood of posttreatment impairments. What Is Cancer Prehab? In its simplest form, cancer prehab can be thought of as medical interventions that help patients get physically and emotionally stronger before they start treatment. For example, swallowing exercises started prior to surgery and
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chemoradiation for head and neck cancer may improve a survivorâs ability to swallow throughout treatment. This would enable the patient to eat, which in turn would prevent weight loss and improve energy and overall strength so that she can better tolerate the treatments. In a scientific article published by the American Cancer Society in the September/October 2013 issue of CA: A Cancer Journal for Clinicians, cancer prehabilitation was defined as âa process on the cancer continuum of care that occurs between the time of cancer diagnosis and the beginning of acute treatment and includes physical and psychological assessments that establish a baseline functional level, identify impairments, and provide interventions that promote physical and psychological health to reduce the incidence and/or severity of future impairments.â Different cancer prehab interventions can be combined to improve both the physical and the emotional health of the survivor. For instance, a woman with breast cancer who is scheduled to undergo a mastectomy and breast reconstruction may benefit from pretreatment support from an oncology mental health professional, who can teach her specific mindbody skills to decrease stress and anxiety about the surgery. A physical therapist can prescribe upperbody strengthening and range-ofmotion exercises that may reduce the risk of postoperative pain and other complications such as âfrozen
shoulder.â If the patient is a smoker, smoking-cessation counseling might help her quit prior to the operation, which is significant because people who are actively smoking at the time of their surgery tend to have more complications. Navigating to Prehab In many hospitals and cancer centers, nurse navigators are uniquely positioned to help identify which patients may benefit from prehab services. The role of nurse navigators is to help patients more easily access care in a complicated medical system. They often focus on âbarriersâ to care. For example, if a woman was just diagnosed with lung cancer and has health insurance but canât afford the co-pays associated with medical appointments, the navigatorâs job is to help identify other resources that might be willing to pay these fees (such as a local foundation or a hospital-based fund that is set up specifically for that purpose). Another example would be if the newly diagnosed patient were not able to get appointments scheduled with doctors or other healthcare providers. A navigator can often step in and help to get the appointments scheduled quickly and efficientlyâalleviating considerable stress on the patient. Nursing navigation is becoming an increasingly important part of survivorship care, and it often begins at diagnosis, with the oncologist and the nurse navigator working together to help a new patient begin the complicated journey through
cancer treatment. Navigators can then facilitate prehab referrals and also conduct some of the assessments and interventions. Lillie Shockney, RN, an associate professor, is the director of the Johns Hopkins Cancer Survivorship Programs and the founder of the Academy of Oncology Nurse Navigators. Lillie believes that prehab has an important role in the cancer care continuum. She says, âIt has been illogical for decades to tell patients to anticipate and cope with side effects during their cancer treatment when, by being proactive, we can diminish or even prevent some of them.â A Window of Opportunity Although some newly diagnosed cancer patients have urgent, lifethreatening problems that require immediate surgery or other treatments, generally this is not the case. In fact, many cancers are first noticed on screening tests such as
a mammogram or colonoscopy. As patients undergo biopsies and other tests to confirm the diagnosis or seek another opinion, they may wait days or weeks for treatment to start. This means that there is usually some time for cancer prehab to physically and emotionally prepare them for the start of treatment. On the other hand, unnecessary delays in cancer treatment, even for prehab, are usually not advisable, and it is important to follow a doctorâs advice. Beginning to Heal before Treatment Even Starts A new cancer diagnosis is shocking and often puts the patient into an emotional tailspin, making her feel out of control, anxious, and scared. Cancer prehab can be a lifeline, offering both emotional and physical support at a critical juncture. Nancy Hutchison, MD, medical director of cancer rehabilitation, survivorship, and lymphedema at Allina Health
in Minneapolis, Minnesota, notes that muscle weakness, fatigue, and difficulty with daily chores or work tasks are some of the main side effects of chemotherapy and radiation therapy. She says, âPatients who improve their fitness level prior to undergoing cancer treatment are better able to tolerate treatment and recover faster.â Although cancer prehab is evolving, Dr. Hutchison believes that it will âbecome the normâ for many types of cancer in the future. David Landay is the founding executive director of SurvivorshipAtoZ. org, which is an online resource that provides information and tools to empower cancer survivors. David says, âPrehab is like dressing in armor for the mind and the bodyâarmor that prepares you for the battle ahead.â Indeed, every newly diagnosed cancer survivor should be asking her healthcare team whether prehab will help her prepare for the upcoming battle.
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BREAKFAST HAS BEN EFITS
I
t is no secret that breakfast comes with benefits. It can boost energy, improve concentration, and stave off weight gain. But thatâs not allâ it might even help prevent type 2 diabetes. In fact, according to the results of a study published in the American Journal of Clinical Nutrition, skipping breakfast even just once a week is linked to a 20 percent increase in the risk of developing type 2 diabetes. In other words, there is no excuse for skipping this important meal.
Researchers from the Harvard University School of Public Health analyzed the eating patterns of 46,289 women who participated in the Nursesâ Health Study. The women were considered healthy and were free of cardiovascular disease, cancer, and type 2 diabetes. The researchers evaluated their eating patterns and health outcomes over the course of six years. At the end of the study, they found that women who skipped breakfast sporadically had a 20 percent higher
risk of being diagnosed with type 2 diabetes compared with women who ate breakfast every day. Whatâs more, the risk was even higher among women who worked full-time and skipped breakfast: 54 percent. Even after adjusting for other factors such as age, body mass index, carbohydrate consumption, smoking, alcohol intake, physical activity, and working status, breakfast was important. Breakfast, Insulin, and Diabetes What does breakfast have to do with diabetes? Itâs all about the insulin. Insulin is a hormone released by the pancreas to transport glucose into the cells, which results in lower blood sugar levels. Food affects our blood sugar level, which in turn affects our insulin level. So, if you skip breakfast in the morningâafter fasting all nightâyour insulin level drops. Once you finally eat later in the day, your insulin level is likely to spike and then crash. It is this constant fluctuation in insulin levels that can lead to insulin resistance, which can lead to type 2 diabetes. Choose Breakfast If you want to avoid the constant blood sugar fluctuationsâand the irritability, fatigue, and weight gain that go along with themâstart by making breakfast a priority. ⢠Eat breakfast every day. ⢠Eat within an hour of waking up. ⢠Eat a balanced breakfast that is low in sugar and high in fiber and protein.
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AR E YO U LI STEN I N G? By Denise King Gillingham, LMSW, ACC, CPM
âThe most basic of all human needs is the need to understand and be understood. The best way to understand people is to listen to them.â âDr. Ralph G. Nichols
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Practice being genuinely curious about someone in your life and see what happens to your relationship.
O
ur world is constantly changing on many levels, but one thing remains static: we all seek to be understood. The good news is that itâs easy to help someone feel understoodâjust listen to them. Is it really that easy? Well, yes and no. Listening can be complex, and the act of listening has many facets. Often we think we are listening when we are not. But despite these potential challenges, most of us can become good listeners if we take the time to learn this critical skill. Try the following six action steps and see if they help you become a better listener.
Listen with all your senses. Be aware of the effect of the environment on your conversation. Is it too noisy? Is there enough privacy? Are you both sitting comfortably? Listen for verbal and nonverbal cues, including body language and facial expressions. Someone might be telling you how happy she is about something, yet her arms are crossed and she is scowling. Try commenting on her body language; for example, âI notice you are not smiling yet you say you are happy.â See where it takes the conversation. (Hint: Keep your observations and questions short and simple.)
Take technology out of the picture. Repeat and summarize. When you commit to an in-person conversation, turn off or silence all technology. Sending even one text during a conversation sends the message that you are not listening to the other person and that the text is more important. Is that the message you want to convey? Give those you are in conversation with the attention they deserve.
Repeating and summarizing what your conversation companion is telling you is a useful listening tool. By restating what you have heard, you avoid any message confusion. It also allows you, the listener, a bit more time to process the information you just received. Does this technique help you respond more effectively?
Be genuinely curious. Remember when you were a child and you kept asking questions just because you wanted to know everything possible about something? You were genuinely curious. You were fascinated by something and wanted to explore it. Try that now as an adult. Be fascinated by whomever you are listening to. Pay attention, explore, and ask questions in response to what the other person is saying. Practice being genuinely curious about someone in your life and see what happens to your relationship. (Hint: Ask questions that are short and that cannot be answered with simply yes or no.) Be quiet. Let the person answer the question. Silence can be difficult, especially around challenging issues, but resist the temptation to give advice or answer the question yourself. Your silence is a gift to othersâit allows them to express emotions that need to be expressed in a safe atmosphere.
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Ask questions that are relevant to what is being discussed. For example, if your friend is telling you about her weight and her desire to begin an exercise program, listen to what she is saying and ask her something about exercising. Donât sway the conversation by talking about the source of her weight gainâstay focused on the flow of the conversation and follow her lead. The first step to being better at anything is awareness. Notice your own patterns as a listener and think about how improving this important skill can affect your relationships: what do you need to change or develop; are there books or other resources on listening that might help you learn more? Then be courageous and try a new way of listening.
H E ALTH Y D I ET, H APPY B L AD D ER By Elizabeth Houser, MD
E
verywhere we look in the media, we find claims that different diets can improve our quality of life. Experts and gurus suggest that we increase our water intake, avoid sugar, become vegetarian, or try a vegan or glutenfree diet. If we follow this advice, experts say, our heart, pancreas, and colon will become healthier.
Sadly, very few experts discuss diets that support and promote bladder health. At the same time, with baby boomers continuing to age, bladder problems such as urinary urgency, frequency, and leakage are becoming very common. Consider these statistics: ⢠One in four women over age 26 experiences stress incontinence
(urinary leakage when laughing, sneezing, or putting stress on the bladder) at some point in her life. ⢠About 17 percent of women in the United States suffer from urge incontinence or overactive bladder (urinary urgency, frequency, and leakage). ⢠Some women have both stress and urge incontinence (mixed urinary
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Both coffee and tea are major bladder irritants because of their caffeine content.
incontinence), and these often have the most severe urinary symptoms. The good news? Research indicates that diet modifications can be an effective conservative therapy for all three types of urinary incontinence. Believe it or not, what you put in your mouth really can affect the health and the behavior of your bladder, especially if you suffer from symptoms of urinary incontinence. YOUR BLADDER AND YOUR DIET The old adage says, You are what you eat. Many of us know that spicy foods can affect our bowels, and food choices can also affect bladder health and bladder control. For example, drinking beer can increase the number of trips you make to the bathroom. Why? Because alcohol is a diuretic, which puts the kidneys into overdrive and causes urinary frequency. Alcohol has a secondary and lesser-known effect on the bladder as well: it has a direct irritating effect on the bladder lining, which can increase urinary urgency, frequency, and leakage. It turns out that alcohol is only one of many potential bladder irritants in our diet. You may be surprised by the number of foods and beverages in your current diet that can cause your bladder to overreact. The good news for those with urinary incontinence is that symptoms can be greatly alleviated by making smart dietary modifications:
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⢠Manage fluid intake. ⢠Avoid bladder irritants. ⢠Take emergency measures as needed. ⢠Maintain bowel regularity. These four types of diet modification are neither complicated nor difficult to integrate into your lifestyle. Best of all, these conservative therapies can help you regain bladder control. AVOIDING BLADDER IRRITANTS A bladder irritant is any food, beverage, or substance that you eat or drink that affects the bladder, causing symptoms such as urinary urgency, frequency, or leakage. But not only foods and beverages can affect your bladderâ other substances can also have an adverse effect. These can include certain food additives, preservatives, and some dietary supplements. Some of these substances directly irritate the bladder, while others are acidic, which lowers the bladder pH and causes bladder spasms. Common bladder irritants include caffeine, alcohol, citric fruits, and foods containing arylalkylamines (tryptophan, tyrosine, tyramine, and phenylalanine). The toxic effect of some substances may not become apparent unless other bladder irritants are present. For instance, your bladder may not react when you eat enchiladas with jalapeño sauce, but add a few margaritas with lime and you may find your bladder start to spasm.
Citric Foods and Drinks Many fruits and certain vegetables are acidic and can cause urinary urgency and frequency. Tomatoes are among the worst offenders, as they are extremely acidic and can often be a hidden ingredient in soups and sauces. Lemons, limes, oranges, grapefruit, and pineapples are some of the most acidic fruits. In addition, beware of fruit juices, which usually have added sugar and preservatives, both of which may affect the bladder. Lowacid fruits include watermelons, papayas, pears, and apricots. Meat Products Meat and meat products can also irritate the bladder. Lean meats are a great source of protein, but they are also a source of acid. All meats and some vegetables contain purines. When the body breaks down purines, the result is uric acid. The body needs uric acid, and the kidneys are responsible for monitoring and regulating its excretion. But excess uric acid in the system can lead to health issues, such as gout, kidney stones, and gastrointestinal disturbances. Excess acid in the body can lead to
intestinal bloating, gas, and flatulence as well as urinary urgency and frequency. Gluten One of the most popular current dietary guidelines involves avoiding eating wheat or, more specifically, gluten. Although not much has been written about the effects of gluten on the bladder, patients in my practice have seen improvements in their symptoms of bladder irritation when they eat a gluten-free diet. For these patients, avoiding gluten along with other dietary changes to reduce bladder irritation resulted in decreased urinary urgency, frequency, and incontinence. Others have noted that avoiding bread that has preservatives, such as BHT (butylated hydroxytoluene) and propionic acid, decreased their overactive-bladder symptoms. Alcohol Consuming alcohol can negatively affect the bladder in multiple ways. First, alcohol is a potent diuretic, which forces the bladder to store more urine. Second, alcohol has a direct irritating effect on the mucosa, or lining, of the bladder. Finally, many alcoholic drinks combine alcohol with other bladder irritants, such as fruit juice and carbonated liquids.   If you do drink alcohol, you can reduce the effects on your bladder by diluting your alcohol intake with water. A good rule of thumb is to drink an 8-ounce glass of water for every
alcoholic beverage you consume. While this increased water intake may send you to the bathroom more often, the dilution effect may decrease your chances of having an embarrassing leakage accident. Coffee and Tea Both coffee and tea are major bladder irritants because of their caffeine content. Even decaffeinated coffees and teas can irritate the bladder because they still contain some caffeine. Caffeine affects the body and the bladder in ways similar to alcohol. The diuretic effect causes increased urine production, while the acidic nature of coffee and tea can cause direct bladder irritation. Herbal teas and coffee substitutes may be good options for some people with urinary incontinence symptoms, whereas others will need to dilute the effects of caffeine with water or some other alkalinizing agent. Artificial Sweeteners and Preservatives The use of artificial sweeteners is somewhat controversial in nutrition literature. While these sugar substitutes may help control caloric intake, most nutritionists recommend using natural sweeteners, such as stevia, instead of artificial sweeteners. Remember the big scare in the seventies when lab rats developed bladder cancer after being forcefed saccharin? Subsequent research on humans showed that artificial sweeteners did not result in increased incidences of bladder cancer. In fact, no studies on humans have linked the development of cancer to artificial sweeteners, but they can still irritate the bladder. This is because the body
converts certain of these sweeteners to sugar alcohols during metabolism; and because alcohol is a bladder irritant, this can lead to urinary urgency, frequency, and leakage.
Many food preservatives are also bladder irritants. Benzoic acid, a preservative in many fruit juices and carbonated beverages, is often combined with citric acid to improve flavor. Sulfites, or sulfur dioxide, are also acidic in nature and are used in wines, fruits, and vegetables to preserve color and flavor. When you put any form of acid in your body, the result may be an overactive bladder. If you tend to have urinary urgency, frequency, or incontinence, it is wise to avoid any preservative that has a color, number, or initial in its name. Bladderhealthy preservatives include salt, sugar, and rosemary. Read labels carefully, and remember that the first three ingredients listed are the predominant ingredients in the product. THE BOTTOM LINE Many ingested substances can irritate the bladder lining, resulting in increased trips to the bathroom and, in some cases, leakage accidents along the way. You can limit or eliminate some of these ingredients from your diet, minimizing their negative effects. With other ingredients, you may have better luck counteracting their effects with other measures. Healthy Diet, Happy Bladder: How Diet Affects Bladder Behavior, by Elizabeth Houser, MD, is available for purchase at Amazon.com
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RESOURCES ã©ã³ã»ãã©ãŒã»ã¶ã»ãã¥ã¢ã»ãã¡ã³ããŒã·ã§ã³ããã³ã¢ã°ã©ãã£ãŒæ©æãå¯èŽ
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å¯èŽãã6å°ã®ãã³ã¢ã°ã©ãã£ãŒæ©åšã¯2013幎9æçŸåšãåèšããã 16300人ã®å¥³æ§ã«å©çšããŠé ããŠããŸããæ€èšºãå蚺ããçŽ60%ã®å¥³ æ§ããåããŠãã³ã¢ã°ã©ãã£ãŒæ€èšºãå蚺ããããšã¢ã³ã±ãŒãã«åçã㊠ããããã³ã¢ã°ã©ãã£ãŒæ€èšºãæ®åããŠããªãããšãç©èªã£ãŠããŸãã Below is a list of hospitals where Run for the Cure® Foundation has donated a mammography machine. 16,300 women have received screenings on these machines and 60% indicated it was their first-ever screening.
åèå¥çç é¢ / Chiba Kensei Hospital ã 262-0032 åèåžè±èŠå·åºå¹åŒµçº 4-524-2 (4-524-2 Makuhari-cho, Hanamigawa-ku, Chiba-shi 262-0032) tel. 043-276-1851 www.chibakensei-hp.jp åèæ°éœåžã©ãŒãã³ã¯ãªãã㯠/ Chiba Shintoshin Rurban Clinic ã 270-1337 åèçå°è¥¿åžèæ·± 138 (138 Soufuke, Inzai-shi, 270-1337) tel. 0476-40-7711 www.chibashintoshi.or.jp
èš å ç / Ibaraki ãŸã€ã°ããŠã£ã¡ã³ãºã¯ãªãã㯠/ Matsubara Women's Clinic ã 300-1152 èšåççš²æ·é¡é¿èŠçºèå·æ¬é· 2018-7 (2018-7 Arakawahongo, Ami-cho, Inashiki-gun, Ibaraki 300-1152) tel. 029-830-5151 www.happy-mw.com
å»çæ³äººéŠšä»äŒ è€æç é¢ / Fujikake Hospital ã 509-0214 å²éçå¯å åžåºèŠ 876 (876 Hiromi, Kani-shi, Gifu 509-0214) tel. 0574-62-0030 www.okbnet.ne.jp/~fuj598
Foundation.
æ± äº¬ éœ / To k y o èè·¯å åœéç é¢ / St. Luke's International Hospital ã 104-8560 æ±äº¬éœäžå€®åºæç³çº 9-1 (9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560) tel. 03-3541-5151 www.luke.or.jp æå倧åŠç é¢ ä¹³è ºå€ç§ ⢠ãã¬ã¹ãã»ã³ã¿ãŒ / Shouwa University Hospital Breast Center ã 142-8666 æ±äº¬éœåå·åº æã®å° 1-5-8 (1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666) tel. 03-3784-8000 showa-breast.com
å è ç / Chiba
å² é ç / Gifu
Medical Institutions that support Run for the Cure®
æ±äº¬å ±æžç é¢ / Tokyo Kyosai Hospital ã 153-8934 æ±äº¬éœç®é»åºäžç®é» 2-3-8 (2-3-8 Nakameguro, Meguro-ku, Tokyo 153-8934) tel. 03-3712-3151 www.tkh.meguro.tokyo.jp
ä¹ å· / Ky u s h u 瀟äŒå»çæ³äººåæäŒ çžè¯ç é¢ / Sagara Hospital ã 892-0833 鹿å 島ç鹿å 島åžæŸåçº 3-31 (3-31 Matsubaracho, Kagoshima-shi, Kagoshima 892-0833) tel. 099-224-1811 ãã¬ã¹ããã¢ãªãã°ç é¢ / Breastopia Namba Hospital ã 880-0000 å®®åŽåžäžžå±± 2-112-1 (2-112-1 Maruyama, Miyazaki-shi, Miyazaki 880-0000) tel. 0985-32-7170 www.breastopia.or.jp
å æµ· é / Hokkaido 瀟äŒå»çæ³äººåæ åæã¯ãªãã㯠/ Hokuto Clinic ã 080-0833 垯åºåžçš²ç°çºåºç· 9-1 (9-1 Kisen, Inadamachi, Obihiroshi, Hokkaido) tel. 0155-47-8080 www.hokuto7.or.jp
倧 éª åº / Osaka 糞æ°ã¯ãªãã㯠/ Itouji Hospital ã 559-0016 倧éªåžäœä¹æ±åºè¥¿å è³å± 1-1-6 (1-1-6 Nishikagaya, Suminoe-ku, Osaka 559-0016) tel. 06-6681-2772 www.myclinic.ne.jp/itoujiclinic/pc/index.html å»çæ³äºº çŽå¹žäŒ è±äžæž¡èŸºç é¢ / Toyonaka Watanabe Hospital ã 561-0858 倧éªåºè±äžåžæéšè¥¿çº 3-1-8 (3-1-8 Toyonaka-shi, Osaka 561-0858) tel. 06-6864-2301 www.watanabe-hp.or.jp/hospital
NPOæ³äºº Run for the Cure® Foundation
ã141-0032 æ±äº¬éœåå·åºå€§åŽ3-6-28 Daiwa倧åŽ3äžç®ãã«6é
(Daiwa Osaki 3-chome Bldg. 6F, 3-6-28 Osaki, Shinagawa-ku, Tokyo 141-0032) Tel: 03â-â6420â-â0860
Email: inquiries@runforthecure.org
www.runforthecure.org
11
PiNK ⢠FA LL 2014
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Do you really know about breast cancer?
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What do you know about breast cancer? How can you tell if you have any abnormalities relating to breast cancer? What does it look like? What does it feel like? How can you detect it?
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乳管 milk duct
Here is how to apply to have a Lemon Seminar at your school, company, or other location.
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Number of attendees: minimum 10
åå 人æ°ïŒ10 人以äž
Average length of seminar: 1â1.5 hours
å¹³åæèŠæéïŒ1 æé ã 1 æéå
Language: Japanese or English
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Fee: FREE!
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We ask of you to provide a venue for the seminar equipped with a screen, projector, computer and microphone if necessary. Please contact pink@runforthecure.org for details and reservations.
Campaign designed by worldwidebreastcancer.com
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PiNK ⢠FALL 2014 www.runforthecure.org
10
Run for the Cure ® Foundation âThe Lemon Projectâ Progress Report
T
he Lemon Project started as Run for the Cure® Foundationâs new education initiative in September 2013. The support of generous corporate and individual sponsors that have participated in the Foundationâs fundraisers and charity eventsâsuch as Pink Ball, Casino Night and Run for the Cure®/ Walk for Lifeâ and/or made donations for our mission have enabled us to develop the Lemon Project. We have been able to visit more companies, schools and organizations to hold breast cancer awareness seminars. While many Japanese people have heard of breast cancer, not many of them know what the symptoms are, or how to carry out self-examinations. The Lemon Project aims to enhance the understanding of breast cancer in Japan and to teach about the signs of breast cancer and breast selfexamination proceduresâdescribing key points with lemons. Those who attend the seminar have the opportunity to learn what breast cancer lumps feel like and to practice how to move their fingers for a thorough self-examination by using silicon breast models. It has been almost a year since the beginning of this project. As of August 2014, we have organized 22 seminars at companies, schools and conferences, including at Marc Jacobs, Citigroup, United Airlines, Yokohama International School, the KSHS National Conferenceâand we have reached some 800 men and women in the process. Some of the positive feedback we have received from those who have participated include, âI have never had a mammogram before, though I am in my forties. But learning about significant positive impacts of early detection and treatment, as well as the importance of annual breast cancer screening, today, I have made the decision to have annual screening from now on.â Other comments include, âI have not learnt self-examination methods until today. I found todayâs seminar very practical and helpful, and will try to examine my breast once a month, starting today.â Further testimony to the value of the Lemon Project includes, âThe self-exam practice using a breast model was very interesting and practical. As our body keeps changing day by day between annual screenings, I decided to do self-examination to know my breasts and notice any changes.â Breast cancer remains the most common cancer among Japanese women and with the highest incident rate. The international symbol of breast cancer awareness, the
ä¹³æ¿ã®ããŒã¿ indentation
ç®èã®ç¡¬å hardening
çªåºããããã bump
éèã®æ匵 ä¹³é ã®çœåŒ growing vein nipple retraction
âPink Ribbon,â as well as discussions about breast cancer may have become more commonplace in Japanese cities; however, many challenges remain in the fight against this life-threatening disease. Comparing annual breast cancer screening rates in Japan and the US, the statistics provided by the Health, Labour and Welfare Ministry shows about 24% of Japanese women over 40 years old have a routine checkup*1, whereas approximately 72.5% of American women between the ages of 50 and 74 do so according to the Centers for Disease Control and Prevention*2. Japanese public education does not incorporate into the school curriculum any lectures to teach about the importance of routine checkups, the signs of breast cancer, or how to perform a monthly self-examination. Yet, such knowledge can empower the individual and potentially save lives. In this light, we will continue to develop and organize The Lemon Project and its seminars in order to raise awareness among Japanese people and to spread the message of âsaving yours and your loved oneâs lives through getting to know your body better.â
*1 Center for Cancer Control and Information Services, National Cancer Center, Japan *2 Centers for Disease Control and Prevention (CDC). Cancer screeningâUnited States, 2010. MMWR 2012; 61(3): 41â45.
9
PiNK ⢠FA LL 2014
ç®èã®ãã ã skin erosion
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www.runforthecure.org
PiNK ⢠FALL 2014
8
SURVIVOR ãµãã€ããŒ ã® æ¹ ãžã®ã¡ãã»ãŒãžã³ãŒ ããŒ
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A
t our 11th annual Pink Ball held on Friday, March 7th, 2014, we collaborated once again with one of our sponsors this year, S.T. Dupont, to host a "Dear Survivor" corner. All guests had the opportunity to write a personal message to a survivor using the elegant pens created by S.T. Dupont. Toward the end of the evening, three survivors each chose their favorite message, and the authors were awarded a Defi Blue, Red or White Ballpen worth around 30,000 yen each. We thought it timely to share some of these inspiring messages with our readers.
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PiNK ⢠FA LL 2014
Stay beautiful Stay flexible Look to the future. Remember, your friends are all here.
I am here because you are here Your life is not only yours. You are me and I am you I will strive for you from my heart.
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Looking back, everything has a positive side. Time is gold.
Dear Survivors, You are the Champions. You encourage me. You are the light of the world. You give women in the world courage and strength. You inspire me. I pray for you all.
Dear Survivor, My sister-in-law is a survivor, just like you. She's living a full, active life. If anything, the event made her stronger and more determined to live life to the fullest. We join you in wishing you a speedy recovery!
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6
How you can help PiNK èªãžã®ãååã®ãé¡ã
Saving Lives We feel that a vital tool for better informing Japanese women about the value of early detection for survival, especially in medically underserved regions, is PiNK. Our quarterly womenâs magazine is distributed for free at key nationwide locations listed below. Please contact us if you are interested in becoming a sponsor of PiNK by underwriting the printing costs or by broadening our distribution points. The fact remains that regular screening and self-examination are key steps to saving a womanâs life. Please help us to continue getting the word out.
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General Donations
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General donations can be made at www.runforthecure.org with your credit card or through a bank transfer to the below account.
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Mitsubishi Tokyo UFJ Bank Shibuya Branch Futsuu 3609116 Tokuhi) Run for the Cure Foundation
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tel.0166-21-3155
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ãã€ã«ãµãã³ CRYSTAL 060-0052 æå¹åžäžå€®åºå 2 æ¡æ± 1-1-
12-511 tel.011-221-7035 1F tel.011-865-6464 tel.011-885-7911 tel.011-666-3358
karadafarm IPPUKU æå¹åžçœç³åºæ¬é·éå 7 äžç®å 3-2-
Yoga Studio ease space æå¹åžæž ç°åºåé 4 æ¡ 3-1-37-1F
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JZ Brat
charm form
New Balance Tokyo
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ç®é»åºèªç±ãäž 2-17-6-1B tel.03-
æžè°·åºæµæ¯å¯¿å 2-3-14 B1 tel.03-5773-1727
ç®é»åºèªç±ãäž 1-3-22 tel.03-3718-4540
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ç®é»åºäžç° 1-4-1 tel.03-5423-7000
åºäžç®é» 3-27-4
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æ°å®¿åºéŠ¬å Žäžçº14 tel.03-3207-8101
åå·åºæã®å° 1-5-8 tel.03-6426-3905
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4588-0670
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3-38-1-703 ãµãã³ )
æžè°·åºç¥å±±çº 40-5 B1 tel.03-3481-5888
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ã©ã¹ãã«ã¹éå±±æžè°·åºç¥å®®å 5-47-6 tel.03-3407-6864 Future Nail
æžè°·åºç¥å®®å 5-47-1 1F tel.03-6427-3030
5-47-1
imageMILL Office
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Shizen Yoga
äžé£é 8-3-6 tel.0422-47-4848
åŒäŒç€Ÿ å®®åçä»å°åžæ³åºæ³äžå€® 3-10-15 tel.022-772-6201( 代ïŒèšå ãŸã€ã°ããŠã£ã¡ ã³ãºã¯ãªããã¯
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tel.042-655-5355
hair CenoteïŒçŸå®¹é¢ïŒæŠèµéåžå祥寺æ¬çº 1-2-
æŠèµéåžå祥寺åçº 2-5-9-201
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ãã®ä»é¢æ± ãžã¥ãªãšãã¿ ã¬ãŒãã³æšªæµåžéœçåºè ã¶åŽäžå€® 17-22-803 tel.045-9439661
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ããã¯å°è¥¿åžèæ·± 138 tel.0476-40-7711 æç°ç©ºæž¯ ãã«ã¿èªç©ºã©ãŠã³ãž é空枯第 1 ã¿ãŒããã«
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åå€å±åžäžåºæ³ 1-18-10-907 tel.052-253-9169
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æ°æœçæ°æœåžäžå€®åºå·å²žçº 2-15-3 tel.025-266-5111
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New Balance
Osaka 倧éªåžè¥¿åºåå æ± 1-6-2 ãµã³ã¯ãŒã«ããã« tel.06-6578-9040 è±äžæž¡èŸºç é¢ æéšè¥¿çº 3-1-8 tel.06-6864-2301
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ãªãŒãã¡ã³ãïŒãšã¬ãµãã³ åºå³¶çååžäžå€® 2-5-12-205 tel.090-9060-1578 ä¹å· ãã¬
ã¹ããã¢ãªãã°ç é¢ å®®åŽåžäžžå±± 2-112-1 tel.0985-28-9616 AKO ãã³ããã·ã§ãã å®®åŽåžæŸå±± 1-9-26 tel.0985-28-9535 çº 4-4152 tel.0982-37-7144 tel.099-224-1811
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鹿å 島åžäžèç°çº 8-6 tel.099-214-2800
Pick up your free copy of PiNK Magazine at the following locations Hokkaido Asahikawa 37 Seven Bldg. 2F 7choume 3jo-dori Asahikawa tel.0166-213155 Nail Salon CRYSTAL 1-1-12 2jo-higashi Chuo-ku minami Sapporo tel.011-221-
Toshima-ku tel.03-5914-0471 Katsushika Central Library 6-2-1-3F Kanamachi Katsushika-
7035 IPPUKU 3-2-1 7choume-minami Hongodori-minami Shiraishi-ku Sapporo tel.011-
Cenote1-2-1 2F Kichijojihonmachi Musashinoshi tel.0422-27-2777 Shizen Yoga 201-2-5-
865-6464 Yoga Studio ease space 3-1-37-1F 4jo Kitano Kiyota-ku Sapporo tel.011-885-
9 Kichijouji-minamimachi Musashino-shi Nomura Hospital 8-3-6 Shimorenjyaku Mitaka-shi
7911 Relaxation Plana 9-6-30 6-jo Hassamu Nishi-ku Sapporo tel.011-666-3358 Hokuto
tel.0422-47-4848 Hachiouji Nyuusen Clinic 4-8 4F Misakicho Hachiouji-shi tel.042-655-
Hospital 7-5 kisen Inada-machi Obihiro-shi tel.0155-47-7799 Tohoku Tahibo 3-10-15
5355 Mukaihara Ni-chome Clinic 2-1-19 2F Mukaihara Higashi-Yamato-shi tel.03-5914-
Izumichuo Izumiku Sendai-shi Miyagiken tel.022-772-6201 Ibaraki Matsubara Women's
0471 Kanto-Other Giulietta Garden 17-22-803 Chigasaki Chuo Tsuzukiku Yokohama
Hospital 2018-7 Arakawa-hongo Ami-machi Inashiki-gun tel.029-830-5151 Tokyo St.
Kanagawa tel.045-943-9661 Fujishin Yokohama 1-1 Sakuragicho Nakaku Yokohama
ku tel.03-3607-9201 hair Stola 2-13-7 Kichijojihonmachi Musashinoshi tel.0422-20-2273 hair
Luke's Hospital 9-1 Akashi-cho Chuo-ku tel.03-3541-5151 Yoga Studio Lotus 8 3-3-
Kensei Hospital 4-524-2 Makuhari-cho Hanamigawa-ku Chiba-shi tel.043-276-1851 Chiba
17 Nihonbashi Chuo-ku tel.03-6825-6888 Japan Esthetic Association 2-12-4F Koujimachi
Foundation for Health Promotion & Disease Prevention 32-14 Shin-Minato Mihama-ku
Chiyoda-ku tel.03-3234-8496 Waseda Eye Clinic 14 Babashitacho Shinjuku-ku tel.03-3207-
Chiba-shi tel.043-246-0350 Fujishin Chiba 3-18-8 Shinchiba Chuo-ku Chiba Rurban Clinic
8101 B&D Sports Shop 2-7-1 Ichigaya Sadobaracho Shinjuku-ku Fujishin Tokyo 8-12
138 Soufuke Inzai-shi Chiba tel.0476-40-7711 Delta Air Lines Executive Lounge Narita
Sumiyoshicho Shinjuku-ku Showa University Breast Centre 1-5-8 Hatanodai Shinagawa-
International Airport United Airlines Red Carpet Club Narita International Airport Niigata
ku tel.03-6426-3905 Temple University Japan Campus 2-8-12 Minami Azabu Minato-
Cancer Centre Niigata Hospital 2-15-3 Kawagishi-machi Chuo-ku Niigata-shi Niigata
ku tel.03-5441-9800 Tokyo American Club 2-1-2 Azabudai Minato-ku tel.03-4588-0670
tel.025-266-5111 Fujikake Hospital 876 Hiromi Kani-shi Gifu tel.0574-62-0030 Chuubu
Tokyo Kyousai Hospital 2-3-8 Nakameguro Meguro-ku tel.03-3712-3151 The Westin
Yoga Studio Reina Park 2-20-11F Oosu Nakaku Nagoya-shi tel.052-253-7768 Nail School
Tokyo 1-4-1 Mita Meguro-ku tel.03-5423-7000 Sunroom YOGA ~Yoga Le Ciel~ 3-27-
"Bi-life support" 1-18-10-907 Izumi Nakaku Nagoya-shi tel.052-253-9169 Fujishin Nagoya
4 Kamimeguro Meguro-ku Resort Yoga Studio HeartOne 2-17-6-1B Jiyuugaoka Meguro-
2-6-6 Meieki Nishiku Nagoya-shi Osaka Itouji Hospital 1-1-6 Nishi-Kagaya Suminoe-ku
ku tel.03-6421-2818 Jiyuugaoka Yoga Studio 1-3-22 Jiyuugaoka Meguro-ku tel.03-3718-
Osaka-shi tel.06-6681-2772 New Balance Osaka 1-6-2 Kitahorie Nishiku Osaka-shi tel.06-
4540 NOS Ebisu (Bar/ Dining/ Event space) 2-3-14-B1 Ebisu-minami Shibuya-ku tel.03-5773-
6578-9040 Toyonaka Hospital 3-1-8 Hattori Nishi-machi Toyonaka-shi tel.06-6864-2301
1727 JZ Brat (Bar/ Dining/ Event space) Cerulean Tower 2F 26-1 Sakuragaokacho Shibuya-ku
Kaizuka Hospital 3-10-20 Hori Kaizuka-shi tel.072-422-5865 United Airlines Lounge
tel.03-5728-0168 charm form (Reservation only) 1-3-18 #A-90 Shibuya Shibuya-ku tel.03-6418-
Kansai International Airport Kinki-Other Ise Red Cross Hospital 1-471-2 Funae Iseshi
7218 New Balance Tokyo 5-50-3 Jinguumae tel.Shibuya-ku tel.03-5774-8576 Jamrock
Mie-ken tel.0596-28-2171 Chuugoku Aroma and Yoga Salon 2-5-12-205 Chuo Kureshi
Cafe 1-21-15 4F Jingumae Shibuya-ku Tokyo Shibuya Corazon (Manicure/ Hairdresser) 40-5
Hiroshima tel.090-9060-1578 Kyuushu Breastopia Namba Hospital 2-112-1 Maruyama
B1 Kamiyamacho Shibuya-ku tel.03-3481-5888 imageMILL Office 3-38-11-703 Jinguumae
Miyazaki-shi tel.0985-28-9616 AKO Bandana 1-9-26 Matsuyama Miyazaki-shi tel.0985-28-
Shibuya-ku Las Chicas Aoyama 5-47-6 Jinguumae Shibuya-ku tel.03-3407-6864 Future
9535 Hair Make Natural
Nail (Nail Salon) 5-47-1-1F Jingumae Shibuya-ku tel.03-6427-3030 Fujishin Aoyama FASTA
7144 Sagara Breast Centre 3-28 Tenokuchi-cho Kagoshima-shi tel.099-224-1811 Kaneko
5-47-1 Jinguumae Shibuya-ku Ginza Plastic Surgery Clinic 1-26-6 4F Minami-Ikebukuro
Clinic 8-6 Kamiaratamachi Kagoshima-shi tel.099-214-2800
(Hairdresser)
4-4152 Totoro-machi Nobeoka-shi Miyazaki tel.0982-37-
eã¡ãŒã«ã¢ãã¬ã¹ã ãè¿ãã«é åžå Žæããªãå Žåã¯ãé£çµ¡ãã ãããæ°åã ãäœæãé»è©±çªå·ã ïŒããå Žåã¯åžæããã¯ãã³ããŒïŒ ãäžèšãŸã§ãç¥ãããã ããã
If you cannot find a location near you, please contact us with your name, address, tel, email, and any past issues you would also like to receive. email: pink@runforthecure.org tel: 03-6420-0860
PiNK ⢠FALL 2014
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äžè±æ±äº¬UFJéè¡ æžè°·æ¯åº æ®é 3609116
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PiNK ⢠FA LL 2014
Shibuya Branch Futsuu 3609116
Tel: 03-6420-0860 Fax: 03-3492-1202
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Monthly Self-Examination èªå·±æ€ 蚺ã§ãã€ãã®æ 觊ãèŠããŠã
You know your body better than anyone else.
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Know your normal so you can detect the
æ© æçºèŠãããªãã®èžãããããŠåœã
slightest abnormality immediately.
æããŸãã
When?
èªå·±æ€ 蚺ã®æ æ
After your menstruation cycle, when breasts
ççãçµãã£ãŠãä¹³æ¿ã®ç·åŒµãè «ãã
are less tender or swollen. If your cycle is irregular or you have reached menopause,
ãªãæãæé©ã§ãã
pick a date you can easily remember and
ççãäžèŠåãªå ŽåããéçµããŠãã
check every month.
ãªãæ¯æåãæ¥ã決ããŠå±è¡ããŸãããã
èªå·± æ€ èšº ã® æ¹ æ³
1
How? Raise arms in front of a mirror and examine for
é¡ã®åã§äž¡è ãäžããä¹³æ¿ã«èµ€ã¿ã»
irritation, swelling or discharge.
è «ãããªãããä¹³éŠããåæ³ç©ã¯ãª ãããèŠãŠç¢ºãããã ã颚åãã·ã£ã¯ãŒã§èº«äœãæŽãæã«ã
While taking a shower or bath, gently explore your right breast and underarm area for lumps with
2
your left hand.
å·Šæã®äººå·®ãæãäžæãè¬æã®ïŒæ¬ã®
Examine thoroughly, and remember how it feels.
æè ¹ã䜿ã£ãŠãå³ a ã®ããã«åãããŠ
Follow patterns shown below, and repeat with the
å³ä¹³æ¿ããŸãã¹ããªã調ã¹ãã
other side.
1) èžã®å€åŽããå§ããä¹³éŠã«åãã£ãŠ
⢠Spiral or ring pattern (fig.1), making concentric
ã¹ãã€ã©ã«ã«
rings that tighten in a spiral, starting on the
2) è©ã®ããäžããèã®æ¹ãŸã§ããŸãªã äžäžã« 3) ä¹³éŠããå€ã«åãã£ãŠæŸå°ç¶ã«
outer edges of the breast and ending around 3
the nipple. ⢠Vertical or "up and down" pattern (or "squares") covering the entire breast ⢠Wedge patterns in and out (or "quadrants")
次ã«å³æã§å·Šä¹³æ¿ã調ã¹ãããŸãã ããããã«å¯ãŠè ãé äžã«æããŠèª¿ ã¹ãæ¹æ³ãããã®ã§ããããããæ¹ æ³ã§æ¯æè¡ã£ãŠã¿ãŸãããã
å³a
Lie with one arm tucked behind the head and,
fig.1
1
with the other hand, examine the opposite breast. 2
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Offer details 1. Three-night stay in a Superior Room/transfers/free use of sports and recreational facilities 2. A pair of roundtrip Delta Air Lines economy class tickets.
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1. Full name: 2. Age; 3. Postal address; 4. Telephone number; 5. Email; 6. Do you arrange for an annual Mammogram?; 7. Please let us know what types of articles (e.g., Q&A, Beauty tips, Survivor stories, Recipes, Exercise regimens, Caregivers, Prevention, Coping, etc.) you'd like to see (more of) in PiNK; 8. Do you know of a breast cancer survivor? If yes, what did you learn from that person? If no, what are the two most important points you know about breast cancer in Japan?
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Entries will be accepted until 10th November 2014. Winners will be announced in the Winter 2015 issue published in December 2014.
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