Intheknow27

know in the

understanding the cancer experience

Issue 27 complimentary magazine

the pink issue breast cancer awareness

Preventive measures, early detection and the latest technologies offer new hope to patients

BOARD OF DIRECTORS Gordon L. Black, M.D., Honorary Michele Aboud Robert Ash Patricia Carter, RN Ted Edmunds Sam Faraone Jeanne Foskett Monica Gomez Dan Olivas Irene Pistella Shelly Ruddock Ruben Schaeffer Ken Slavin Polly Vaughn Patti Wetzel, M.D. Steve Yellen EXECUTIVE DIRECTOR Patricia Tiscareño PROGRAM OFFICER Jutta Ramirez DIRECTOR OF MARKETING AND COMMUNICATION Izzy Mora OFFICE MANAGER Cindi Martinez

in

this issue:

Dear ITK Readers: As a child, October was a most favorite month of the year, because with October came Halloween! My sisters and I would rush home from school, wolf down dinner (‘you may not go trick or treating until you eat’), don a cushioning layer of pajamas under our home-made costumes, and hit the streets until we had filled to sugary capacity our brown paper Safeway shopping bags.

When I got older, October was still a seductive month, but it was more because of the promise of cooler weather and the excitement of the approaching holidays.

Now, October brings a whole new meaning to me; one of utter respect for the millions of women (and men) whose lives have been impacted by a breast cancer diagnosis. Love it or hate it, the Pink Ribbon and its evolution to representing the fight against breast cancer means solidarity, support and hope.

So, welcome to our “Pink Issue”, our first dedicated to understanding the breast cancer experience. Prevention and early detection are the frontline soldiers in the battle, and Michelle Brown tackles some of the more accepted and promising ways in which we can all take charge. Survival rates are on the rise, which translates to more effective treatments and an ultimate cure.

In the shadow of the very public Angelina Jolie decision toward prophylactic mastectomy, John del Rosario offers up information about genetic testing when a familial predisposition is evident. He talks with noted El Paso physicians to answer questions about this timely topic.

We welcome Mamoo the bovine, a new member of our ITK family to our pages in this issue. She is a friendly and savvy reminder that breast self examination is one of the most effective weapons in our personal arsenals against breast cancer. It only takes a few moments each month to do Breast SelfExamination (BSE); moments that could make a huge difference in a woman’s health and wellbeing.

Thank you to Judy O’Connor who shares her personal story with our ITK readers. I have heard Judy speak about her breast cancer experience and all she did during her active treatment to stay focused and positive. She is an inspiration to me and many others who have witnessed the immense strength of her faith and determination to live fully through and beyond the diagnosis.

Stop by our offices at 10460 Vista del Sol, Suite 101 during October and pick up your Pink Ribbon. I will wear mine in October as a reminder that keeping me healthy is a tribute to my loved ones. And, I will wear it in honor of the many women (and men) whose courage and conviction toward eradicating the disease have inspired me to want to do the same.

Patty Tiscareño Executive Director

ADMINISTRATIVE ASSISTANT Maggie Rodriguez

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FEATURES

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Rio Grande Cancer Foundation 10460 Vista del Sol, Suite 101 El Paso, TX 79925 (915) 562-7660 fax (915) 562-7841 www.rgcf.org by

Risk & Prevention

Self Exams

Ready, set, shop

Perhaps the greatest tool at our disposal is information. In this multi-page feature we outline breast cancer risks, preventative measures and the latest technologies for treatment.

Statistics show that a regular self breast exam is one of the most important methods for early detection. Here, we take you through a self exam step-by-step.

There are numerous companies that offer a percentage of their proceeds to breast cancer research. Showcased here are some of the most stylish!

Snappy Publishing ted@snappypublishing.com El Paso, Texas 79912 (915) 820-2800 Those submitting manuscripts, photographs, artwork, or other materials to In the Know for consideration should not send originals unless specifically requested to do so by In the Know in writing. Unsolicited manuscripts, photographs, and other submitted materials must be accompanied by a self-addressed overnight delivery return envelope, postage pre-paid. However, In the Know is not responsible for unsolicited submissions. ©2013 Rio Grande Cancer Foundation. All rights reserved. No part of any article or photograph contained in this magazine may be reproduced in any way without the written consent of In the Know.

In the Know assumes no responsibility whatsoever for errors, including without limitation, typographical errors or omissions in In the Know. Editorial or advertising content in In the Know does not necessarily reflect the opinions of the publishers. In the Know assumes no responsibility for the products or services advertised in this magazine. Publisher reserves the right to edit any material or refuse any advertising submitted.

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breast cancer awareness Understanding the risks WISE LIFESTYLE CHOICES BEST WAY TO REDUCE BREAST CANCER RISK

By Michelle J. Brown

We have all seen the troubling statistics that report one in eight women will develop breast cancer in her lifetime.

But what is it that causes one woman to develop breast cancer and not another?

Researchers know that things like age, race, physical activity, weight, alcohol use, and use of hormone therapy after menopause, as well as other factors may affect a woman's risk of breast cancer.

But a lot of women who have one or more of these risk factors never develop the disease. And many women with breast cancer who have no known risk factors (other than age and being female) develop the second most deadly cancer among American women.

So given the confusion, what can a woman do to decrease her risk of getting breast cancer?

Weighing the Risks “While there is no way to completely prevent breast cancer, you can control your actions and reduce your risk,” said Anuradha Gupta, M.D. who specializes in radiation oncology at Texas Oncology

in El Paso. “You can’t change factors beyond your control, like your genes, gender and age. You can take critical steps to maintain a healthy weight, optimize your BMI (body mass index), exercise at least 30 minutes daily and balance nutrition.”

Many studies link breast cancer to factors including weight and excessive alcohol consumption—the heavier you are and the more alcoholic beverages consumed per day increase chances of developing or recurring breast cancer.

In published findings from the Journal of the American Medical Association, a large analysis found that even moderate alcohol consumption was associated with a slight increase in breast cancer.

“While one drink a day has a modicum of increase, three to five per day showed a one and one half times higher risk,” added Dr. Gupta.

Weight gain is another consideration in the equation, especially pounds put on after menopause. We know that losing even a little bit of weight (5%-10% of starting weight) improves your overall health by lowering your risk of breast cancer, cardiovascular disease and diabetes. “Estrogen stored in fat cells increases the risk, particularly in postmenopausal women”, says Gupta, “so

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Breast cancer cannot be completely prevented, but there are steps women can take to decrease their risk and/or improve early detection of the disease.

Screening Women should begin monthly breast self-exams in their 20s. Any changes in their breasts should be reported to a physician immediately.

Lifestyle Regular exercise, limiting alcohol intake, and maintaining a healthy body weight may reduce the risk of breast cancer.

Higher Risk

Women in their 20s and 30s should have a clinical breast exam every three years. Women age 40 and older should consider annual clinical breast exams. Women age 50 and older should have an annual clinical breast exam.

Women over 40 should consider annual mammograms, and women over 50 should have annual mammograms.

Women in their 30s should discuss their breast cancer risk level with a physician to determine the most appropriate breast cancer screening options, including mammograms and MRI screenings. Women 40 and older should consider an annual MRI screening, if recommended by a physician.

Women with a family history of breast cancer should discuss genetic testing with their physician. If genetic tests indicate a woman is BRCA-positive, there are a number of risk reduction strategies to discuss with her physician.

Women with a first degree relative who had breast cancer before age 50 should begin receiving mammograms 10 years before reaching that relative’s age at diagnosis.

exercise is important, especially at this stage”. What's more, besides lowering a woman’s breast cancer risk, losing and maintaining your ideal weight is just good practice. Body weight is one of the few breast cancer risk factors women have control over.

Breastfeeding has often been included in the protective behaviors against breast cancer, and while breastfeeding is purported to reduce a woman’s risk for breast cancer, Dr. Gupta noted that women are waiting longer than previous generations to have children.

“Breastfeeding is much easier to do in your 20s than in your 30s and for some women, it’s just not practical at all,” she adds.

I’m High Risk – Now What?

What about women whose risk factors are off the charts? “There are a number of chemo prevention drugs available that may help reduce breast cancer for those at high risk, says Dr. Gupta. “Tamoxifen, Raloxifen and Arimidex are proven tried and true in helping reduce breast cancer in high-risk individuals,” she said.

Additionally, gene identification for hereditary breast cancer (about 10% of cases) has received an abundance of media attention and done wonders to

Sources: American Cancer Society, National Cancer Institute, and Texas Cancer Registry

raise awareness of breast cancer.

However, Dr. Gupta stressed that those tests do not affect 80-90 percent of women who don’t have those genes but still get breast cancer. (For more information, see related story on BRCA genetic testing on page seven.)

Stay Informed Potential causes of breast cancer can be the result of environmental hazards.

While much of the science on this topic is still in its earliest stages, this is an area of active research. In a long-term study funded by the National Institute of Environmental Health Sciences (NIEHS), researchers enrolled 50,000 women who have sisters with breast cancer. Known as The Sister Study, the project will follow these women for at least 10 years and collect information about genes, lifestyle, and environmental factors that may cause breast cancer. An offshoot of the Sister Study, the Two Sister Study, is designed to look at possible causes of early onset breast cancer. To find out more about these studies, call 1-877-4SISTER (1-877-474-7837) or visit the Sister Study Web site (www.sisterstudy.org).

The Good News In the United States alone, there are more than 2 million women living with breast cancer. “The facts are treatments have improved and long-term survival rates have increased. This has generated a real need for long-term survivor support,” said Dr. Gupta. As the Rio Grande Cancer Foundation strives to focus on the needs of the long-term cancer survivor, concerns like maintaining a survivorship plan to avoid recurrence are in the works.

“A long-term survivor group support is vastly important”, says Dr. Gupta.

“Women at all ages and risk factors must take control of their lives and be responsible for their lifestyle choices regarding nutrition, exercise and alcohol moderation. Be smart. Keep yourself educated and engaged, maintain dialog with your healthcare provider and live, NOT in fear, but with confidence and hope.”

Know more>

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breast cancer awareness

Early detection

REVOLUTIONARY IMAGING TECHNIQUES IMPROVE BREAST CANCER DETECTION One of the most hotly debated topics in breast cancer detection triggered a media frenzy in recent years after several medical circles proclaimed women could wait until age 50 for routine digital mammogram testing. This was in direct opposition to the decades-long viewpoint that 40 was the proper age to screen women who weren’t at a high-risk.

The claim that earlier testing was unnecessary because it did not improve positive outcomes was confusing to physicians like Dr. Anuradha Gupta of El Paso’s Texas Oncology.

“I and many other physicians strongly believe that women age 40 and up should have an annual mammogram,” she explained. “It remains the best and most widely available screening tool.”

Another in the small arsenal of tools for detecting breast cancer has always been the monthly breast selfexamination (BSE). Heavily promoted for women age 20 and older to detect any visual or physical breast changes, BSE is second to an

clinical breast exam. Breast Selfexamination and is often performed incorrectly and generates significant stress in countless women” says Dr. Gupta. Subsequently, many physicians such as Dr. Gupta recommend that women instead practice breast awareness.

“BSE is fine, but so many women are uncomfortable with it,” she said.

“Breast awareness is natural, not regimented, and a much better alternative for many women.” Breast awareness means that one should “be aware of their look, shape, feel and contours as you dress, when you shower, and in the mirror as well as when applying lotion or creams. Pay attention to any rash, redness, to dimpling, indentation and any changes to the nipples or skin”, adds Dr. Gupta.

Although regular mammograms remain the most common diagnostic tool for breast cancer, Dr. Gupta explained that several newer imaging methods are now being studied for evaluating abnormalities that may be breast cancers.

Tomosynthesis (3-D Mammography) technology is basically an extension of a digital mammogram. For this test, the breast is compressed once and a machine

takes many low-dose x-rays as it moves over the breast. The images taken can be combined into a 3dimensional picture.

Although this uses more radiation than most standard 2-view mammograms, it may allow doctors to see problematic and overlapping areas more clearly, lowering the chance that the patient will need to be called back for more imaging tests. A breast tomosynthesis machine was approved by the Food and Drug Administration (FDA) in 2011 for use in the U.S., but is not yet available in the El Paso region, according to Dr. Gupta. However, plans are underway for its obtainment.

“Tomosynthesis may prove to be a strong adjunct to diagnostic mammogram,” said Dr. Gupta. “It will be a wonderful addition for detection in younger women with dense breast tissue. It’s not the gold standard screening tool that digital mammography is, but will be critical to help identify tumors and calcification in dense breast tissue that is so common in younger women.”

Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body. In many cases MRI may show problems that cannot be seen with other imaging methods.

MRI for breast screening remains reserved only for high-risk women (20% or more lifetime risk). Women with known gene mutation, or gene mutation in a first degree relative, or who had chest radiation at a young age (such as with Hodgkin’s Lymphoma as a child or in their 20s) also are candidates for MRI. On the Horizon According to the American Cancer Society, research in the field of breast imaging is being done to find more cancers even before they can be felt by the patient, her doctor or detected by mammograms. Some of the promising, breast imaging techniques in current research include:

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Optical imaging tests either pass light through the breast or reflect light off it and then measure the light that returns. The technique does not use radiation and does not require breast compression. Optical imaging might be useful at some point for detecting tumors or the blood vessels that supply them.

Molecular Breast Imaging (MBI) is a new nuclear medicine imaging technique for the breast. It is being tested to see if it may be a less expensive and more specific way to identify breast changes that have been seen on a mammogram or ultrasound.

Positron Emission Mammography (PEM) uses an FDA-approved sugar attached to a radioactive particle to detect cancer cells. The PEM scanner, also FDA approved, works much like a PET scan, and may be better able to detect clusters of cancer cells within the breast.

There are plenty of reasons to be hopeful that breast cancer survival rates will increase because of these advances in treatments.

The best course of action is to be knowledgeable about your own body.

“Know your body, know your breasts and become familiar with your norms,” concludes Dr. Gupta.

achieved a 5-year cure rate of 40% through a number of innovations: his aggressive approach to tissue removal, his use of the antiseptic techniques introduced by Joseph Lister, and his introduction of the use of rubber gloves.

Today, more women with breast cancer choose surgery that removes only part of the breast tissue. This may be called breast conservation surgery, lumpectomy, or segmental mastectomy.

Some women still have a mastectomy (removal of the entire breast), however it has vastly improved since Halsted’s 1882 surgery.

Breast-conserving surgery (lumpectomy or partial mastectomy) can often be used for early-stage breast cancers. But in some women, it can result in breasts of different sizes and/or shapes. For larger tumors, it might not even be possible and a mastectomy might be required. While the number of women with breast cancer choosing breast conservation therapy has been steadily increasing, there are some women who, for medical or personal reasons, choose mastectomy. Some of them also choose to have reconstructive surgery to restore the breast's appearance.

Some doctors address this by combining cancer surgery and plastic surgery techniques, known as oncoplastic surgery. This typically involves reshaping the breast at the time of the initial surgery, and may mean operating on the other breast as well to make them more symmetrical.

“Oncoplastic surgery may be the best answer for many women,” says Dr. Anuradha Gupta.

Technical advances in microvascular surgery (reattaching blood vessels) have made free-flap procedures an option for breast reconstruction. For several years, concern over a possible link between breast implants and immune system diseases has discouraged some women from choosing implants as a method of breast reconstruction.

treatment a new

LATEST TREATMENT OPTIONS HELP INCREASE SURVIVAL RATES In 1882 the American surgeon William Halsted first performed what would become known as the Halsted Mastectomy, which involves removal of the entire breast, area lymphatic tissue, and the pectoralis muscle. Halsted

Recent studies have found that although implants can cause some side effects (such as firm or hard scar tissue formation), women with implants do not have any greater risk for immune system diseases than women who have not had this surgery. Similarly, the concern that breast implants increase the risk of breast cancer recurrence or formation of new cancers is not supported by current evidence.

In addition, advances in hormonal therapy and chemo/radiation therapy are improving survival rates. Genetic testing on the cancer itself helps determine the potential recurrence score and direct treatment.

“These improvements help physicians truly tailor treatment to each individual,” says Gupta. “New, more effective drugs and molecular marking of the cancer will help base treatments on those specifics to significantly improve prognosis and cure rates.”

“Newer three-dimensional modalities and advances in radiation therapy techniques have evolved to greatly reduce the risk to normal tissues,” added Dr. Gupta. “The ability to view normal tissues such as lung and heart in three dimension and reduce exposure to these critical organs, in turn, reduces damage and long-term side effects.”

On a less complicated note, one might consider the use of vitamin supplements.

A recent study found that women with early-stage breast cancer who were vitamin D deficient were more likely to have their cancer recur in a distant part of the body and had a bleaker outlook.

More research is needed to confirm this finding, and it is not yet clear if taking vitamin D supplements would be helpful, according to the American Cancer Society. Still, you may want to talk to your physician about testing your vitamin D level to see if it is in the healthy range.

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breast cancer awareness Getting to Know the BRCA Gene By: John Del Rosario

In May of this year, world famous actress Angelina Jolie made headlines when she revealed that she underwent a double mastectomy as a preventative measure against breast cancer.

She told her story in a piece published in the New York Times titled "My Medical Choice" where she wrote about her mother who had succumbed to cancer at the age of 56. But the piece did not only serve as a platform for a celebrity to set the record straight on what would have otherwise been a widely scrutinized on medical decision. It was jointly a message of appreciation to her family and friends for their support, a call to action for women to be more aware of the signs that could lead to cancer and, perhaps most importantly, an informative piece on the infamous BRCA 1 gene, which she had.

The BRCA gene is a hereditary gene that belongs to a class of genes known as "tumor suppressors," according to the National Cancer Institute. Though they are known as "suppressors," it is the mutations of these genes that may lead to cancer. "BRCA" stands for "BReast CAncer susceptibility gene." The gene comes in two types: BRCA 1 and BRCA 2, the difference

being that the former proves a slightly increased risk of ovarian cancer whereas the latter proves an increased risk of other cancers like pancreatic cancer and melanoma.

"If you take all breast cancer cases, roughly 5% of all the patients we have may carry the BRCA gene," said Dr. Zeina Nahleh, M.D., F.A.C.P., of the Texas Tech University Health Sciences Center.

"And if you take all patients with ovarian cancer, about 10% may carry the gene. So, it's not that common in cancer patients."

Not to downplay the significance of such a serious occurrence she added, "Although, if you do carry the gene, your risk for cancer is very high. In her lifetime, if a woman carries it, her risk for breast cancer is 80% if she lives up to 80-years-old.

Her risk for ovarian cancer is 4050%."

Although breast cancer is the most common form of cancer found in women, the BRCA gene is also an occurrence in men. "It's not only exclusive to females," Dr. Nahleh said. "It can happen to men. Not only breast and ovarian cancers. It can include other cancers like pancreatic cancer, prostate cancer or colon cancer. So if you have a lot of family members with multiple cancers, this

is a red flag. In fact, if you have a close family member with male breast cancer, that's an immediate indication that you should be tested."

Testing for the BRCA genes is available at most hospitals with an oncology department. At the Texas Tech University Health Sciences Center's University Breast Care Center, testing is available in the city’s only accredited breast care program.

"There are different ways to do the test," Dr. Nahleh said. "The one we follow is a saliva test. We do a swab and we send it to a specialized genetic laboratory and they tell us whether you have a mutation or not and what mutation you have." The downside to the test is the price tag it comes with. "It is costly, but most insurance companies approve the payment," Dr. Nahleh said. "If they do get denied or the patient doesn't have insurance, we have ways of discussing with the providing company to see if they qualify for the test. If they do, the company may be able to work with the patient on that.

So far, I'd say, in 100 patients that qualify, only one or two are not able to get it."

Dr. Nahleh warns that testing should come with added counseling and should not just be taken for the

Actress Angelina Jolie announced in a New York Times op-ed article that she underwent a preventive double mastectomy after learning that she carries a mutation of the BRCA1 gene, which sharply increases her risk of developing breast cancer and ovarian cancer.

Dr. Nahleh warns that testing should come with added counseling and should not just be taken for the sake of taking. "The test should be done under a regulated, controlled counseling environment," she said. "It's wrong to do the test without pre-test and posttest counseling. We have to explain to the patient what this means. It is a big deal to carry a hereditary mutation. The patient has to know the consequences.

If you carry the gene it has implications psychologically for you and your family as well. We have multiple sessions with a patient explaining what it means and to give them a plan as to what to do.

It's rather time-consuming."

Treatment for those with the BRCA genes can come in a number of forms.

Jolie took the most efficient route by having a double mastectomy, which Dr. Nahleh said is the best-tested and preventative measure one could take in terms of breast cancer. "That will prevent cancer from happening by 90-95% or even more in the breast," she said. "For ovarian cancer, we also recommend that a patient have their ovaries removed, provided that they are ready, when they have completed their child-bearing."

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breast cancer awareness

Taking matters into your own hands The importance of a regular self breast exam

Breast self-exam (BSE), or regularly examining your breasts on your own, can be an important way to find breast cancer early, when it's more likely to be treated successfully. Not every cancer can be found this way, but it is a critical step you can and should take for yourself.

Over the years, there has been some debate over just how valuable BSE is in detecting breast cancer early and increasing the likelihood of survival. For example, in summer 2008, one study of nearly 400,000 women in Russia and China reported that breast selfexamination does not reduce breast cancer mortality and may even cause harm by prompting unnecessary biopsies (removal and examination of suspicious tissue). Because of the ongoing uncertainty raised by this and other studies, the American Cancer Society has chosen to advise women that BSE is an “optional” screening tool.

Breastcancer.org still believes that BSE is a useful and essential screening strategy, especially when used in combination with regular physical exams by a doctor and mammography. About 20% of the time, breast cancers are found by physical examination rather than by mammography. We recommend that all women routinely perform breast selfexams as part of their overall breast cancer screening strategy.

Tips for performing BSE Few women really want to do a breast self-exam, or BSE, and for many the experience is frustrating — you may feel things but not know what they mean.

However, the more you examine your breasts, the more you will learn about them and the easier it will become for you to tell if something unusual has occurred.

Breastcancer.org believes that BSE is an essential part of taking care of yourself and lowering your risk of breast cancer.

Try to get in the habit of doing a breast self-examination once a month to familiarize yourself with how your breasts normally look and feel. Examine yourself several days after your period ends, when your breasts are least likely to be swollen and tender. If you are no longer having periods, choose a day that's easy to remember, such as the first or last day of the month.

Don’t panic if you think you feel a lump.

Most women have some lumps or lumpy areas in their breasts all the time. In the United States, only 20% of women who have a suspicious lump biopsied turn out to have breast cancer.

Breasts tend to have different “neighborhoods.” The upper, outer area — near your armpit — tends to have the most prominent lumps and bumps. The lower half of your breast can feel like a sandy or pebbly beach. The area under

the nipple can feel like a collection of large grains. Another part might feel like a lumpy bowl of oatmeal.

What’s important is that you get to know the look and feel of YOUR breasts' various neighborhoods. Does something stand out as different from the rest (like a rock on a sandy beach)? Has anything changed? Bring to the attention of your doctor any changes in your breasts that last over a full month's cycle OR seem to get worse or more obvious over time.

You may want to start a journal where you record the findings of your breast selfexams. This can be like a small map of your breasts, with notes about where you feel lumps or irregularities. Especially in the beginning, this may help you remember, from month to month, what is “normal” for your breasts. It is not unusual for lumps to appear at certain times of the month, but then disappear, as your body changes with the menstrual cycle (if you are still menstruating). Only changes that last beyond one full cycle, or seem to get bigger or more prominent in some way, need your doctor's attention.

Source: http://www.breastcancer.org

Mammoo says: ”Mammoo” is our divine bovine who reminds women of all ages to to perform a regular self breast exam.

“Check your breasts monthly” Breast cancer is the most common cancer in women today. For women of all ages, the breast self-exam is a useful tool that is easy to do. It is used to look for unusual lumps, skin changes, or discharge. For most women, once-a-month exams are easy to remember, with the best time being about one week after the start of a period.

How should a breast self-exam be performed?

1) In the Shower Using the pads of your fingers, move around your entire breast in a circular pattern moving from the outside to the center, checking the entire breast and armpit area. Check both breasts each month feeling for any lump, thickening, or hardened knot. Notice any changes and get lumps evaluated by your healthcare provider.

2) In Front of a Mirror Visually inspect your breasts with your arms at your sides. Next, raise your arms high overhead.

Look for any changes in the contour, any swelling, or dimpling of the skin, or changes in the nipples. Next, rest your palms on your hips and press firmly to flex your chest muscles. Left and right breasts will not exactly match—few women's breasts do, so look for any dimpling, puckering, or changes, particularly on one side.

3) Lying Down When lying down, the breast tissue spreads out evenly along the chest wall.

Place a pillow under your right shoulder and your right arm behind your head. Using your left hand, move the pads of your fingers around your right breast gently in small circular motions covering the entire breast area and armpit.

Use light, medium, and firm pressure.

Squeeze the nipple; check for discharge and lumps. Repeat these steps for your left breast.

There are a number of major corporations that contribute to breast cancer research when you buy their products. Here are just a few examples.

Take ‘charge’ of your next purchase and help find a cure for breast cancer.

Versace Bright Crystal Parfum

This refreshing fragrance features notes of chilled yuzu, pomegranate, peony, magnolia, musk and amber.

During the month of October, when you buy a 3.4 oz bottle of the scent, Versace will donate a dollar to Breast Health International. As an added bonus, you willl also receive a complimentary pink Versace umbrella with your purchase.

Ladies,

Estée Lauder Evelyn Lauder Pink Ribbon Collection This gorgeous makeup set features a chic accessory bag and Pure Color Lipstick in Wildly Pink, a shade handselected by Evelyn Lauder, the chairman of Estée Lauder Cosmetics and an active supporter of breast cancer research. Twenty percent of the suggested retail price will be donated to the Breast Cancer Research Foundation.

Shiseido Shimmering Rouge Lipstick in Iron Maiden

We’ve been obsessed with these shimmering lipsticks ever since they first launched, and this gorgeous violet hue has us even more hooked.

During the month of October, Shiseido will donate five dollars for every Iron Maiden shade sold to Cancer And Careers, a non-profit dedicated to supporting working women living with cancer.

let’s go shopink!

Sonia Kashuk Proudly Pink Five-Piece Purse Brush Set

Housed in a cool silver clutch, these five mini brushes–powder/blush, crease, foundation/concealer, eyeshadow and bent eyeliner–are all you need to get fabulous on the go.

Best of all, 15% of the purchase price of this set benefits the Breast Cancer Research Foundation.

Donna Karan Cashmere Mist Candle

With notes of lily of the valley, Moroccan jasmine, suede, amber, and tonka bean, this sensual scent is a cult classic that we want to wrap ourselves up in again and again.

This limited-edition version features a pink ribbon box, 36 hours of burn time and, most importantly, $5 from the sale of each one goes to the Breast Cancer Research Foundation

OPI Pink Shatter Polish

We can’t get enough of shatter nail polishes, so this punky pink hue is right up our alley. Each bottle has a pink ribbon tag and pink cap to help draw attention to breast cancer awareness. In addition, OPI will make a $25,000 donation to the Susan G. Komen For The Cure Foundation.

ShoeDazzle Powerful Pink Collection Stephanie Pump Help find a cure for breast cancer and look hot while doing it with these gorgeous pink heels. The Stephanie Pump, named after a ShoeDazzle client who is a breast cancer survivor, is part of a Powerful Pink collection that features three shoes, a bag and a scarf. The site, started by Kim Kardashian, will donate 10% of the sales from this collection to the Susan G. Komen For The Cure charity.

Stila Positive And Pretty Palette

This limited-edition palette features four beautiful eyeshadows, a flirty cheek color and a shimmery highlighter, plus a detailed how-to for getting the look. Ten percent of the proceeds will be donated to a variety of breast cancer awareness charities, including the Breast Cancer Research Foundation.

Movado Bold Watch

This stunning statement accessory features a modern black strap and face, with berry accents and Swarovski crystals. For every watch sold, Movado will donate $50 to the Breast Cancer Research Foundation.

for more information, visit: thedailymakeover.com

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Brighton’s Power of Pink Campaign Marks Over A Decade of Making a Difference Through Supporting Breast Cancer Charities

During the past 11 years of supporting breast cancer charities with over $4.5 million in donations, Brighton Collectibles has remained dedicated to their dream of a world free from breast cancer. To continue in that quest, the accessory company’s designers have again created a special piece of jewelry that will be available from September 27th through the month of October while supplies last.

Brighton’s founder and owner, Jerry Kohl, explains how, with this bracelet, there is a healing power we can all unleash, “Each one of us can make a difference and when we all act together to make a difference that’s how we create change.”

Brighton will contribute $10 for each $60 bracelet sold from September 27, 2013 to October 31, 2013 to breast cancer awareness and research organizations. Call Brighton Collectibles at Cielo Vista Mall, 915779-5881 to reserve your special bracelet now.

Brighton Collectibles at Cielo Vista is excited to partner with Rio Grande Cancer Foundation and together make a difference in this cause.

Breast cancer strikes not just the elderly and middle-aged but thousands in their 20s and 30s. This year alone, an estimated 226, 870 women and men will be newly diagnosed. Nearly 40,000 women in the U.S. die from breast cancer each year. The silver lining is that with treatment advances, early detection and increased awareness, death rates have decreased by about 2% each year since 1990. Many more lives still need to be protected, so Brighton ensures that their charity donations are used effectively by worthy organizations working to find the cure we all hope will come soon.

Believing that “none of us can stop until we cure this disease,” Brighton’s intention is to set off a chain reaction of donations to breast cancer organizations – which doesn’t end with the retailers and events, but continues to spread awareness that results in many individuals giving donations to organizations working toward this goal.

In addition to jewelry, Brighton offers a broad-ranging assortment of finely crafted handbags, belts, footwear, small leather essentials, eyewear, luggage, fragrances and gifts. To see the entire line, visit www.brighton.com.

Photos of jewelry are for graphic purposes only.

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Survivor Conference has them dancing in the aisles Over 200 cancer survivors, caregivers and volunteers celebrated their survivorship at the Fifth Annual Keep on Dancing Survivor Conference sponsored by the Rio Grande Cancer Foundation. Held on Saturday, August 24, 2013, the full-day conference kicked off with a keynote speech from Stage IV Oral Cancer Survivor, Eva Graysel, who danced, sang and charmed the audience with her upbeat and positive message about thriving after a cancer diagnosis. Participants spent he day networking with each other, bidding on themed baskets and attending an impressive array of presentations on varied health and wellness topics.

The attendees left the conference inspired that “Cancer is just a misstep: You have to pick up your shoes and Keep on Dancing!”

On the following pages are more photos of this fantastic event. > Top left: KOD Volunteers Ellen Saad and Nicole Grado. Top right: Keynote Speaker, Eva Grayzel

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The staff of Candlelighter of El Paso

Anne Hernandez and Maria Elena Aguirre

Emilio Araujo and Elaine Williams

Claudia Trevizo

Diane Stowe, Cancer Survivor and Mando Rodriguez of Shundo Dance Studio

Marie Racine and Norma Rangel

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a a Avign rs Norm to la s e n d a Tr on Spanish aria Eugenia C and M

Oral Can cer Surviv ors Eva G rayzel and Hugo Blanco

Dan Olivas, President of the Board, Rio Grande Cancer Foundation

Hanging with Tai Chi Tex - Ray Abeyta

Maureen Henry, Ph.D Jutta Ramirez and Jane Ratcliff

Stephanie Townsend Allala

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Thank you!

The Rio Grande Cancer Foundation would like to express our sincere appreciation for the Sponsors & Donors that made our ‘Keep on Dancing’ Survivorship Conference a huge success!

Pizza Properties

Red Mountain Bistro

Milan Institute

Indian Cliffs Ranch

Landry’s Seafood House

Premiere Cinemas

Sorrento’s Italian Restaurant

Michelino’s Italian Restaurant

Ron & Tycha E. Stading

Walmart

Great American Land & Cattle Co.

Sharon’s Hallmark

Charlotte’s Fine Furnishings

Studio One

Scholarship Patrons

Regency Beauty Institute

The Nail Company

Kathrin Berg Pettit

Galleria Zia Native Arts

GeoGeske’s

“Buffy” Boesen

At the El Paso Airport

Cabo Joe’s

Flo Buchmueller

N’ Dulge Day Spa & Salon

Geske’s Fire Grill

Jeanne Foskett

Pelican’s Restaurant

Ruli’s International Kitchen

Monica Gomez

Debbie’s Bloomers

Patricia’s Electrolysis Clinic

Maureen Henry

Eastside Choice Meats

Curves

Brenda Johnson

COSTCO

Kemp Smith, LLP

Bernice Klingstedt

Nails Glamorous

Deb Benedict

Maria A. Kostal

Villa del Mar

G2

Ken Slavin

The Wyndham El Paso Airport

Geske’s Fire Grill

Jutta Ramirez

UTEP Athletic Department

Great American Steakburger -

Beverly Rebe

Ruddock Manufacturing

Yarbrough

Mike and Cecilia Rosales

Ardovino’s Pizza

HFP Benefit Solutions

Patsy Slaughter

West End Hair Company

Mary Hunter – Face Etc.

Patty Tiscareño

Spira

Mesa Street Bar & Grill

Julieta Woods

Airline International

The Greenery

Steve Yellen

Ripe Eatery

Bernice & Kerstin Klingstedt

Rudy’s BBQ

Sharon Kern

know&tell

Know where to go

Breast Cancer Awareness Happenings Around El Paso in October

Monday, 9/30/2013 9:30 a.m.

Reading and approval of the City proclamation declaring October as Breast Cancer Awareness Month. The El Paso County Commissioners Court House

Tuesday, 10/15/2013 Mammography Community Event throughout October Sponsored by the Cancer and Chronic Disease Consortium limited number of free mammograms for more information call 771-6305

Wednesday, 10/23/2013 9:00 a.m.

Hanging of the Pink Ribbon Wreath at the El Paso Court House Gallery; sponsored by the Cancer and Chronic Disease Consortium

Yoplait Save Lids to Save Lives General Mills donates 10 cents to Susan G. Komen El Paso for each lid received (and also for each code entered from select Yoplait products) by 6/30/14. Yoplait pink lids and General Mills box tops can be found in stores starting in September 2013.

Tuesday10/15/2013, 10 am – 3 pm Sunland Park Mall, Dillard’s Thursday, October 17, 10 am – 3 pm Cielo Vista Mall, Dillard’s Wacoal Fit for the Cure Attend a Fit for the Cure event and let a Wacoal fit specialist help you determine your true bra size. For every woman who participates, Wacoal will donate $2 to Susan G. Komen El Paso to help fund breast cancer community outreach projects. (No purchase necessary).

Glo the Park Friday, October 18, 6:00 pm An after dark running experience at Ascarate Park Registration at www.komenelpaso.org; youth and group registration rates available

Taking Breast Cancer to Heart – Sponsored by the University Medical Center Foundation October 2, 2013 at the El Paso County Coliseum For more information: umcfoundationelpaso.org or call 521-7229

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know&tell How Can "Animal-Assisted Therapy" Can Help People Living With Cancer

By Lynne Eldridge MD, About.com ”A pet is a medication without side effects that has so many benefits. I can’t always explain it myself, but for years now I’ve seen how instances of having a pet is like an effective drug. It really does help people.”

- Dr. Edward Creagan, Oncologist at Mayo Clinic Rochester, Minnesota

Pet Therapy for Cancer

Pet therapy, something also referred to as "animal-assisted therapy," has been gaining popularity in the last several years. From animal visits for children in hospitals, to those with dementia, and now people with cancer, studies suggest there are some important benefits obtained from these furry visitors. And as the quote above says so well: it’s often like an effective drug but without side effects. What are some of the ways that pet therapy has helped those struggling with physical and mental illnesses, and what are we starting to learn about it’s role in cancer treatment?

History Animals have been man’s companions since recorded time, but the use of this companionship to foster health and wellbeing has only recently taken off as a complementary therapy. Animal-assisted therapy (AAT) was first used to assist those with mental illnesses beginning in the 1800s, and was found to be a helpful adjunct to psychoanalysis by Sigmund Freud. Yet animals as companions to those with physical illnesses became recognized only as recently as 1976 when Therapy Dogs International — followed closely by the Delta Society (now called Pet Partners) — was founded.

Pet therapy has been used and studied in many forms. Research has looked at both pet ownership as well as visiting pets. In this article, I’ll be focusing primarily on visiting pets, but I’ll also share some studies about pet ownership as they relate to overall health.

What Animals are Used for Pet Therapy?

The type of animals that have shared their

Tips for dog adoptions Before You Take Your Dog Home

lives with people who are ailing is also diverse. Most commonly studied have been dogs (canine therapy) with the most popular breed for pet therapy being golden retrievers, but benefits have been found via companionship with cats, birds, farm animals, and even dolphins.

General Benefits Many studies have been done that have evaluated both the physical and emotional effects of pet companionship.

With regard to pet ownership, one study found that people with pets had significantly lower heart rates and blood pressure than those without pets. In another study people with dogs were more likely to be alive one year after suffering a heart attack than those who did not have a dog.

Focusing on visiting pets – animal assisted therapy – many physical and emotional benefits have been witnessed.

Some of these have included: • A decreased need for pain medications in those who suffer from chronic pain • Lowered stress levels • A calming effect in patients with dementia • Improved mood • Decreased anxiety in hospitalized patients • Decreased loneliness and social isolation, and a sense of emotional connection • Pet therapy may even enhance the will to live As an added plus, it’s been found that pet therapy not only helps those with physical and emotional needs, but appears to benefit the entire family, as well as the hospital nursing staff in those who are hospitalized.

Benefits for Cancer Patients Fewer studies have been done looking at pet therapy for people with cancer than with other conditions such as Alzheimers, but those that have focused specifically on cancer patients have shown promising results. One study on radiation therapy patients found that those people who had dog visits rated their health as better than those who did not have dog visits as part of their therapy. Another study noted that pet therapy during chemotherapy improved depression as well as blood oxygenation (the amount of oxygen carried in the blood.)

Other studies on people with cancer have

found that AAT: • Decreased pain and was helpful as a way to decrease the need for pain medication • Decreased psychological distress, and • Decreased fatigue There are currently several clinical trials in progress to evaluate the benefits of pet therapy, some of these specifically for cancer patients.

Why Does Pet Therapy Work?

There are several theories that have attempted to explain why pet therapy helps those with physical and mental conditions.

Intuitively it seems that relaxation, as well as buffering the stressors in our lives would play a role.

Researchers have actually found a physiological basis for what intuition tells us. A study on healthcare professionals who were visited by a pet therapy dog found that those who had time with the dog had a significant decrease in cortisol levels in the blood. This "biological" stress reduction was noted with as little as 5 minutes of time spent with the dog. Another study found that AAT decreased catecholamines in the blood.

To understand the significance of this, chemicals in our bodies such as cortisol and the catecholamine epinephrine (adrenaline) are known as stress hormones. These chemical messengers do have a place and a role in the functioning of our bodies. As instigators of the “fight or flight” response, they are what make us alert if we hear a prowler in the middle of the night, or have to fight off a lion in the jungle. On the other hand, chronic increases in these stress hormones has been linked with heart disease and possibly even cancer and cancer recurrence.

Pet therapy appears to affect another type of chemical in our bodies as well endorphins. Endorphins are chemicals secreted by the body that act as the body’s natural pain relievers. They are responsible for what has become known as the “runner’s high.” At least one study has found that animal assisted therapy has resulted in an increased level of endorphins in patients who have spent time with a dog.

There are many advantages to adopting an adult dog. You already know the size and the disposition of your pet, something not known of a puppy. However, you do not know your pet's past. You do not know if he is housebroken or trained. He has had to adjust to different situations so it is imperative you be patient with your new pet and let him know and understand your patterns.

The First Day Home To avoid your new best friend from getting diarrhea from a change in diet, give boiled potatoes with the new food.

Keep your new dog on a leash. Show him where his water and food dish are kept. Show him where he is to sleep. When he is indoors be sure and keep him confined with you, taking him outdoors at frequent intervals to relieve himself. Take him to the same spot each time and praise him heartily when he goes. Until he learns this new routine he will have to be watched closely. If there is an accident in the house please do not assume he is not housebroken. He must get accustomed to his new home and his new routines. However, loudly say "NO!" and take him outside immediately. You must catch the dog in the act if the correction is to be effective. NEVER hit your dog if an accident occurs. Praise, not punishment, is the key to a well behaved pet.

Period of Adjustment The first couple of weeks you and your pet are "getting to know one another". He doesn't know why he has come to your home nor what is expected of him. Please be patient with him and anticipate problems before they occur.

Don't leave tempting shoes, clothing, or children's toys within reach of your dog. If he is left out in your backyard while you work, please understand the first few days will be rough on him. Try to leave the home with as little fanfare as possible. Tearful goodbyes do nothing but add to your dog's anxiety.

Things to Watch For When he's first settling in, your dog may experience shyness, anxiety, restlessness, excitement, crying or barking. He may exhibit excessive water drinking, frequent urination, or diarrhea. His appetite may not be good. If any of these symptoms last more than a few days, call your veterinarian.

Be Consistent Your new dog must learn a whole set of new rules. Be patient and be consistent. If you want him off the furniture, don't allow him to sit on the couch "sometimes". Don't allow him to do something one time and forbid it another.

A New Member of Your Family Within a week or two, your dog will have settled into his new home and his new routine.

Some will take a little longer. Very few are unable to adjust at all. In most cases the dog will be a well-adjusted member of the family within a month. And well worth it, it will be.

In fact, you will probably have trouble remembering when he wasn't one of you.

know&tell Check out these DVDs at the Greenhouse Breast Cancer Path to Healing And Wellness - DVD This release offers hope and insight about dealing with breast cancer, with prominent breast cancer survivors like Christina Applegate, Sheryl Crow, Melissa Etheridge, Olivia Newton-John, Joyce Ostin, Jaclyn Smith, as well as leading doctors and experts like Dr. Helena Chang, Dr. Deepak Chopra, Dr. Patricia Ganz, Dr. Armando Giuliano, Dr. Susan Love, and many others, who offer concrete advice, as well as inspiring and affirming stories of hope.

Yoga for Breast Cancer Patients and Survivors - DVD Yoga for Cancer is the first DVD created exclusively to address the needs of breast cancer battlers and survivors. The yoga poses were chosen not only for their stress reducing and energizing properties, but also to address the unique needs of breast cancer battlers. It incorporates a special series of poses that will increase flexibility, bring healing energy to the areas that need it most, calm the nervous system, and relax the mind and body. We are just beginning to understand the profound impact and power of the mind-body connection as it relates to cancer. Studies have shown that women with breast cancer who participated regularly in yoga classes were more relaxed, experienced less pain and fatigue, had better quality of life, and were half as likely to be depressed than their counterparts. We seek to complement traditional medicine and treatments with our healing and restorative yoga practice. The video creates active energy through standing poses, restorative energy through mat poses, and mental and physical relaxation from meditation. The practice can be done in the privacy of your home, with friends, or in a communal setting with other survivors. Our goal is to move from surviving breast cancer to thriving after breast cancer. 50% of all videos produced are donated to cancer care centers and hospitals to share with patients.

Pilates for Pink Workout – DVD The Mari Winsor Pilates for Pink workout offers a unique blend of Mari’s Pilates and resistance band moves in an easy-to-follow core workout. The workout strengthens your muscles evenly from head to toe with strong emphasis on your core and enhances flexibility and body awareness. As a result, you ll create a taller, slimmer, more graceful shape. Use the band as added resistance to improve your overall muscle tone.

Where to get ‘In the Know’ Pick up your free copy of In the Know at these locations: All Mister Car Wash Locations • 6355 Montana • 8857 Gateway West • 4800 Osborne • 12120 Montwood • 8835 N. Loop • 11184 Vista del Sol • 1482 George Dieter All Martin Tire Locations • 901 Texas • 12110 Montwood • 9425 Montana • 5255 Woodrow Bean, Suite 1 • 1342 N. Lee Trevino • 8008 N. Mesa • 901 Talbot, Canutillo Marina’s German Bakery 2033 Trawood Starbucks 6669 Gateway West In the Know is also available at all Greenhouse branches, most local pharmacies, oncologists offices and hospitals.

Visit rgcf.org for past issues of In the Know

A survivor’s story Judy Phelan O’Connor Definition: survivor sur·vi·vor [ sər•vi•vər ] In the world of cancer, a survivor is defined as anyone who has been diagnosed with cancer, from the time of diagnosis through the balance of his or her life.

The number of cancer survivors in the U.S. is growing for several reasons, including doctors' ability to find cancer earlier, diagnose cancer more accurately, and treat cancer more effectively.

In the Know is pleased to feature a survivor in each issue.

Judy Phelan O’Connor was diagnosed with metastatic adenocarcinoma breast cancer on March 15, 2012, one day shy of her 59th birthday. A person of deep faith, Judy set a personal deadline to be cancer free by her 60th birthday. After 24 years of working in senior care and living, Judy has been personal witness to many life lessons. “Lesson One is”, she says “Attitude is a Choice”. “As Lou Holtz contends”, she continues, “Life is ten percent what happens to you and ninety percent how you respond to it”.

One way in which Judy practiced this mantra was in the creation of a blog she titled “Patio Perspectives”, thoughts based on her cancer experience penned in the peacefulness of her backyard patio.

An admitted country music junkie, Judy frequently tied her perspectives to familiar Country & Western songs.

The following are excerpts from her writings which she shared with friends and loved ones who needed to know she was doing OK during her cancer journey!

A Song in My Heart Judy Phelan O’Connor March 15 DIAGNOSIS -- Breast Cancer. TREATMENT PLAN – 6 months of chemo followed by surgery and 6-8 weeks of radiation. I dreaded the year ahead. But I DID IT thanks to faith, family, friends and A Song in My Heart.

Dr. Robert Schuller says "You are what you think about all day long."

March 23

There’s A Song in My

Heart. It Is No Secret What God Can Do…what He’s done for others, He’ll do for you. Many have survived cancer. I will too.

carries me,” Everyone at Regency carries me. Thank you, Don Pendergras, for caring about me and not how much I’m getting done.

April 26 Kelsey and I went to MD Anderson then spent Easter with the O'Connor clan! Thanks to the Rio Grande Cancer Foundation for the plane ticket. Chemo at UMC with Oncologist, Zeina Nahleh, Texas Tech UBCC. My Radiation Oncologist, Teresa Reed, says: “Why don't we look at cancer as a chronic disease? People aren't afraid of diabetes or hypertension. We cure cancer.”

July 27 I’ll be a survivor model at the UBCC Luncheon. Please support UBCC and the women they serve… the women I see every Thursday. We are kindred spirits. My Spanish is limited but a hug is a hug in any language.

May 20 I’m little sister to 3 big brothers. Our family, the Phelans, were patio sitters. Every morning Lucky sits on my lap while we watch the turtles and birds.

June 3 My hair is gone! Shania Twain has me singing JUANITA -“She’s our voice when someone tries to take away our choice… DREAM with her, SCREAM with her!” Here’s to you! my friends and family, especially Rod for having coffee in the UMC Infusion Center Thursday mornings.

June 21 Celest said YES! She’ll marry my son, Huston, in March. Have you heard Cory Morrow’s He Carries Me.?

“But I know every day I’m lucky just to breathe the air I breathe And I hope everyone can feel the love that’s bustin’ out of me Sometimes I stumble that’s when He

September 25 6 years ago today a box with a little Chihuahua came into Regency and I took LUCKY home. P.S. Schedule your mammogram.

March 16 It’s my 60th birthday - I’m singing Three Dog Night’s CELEBRATE. May 1 The will of God will never take us where the grace of God cannot protect us, my mantra for this year. I wouldn’t change a thing … I am a blessed woman.

The future looks good from JUDY’S PERSPECTIVE. I feel good, my family is happy, and I’m DONE. I hope you have A Song in Your Heart.

Judy O’Connor is General Manager at Regency of El Paso Assisted Living.

She has a speech “What I Know about Life I Learned in the Retirement Community.” She would love to speak to your group 584-8438

Rio Grande Cancer Foundation 10460 Vista del Sol Suite 101 El Paso, TX 79925

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Help RGCF save valuable time and resources As you already know and have experienced for yourself, our magazine, “In The Know: Understanding the Cancer Experience” is a real treasure of insight and inspiration. One of our biggest charges here at the Rio Grande Cancer Foundation is to be FISCALLY prudent so we can continue granting dollars to not-forprofits and to sustain our own programs. Another is to be SOCIALLY responsible to our community and resources. To that end we are now offering two ways for our readers to get In The Know and stay in the know. We will offer a digital version of our magazine to be a little more earth friendly and to cut down on printing costs!

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