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FALL 2017
A magazine for women's health
proud PURPOSE Q&A with Joan Lunden
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CONTENTS 2 8 13 16 18 20 22
Proud Purpose: Q&A with Joan Lunden Healthy Resolution Revolution
Fall 2017
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Have You Ever Heard of âDense Breastâ? Managing Hot Flashes: A Return to Basics Access is Power It's in the Genes: Genetic Testing Tutorial Annual Order: Talk to Your Doc
From the Foundation (Follows English section) 1. RFTC News 4. Resources 5. What I Can Do ... 6. RFTC Products 7. Monthly Self-Examination 8. Lemon Project 10. What Do You Really Know About Breast Cancer?
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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 14,000 women have benefited from mammograms, with over 3,600 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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Photo: Phil Penman
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PiN K â€Â¢ FALL 2017
with Joan Lunden
PROUD PURPOSE Joan Lunden shares her personal perspective on how a cancer diagnosis has propelled her to become an advocate for cancer survivors and to recommit to health and wellness in her own life. PHOTOS: JOAN LUNDEN (Unless otherwise stated)
A
s an award-winning journalist and bestselling author, Joan Lunden has shared her insight and energy with viewers and readers for more than 30 years. In a television career that included nearly 20 years as co-host of Good Morning America, Joan reported breaking news and in-depth stories from around the world and close to home as she empowered viewers with information and inspiration. As an author she has shared her passion for health and wellness, family, and lifestyle topicsâalways with an authenticity and compassionâin 10 books.
In June 2014, Joan was diagnosed with triple-negative breast cancer, an aggressive form of the disease requiring intensive treatment. She shared the diagnosis and subsequent journey publicly, committed to using her experience to help other women facing a diagnosis, and she authored a memoir of the journey: Had I Known: A Memoir of Survival (Harper, 2015).
Joan recently spoke with Amy Gibson, Emmy Awardâwinning actor, hair-loss expert, and creator of the Cancer HairCARE Center for CancerConnect.com, to share her story. The following interview shines a light on the challenges and changes Joan faced in the wake of the diagnosis, as well as the lasting lessons of the journey.
As an author she has shared her passion for health and wellness, family, and lifestyle topics
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Amy Gibson (AG): You have empowered so many women over the years and have given so many women hopeâespecially with Had I Known. Can you tell me about the title? Joan Lunden (JL): Thank you. I was having a conversation with my coauthor [Laura Morton] as we discussed the book, and I kept saying, âHad I known that only 10 percent of women diagnosed with breast cancer had a family history, I wouldnât have felt so immuneâjust because I didnât have a family history.â After about the fourth or fifth time I used that phrase, my coauthor said, âWell, thereâs your title.â
AG: That really is true, isnât it? As a specialist in cancer hair loss, I often ask my clients, âIs there a family history of breast cancer?â And over and over, they say, âNo, no family history.â Whatâs going on? JL: Too many of usâmyself included, and I have interviewed so many experts and patientsâfall prey to this myth of family history. But it truly is only 10 percent of breast cancers that are hereditary. We think that because breast cancer isnât in our family history, itâs some other womanâs problem. I really never thought I was going to be
affected by it. And thatâs dangerous because it renders you nonchalant.
AG: Without a family history, without any notion that you had cancer in store, you were diagnosed through an ultrasound following a routine mammogram. What were your first thoughts when you heard, âYou have cancerâ? JL: Honestly, when I first sat across from the breast surgeonâwho had just been delivered the results of my biopsyâand was told I had triplenegative breast cancer and that I would have to have aggressive chemotherapy, my first question was, âYou mean Iâm going to lose my hair?â That was the first thought. From there I was consumed with the fact that I had all these choices to makeâlife and death choices: Which doctor should I choose? Which one will help save my life? Which course of treatment should I go with? Which one will give me the best chance of survival? Itâs overwhelming, this set of choices. And as you go down this path of the battle with cancer, you are continually confronted with choices and with the
âHad I known that only 10 percent of women diagnosed with breast cancer had a family history, I wouldnât have felt so immuneâjust because I didnât have a family history.â
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realization that as the patient you have to make the decision; itâs really scary.
AG: So how did you navigate that? How did you choose treatment? JL: I went to two different doctors and got two different opinions: One recommended the standard approach to care, which would consist of surgery followed by chemotherapy and radiation. The second doctor I saw recommended neoadjuvant chemotherapy (chemotherapy delivered before surgery), which could potentially shrinkâ or eliminateâthe tumors (I had two tumors, about an inch apart) ahead of surgery and therefore reduce the chance that I would need reconstructive surgery. I considered the research and decided to go with the neoadjuvant approach. I received the chemotherapy drugs Taxol® [paclitaxel] and Paraplatin® [carboplatin] first; when they did an ultrasound after that phase of treatment, one tumor was gone completely, and the triple-negative tumor was reduced by about 90 percent. Then I underwent surgery. My surgery was difficult, but because the tumors were so reduced it was less extensive and I didnât have to have reconstruction. I went through additional dose-dense chemotherapy after surgery, followed by radiation.
By virtue of being on the air, of being public for 30 years, I had a mountain to stand on top ofâa ready platform to inform and empower women and give them hope.
AG: That kind of treatment can be intense and can bring on side effects. What side effects did you experience, and how did you cope? JL: I was really lucky. I had minimal side effects. I did lose my hair, but I had decided that I would shave my head before my hair fell out, and I did that. I wanted that power. I had a wig made right away before I started treatment; then, soon after I started treatment, I walked into a salon and had someone shave my head. Then I put the wig right on and went about my day. I did errandsâpicked up some glasses and had my nails doneâand I kept expecting people to notice, but nobody did. I thought, The hair part really isnât so bad. I adapted pretty quickly. I had also been told that mouth sores were a possibility because the chemotherapy targets all rapidly reproducing cellsâincluding the cells in your mouth. Someone told me to keep ice chips in my mouth for five minutes before the chemo drug was pushed through the IV [intravenous line] and for five minutes after, which constricts the blood vessels, and that helped a lot. I worked with a nutritionist too, and I cut out wheat, sugar, and dairyâI ate really clean, whole foods. And I think that really helped. I didnât have nausea or any real stomach upset. You think
it will be hard to make those changes, but itâs really just about trade-offs, swapping out some foods for others.
AG: Youâve always been a public persona, but what made you go public with your cancer journey? JL: Thirty-five years ago I got a call in my newsroom. It was my agent telling me I had been offered the role of cohost of Good Morning America. And literally 30 minutes later, I got a call from my gynecologist, telling me I was pregnant with my first child. Both were wonderful, but did they have to happen at the same time? But what are you going to do? What youâre going to do is say yes and just put one foot in front of the other and do it. And I did. â After my first show as co-host, we did a press conference, and the first person who stands upâa reporter from Time magazineâ says, âWe understand youâre bringing a baby to work and that you have it in your contract that you can bring your baby to work.â And the next question,
from Newsweek, was about the same thing: about my on-air pregnancy and my role as a working mother. These were topics that, before then, had really not been discussed publicly. Long story short, I had already gone down that pathâI had already spoken publicly about that which was supposed to remain private. I had already broken through that barrier. So when it came time to share my cancer story, I knew that it was important to have this open dialogue. I also knew that, by virtue of being on the air, of being public for 30 years, I had a mountain to stand on top ofâa ready platform to inform and empower women and give them hope. That role has been incredibly fulfilling; it has shown me I have a purpose on this earth, which is so resoundingly obvious to me now. On a very personal note, sharing my experience has also allowed me to follow in the steps of my dad, a cancer surgeon, whom I always wanted to emulate. I had always felt like a tad bit of failure because I had not lived up to my early dream of becoming a doctor.
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hard time asking for and accepting help. I had a really hard time getting over that through treatment. I would always say, âYou donât have to go with meââespecially with radiation. But my husband would always say, âNo, weâre both going through this, and you are not going to go by yourself.â Between my husband and my three older daughters, who are in their twenties and thirties, I really had it good. There are a lot of women who donât have that circle of support, and I always think of them and how hard it is for them to go through this. Photo: Annie Watson
I had always wondered, in the back of my mind, Why didnât I work a little harder in college and go through medical school and become a doctor? This diagnosis presented an opportunity to remedy that, in a sense. It said: Here you go: You want to help save lives? Step over here.
AG: We always wonder what our journey is about, but you were really offered the opportunity to find purpose, werenât you? JL: I talked to a woman recently who is 32 years old, raising two young kids on her own and working, and was just diagnosed with breast cancer. She said to me, âI remember sitting there and being told I would have to have a double
mastectomy and chemo, and the first thing that came to my mind was the picture of you on the cover of People magazineâbald. And I remembered the smile on your face. The memory of that smile made me register that this was not the most horrible thing; if you could smile like that, I was going to make it through.â I donât need any further reason than that to continue making my cancer journey public.
AG: You clearly had tremendous public support, but whom did you turn to in your private life? JL: Definitely my husband. Iâm really lucky to have an amazing partner in life. Admittedly, as a type A, I have a
As long as youâre still alive, you have to worry about living. If cancerâor anything elseâcomes along, youâll fight it with everything you have, but until then you have to focus on living.
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AG: Youâve been very candid about the fact that being declared cancer-free has not provided the closure that you expected. How so? JL: As I neared the end of treatment, I had an expectation that I would feel a sense of relief, that I wouldnât have a worry in the world. But my oncology nurses tipped me off that it might not be that easy. They told me that even though a lot of people celebrate the end of treatment, it can be an emotional roller coaster because when you leave here, you donât have the consistent testing and reassurance of regular medical care. That abrupt end can be hard. And it was. I went in that last day and came completely unglued: Itâs like someone pushes you off a cliff and tells you, âDonât worry, you can fly.â And you think, How do I know Iâm okay? When youâre going through it, someone is taking care of you every couple of weeksâall these medical people making sure youâre okay. And thereâs a lot of solace in that. Once you walk out that door, itâs just you and that voice in your head. And you wake up with a headache and you wonder, Do I have brain cancer? Or you wake up with a sore elbow and you wonder if you have bone cancer. I had heard so many
stories of recurrence, and walking out and not worrying again was not an option.
AG: How do you manage that anxiety? JL: I have to admit that I fight with that inner voice, that voice that says I know thereâs something in there that can come and get you. But you canât go there. You canât keep worrying about dying when youâre still alive. As long as youâre still alive, you have to worry about living. If cancerâor anything elseâcomes along, youâll fight it with everything you have, but until then you have to focus on living. If you focus on the fear, it will lessen your quality of life, and it will add to your stress. And weâre learning so much about stress and the impact of stress on the immune system. You have to fight that scary voice in your head.
AG: So what are you doing today to maintain your health and focus on life? JL: Earlier in my life, with young children and a demanding job, I didnât work out, and I didnât eat as well as I should have. In my late thirties, I had an aha moment when I interviewed someone from the American Heart Association who was sharing information about evaluating heart health risks. I looked at my own habits, and it hit me like a ton of bricks: Iâm not healthy; I want to be racing in the race 20 years from now, not watching it. In the next year, I took my health on as a job: I hired a trainer. I changed my diet. I took control of my health. Now I know that I need to maintain those habits for a lifetime, especially in the wake of my diagnosis.
AG: Women who face cancer have to dig deep. On an emotional and spiritual level, what has changed for you post-cancer?
JL: When I was diagnosed, I kept hearing from people, âYou go in as one person and come out as another.â Boy, were they right. The Joan after cancer is much more focused on the meaning of happiness, the meaning of life. I took an inventory of the things I was doing in my life: anything that was not fulfilling, Iâm crossing them off the list. The experience brings an intense appreciation for the people in your lifeâ and not just family and friends. I was really touched and spiritually affected by the outreach from strangers, from the public, via social media. It was so therapeutic to know that all of these people were taking a moment in their day to reach out and offer prayers and support. I have an intense appreciation for them. I also really appreciate the heightened awareness I have of my ability to have an impact on this earthâthat when all is said and done, my life will have had significant meaning. Most important, maybe, is the gratitude I have for my life, for my incredible career and family, and for the ability to say, âIt has been enough. Whatever happens, it has been enough.â
it was behind me, and I was looking at it in the rearview mirror. It was a bad chapter, but it was just a chapter. I hope this can be the case for many other women, as well. Women should also feel comforted by the fact that we are lucky to be living in a time with so many effective treatments and with research offering new treatments at record speed. As researchers team up and the discovery of new treatments accelerates, there are more and more options for treatment. Finally, know that there is an incredible community of survivors ready to support you. Take the opportunity to reach out to the communityâthrough events, through online supportâand express your fears; ask your questions. Go to events to learn, to be inspired, and to hold on to hope. That breast cancer community is powerful, compassionate, and there to support usâ itâs so far-reaching. Donât go through this alone.
AG: When a woman is newly diagnosed and she looks at your website or reads this article, what insight do you hope sheâll take away? JL: For me, when I first heard I had cancer, it felt like it would take over my life forever, and it felt so overwhelming. Luckily, for me, before I knew it,
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Healthy Resolution Revolution Put a positive spin on your nutrition goals to effect lasting change. BY HEIDI REICHENBERGER MCINDOO, M S , R D, L D N
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PiN K â€Â¢ FALL 2017
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he beginning of the year is certainly the most popular time to vow to adapt a healthier lifestyle. Taking steps to improve your health, however, need not be limited to just once a year. You can resolve to make behavior changes that improve your health on a birthday, anniversary, or tomorrowâand start benefiting from the changes immediately. Historically, health resolutions tend to lean toward the negative: âI will lose X poundsâ; âI will stop drinking sodaâ; âNo more ice creamâ; âI will never eat fast food again.â It can be
difficult to maintain goals that focus on deprivation and elimination. If youâre attempting to change some lifestyle habits, how about putting a positive spin on your goals instead? Itâs much easier to meet your goals when youâre aiming to add to life instead of take away from it. In addition, when youâre striving to increase a food or an activity in your day, donât be afraid to start small; even minor changes can offer great rewards over time, and you can continue to add to your efforts as you feel able. Success is more achievable through small steps, and frequent wins with these minor changes will boost your
confidence. Alternatively, many negative resolutions are black and white: if you donât avoid an unhealthy food or drink entirely, you feel as though youâve failed. Small successes encourage you to keep going, whereas failures often lead to giving up entirely. So donât wait for New Yearâs resolutions or birthday bravado for inspiration; consider which small but mighty changes you can make today to improve your eating habits and your overall health. As you do, put the power in the positive: instead of making an intimidating list of necessary cuts, boost your health by adding the following essential elements to your nutrition plan.
Itâs much easier to meet your goals when youâre aiming to add to life instead of take away from it.
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grain. If whole grains typically arenât Wondrous Protein takes your thing, you might want to reconlonger to digest and Whole Grains sider. You can now find white wholeThe US Department of Agricultureâs wheat bread that may be more appealtherefore keeps us ChooseMyPlate.gov tool encourages ing, as well as a variety of crackers and feeling fuller for Americans to make at least half the cereals made from whole grains. grain foods they eat be whole-grain a longer period of foods. The Whole Grains Council Fantastic Fruits time than does a reports that only a little more than half and Vegetables of Americans are meeting that goal, so low- or no-protein there is lots of room for improvement. it comes to fruits and vegetables, carbohydrate snack Replacing more of your refined grains When it often seems like theyâre an after(things like white bread and white rice) thought (or a never-thought). Produce or meal.
Protein Power Proteinâs most basic job is to build and repair body tissue and help key bodily functions happen as needed. But it actually does much more. Recent research has shown that the current recommended daily allowance guidelines for protein should be raised in light of the increasing benefits protein provides. Two of the most crucial roles of protein include preventing muscle loss as we age and increasing satiety after meals, which can help with healthy weight maintenance. As we age, our muscle mass deteriorates, which leads to frailty and disability. Research has shown that eating more protein throughout the day can help prevent this and, in turn, promote more selfreliance. Protein takes longer to digest and therefore keeps us feeling fuller for a longer period of time than does a lowor no-protein carbohydrate snack or meal. Longer satiety helps prevent cravings between meals, as well as overeating at the next mealâtwo factors that can lead to weight gain. To get the most benefit from protein, aim to include 20 to 35 grams of goodquality protein in each meal. Beans, nuts, eggs, and lean meats are all good sources.
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with whole grains (such as whole-grain bread and oats) has been shown to promote many health benefits. Whole grains can help lower a personâs risk of a stroke, heart disease, certain cancers, and diabetes, not to mention help control weight and blood pressure. This is one case where more can be better: while you reap the benefits of whole grains with one serving per day, those benefits increase as your intake ratio of whole grains to refined grains increases. To ensure that you are choosing whole-grain foods, donât rely simply on the packageâs labeling. You need to flip it over and look for the ingredients list. The first ingredient listed should be a whole grain (such as 100 percent whole wheat, oats, quinoa, or barley). A listing of âwheatâ most likely means refined white flour, which has had components removed, making it no longer a whole
in general is extremely versatile and can be easily incorporated into any meal or snack. Most can be eaten raw or cooked. Many can be sweet or savory. Because of their color, they make our plates look so much more attractiveâand we do eat with our eyes first. But those bright colors do more than simply make our food look appealing. When viewing the vibrant reds, greens, and oranges in your fruits and vegetables, youâre actually seeing the powerful nutrients found within. Fruits and vegetables are incredible sources of a variety of antioxidants or supernutrients, whose powers go way beyond the basic proteins, carbs, and fats. One major type of antioxidant is flavonoids, which just happen to be the natural pigments that give a variety of plant foods their deep color. Every day your body is exposed to pollution, cigarette smoke, ultraviolet
rays from the sun, and the results of your bodyâs metabolism. All of these and more can harm the cells in your body. Antioxidants act sort of like a sponge and absorb the bad stuff before it can cause harm, and in so doing they protect all the cells in your body. When your cells are protected, youâre at a decreased risk of developing a variety of diseases, including cardiovascular disease, macular degeneration, several types of cancer, and many other chronic conditions. Strive to eat a piece of fruit and/or a vegetable at every meal and snack. Once youâve hit that goal, aim to have both at every meal and one at each snack. Try for as much variety as you can get. This helps prevent boredom but also maximizes your nutrient intake. For breakfast and snacks, a fruit smoothie is satisfying, nutritious, and delicious. At lunch a piece of fruit is a great accompaniment to a sandwich. At dinnertime try eating a brightly colored garden salad before your meal, as well as a cooked vegetable as a side dish.
Snack Time Snacking often has a negative connotationâconsidered an unhealthy behaviorâperhaps because, in the
United States, the âsnack foodâ designation often means candy, chips, and soda. Or maybe itâs because so much of the marketing around snack food has been directed at kids. If either of these ideas comes to mind when you think about snacks, itâs time to change your thinking. Healthy snacking is an important part of healthy eating. Snacking wisely helps fill in the gaps between meals in more ways than one.
A well-chosen snack can provide vitamins, minerals, and other nutrients you may be missing out on from just three meals a day, helping you meet all of your recommended nutrient goals. For example, say your recommended daily allowance for calcium is 1,200
milligrams. To meet that in just three meals, youâd need to consume more than 1 cup of yogurt or milk at each meal every day. By adding two or three snacks into the picture, you have much more flexibility with how much you need to consume at each sitting, as well as what you need to eat. Multiply this by every nutrient and food group, and you can see how much easier meeting your nutrient needs is when you have more than three occasions to make healthy choices. In addition, timing your snacks appropriately between meals can help prevent overeating at mealtime and stave off those late-afternoon energy slumps and cravings, which have a tendency to result in grabbing a candy bar or a bag of chips or lead to an unplanned trip through the nearest drive-thru. When situations like this become habits, maintaining a healthy weight becomes difficult. By planning and preparing a nutritious snack, you prevent not only your body from getting overhungry but also these lessthan-desirable scenarios. To maximize the benefits of healthy snacking, aim to eat a small snack about midway between meals during your waking hours. Ideally, that will be roughly three hours or so after a meal. What you choose to eat is as important as when. You want a combination of carbohydrates (fruits, vegetables, whole grains) to give you energy and protein (cheese, Greek yogurt, nuts, nut butters) to give the snack staying power. There are several eating resolutions that you can set for yourself to become healthier. By framing your goals in a positive light, you may find them easier to reach and maintain. This will greatly increase the chances of success. And remember, eating nutritiously doesnât need to mean sacrificing flavor and pleasure. Check out the healthy recipes on the following page for tasty, healthy inspiration.
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Edamame Hummus Prep time: 5 to 10 minutes High-protein soybeans put a different spin on classic hummus. ⢠⢠⢠⢠⢠⢠â¢
1œ cups frozen, shelled edamame 3 tablespoons tahini 2 tablespoons lemon juice Œ teaspoon Kosher salt 2 cloves garlic œ teaspoon ground red pepper 1 tablespoon olive oil
In a microwave-safe dish, heat edamame on high, covered, for 2 to 3 minutes. In a food processor fitted with a chopping blade, combine edamame and the rest of the ingredients. Process until it reaches your desired consistency. Serve with your favorite raw vegetables, such as carrot and celery sticks, red pepper slices, and cucumber slices.
Healthy Recipes Roasted Green Beans
Baked Fish Fillets
Prep time: 8 minutes Cooking time: 20 minutes
Prep time: 5 minutes Cooking time: 15 minutes
A delicious and easy way to get more veggies into your diet
Fish is a fantastic source of high-quality protein. This is a simple recipe to add to your dinner repertoire.
⢠1 pound fresh green beans, washed and trimmed ⢠2 tablespoons olive oil ⢠Kosher salt
⢠1 tablespoon butter ⢠2 to 3 tablespoons grated or finely chopped onion ⢠1 pound fish fillets, such as cod, haddock, or domestic catfish ⢠3 tablespoons lemon juice ⢠â teaspoon cayenne, Italian seasonings, lemon pepper, or other spices ⢠Œ teaspoon salt
Preheat oven to 425°. Spread the beans on one or two baking sheets. Drizzle with oil and toss by hand. Sprinkle with salt. Roast about 18 to 20 minutes, until the beans are starting to brown. Shake pan about halfway through so the beans donât stick. Options ÂŒ large onion, chopped ÂŒ large red pepper, chopped Add either or both to pan with beans before drizzling with oil.
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Preheat oven to 425°. Add butter to a medium frying pan and sauté onion for about 3 minutes, or until golden. Line a 9-by-13-inch baking pan with foil and spray with oil or cooking spray. Arrange fish in a single layer in prepared pan. Stir onion, adding lemon juice, seasonings, and salt. Spoon over fish, being sure to get some on every piece. Bake uncovered for about 10 minutes, or until fish flakes easily with a fork.
Have You Ever Heard of
âDense Breastâ? BY HIROFUMI NAMBA
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âH
ave you ever heard of âdense breastâ?â I have many occasions to pose this question of women because of my business. Typically, their answer is no. However, I have recently noticed that this is no longer the case. Since the beginning of the year, the term âdense breastâ has rapidly become more familiar and recognized; part of it is due to the increased newspaper and online media coverage on dense breast and related blog entries by celebrities. Along with all that, there has been an increase in inquiries handled by medical institutions regarding this term. Dense breast generally means a type of breast with a high density of lacteal glands. There may only be a handful of people who would actually understand what is meant by this definition alone. Let me explain further. When you have a mammography screening, the image shows fatty tissue in black and lacteal
Image 1
glands in white. Image 1 is a collection of mammogram images; and the one on the far left is the least dense in lacteal glands. The density increases as you move along to the right; Images C and D are mammogram images of breasts with high lacteal density. Please bear in mind that dense breast is not an illness,
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Image 2
1.
2.
3.
4.
Explanation about dense breasts
Mammography screening
Breast density result
Ultrasound screening Dense breasts
Non-dense breasts
4. Return home
but rather a single characteristic. If it is not a disease, why has âdense breastâ become a popular topic for discussion? I mentioned earlier that a mammogram shows fatty tissues in black and lacteal glands in white. So what about breast cancer? Breast cancer appears in white. Now, let us imagine finding white breast cancer signs on a mostly white image of a mammogram. You can probably draw the conclusion quite easily that it is extremely difficult to detect breast cancer this way. It is also known and discussed at medical conferences that the number of missed breast cancer diagnoses is greater among women with dense breast than those without it. What can women with dense breast do to tackle this predicament? At the moment, there is no other screening methods other than mammography that have been scientifically proven to reduce the breast cancer mortality rate. However, there are other methods availableâincluding sonography, tomosynthesis (3D mammography), and MRIâas useful screening methods that may increase the chance of
detecting breast cancer in women with dense breasts. A sonogram may be the most accessible and affordable option among these alternative methods, considering the fact that an MRI remains expensive as a screening exam alone and that tomosynthesis is not available at all medical facilitiesâ albeit the number of facilities with 3D mammography machines has been on the rise over the past few years. Some may now think that women with dense breasts do not need to have mammograms; actually, the opposite is true, because there are types of breast cancer that cannot be detected without a mammography screening. The technology has advanced as well, so there is software, such as Volpara Density, that can evaluate objectively about whether a patient has dense breasts when she undergoes a mammography screening. Subsequently, women are now able to proceed to an ultrasound screening when the results indicate they have dense breasts. Other patients at some medical facilities can go home when the results show that they do not have dense breasts. Mammography screenings, therefore, can serve as a gateway to other screening methods (see Image 2). Looking at dense breast awareness on a global scale, the United States is one step ahead of other countries. Nancy Capello started a grass-roots campaign called âAre You Dense?â to
I wish to reiterate that dense breast is not a disease, but rather a possible characteristic of the breasts. raise awareness about dense breasts, after her own breast cancer diagnosis. She was one of the women whose diagnosis was delayed due to the condition of dense breast, which filled her with a strong determination to take action so as not to let the same thing happen to other women. Because of herâand her teamâsâeffort, as many as 32 US states out of 50 have legislated and implemented Dense Breast Notification Laws (see Image 3). Such legislation requires doctors to notify patients about their breast density. Some states cover ultrasound and other necessary screenings through insurance policies issued to those women with dense breasts. Throughout this process, the most important point is not about notifying
women about dense breast, but rather about having women understand properly such a condition and its impact on breast cancer detection. âNowadays, the movement to raise awareness about dense breast has spread globally, no longer limited to the U.S., through the efforts of women. While research about dense breast by medical professionals has advanced; there are more things we all can do to improve and influence society about this issue. We believe there should be more conversation about dense breast at screening facilities, on a daily basis, and that people should be able to know that there are other methods other than mammograms available to them.â The movement has gradually grown in Japan as well. As of February 2017, there is an increasing number of municipal governments instituting measures to notify women with dense breasts about their condition and recommending them to have ultrasound screenings as a follow-up. It remains vital to inform more women about dense breast through the various media, both print and digital. A further
challenge at the same time is the difficulty in finding accurate information among millions of sources out there. It is my sincere wish that everyone will be able to receive the correct updated information on dense breast from such credible sources as the Japan Breast Cancer Society and the Japan Association of Breast Cancer Screening. In conclusion, I wish to reiterate that dense breast is not a disease, but rather a possible characteristic of the breasts. There is no need for alarm should you have dense breasts. In fact, some studies presented at the Japan Association of Breast Cancer Screening showed that about 80% of Japanese women have dense breasts, which indicates it is quite common here. I believe the most critical point is that we all understand the condition and are cognizant of how to manage better the screening for breast cancer in women with dense breasts. In cooperation with Volpara Solutions Ltd. (www.volparasolutions.com) and Are You Dense Advocacy Inc. (www. areyoudenseadovocacy.org).
Image 3
PROFILE
Hirofumi Namba President, Breast Healthcare Inc.
PINK: Enacted Law RED: Introduced Bill BLUE: Working on Bill WHITE: No Action BLACK â : Insurance Coverage Law
Born in Miyazaki in 1985, Hirofumi Namba started Breast Healthcare Inc. in 2013, with the objective to realize a society where all women feel secure by providing the means to healthcare and programs related to breast cancer. He has been an active advocate of dense breast issues in Japan since the establishment of the company.
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M A NAGI NG HOT F L ASH E S
A RETURN TO BASICS Healthy lifestyle choices can go a long way toward managing or eliminating hot flashes, no matter your age or stage in life. DIANA BITNER, MD
H
ot flashes during perimenopause and menopause can be very disruptive and confusing, and they can be induced by many factors other than low estrogen. Instant menopause caused by chemotherapy, pelvic irradiation, or surgery to remove the ovaries can be especially shocking to the system. But there is hope: it is possible to have a hot-flash-free life even without estrogen.
Estrogen Is Not the Only Solution Women who cannot take estrogen because of estrogen receptorâpositive cancer or other risk factors (such as cardiovascular disease) should not despair. Estrogen is powerful, but it is not the only solution. Research is continuing to reveal that acupuncture can provide significant relief, as can medications other than estrogen. Most important, perhaps, is the evidence to support the significant improvement women experience when they make consistent, healthy lifestyle choices. Specifically, the idea is to focus on
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the essential components of wellness: make a daily habit of taking simple steps toward health. I like to offer women an easy way to remember the key pillars of a healthy lifestyle, with the acronym SEEDS, which stands for seven essential elements of daily success: ⢠Water: 80 net ounces per day (total servings of water minus caffeine and alcohol) ⢠Sleep: 50 quality hours per week ⢠Micronutrients: multivitamin and vitamin D ⢠Macronutrients: a healthy balance of protein, smart carbohydrates, and fat (and only one treat) ⢠Daily exercise: should include a balance of aerobic exercise three times per week and strength-training or interval training three times per week, as well as regular stretching ⢠Fiber: 35 grams per day to promote healthy bowel habits ⢠Meditation or gratitude practice: twice per day Making a conscious effort to live a healthy lifestyle can reduce hot flashes as well as improve your overall health; for cancer survivors it can also reduce the risk of recurrence. Poor lifestyle
choices, on the other hand, can cause hot flashesâeven for those already taking hormones.
How the SEEDS Were Planted Whether a woman is 20 years old and menopausal after chemotherapy for leukemia, 35 and has received chemo for estrogen receptorâpositive breast cancer, or 45 and BRCA-positive and has undergone risk reduction surgery to remove her ovaries, the symptoms of menopause can be overwhelming. Since 2008 I have spent many hours working to understand the symptoms of menopause. As a general OB/ GYN who has seen many women get through the transition with minimal symptoms and others suffer from symptoms that interfere with quality of life, I wanted to help. As I considered my experiences with patients, I was confused about why women could have symptoms even though they took estrogen. That neither make sense nor fit what I had been taught about menopause. I asked myself, Is there a better solution than a prescription for estrogen? My aha moment came with a patient I will call Deb. She was 54 and experiencing terrible symptoms that she knew to be associated with menopause, including hot flashes, night sweats, trouble falling asleep and staying asleep, irritability, lack of motivation, debilitating fatigue, foggy brain, and zero sex drive. She had started estrogen prescribed by her primary care doctor, but she was not feeling relief from the doseâthe maximum her doctor would prescribeâand came to me wanting the dose increased. She needed the symptoms to go away. At the time I was not sure what to do, but I did know that a higher dose would increase the risk of complications, so I did not increase her dose. Unfortunately, another physician did agree to up Debâs dose, and she developed a blood
I asked myself, Is there a better solution than a prescription for estrogen? clot in her lungsâand almost died. And the higher dose of estrogen had not reduced her symptoms. After her successful recovery, Deb returned to my office to discuss options. By this time I had been to several North American Menopause Society conferences, had researched the cause of menopausal symptoms, and had developed a strategy for symptom treatment. I realized that the best treatment required consideration of the whole person. In evaluating Debâs overall health, I was able to understand the many factors contributing to her symptoms. In addition to low estrogen, Debâs poor daily health habits, co-existing health conditions (such as obesity and prediabetes), many life stressors, and unhealthy relationships were contributing to the frequency and intensity of her symptoms. By addressing barriers, talking through solutions, and improving her habits, Deb was able to find a comprehensive strategy that worked.
A Daily Journey toward Health While estrogen can be effective in helping women address hot flashes and other frustrating symptoms of menopause, there are other solutions for women who suffer from hot flashes, night sweats, fatigue, sleep deprivation, and emotional upset. As Debâs case illustrates, a whole-person approach to health can offer many benefits. â At the end of the day, even with my years of experience and insight into the causes of menopause, I still have the occasional night sweat myself. I use it as a gift to invite review of my daily habits and consider the factors I need to keep in mind to stay well during my own menopause transition.
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ACCESS IS POWER Personalized medicine has the potential to save womenâs lives, but not if they canât access it. B Y S TA C E Y L . W O R T H Y, E S Q .
O
ne of the most exciting advances in healthcare is the growing field of personalized medicine. Personalized medicine involves identifying genetic and genomic information that helps predict a personâs susceptibility to developing a particular disease, the possible course of that disease, and the diseaseâs response to different treatments. Personalized medicine made it possible for Sarah Kelsey, a healthy 41-yearold woman living in Virginia, to take control of her future. Sarahâs mother passed away from metastatic breast cancer in her early forties, and after several other maternal relatives were given the same devastating diagnosis, Sarah ultimately
decided to have the genetic test that would determine whether her genetic makeup included the BRCA mutationâ an indicator of a strong likelihood of developing breast or ovarian cancer during oneâs lifetime. A strong family history of breast cancer was enough for Sarahâs insurer to cover the cost of genetic testing. After undergoing the genetic test, Sarah learned that she did carry the BRCA mutation. She worked with her care team to evaluate her options, which included vigilance, surgery, and specifically tailored drug therapy. The oncology team treating Sarah recommended close monitoring, which would consist of frequent clinical exams and magnetic resonance imaging (MRI), which is more accurate than mammography when it comes to detecting early-stage
breast cancers in young women, who typically have dense breast tissue. This seemed to be a reasonable treatment plan given the positive test results for the BRCA mutation and considering that Sarah was not yet ready to undergo preventive surgery. When preparing to follow the prescribed testing, Sarah learned that her insurer would not cover the cost of repeat, nondiagnostic MRIs. Although she and her husband paid for the MRIs themselves for a while, the compounding expense was a factor in Sarahâs ultimate decision to switch gears and undergo preventive surgery.
Limited Access to Personalized Medicine Affects Women Although Sarahâs family medical history qualified her to receive BRCA testing through her insurer, many women still experience difficulty in getting coverage of not only MRIs but also BRCA testing. This is despite the fact that BRCA testing is currently the only preventive genetic test endorsed by the US Preventive Services Task Force. The Patient Protection and Affordable Care Act (ACA) requires most plans to cover the cost of BRCA testing if a womanâs family history indicates a higher-thanaverage risk for a BRCA mutation. Many women also have difficulty accessing another area of personalized medicine: treatments that are tailored to their unique genetic makeup. Pharmacogenetics, which is the study of how a patientâs genes affect whether a treatment is likely to be effective, what the appropriate dose should be, and whether the patient is likely to experience a serious side effect, can assist in identifying the most appropriate treatment without requiring a woman to undergo ineffective treatment or endure unnecessary adverse effects. Theoretically, the ACA also requires most plans
to cover pharmacogenetic testing because the ACA mandates coverage of laboratory services that allow doctors to determine whether a medication is effective. Insurers skirt these requirements, however, by exploiting loopholes in the ACA. They use burdensome cost containment policies, such as prior authorization, to make it harder to access innovative treatments and technologies. Prior authorization is a list of criteria that must be met before the technology will be considered medically necessary for disease diagnosis or treatment. For example, insurers have instituted prior-authorization policies that require individuals see a genetic counselor before qualifying for BRCA testing, even though a patientâs physician is fully capable of assessing whether the testing is medically necessary simply by determining that breast cancer runs in the family. Not only does this requirement result in additional out-of-pocket costs for the patient to see a genetic counselor but it may be particularly hard for women in remote areas to find a genetic counselor at all. These women must either travel long distances to find a counselor or forgo
States are beginning to enact laws that correct some access problems, but most of these laws do not reach far enough.
the testing altogether because they do not meet the prior-authorization requirement. States are beginning to enact laws that correct some access problems, but most of these laws do not reach far enough. They often do not include any protections for testing technology. Far too many women find themselves in the same position as Sarah: in need of pharmacogenetic or diagnostic testing but ill equipped to implement their physicianâs recommendations and the medical communityâs widely accepted standard of care.
Take Empowering Action So what can you do if your insurer denies access to the testing and treatments recommended by your physician and accepted as the established standard of care? The first step is to appeal the decision. All insurers have appeals processes, and patients often win if they appeal a denied health claim. Work with your physician, who can send a letter on your behalf; and, if you need help with the process, contact a patient advocacy group, such as the Patient Advocate Foundation, that offers a variety of resources to help patients access care. If you have exhausted the appeals process and still cannot access testing, file a complaint for unfair business practices with the state attorney general or insurance commissioner. While personalized medicine can offer lifesaving preventive and treatment approaches, it saves no lives if it cannot be accessed.
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I
n a survey conducted by Anna Middleton, PhD, MSc, RGC, of the Sanger Institute, 7,000 people were asked whether they would want to know whatâs in their DNA. Interestingly, 98 percent of those surveyed said yes, even if the findings revealed a gene linked to a serious health condition. The results revealed a general sense of excitement about the idea of preserving oneâs health through the use
about whatâs in your DNA, it is important to understand some of the nuances. We have bucketed DNA tests into five distinct categories to help simplify the information available to you.
Recreational DNA Tests A recreational DNA test is one that gives you some fun tidbits about you and your family, such as ancestry, bitter taste perception, or the propensity for freckles. Recreational DNA tests do not require the involvement of a healthcare
ITâS I N TH E GEN E S
GENETIC TESTING TUTORIAL If you are considering genetic testing, itâs important to understand the purpose and scope of available genetic tests. BY SHIVANI NA Z ARETH AND C AROLINE LIEBER
of genetic information. Also indicative of this trend: when actress Angelina Jolie announced her decision to have prophylactic surgery to reduce her inherited risks of breast and ovarian cancer, genetic testing rates increased significantly. As the science of genetics advances, the possibility of disease prevention is intriguing. But navigating the maze of genetic-testing options can be tricky. If you are considering learning more
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professional and are not used to make medical decisions. Some recreational DNA tests market their kits as âwellnessâ or âhealthâ tests, but the fact is that the genetic components of your overall health are complex and cannot be attributed to any one particular DNA finding. If you want to learn about some interesting physical or ancestral traits, a recreational DNA test can be a cool family activity. These tests should not be confused with medical advice.
Predictive DNA Tests A predictive DNA test is one that is ordered and interpreted by a physician, genetic counselor, or qualified health professional. There are thousands of predictive DNA tests, and they are used to determine whether you may have inherited (or can pass to children) a particular disease, such as colon cancer, Huntingtonâs disease, or cystic fibrosis. Some predictive DNA tests are actionable, while others are not. An actionable result means that you can use the information to reduce your risks or plan ahead, as Angelina Jolie did with her DNA test for breast and ovarian cancer. Testing for Huntingtonâs, a degenerative neurological disease with no available treatment, is not actionable. Despite the fact that there is no medical action to take, some people feel that simply knowing their risk allows for preparation, estate planning, and relief from the burden of the unknown. Predictive DNA tests are used for medical decision-making during adulthood or pregnancy, and the choice to pursue the information is very personal.
Diagnostic DNA Tests A diagnostic DNA test is also ordered by a physician, and it is used to help figure out the underlying cause of symptoms in a patient experiencing health issues. For example, a child who has delayed walking or difficulty balancing may undergo neurological DNA tests to look for certain types of inherited muscular dystrophy. An exciting new area within the field of diagnostic testing is whole-exome sequencing. Rather than focus on targeted genes, whole-exome sequencing looks at all of a patientâs DNA to determine the potential cause of a disease.
Therapeutic DNA Testing Certain therapeutic DNA tests can guide decisions regarding which therapies or
medications are best for a particular diagnosis. One example involves the biomarker called HER2 (human epidermal growth factor receptor 2), which provides therapeutic insight in about 20 percent of breast cancer cases. The HER2 gene, when mutated (called HER2-positive), codes for a protein that advances cancer cell growth. A HER2positive breast cancer tends to be less likely to respond to hormonal therapy; however, hormonal treatments that specifically target HER2 are very successful. These treatments are in fact so effective that the prognosis for HER2positive breast cancer is quite good.
Research Genetic Testing Some genetic tests are available as part of research, often as part of clinical drug trials. The scope of results may be limited, however, because the research is often designed to accelerate drug development rather than provide health information. The results from such testing are usually not available to patients or to the referral source, and enrolled family members may not get results from this type of testing. If you are considering research genetic testing, talk
with your doctor, genetic counselor, or other healthcare professional about the benefits and limitations.
Conclusion As you can see, most of the time the information you will receive from DNA testing is really useful. But there are times when results are difficult to interpret or may bring up unknown variables (nonpaternity as a classic example). Understanding the benefits and limitations of testing options is important so that whatever path you choose, you are comfortable with the decision.
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A N N UA L OR DER
TALK TO YOUR DOC The focus of your gynecologic exam will evolve as you age. Talking openly with your OB/GYN during your annual visit will ensure that you get what you need at your stage of life. BY DIANA PRICE
D
o you see your gynecologist each year for an annual exam? For many women various guidelines released by medical organizations over the past several yearsâwhich have included differing opinions about the value of annual pelvic exams, conflicting statements related to the recommended frequency of mammograms, and updated Pap test schedulesâhave caused some confusion about whether an annual exam is necessary and what should be included in the visit. The recommendation against regular pelvic exams, issued by the American College of Physicians in 2014, and the mammography schedule released by the US Preventive Services Task Force, which pushed the start to annual mammogram screening to age 50 (from 40), were both based on evidence that the risks associated with these preventive screenings may outweigh the benefits for healthy, low-risk populations.
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Lauren Streicher, MD, associate clinical professor of obstetrics and gynecology at Northwestern Universityâs Feinberg School of Medicine and author of The Essential Guide to Hysterectomy: Advice from a Gynecologist on Your Choices before, during, and after Surgery (M. Evans, 2013; $22.95) and Sex Rx: Hormones, Health, and Your Best Sex Ever (Dey Street Books, 2015; $15.99), says that when evaluating these recommendations and planning medical care, women should remember that âthese are not rules; they are recommendations from various organizationsâ and that each woman should consider her own needs and her and her familyâs medical history to determine when and with what frequency to see her gynecologist. As part of that decision-making process, Dr. Streicher says, women should be aware of the many benefits of an annual exam with an obstetrician/gynecologist (OB/GYN)âand the risks of avoiding the visit. âConflicting guidelines can be confusing, but putting off
an appointment until you experience symptoms of some kind is not a good idea.â This is because, according to Dr. Streicher, a thorough gynecologic exam includes a lot more than a Pap test. âA lot of women arenât aware of all the components of an exam: Iâm looking at the vulva [the external opening of the vagina] to screen for precancers and lesions; Iâm examining the cervix and also the walls of the vagina and the tissue integrity; Iâm looking for abnormal discharge; and Iâm conducting a bimanual exam to check for any pelvic masses.â The American Congress of Obstetricians and Gynecologists (ACOG) recommends that women begin seeing a gynecologist in their teens (age 13 to 15) and continue annually. ACOG guidelines6 for this annual visit include a general exam (height, weight, and body mass index, or BMI); a breast exam; a pelvic exam (with or without a Pap test); blood, urine, and screening for sexually transmitted diseases (STDs); bone mineral testing; colorectal cancer screening; and appropriate diabetes and heart health tests as necessary. If you havenât had an annual exam recently, or if you are planning for your next regular visit, Dr. Streicher offers the following discussion topics to address, in addition to those recommended by the ACOG, based on your age and stage in life.
Twenties Though this decade can be a time of transition for many women, establishing and maintaining regular visits with a gynecologist in your twenties can help you make good choices for longterm gynecologic health. Dr. Streicher recommends the following priorities for care. Establish a relationship with a gynecologist. Dr. Streicher notes that itâs important to seek out a specialist
who is an expert in the issues that are of greatest concern to you: âA lot of women assume that all OB/GYNs have the same training and area of expertise, but there are not only subspecialties in the field, there are also specific areas of interest. Ask yourself what your needs are and find a doctor who shares your care priorities.â Compile family history and identify cancer risk. âThe most important thing for a woman in her twenties is to do a careful family history,â Dr. Streicher says. âThis is the time you sit down with your mother and father and get as specific as possible about any family cancer history.â Having put together a very careful history, discuss it with your gynecologist to create a screening schedule that reflects your history. Address your sexual health. Be sure to discuss both STD screening and prevention, as well as any questions you have about sexual pleasure. âWe talk a lot about safe sex but not about good sex,â Dr. Streicher says. âYour gynecologist should be able to help you navigate having a pleasurable sexual experience, if thatâs an issue for you, so bring this up at your appointment.â Discuss fertility. Whether youâre seeking contraception or are considering starting a family, discussions with your gynecologist in your twenties will likely include fertility. âMake sure you have a method of contraception that is appropriate and the safest for you,â Dr. Streicher says, âand be proactive about discussing fertility preservation.â
If you havenât already, get your HPV vaccine. âWe know that the human papillomavirus (HPV) is not only responsible for cervical cancers but can also lead to vulvar, vaginal, anal, and some head and neck cancers,â says Dr. Streicher. âGet your vaccine in your twenties because thatâs when insurance will cover it.â And, she notes, if youâre worried that itâs too late to be vaccinated because you may already have been exposed, be aware that the vaccine offers protection against nine types of HPV; even if youâve been exposed to one or two HPV types, youâll still get protection from the others.â
Thirties For many women gynecologic visits in this decade revolve around fertilityâ contraception, pregnancy, and fertility preservation. âDuring your thirties we focus on timingâwhat we can do to get ready to be pregnant or, if youâre not ready to get pregnant, fertility preservation,â Dr. Streicher says. Contraception. As in your twenties, engage in an open dialogue with your gynecologist about what birth control options are best for you, understanding that they may change over time. Sexual health. Again, Dr. Streicher encourages women to be advocates not only for STD prevention but also for their own sexual experience: âOnly about 3 percent of physicians will bring up sexual pleasure, and if they do, itâs along the lines of âDo you have any sexual problems?â rather than âAre you able to have an orgasm?ââ Talk openly with your gynecologist; and, if that physician isnât comfortable with the topic, consider seeking a gynecologist with expertise in sexual health.
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Pregnancy. If you are trying to get pregnant in your thirties, be open and proactive with your gynecologist. âThereâs this myth out there that you should try for a year to get pregnant before looking into why youâre not getting pregnant, but thatâs crazy,â Dr. Streicher says. âIf youâre having a problem, letâs identify it right away and jump on that.â Fertility preservation. If youâre not ready to have a baby now but you want to have the option later, begin conversations early with your gynecologist. âThis is the time to talk about egg freezing and other options so that someone has a sense of what the timeline is and we can address things proactively to ensure a woman has as many options as possible.â
they have the expertise to treat these issues,â Dr. Streicher says. Cancer screening. In addition to screening for cervical cancer with a Pap test, Dr. Streicher notes, your gynecologist can be on the lookout for signs and symptoms of other gynecologic cancers, including cancers of the vulva, ovarian cancer, and uterine cancer. âUterine cancer is the most common gynecologic cancer,â she says, âand it often manifests with irregular or heavy bleeding, which can be tricky. Donât assume that irregular bleeding is related to menopause.â Depending on your personal screening timetable, you may also begin having regular mammograms at 40.
Forties
Menopause is the central gynecologic health concern for most women in their fifties, according to Dr. Streicher. Menopause symptom management. If you feel that your concerns about symptom management are not being addressed, Dr. Streicher
For some women the forties may be a time when the annual visit takes a backseat to the demands of family and professional responsibilities, or the visit is postponed because of the perception that if annual Pap tests arenât recommended, the visit isnât as necessary. But Dr. Streicher cautions again that women should be aware of the additional areas an exam covers: âIf a woman hasnât seen a gynecologist in three years because she hasnât needed a Pap test, she wonât have had STD screening, she may have fibroids or other issues that havenât been examined, and we wonât see her until she has symptoms of some kind that could have been detected earlier through an annual exam.â Here are the topics to be sure to cover in conversations with your gynecologist in your forties. Hormonal changes. âWomen are likely starting to experience hormonal changes; if so, be sure that your gynecologist is prepared to discuss symptoms and management and that
Fifties
Sexual health. Dr. Streicher notes that the fifties can be a transitional time for women, a period that often includes life changes around children leaving home, divorce or separation, and career changes. For women with new sexual partners at this time in life, review of STD prevention and screening and other topics related to sexual health is essential.
Sixties and Beyond As womenâs lives remain increasingly full through later years, careful care for sexual health and lingering menopausal symptoms is important. âThe idea that menopause issues are over by this time is just wrong,â says Dr. Streicher. âVaginal dryness persists and gets progressively worse, hot flashes remain an issue, and we start to deal with incontinences, urinary prolapse, and vulvar issues through the sixties, seventies, and eighties.â Keep the conversation going. Dr. Streicher urges women to continue an open dialogue with their gynecologist as they age and to bring up the issues that matter to them to live their best life during these years. âWomen are always so relieved when I bring up topics like vaginal dryness that I might notice during an exam,â Dr. Streicher says, âbecause often theyâre embarrassed to broach the topic themselves.â Incontinence. Itâs especially important to let your gynecologist know about incontinence issues, Dr. Streicher says. âThirty percent of women at some point in their life have an involuntary loss of urine or stool, but they generally wonât bring it up because they assume itâs just part of aging and that there isnât a solution.â But, she adds, âjust because itâs a common problem doesnât mean you have to accept it or that there arenât solutions.â
âjust because itâs a common problem doesnât mean you have to accept it or that there arenât solutions.â
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recommends seeking an expert through the listing offered by the North American Menopause Society (menopause.org): âWomen should know that just because their current gynecologist hasnât been able to help, there are solutions available for issues like hot flashes and vaginal dryness.â Cancer screening. This remains an important issue for women in their fifties. In addition to scheduling an annual mammogram, women should be aware that the risk of vulvar and vaginal cancers also increases with age and should be monitored by a gynecologist.
ããªãã®ã¹ããŒãªãŒã ãèããäžããïŒ Share your story in PiNK! PiNK ã«çµéšè«ãå¯çš¿ããŠã¿ãŸãããïŒ Would you like us to publish your story?
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åçš¿ã¯ããœã³ã³ã§äœæããŠãã ããããŸããå°å·ç©ã CD ã§å çš¿ããéµéããã ããå Žåãæ²èŒã®æç¡ã«ãããããè¿åŽã ãããŸãã®ã§ãããããããäºæ¿ãã ããã Please compose your draft in Word or any other comparable format. Please note that hardcopies or CDs with the article sent by mail will not be returned regardless of publication status. Also, please be reminded that the purpose of the article is to inspire, give hope and provide positive support to others in Japan regarding early diagnosis, treatment and care of breast cancer. æ¬æã§è§ŠããŠããã ãããç¹ïŒ ïŒ ä¹³ãããèŠã€ããçµç·¯ ïŒ å®æçãªãã³ã¢ã°ã©ãã£ãŒæ€èšºãåããŠããã ïŒ å®æçãªèªå·±æ€èšºãè¡ã£ãŠããã ïŒ ä¹³ãããšèšºæãããæã®ã¹ããŒãž ïŒ æ²»çå 容 ïŒæè¡ãæããå€çæ³ã ãã«ã¢ã³çæ³ãªã©å ·äœçã«ïŒ ïŒ è¬ãæçšãããå Žåã¯ãã®çš®é¡ãšæé Please include in your article draft: 1 How you found out you had breast cancer; 2 Whether or not you regularly had annual mammography screenings;
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Whether or not you regularly conducted self-examinations; At which stage you were diagnosed; What kinds of treatment you underwent (surgery, chemotherapy, hormone therapy, etc.); and What types of drugs you were prescribed if any.
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⢠èªé¢ã®éœåãªã©ã«ãããé©å®ç·šéã»ç»åã®ãªãµã€ãºãªã©ã ãããŠããã ããŸãã ⢠ã»ãã®èäœç©ãåŒçšã»è»¢èŒããå Žåãèäœæš©ã«ååãªã é æ ®ã®äžããå·çãã ããã ⢠æ²èŒã®å¯åŠãæ²èŒææãé çªãªã©ã¯åœæ¹ã«äžä»»ããŠããã ããŸãã ⢠åçš¿æã»ã瀌ãªã©ã®ãæ¯æãã¯ã§ããŸããã®ã§ããããã ããäºæ¿ãã ããã ⢠Make sure to provide in writing your name, age, mailing address, phone number, and email address when submitting your article. ⢠Please be reassured that we will not use your personal information for any purposes other than publication and delivery of the magazine without your prior consent. ⢠The Foundation reserves the right to edit your story for consistency in style regarding PiNK magazine, and to crop or resize the photography you submit to fit our layout. ⢠Confirm in writing that there is no copyright infringement regarding the direct quotes from other sources used in your article. ⢠Publicationâas well as timing and orderâof your article in PiNK magazine are up to the discretion of the Foundation. ⢠There is no compensation for the story you submit.
P I NK ⢠FALL 2017
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RUN FOR THE CURE® NEWS @RFTCtokyo
Run for the Cure Foundation
Cuisine for the Cure 2017 Delicious food, beautiful surroundings, important cause BY ANDREW HOWITT PHOTOS BY STEVE MORIN
Itâs hard to keep your mouth from watering when you read âricotta and spinach ravioli in fresh tomato sauceâ, âlasagna with Genovese pestoâ and âmini Parmigiana with organic vegetables and Franciacorta fondueâ. And thereâs no mistaking a menu like this one for being anything other than Italian. The fourth annual Cuisine for the Cure fundraising event, put on by Run for the Cure® Foundation on June 8th, had a distinctly Italian theme. Held at the residence of the Italian ambassador to Japan, the 144 guests in attendance were served authentic Italian dishes such as these while, at the same time, supporting breast cancer awareness and helping in the fight against the disease in Japan. âWe are very grateful to Ambassador Giorgio Starace for hosting this event in his magnificent restaurant ⊠I mean residence,â joked Vickie Paradise Green, founder of Run
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PI N K ⢠FALL 2 0 1 7
for the Cure® Foundation in her speech at the start of the evening. Paradise Green commented on the fact that breast cancer is the most common cancer, and the leading cause of cancer death, among Italian women. âWhether you have been personally affected by cancer, or because a loved one or friend has, your presence here tonight says that bringing an end to breast cancer is important to you,â she continued. In his welcome speech, Ambassador Starace expressed his gratitude to those who had come and reminded everyone that their contribution would make a difference. âIn order for our battle against breast cancer to be successful, it is very important to keep investing money in prevention, awareness campaigns, scientific studies, and caring assistance to those affected,â the ambassador stated. Before the start of the live auction, the main event of the evening, many people took their
arancini rice croquettes, their swordfish and eggplant involtini rolls on pizzaiola sauce and their glasses of red and white wine outside onto the patio to watch the sun set over the residenceâs beautiful, historic garden. âEverything was delicious,â raved Noriko Matsumoto of Toshiba Carrier. âI thought the truffle risotto was especially good.â Elio Orsara, owner of the Elio Locanda Italiana restaurant in Tokyo, was the guest chef for the evening. âWe have one of the most beautiful embassies,â he said. âI am glad that all the guests here tonight are really enjoying the embassy, and my Italian food, too.â Although everyone clearly appreciated the delicious food and the beautiful surroundings, the reason for the eveningâs
ã¹ã¿ã©ããã§å€§äœ¿ããã¯ã ãä¹³ãããšã®éãã æåã«å°ãããã«ã¯ãäºé²ãåçºãã£ã³ããŒã³ã ç 究ããããŠä¹³ãããšéãæ¹ãžã®æ¯æŽã«æè³ã ãããšãéèŠã§ãããšããåŒã³ãããšãšãã«ã åå è ãžã®æè¬ãšæè¿ã®èŸãããã ããŸããã æ¬äŒã§ã®ã¡ã€ã³ã€ãã³ãã§ããã©ã€ããªãŒã¯ ã·ã§ã³ãå§ãŸãåã«ãã²ã¹ãã¯æ¥æ¬åŒã®äŒçµ±ç ãªãåºã§ã¢ã©ã³ããŒããã¡ã«ãžããšãã¹ã®ã€ã³ ãŽã£ã«ãã£ãŒããããã¡ã€ãªãŒã©ãœãŒã¹æ·»ãã ã奜ã¿ã®ã¯ã€ã³ã«èéŒãæã¡ãŸããã ãã©ãã倧 å€çŸå³ããã®ã§ãããããªã¥ããªãŸãããæ Œå¥ ã§ããããšã æ±èãã€ãªã¢æ ªåŒäŒç€Ÿã®æŸæ¬å žåæ°ã æ¬ã€ãã³ãã®ã²ã¹ãã·ã§ãã§ããšãªãªã»ãã«
gathering was foremost on peopleâs minds. âI have family who have been affected by this terrible disease,â Orsara said. âI am so happy to be supporting this cause.â Danny Risberg, chairman of Philips Electronics Japan, commented that, âbreast cancer is a giant issue and screenings are very low in Japan, so we need more awareness. If youâre going to get involved with something, you should get involved with causes like this one that make a real difference.â Throughout the evening, guests had the chance to bid on 33 silent auction prizes, including two nights at the Kolbe Hotel Rome, a facial and aroma treatment from Natural Beauty TULA, and crystal stemware from both Riedel and Zwiesel. The eveningâs Italian theme even extended to some of these items, with scarves and paintings by Sicilian oil painter Loredana Messina; and wine, cheese and salami from VERA@ITALIA. As people finished their chocolate cake and mousse, the live auction began. Generous bids were made on a designer buckskin bag from ETRO, and lunch and dinner for two at Il Ristorante Luca Fantin together with afternoon tea at BVLGARIâs Il Bar. The back-and-forth over the third and final prize, a Fizzy Necklace by Swarovski, became intense as two guests on opposite ends of the living room tried to outbid each other. The live and silent auctions raised a combined total of Â¥2,930,000 for Run for the Cure® Foundation. âMore than Â¥535 million has been raised by the Foundation over the last 15 years â that is well more than half a billion yen for breast cancer awareness,â stated Paradise Green. âI am so proud of how much we have accomplished over the years, thanks to your continued support.â
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Run for the Cure® Partners (Alphabetical order)
P I NK ⢠FALL 2017
3
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Resources ã©ã³ã»ãã©ãŒã»ã¶ã»ãã¥ã¢ã»ãã¡ã³ããŒã·ã§ã³ããã³ã¢ã°ã©ãã£ãŒæ©æã
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Medical Institutions that support Run for the Cure®
å¯èŽãã6å°ã®ãã³ã¢ã°ã©ãã£ãŒæ©åšã¯2016幎8æçŸåšãåèšã ãã19,180人ã®å¥³æ§ã«å©çšããŠé ããŠããŸããæ€èšºãå蚺ããçŽ 60%ã®å¥³æ§ããåããŠãã³ã¢ã°ã©ãã£ãŒæ€èšºãå蚺ããããšã¢ã³ã±ãŒ ãã«åçããŠããããã³ã¢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. 19,180 women have received screenings on these machines and 60% indicated it was their first-ever screening.
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 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
å² é ç / Gifu
Foundation.
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¢å®®åŽç é¢ / Breastopia Miyazaki 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
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
瀟äŒå»çæ³äººåæ åæã¯ãªãã㯠/ Hokuto Clinic ã 080-0833 垯åºåžçš²ç°çºåºç· 7-5 (7-5 Kisen, Inadamachi, Obihiroshi, Hokkaido) tel. 0155-48-8000 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
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Monthly Self-Examination èª å·± æ€ èšº 㧠ã 〠ã ã® æ 觊 ã èŠ ã ãŠã
You know your body better than anyone
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else. Know your normal, so you can detect
æ© æ çº èŠ ã ããªãã®èž ãããããŠåœã
the slightest abnormality immediately.
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When to examine It's best to self-examine after your
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menstruation cycle, when breasts are less
ç ç ã çµãã£ãŠãä¹³ æ¿ ã®ç· 匵 ãè « ã ã
tender or swollen. If your cycle is irregular
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or you have reached menopause, pick a
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date you can easily remember and check
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every month.
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Self-Exam Procedure 1.
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Raise arms in front of a mirror and examine for irritation, swelling or discharge.
ãŠç¢ºãããŸãã
2.
and ring finger; to check your right breast, use your
ã¯ããŠã¿ãŸãããã人差ãæãäžæãè¬æ ã®ïŒæ¬ã®æè ¹ãå³èžããã§ãã¯ããéã¯å·Š æã䜿ããŸããÂ次ã®ããã«åãããŠèã®äžã
left hand. Gently explore your breast area within the
2
boundaries connecting armpit, rib, collarbone and shoulder for lumps following the patterns below, and
ãã©ã©ã€ã³ãã¿ããã¡ãé骚ãè©ãã€ãªã
repeat with the other side.
ã èž å š äœ ããŸã ã¹ ããªã調 ã¹ ãŸãããã çµãã£ãããå³æã§å·Šèžã調ã¹ãŸãããã
a) Draw three coin-sized circles in one spot, applying different pressure each time: light, medium and deep.
a) ïŒç® æã«ã€ãã³ã€ã³ãµã€ãºã®åãïŒåæãã軜ãã»å° ã匷ãã»æ·±ããŸã§è§Šããããã«ãå§åãå€ããŠãã§ãã¯ã
b) Vertical or "up and down" (or "squares") pattern
ãŸãã b) èã®äžããå§ããèžå šäœã«ããã£ãŠäžäžæ¹åã«ãäž
You can self-examine while taking a bath or shower. Use the pads of your pointing finger, middle finger
2. ã颚åãã·ã£ã¯ãŒã§èº«äœãæŽãæã«ãã§ã
covering the entire breast. When moving downwards, move your ring finger one space over and have your
3
ã«ç§»åïŒè¬æãäžã«æ 1 æ¬åã¹ã©ã€ãããããŠä»ã®æã
other fingers follow. Move horizontally by moving
åãããŸãã次ã®åã«ç§»åïŒäžæãé¢ç¯ 1 ã€åã¹ã©ã€ãã
your middle finger one joint over. When moving
ãããŠä»ã®æãåãããŸããäžã«ç§»åïŒäººå·®ãæãäžã«
upwards, move your pointing finger one space over
æ 1 æ¬åã¹ã©ã€ãããããŠä»ã®æãåãããŸãã
and have your other fingers follow.
c) åãæ¹æ³ã§é骚äžã®ãžããã éšåãšé骚ããã§ãã¯
c) Draw two strips using the same methods from
ããŸãããã
shoulder to the center of the collarbone.
3. ãŸããä»° åãã« å¯ãŠãè ãé äžã«ãã㊠調ã¹ãããšãã§ããŸãã ãããããæ¹æ³ã§ æ¯æè¡ããŸãããã
3.
There is another method where you lie down with one arm tucked behind your head. Check your breast every month with whichever method you find easiest.
å€åãç°åžžãæãããšãã¯ãããã«å°éå»ïŒå€ç§ãä¹³è ºå€ç§ãä¹³è ºç§ïŒã«çžè«ããŸãããã幎ã«äžåºŠã¯ããã³ã¢ã°ã©ãã£æ€èšºã åããäºãæšå¥šãããŠããŸãã觊ã£ãŠãããããªããããªå°ããªãããèŠã€ããããšãã§ããŸãã If you find any changes or abnormalities, contact your doctor immediately. Some abnormalities cannot be detected by touch alone; therefore, it is recommended that women receive a mammography once a year. ç£ä¿®ïŒé岡ããã»ã³ã¿ãŒ ä¹³è ºå€ç§ é«æ©ãããå»åž«ãMammaCare Corporation
P I NK ⢠FALL 2017
7
Breast Cancer Awareness and Education Initiative
The Lemon Project
Progress Report The summer season isn't the only thing heating up. Since the launch of The Lemon Project in 2013, many companies and community organizations are becoming more active in our shared goal of increasing knowledge and raising breast cancer awareness. Over 2,950 men and women have participated in the program. Building on the momentum initiated earlier in the year, summer has been a great season for the Foundationâs outreach initiatives. Beginning with information technology giant, Oracle Corporation Japan, invitation to their first seminar was opened to both men and women in the company. The Lemon Project has been making great strides to have men participate, while still emphasizing that breast cancer is more dominant in women. Their second seminar was made available to the A-Cross group,
Contact us today to host your own seminar and to spread the good news about our free educational initiative, The Lemon Project. which Midori Kawamukai from Oracle initiated to foster communications among companies in Aoyama. The seminar was hosted in a cafeteria inside the company, and the presentation included a handson demonstration on how to perform selfexamination, providing silicon breast models for participants to practice with.
8
PI N K ⢠FALL 2 0 1 7
www.runforthecure.org
The informative seminar was also one filled with enthusiasm as the attendees were engaged and asking questions. During the session using the silicon models, the room reverberated with participants proclaiming: "My arms are a bit sore. This is harder than it looks, but managed to find a few lumps!" The Nakagawanishi Community Center, with support by the Yokohama municipal government, offered another wonderful opportunity to organize a seminar with Jun Kuniyoshi, who had shared her testimony in PiNK Fall 2015. Participants included a wide turnout of mothers who represented a significant age range. Aflacârecognized in Japan as the insurance company with a duck mascotâ has been supporting our Foundation over the years. Aflac has been implementing its CSR activities to support pediatric patients with cancer and their families, as well as bring greater cancer awareness across Japan for prevention and early detection. As part of their activities, Aflac has hosted The Lemon Project seminars in their offices since 2016 to educate and empower employees. Nikon Business Service and Adobe Systems have also joined the education program for the first time. At Nikon Business Service, employees, as well as the team in charge of public welfare, attended the seminar to initiate breast cancer awareness in the office. Adobe hosted the sessions at their Family Day and invited not only the employees, but also their family members, organizing a custom-made Adobe T-shirt shop and charity goods' sales to raise funds for the community
outreach programs of the Foundation. We have coordinated multiple seminars through the years, observing nothing but success and a growing passion within participating companies. This is due in large measure to those who have supported us and continue to share in the same mission of wanting as many people to have a heightened understanding about breast cancer and the available screening methods provided in Japan for early detection. We are excited to organize The Lemon Project with many more companies and individuals in the future as the Foundation continues to reach out nationwide, including in the remote, medically deprived areas. Contact us today to host your own seminar and to spread the good news about our free educational initiative, The Lemon Project.
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Campaign designed by worldwidebreastcancer.com
P I NK ⢠FALL 2017
9
What do you really know about breast cancer?
ä¹³ããã®ããš æ¬åœã« ç¥ã£ãŠããŸããïŒ
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?
ä¹³ããã«ã€ããŠãã¿ãªãããåç¥ã§ããã
ä¹³æ¿ã®ããŒã¿ indentation
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ç®èã®ãã ã skin erosion
èµ€ã¿ã»ã»ãŠã redness or heat
ä¹³é ããã®åæ³ new fluid
ç®èã®ç¡¬å hardening
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çªåºããããã bump
ä¹³æ¿å ã®ããã inside lump
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You can learn more about the program and request the seminar online!
ããã°ã©ã ã®è©³çŽ°ç¢ºèªãã»ãããŒã®ãªã¯ãšã¹ãã¯ãªã³ã©ã€ã³ã§ãå¯èœã§ãïŒ
The Lemon Project reports are also available on our website.
ãŸãã ã¬ã¢ã³ãããžã§ã¯ãã®ã¬ããŒãããŠã§ããµã€ãããã芧ããã ããŸãã
Please visit http://runforthecure.org/en/feature/lemon-project/
http://runforthecure.org/feature/lemon-project/ ããã§ãã¯
or contact us at PiNK@runforthecure.org
ãŸã㯠PiNK@runforthecure.org ãŸã§ãé£çµ¡ãã ããã
Looking for an English-speaking support group?
10
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www.runforthecure.org
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
Campaign designed by worldwidebreastcancer.com
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This is an opportunity for our loved ones, as well as those who may not know about breast cancer, to become empowered with life-saving knowledge.
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Know more about breast cancer. Share information. Increase awareness.
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Share your breast cancer awareness activities at your company, school and/or group with Run for the Cure® Foundation, at PiNK@runforthecure.org
Share your breast cancer awareness activities with us RunfortheCureFoundation
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