Cancer awareness, october 15, 2013 by Cowles Publishing

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6 Ways to Reduce Breast Cancer Risk Preventative Mastectomies: Right for you?

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How to Support Your Loved One’s Fight 9 Best Prevention Foods Change Your Life, 1 Habit at a Time

YOU WILL SURVIVE

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Scheduling a mammogram is one of the best things you can do for yourself.

October is Breast Cancer Awareness Month, and we’ve got you covered. One out of every eight women will develop breast cancer. But statistics show more women survive this diagnosis when it is detected and treated early. According to the American Cancer Society, mammograms remain one of the most eﬀective methods for early detection. If you are 40 or older, or are considered to be at risk, Rockwood Health System encourages you to have a mammogram once a year – starting now. Schedule your mammogram at one of our four convenient locations. Deaconess Hospital Breast Evaluation Center 800 West Fifth Avenue • 509-473-7777 Rockwood Breast Health Center 12410 East Sinto Avenue, Suite 105 • 509-342-3555 Rockwood Imaging Center 400 E. Fifth Avenue • 509-342-3555 Valley Hospital Women’s Imaging Center 12606 E. Mission Avenue • 509-473-5483

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Appointments are on a first-come, first-served basis. A physician order is not required but the patient must provide a physician’s name when an appointment is made. If the patient does not have a physician, a list will be provided for the patient’s selection. All mammogram reports will be sent to the physician and follow-ups are the responsibility of the patient.

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LOCAL COMMUNITIES, NOT NATIONAL EXPOSURE, FOCUS OF KOMEN FOUNDATION E. Washington afﬁliate helps residents with screenings BY RENEE SANDE MARKETING CORRESPONDENT

Funds come primarily from the Susan G. Komen Race for the Cure 5K run/ fitness walk each spring. The annual event started in 2006 and attracted nearly 7,000 participants last spring.

“A lot of our counties are underserved populations so we’re screening many women who might not otherwise get that chance,” said Claudia Bell, executive director of the affiliate which serves 14 counties.

“There’s a 99 percent chance of curing breast cancer if found before it spreads beyond the breast; early detection of any abnormalities in your breasts is so important,” she said.

Over the last nine years, the local affiliate has awarded over $2.7 million in local community health grants for breast health programs.

The amount of money raised – and allocated locally – may surprise people, Bell said.

ince 2002, the Eastern Washington affiliate of the Susan G. Komen Foundation, has contributed to at least one diagnosis of breast cancer each month throughout the region.

Early detection is vital.

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“One of the biggest misconceptions about Susan G. Komen is that we’re this big conglomerate with ivory towers,” she said. “We’re a very grass-roots organization that started out 100 percent volunteer-based, and it’s still all about the community efforts that’s really helped us grow.”

the Pink Tie Guys or 13 Guys Saving Lives, a group of men from all walks of life who will be engaging our community about the Susan G. Komen mission.

The local affiliates don’t pay for overhead expenses for the national organization. Instead, 75 percent of all funds raised stay in the 14-county service areas to help fund community breast health programs. The remaining 25 percent goes toward funding the exceptional research programs funded by the Komen National organization.

The Susan G. Komen Foundation began with a single grant of $28,000 in 1982, and is now the largest non-government funder of breast cancer research in the world, funding a total of $755 million in research and supporting more than 2,100 grants.

The Eastern Washington Affiliate awarded over $346,000 in local community health grants in 2013 alone.

“All these men’s lives have been touched by this disease in some way, so we’re tapping into that energy and unleashing it on the community,” says Bell.

For more information, call (509) 315-5940 or komeneasternwashington.org.

“Every grant has an educational component; one of our messages is living a healthy lifestyle,” said Bell. “There’s also a lot of misinformation out there to dispel, like if you don’t have a family history, you’re not at risk.” Actually, she said 80 percent of patients diagnosed with breast cancer do not have a family history of cancer. Other factors such as having dense breasts, beginning to menstruate before age 12 and having a first full-term pregnancy after age 30 can be contributors. To assess where specific needs and opportunities for engagement and education exist within their service territory, Bell says the affiliate conducts a community profile every 2-3 years which looks at breast cancer data and demographic data. This info helps identify strategic partners in the local fight against breast cancer. Screening remains a top priority, but Bell hopes that in the future, funds can also be used for other important issues like quality of life and clinical trials. More focus has also been given lately to co-survivors of cancer. “Breast cancer doesn’t only affect the one who has it,” says Bell. At the Laugh for a Cause fund-raiser earlier this month, the affiliate introduced

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Claudia Bell, far right, executive director of the Susan G. Komen Foundation for Eastern Washington, says early detection is vital.

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WHERE IS MY MIND? BY RACHEL GRAF CTW FEATURES

Memory loss is a common complaint of breast cancer patients. Here’s why it happens and how to ‘ﬁx’ it.

isplaced car keys, difficulty with multitasking and the need to write down everyday tasks are all symptoms of “chemo brain,” a form of cognitive decline that affects many women after chemotherapy treatments for breast cancer.

Post-treatment breast cancer patients report higher complaints about their memory and their higher-level cognition than do women who have not undergone treatment, according to a recent study by researchers at the University of California, Los Angeles. The study is one of the first to demonstrate

that patients’ self-reported memory complaints are backed by objective test results. “In the past, many researchers said that we can’t rely on patients’ selfreported complaints or that they are just depressed, because previous studies could not find this association between neuropsychological testing and cognitive complaints,” says Patricia Ganz, director of cancer prevention and control research at UCLA’s Jonsson Comprehensive Cancer Center. “In this study, we were able to look at specific components of the cognitive complaints and found they were associated with relevant neuropsychological function test abnormalities.” The researchers’ subjects were 189 breast cancer patients with an average age of 52. The patients had completed the initial cancer treatments but had not yet undergone hormone-replacement therapy.

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These patients completed a selfreport questionnaire about cognitive abilities. Generally, women with breast cancer reported higher complaints regarding memory than the control group of healthy women about the same age who do not have breast cancer. About 23 percent of the women with breast cancer reported greater complaints about memory and about 19 percent of those women reported greater complaints about higher-level cognition and problemsolving ability. Women who

had undergone both chemotherapy and radiation were especially likely to report memory problems compared to women who had undergone only chemotherapy or only radiation. Typically, cognitive decline affects patients anywhere from two months to three years, says Virginia Kaklamani, MD, oncologist, Northwestern Memorial Hospital and associate professor of hematology-oncology Northwestern University Feinberg School of Medicine. Neuropsychological testing that was also conducted during the study supports the results of these self-report questionnaires. Patients who reported even subtle memory changes showed significant differences in neuropsychological testing. The women who were tested completed about two hours of standardized tests that included many questionnaires. For example, the women may have been asked to read a story without any further initial instruction. About 15 minutes later, the testers would ask these women what details they could recall from the story. Women who had undergone therapy performed worse than those who had not. Although a link between chemotherapy and cognitive decline has been proven, doctors do not yet know its cause. A couple leading hypotheses are that it’s due to a lack of oxygen to the brain or an early onset of menopause due to chemotherapy. Because there are confounding factors present during breast cancer treatments, such as a spike in estrogen levels, it is difficult for doctors to know what effects are due to chemotherapy and what effects are due to a change in estrogen levels that

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accelerate menopause. Women experiencing menopause often experience cognitive decline as well. Partly because of the uncertainty regarding its cause, doctors have not determined a cure for “chemo brain.” Research is being conducted about how to minimize or mitigate these effects, but nothing definitive has been determined. Angie Plagman, 39, Casey, Ia., completed treatment for breast cancer nearly a year ago and is still suffering from symptoms of cognitive decline. Plagman says she has difficulty remembering everyday tasks at work and at home, so she now takes notes about everything. Doctors rarely alert breast cancer patients about the possibility of mental decline, although the majority of patients complain about it, Dr. Kaklamani says. This is largely because there is very little that doctors can do to prevent the memory loss or loss of focus.

“Honestly, at the time you have so many things that they’re telling you will happen to you, even if they would’ve told me, that was probably the least of my worries,” Plagman says. Dr. Kaklamani says that doctors instead focus on post-treatment therapy that these women can complete after chemotherapy. Exercises to combat the effects of chemotherapy include sudokus, memory games and similar brain-focused exercises. Most women eventually do recover from the effects of “chemo brain.” In the meantime, experts urge patients to encourage family and friends to be understanding. These women should acknowledge that there’s a problem and not be afraid to ask for help, says Jamie Myers, adjunct assistant professor at the University of Kansas school of nursing. “Give yourself permission not to be perfect,” Myers says. “You don’t have to be superwoman.”

There are very few people who have not been touched by this terrible disease. Larry H Miller Honda and Larry H Miller Toyota support the ongoing ﬁght to ﬁnd a cure.

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THE 9 BEST BREAST CANCER PREVENTION FOODS What you put into your body could help your body reduce or slow the occurrence – or recurrence – of breast cancer. BY CAMILLE NOE PAGAN CTW FEATURES

o one food or diet plan has been proven to keep cancer at bay. But research shows that a healthy, primarily plant-based diet will provide your body with the nutrients it needs to stay healthy, and to keep your weight in check, too, which will further reduce your risk of breast cancer.

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Eat these nine nutrition superstars on a regular basis: 1. Oatmeal. Oatmeal is high in fiber, which helps “soak up” excess estrogen circulating in the blood stream. Plus, oatmeal is a good source of antioxidants called phenols, which may help repair cell damage that contributes to cancer growth, says Franella Smith Obi, a registered dietitian/nutritionist at the Greenville Health System Cancer Institute in Greenville, S.C. 2. Broccoli … and cauliflower, cabbage and kale. “These cruciferous vegetables are rich in sulforaphane, phytochemicals that have anti-cancer properties,” Obi says. 3. Beans. “In addition to being high in fiber, they’re an excellent source of protein—making them a good swap for red meat and other animal protein, which can be high in saturated fat and has been linked to a higher risk of breast cancer,” says Sally Scroggs, clinical program manager of integrative health in cancer prevention at The University of Texas MD Anderson Cancer Center.

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4. Kale … and collards and spinach. All three have super-high levels of carotenoids, a type of antioxidants that protects against free radical damage that contributes to cancer development. 5. Citrus fruit. A recent Korean study found that women who regularly consumed oranges, grapefruit and other citrus had a 10 percent reduction in their breast cancer risk. 6. Berries. Strawberries and raspberries, in particular, are a potent source of ellagic acid, a phytochemical that has been shown to prevent cancers of the breast, skin and lung in lab studies, according to the American Institute for Cancer Research. 7. Fatty fish. Lab studies suggest that the ultra-healthy omega-3 fatty acids in fish like salmon and mackerel may slow the growth of breast cancer cells.

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8. Lentils. Lentils are one of the best sources of folate – and research suggests that women who have high levels of folate are up to 44 percent less likely to develop breast cancer. 9. Spices. University of Michigan researchers found that piperine (a compound found in black pepper) and curcurmin (the main ingredient in turmeric) reduced the growth of breast cancer-initiating team cells in lab studies. Other research has shown that pepper and turmeric have antiinflammatory benefits – and they’re a smart way to add flavor to food without adding fat or calories, too.

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SURVIVORS STRESS PRO-ACTIVE ATTITUDE TO REMAIN CANCER FREE Two Spokane area women under 40 share inspirational stories, fears, hopes. BY COURTNEY DUNHAM MARKETING CORRESPONDENT

ebra Minkove’s boyfriend asked an unexpected question one night, which made them both giggle a bit – had she ever performed a breast self-exam? After the laughs ended, the 32-year-old A reached up, felt her left breast, and right away rea found a lump. fou She called her gynecologist the next morning. Her doctor thought it was just a m fibroadenoma, but recommended a fib mammogram to be safe, followed by a m needle biopsy. n

“They called me while I was at work and ttold me I had breast cancer. I was numb. I bbroke down with tears and anger. I wondered why me,” Minkove said. “After won Debra Minkove was diagnosed with many emotions, I told myself I wasn’t going to die of breast cancer at age 32. cancer – I would die from something way cooler.” COURTESY PHOTO

Today, Minkove exercises daily and tries to eat balanced meals. “I live life to its fullest and don’t take anything for granted. I am very blessed and grateful for everything that has happened,” she said. Minkove got involved with a Northwest nonprofit called Check Your Boobies, which educates women about breast health in a frank, fun, and fear-free manner. “In the past few years we have witnessed heightened breast cancer awareness. But awareness hasn’t led to action. Eight out of 10 women said they don’t perform breast self-exams regularly,” she said. “They don’t know how to check properly. They are not in tune with normal monthly changes in their breasts. They are afraid. They are scared they might actually find something, so they just don’t do it.” Minkove and her colleges are on a mission to change that. She became one of CYB’s facilitators, a group of breast cancer survivors who attend parties to share their cancer stories. They describe how they learned about their cancer and briefly discuss treatment. Most importantly, they reinforce the importance of early detection. “I had no idea that I would be traveling across the country sharing my story and possibly changing lives,” she said. “I’m grateful for this organization. It has been therapeutic for me as well.”

She began her cancer journey by seeking out an amazing oncologist, followed by genetic testing, a lumpectomy, and then chemo. Then came more unexpected bad news: she learned she had a mutated BRCA 1 gene, like Angelina Jolie, that would make her susceptible to both breast cancer and ovarian cancer. The smartest, safest decision seemed to be a double mastectomy.

Minkove becomes emotional when she hears that her story has w made others go out and get m cchecked. “It makes me feel like I really do have a purpose. It’s just so cool d to know they aren’t just listening – that they’re taking it to heart aand being pro-active. That’s all I want is for young women and w men to take what I’m saying m sseriously and take action.”

“My grandmother on my father’s side passed away from ovarian cancer. The gene was passed onto me through my father, so I didn’t want to take any chances,” she said. That was almost six years ago, and Minkove continues to get ultrasounds regularly to check her ovaries. She believes early detection, spurred by her boyfriend’s question, saved her life. Now, she encourages others to be pro-active with their bodies. “If I had been scared to find out what the doctor would say about the lump and not done anything about it, I wouldn’t be here today,” she said. “I have a life – an amazing one at that - because I took action early. I would advise everyone to get to know their body and not to be afraid.”

PHOTO BY COURTNEY DUNHAM, CORRESPONDENT

Survivor Debra Minkove, right, now works with a group called Check your Boobies to educate women about self-screening.

Lisa Canby wishes she had kknown that breast cancer can ooften strike people under 40 years old. She was 38 three years ago ol when she was diagnosed.

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â€œI was planning on getting a mammogram when I turned 40 since thatâ€™s what you always hear,â€? she said. â€œSo it was nowhere on my radar until my annual exam when my doctor found a lump. Even then I figured that it was probably a cyst.â€? With two young children under age 5, Canby said she now realizes that she was in complete denial about the possibility of cancer. â€œThere was no way that I could be sick, right? I felt fine and had plenty of energy â€“ well, as much as you can have with small children. I didnâ€™t feel sick at all.â€?

responsive to the drugs. She believes that something much greater than her fear took over and will continue to watch over her. â€œI believe in God, but I also have hope in the angels that I know I have up there looking out for me too,â€? she said. Canbyâ€™s mother died of a heart attack when she was only 16 years old. â€œI know sheâ€™s fighting for me up there because she doesnâ€™t want my babies to go through with what I did.â€?

But Canby was diagnosed with Stage 3 breast cancer. She can recite word-forword everything her doctor told her, and her husband Ken, but canâ€™t recall how sick with worry her husband really felt. â€œOn the outside, he handled the news like a complete champion and cheerleader,â€? she said. â€œHe knew how frightened and scared I already felt â€“ not for me but for our kids.â€? It wasnâ€™t until she started recovering and her diagnosis improved that he shared his fear and anguish. Like Minkove, she consented for a double mastectomy and chemo, and two years later, sheâ€™s cancer free. Although she knows and is grateful everyday that sheâ€™s alive, a part of Canbyâ€™s heart will always have a small fear of remission. â€œI wish I didnâ€™t think twice about it, but I would be lying because thatâ€™s not the case,â€? she said. â€œWhen someone or something threatens to take your life and family away, you never forget it and feel totally at ease.â€? But she feels more hopeful than anything else. Canby knows her chances for survival greatly improved after the double mastectomy, and the cancer was very

PHOTO BY COURTNEY DUNHAM, CORRESPONDENT

Visitors at a Check Your Boobies party are taught how to perform screenings.

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THE PREVENT DEFENSE 6 Ways to Reduce Your Risk of Breast Cancer BY CAMILLE NOE PAGAN CTW FEATURES

ust 10 percent of breast cancers are due to genetic factors. The rest? “They’re related, directly or indirectly, to lifestyle,” says Dr. Marisa Weiss, president and founder of BreastCancer.org, who is a breast cancer survivor herself. While that may sound like cause for concern, Dr. Weiss says it’s actually empowering: “Whether you’ve never been diagnosed or you’ve had the disease in the past, there’s plenty you can do to reduce your risk.” Here are six positive steps to take today:

1. GET MOVING.

Researchers haven’t found a way to prevent breast cancer yet – but until they do, there’s plenty you can do to lower your risk. Here’s how.

Numerous studies have shown that women who exercise reduce their likelihood of being diagnosed, or re-diagnosed, with breast cancer. Among the evidence, University of North Carolina, Chapel Hill researchers found that two hours of daily physical activity (from working out as well as activities like household chores), reduced women’s odds of breast cancer by a notable 30 percent. New research from the University of Minnesota suggests that exercise helps by allowing the body to break down estrogen, the hormone that plays a major role in the disease’s development. Tight on time? “Every little bit makes a difference,” says Dr. Kathy J. Helzlsouer, director of prevention and research at Mercy Medical Center in Baltimore. “I tell all of my patients to look for free moments; for example, I always take the stairs instead of the elevator. It adds up throughout the day.”

2. GO EASY ON ALCOHOL.

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Alcohol consumption increases risk of breast cancer – and the more women drink, the higher their odds, show studies. That’s not to say you should never have a cocktail again, “but keeping

your intake to no more than three to five drinks a week is a good idea, both for breast cancer and overall health,” says Dr. Weiss. (One drink is the equivalent of one and a half ounces of liquor, five ounces of wine, or 12 ounces of beer).

3. MIND THE SCALE. Fat tissue increases the production of estrogen. Researchers believe that may be why women who are overweight or obese are at a higher risk for breast cancer. Fortunately, losing just five percent of body weight – if you weigh 170, that’s eight and a half pounds – lowers postmenopausal women’s blood levels of estrogen and reduces breast cancer risk by 22 percent, according a study from the Fred Hutchinson Cancer Research Center in Seattle. “The closer you can get to a body mass index (BMI) of 25 or lower, the better,” Dr. Helzlsouer says. Go to CDC.gov for a free BMI calculator.

4. KICK BUTTS. Smoking gets a bad rap because of lung cancer, but it’s a major breast cancer risk, too, stresses Dr. Maurie Markman, national director of medical oncology at the Cancer Treatment Centers of America. “Even secondhand smoke is dangerous,” Dr. Markman says. “Smoke is a carcinogen that damages tissue and triggers cell abnormality.” If you need to kick the habit, don’t go cold turkey; research shows that using smoking cessation aids – such as counseling, nicotine patches, gum and/or medication – more than triples your chances of success. Visit SmokeFree.gov for free resources.

5. CONSIDER THE BENEFITS OF MOTHERHOOD AND NURSING. Women who have at least one child in their 20’s are

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less likely to develop breast cancer than those who give birth later; those who breastfeed for two years of their lives, total, are also less likely to have breast cancer for similar reasons. Researchers arenâ€™t sure why, but it may be related to a reduction in overall estrogen exposure.

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6. STAY IN CLOSE CONTACT WITH YOUR DOCTOR. When it comes to prevention, â€œOne size does not fit all,â€? says Dr. Nancy Klauber-DeMore, a surgical oncologist and professor of surgery at the University of North Carolina School of Medicine. â€œWomen should talk to their physicians about their health history, family history and lifestyle to figure out their individual risk, then tailor their approach accordingly.â€? If you have a first-degree relative whoâ€™s had breast cancer, or a genetic risk factor such as the BRCA1 or BRCA2 gene, your doctor may recommend extra steps, such as bi-annual screenings (including physical exams, mammograms and/or MRIs), or preventive medication like Tamoxifen. If youâ€™ve had breast cancer in the past, â€œperhaps the most important thing you can do is to stay the course with your treatment,â€? Dr. Helzlsouer says. â€œNo oneâ€™s better equipped to help you with that than your physician.â€?

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ASK THE EXPERT:

THANK YOU FOR BEING A FRIEND Letty Cottin Pogrebin, author of “How to Be a Friend to a Friend Who’s Sick” shares advice on helping a friend through an illness

BY RACHEL GRAF CTW FEATURES

or one reason or another, sickness tends to render people awkward and uncomfortable. Even with long-time friends, visitors might be unsure how to treat them in light of their sickness. It might be difficult to find a balance between the desire to be considerate and sympathetic and the desire to pretend nothing has changed. The disconnect between how patients

want to be treated and how they are treated prompted Letty Cottin Pogrebin to write her book “How to Be a Friend to a Friend Who’s Sick” (PublicAffairs, 2013). Pogrebin was recently treated for breast cancer and says she was often shocked by how friends acted toward her. “I wanted to say, ‘Stop treating me like cancer girl,’” Pogrebin says. “‘Treat me like a normal friend who happens to

be going through something hard.’” In her book, Pogrebin offers proper etiquette advice for treating someone when they’re sick. She covers topics such as what to say, how to act and what types of gifts to bring. If you have a friend or loved one who is sick, you might be asking yourself the very same questions that Pogrebin answered for us.

Q. Visiting a friend in the hospital can be hard. How should we approach the situation so it isn’t uncomfortable? When talking to a friend who is going through treatments, establish absolute honesty the minute you hear the diagnosis. If you establish honesty from the beginning, you don’t have to worry about whether you’re being intrusive or offensive because you’ve established a policy. In terms of how to behave, kindness equals empathy plus action. You have to be able to listen to their needs, as well as actually help with those needs. If you’re unsure how to help, tell your friend that you want to be helpful but really don’t know how to be. Q. When is offering to help helpful and when is it degrading? Offering help is never degrading but it may be infantilizing. People don’t want to be treated as helpless. I recommend that you should ask directly how you can help. You should add that you genuinely mean it. Otherwise, people will assume you’re just saying it to be polite.

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Q. What are the best ways to comfort a friend? Bringing gifts can be comforting to patients, but be sure the gifts are thoughtful. Chances are, she’s not going

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to eat all that fruit, but she may be really excited if you give her a certificate for a manicure or pedicure. Take time to think about what you will bring, and ensure that whatever you choose will really help her feel good.

Q. Should you ever try to relate to the patient through experiences of your own or of someone you know? Some people immediately respond by citing their own experience with illness, or they’ll start recommending treatments, vitamins and so on. None of this is helpful to a patient. Your story is your story; your illness and your response to it are unique to you. Try not to be self-referential in your remarks to any patient unless she specifically asks for your experience with the same disease. Q. How do you know when to step back? Friends should be alert to a patient’s body language, facial expressions and the type of response they give to your questions. If they try to slough off your question with a short, non-descriptive answer, that’s your signal to back off. Not everyone wants to be interviewed about their illness, treatment or condition. They may consider your questions to be intrusive or they may simply be tired of talking about their problem. No one wants to become their illness in the eyes of their friends. Q. What’s the best way to end your visit or talk? This goes back to what I was saying earlier about honesty. Ask your friend to tell you when to leave. You need to tune into the cues of the patient. If I had to give an answer for how long to say, I would say long enough to show that you care, but not as long as you think.

HOW TO SAY WHAT YOU WANT TO SAY IN THE MOST TACTFUL WAY

The Pink Shamrock Foundation is proud to announce the recipients of this year’s grants of over $21,000. ✤ Hospice of Spokane ✤ Kootenai Health Foundation ✤ Community Cancer Services (Sandpoint) ✤ Because there is Hope (Spokane) ✤ St Joseph Family Center ✤ Lourdes Health Network (Tri-Cities) ✤ Native Health ✤ INHS (Spokane) ✤ Casting for the Cure (Lewiston) ✤ Providence Regional Cancer Center ✤ Priest Communities Care (Priest River) Founded in 2001 in memory of Denny Anne Murphy, its mission is to ensure that all women, especially those with limited funds and resources, have access to the care and support they need to ﬁght breast cancer and win. The foundation, operated by Denny’s family and has given over $140,000 in grant funds to different organizations.

History and instructions for donating available at pinkshamrock.org.

Everyone should be especially thoughtful of what phrases they choose when speaking with a sick friend, Pogrebin says. Old greetings that have become second nature might suddenly have a different connotation for someone who’s sick. “I resented being asked ‘how are you?’ all the time,” Pogrebin says. “That simple line becomes a problematic line for someone with breast cancer because it means we have to calibrate how much that we want to tell our friends.” She suggests instead that you should establish honesty from the start so you know what conversations are on or off-limits. Also, don’t be afraid to talk about daily activities – not just the illness. In her book “How to Be a Friend to a Friend Who’s Sick,” Pogrebin offers seven examples of phrases that sick people typically want to hear:

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I’m so sorry this happened to you

Tell me how I can help

I’m here if you want to talk

Just give me my marching orders

That sounds awful; I can’t even imagine the pain

I’m bringing dinner

You must be desperate for some quiet time. I’ll take your kids on Saturday.

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CANCER CARE NORTHWEST CAN BE AN IMPORTANT RESOURCE Medical team, family physician can collaborate for treatment plan PROVIDED BY CANCER CARE NORTHWEST

he symptoms are clear, and your family doctor has suggested you have breast cancer. To confirm these suspicions, your doctor has probably referred you to a breast cancer specialist or oncology center.

The idea of visiting a cancer center might feel daunting, but at Cancer Care Northwest, our mission is to not only help you battle cancer, but to also help you feel as comfortable and supported as possible through your treatment while providing the best care available. As part of this education process, breast cancer specialists Dr. Joni Nichols, a board certified medical oncologist and physician president, and Dr. Christopher Lee, a board certified radiation oncologist, discuss common questions regarding breast cancer diagnosis.

WHAT IS YOUR SPECIALTY WITHIN BREAST CANCER?

DL: Our goal at Cancer Care Northwest is to provide education about their situation, explaining the many resources available within our practice and community. We also like to share standard treatment options plus available national research that applies to their diagnosis. We also discuss nutritional and emotional support teams available at Cancer Care Northwest that can offer assistance.

HOW DO YOU INTERACT WITH OTHER PHYSICIANS BOTH INSIDE AND OUTSIDE CANCER CARE NORTHWEST? DL: In almost all cases, cancer is best treated by a well-coordinated team of cancer specialists, which includes doctors, nurse practitioners, nurses and more. We use a comprehensive, integrated care model, which allows us to continually reach out to partners to discuss complex situations and questions. We have weekly cancer conferences as well as educational meetings to optimize the care for each patient. We pride ourselves in offering a wide spectrum of care (including cutting-edge technologies) so that patients can have treatment in Spokane at the same level as leading academic institutions. Multiple physicians at Cancer Care Northwest have also recently published a book “Living and Thriving with Breast Cancer,” which emphasizes the importance of education and a collaborative team to optimize care for each individual. This book is now being distributed nationally by The Breast Cancer Society and is a great resource for patients going through treatment.

Dr. Nichols: I am a medical oncologist and specialize in the medical treatment of patients with breast cancer. That entails evaluating the disease and prognosis and making recommendations for further diagnostic testing, along with diagnosing therapy with chemotherapy and/or endocrine therapy. I work closely with the surgical oncologist and the radiation oncologist to coordinate an individual care plan. Dr. Lee: I am a radiation oncologist and specialize in targeting the breast and surrounding lymph nodes with precision while protecting the surrounding vital organs.

WHAT STEPS DO YOU TAKE TO DIAGNOSE AND TREAT PATIENTS?

ONCE A PATIENT FINDS OUT THEY HAVE BREAST CANCER, WHAT DO YOU DISCUSS?

METRO CREATIVE

DN: We gather all the pertinent information and evaluate a patient to determine the optimal therapy for treating their cancer. As doctors, we often discuss a patient’s situation in a Breast Cancer Tumor Board to receive input from other providers, including radiologists, pathologists and plastic surgeons. This is part of our integrated care model. DL: We also talk with each patient extensively about the proper testing needed. In most cases, this involves a biopsy as well as mammograms, CT scans or MRIs. Sometimes, we also use a PET scan, which looks at the body’s metabolism and metabolism of areas containing cancer.

DN: We believe collaboration is crucial. Our physicians and health care teams work together to find the best treatment plan for each patient.

WHAT ARE COMMON SYMPTOMS YOU SEE FROM PATIENTS DIAGNOSED WITH BREAST CANCER? DL: Due to the wide use of mammography, many women are being diagnosed in the earliest stages and don’t yet have symptoms. When the cancer has time to grow to a larger nodule, patients can have breast swelling, tenderness, skin color or texture change, and abnormal nipple drainage. If you think you have any of these symptoms, don’t hesitate to contact our clinic for a consultation.

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IF A PATIENT RECENTLY LEARNED THEY HAD BREAST CANCER, WHAT SHOULD THEY DO?

HOW WILL THE MOVE TO THE NEW STATE-OF-THE-ART VALLEY OFFICE HELP PATIENTS?

DN: The first step is to seek consultation with a breast surgeon, and begin the education process. There are many excellent resources so be prepared with a list of questions for your provider.

DL: The new Valley Office will offer the full spectrum of oncology treatments as well as supportive care for every patient. Physicians specializing across multiple cancer fields will be on-site to evaluate and treat patients facing a cancer diagnosis. The entire center is designed to optimize collaboration between medical specialties, educate patients, and provide a healing environment.

DL: Cancer treatment today is not like “your grandmother’s treatment.” Many cutting-edge tools and novel therapies are now available. These resources improve cure rates, limit side effects, elevate quality of life and provide hope. Because of progress in cancer therapy, each patient has more treatment options and reasons to be optimistic.

WHAT IS UNIQUE ABOUT CANCER CARE NORTHWEST? DN: In addition to having four comprehensive clinics in the region, including the relocation of our new Valley Office, we put a special focus on the overall wellbeing of patients. DL: Speaking for the radiation group, we are pioneers in this region for advanced radiation treatment techniques such as IMRT, stereotactic body radiation therapy (SBRT or SABR) and brachytherapy, a form of internal radiation. Our team has a passion for research, and we publish scientific papers each year on ways to optimize treatment for patients and improve outcomes. The goal of our oncology teams is to be available to help at the time of diagnosis and continue to provide support and follow-up after a patient’s initial treatment if additional therapies are needed.

WHY DID YOU CHOOSE TO PURSUE A MEDICAL CAREER IN CANCER? DL: I feel uplifted and inspired by how our patients fight against their cancer diagnosis. I am continually impressed by the human spirit. I am also fascinated by new research and cutting-edge tools now available for cancer therapies, and continually strive to integrate these into our daily practice. DN: Patients are our inspiration. I am awed by their strength and courage as they face many challenges. Cancer Care Northwest is a fully integrated, comprehensive cancer clinic providing specialization in surgical, medical, radiation, gynecological and endocrine oncology. For over 30 years, Cancer Care Northwest’s priority has been to offer the best cancer treatment in Spokane and surrounding counties. Its stateof-the-art technology, experienced physicians and talented health care teams make Cancer Care Northwest a premiere cancer center for patients and their families.

Learn more at CancerCareNorthwest.com.

DR. CHRISTOPHER LEE Dr. Christopher Lee graduated cum laude in Biochemistry from Brigham Young University in 1997 which included a summer research fellowship at Harvard University and Brigham and Women’s Hospital. He subsequently attended Saint Louis University School of Medicine where he received COURTESY PHOTO his M.D. with Distinction in Research degree in 2001. He completed four additional years of specialty training in Radiation Oncology at the Huntsman Cancer Hospital and University of Utah Medical Center during which he was given multiple national awards, including the Beckstrand National Cancer Fighter of the Year Resident Scholarship and RSNA Roentgen Resident Research Scholarship. Dr. Lee has actively pursued both basic science and clinical research throughout his career. He continues to be a proliferative author of scientific papers and regularly gives presentations on radiotherapy technique and the use of targeted radiation in the care of patients with head and neck (throat), brain, breast, gynecologic, and prostate malignancies.

DR. JONI NICHOLS Dr. Joni Nichols, Cancer Care Northwest Practice President, is a medical oncologist specializing in breast cancer. She has practiced medical oncology in Spokane for 20 years, and has been with Cancer Care Northwest since 1995. She has seen CCNW COURTESY PHOTO grow from six medical oncologists to the comprehensive, integrated organization today. Dr. Nichols enjoys being part of a multi-disciplinary breast cancer team that provides patients with individualized and personal treatment. She has served on community advisory boards with the American Cancer Society and Susan G. Komen Foundation. She also has a special interest in palliative care and has served as a part-time medical director of Hospice of Spokane since 1996. Dr. Nichols and her husband enjoy their family and outdoor activities. She is an avid reader and just installed a small, free library at home.

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TO PREVENT OR NOT TO PREVENT?

BY JESSICA ROYER OCKEN CTW FEATURES

t certainly was Angelina Jolie’s revelation of her preventive double mastectomy in the May 14, 2013, New York Times that got the general public talking about preventative mastectomies. However, since genetic testing has become more widely available in the last 10 to 15 years, more and more women are being tested for BRCA1 and BRCA2 gene mutations, the presence of which significantly raises a woman’s risk for developing breast and ovarian cancers, explains Dr. Lisa Kay Jacobs, of the Johns Hopkins Breast Center in Maryland. Increased genetic awareness has likely led to the steady rise in mastectomies performed in the last 10 years (including those in women who have not been diagnosed with cancer), as has the growing number of women who want to be “proactive” and “avoid dealing with cancer,” she notes.

Angelina Jolie’s double mastectomy made headlines, as did the swell of support – and criticism – of her choice. So, how do you know if a preventative mastectomy is right for you?

However, a mastectomy – and a double mastectomy in the case of preventive procedures – is an involved surgery and not a choice to be made lightly. “It’s a personal decision even with the highest risk, because it is prevention,” Jacobs says. “When you talk about prevention, you want to compare the risk of the procedure to the benefit to be gained.” So, the place to begin is with an accurate assessment of a woman’s risk for breast cancer. The higher her risk, the greater potential benefit from a preventive mastectomy. CTW

WHO’S A CANDIDATE? The general population’s risk of developing breast cancer over a lifetime is 12 percent, Jacobs says. Factors raising a woman’s risk include a family history (particularly among immediate female relatives) of breast and/or ovarian cancer before menopause and any male family members with breast cancer. Family histories don’t often take the father’s side into account, but breast and ovarian cancers among female relatives on the father’s side can indicate the presence of a genetic mutation, which is another risk factor. Genetic mutations – BRCA1 and BRCA2 – account for only about 5 percent of breast cancers, but among those who have them, the risk of developing cancer can be as high as 85 to 87 percent, reports Dr. Marisa Weiss, founder and president of breastcancer.org. A strong family history without a BRCA mutation may yield a risk of 30 to 40 percent, Jacobs notes. So if you have an elevated risk and want to lower it, explore all your options, Weiss urges. Lifestyle adjustments like getting to a healthy weight, exercising, quitting smoking, limiting alcohol consumption and avoiding unnecessary radiation might reduce your risk by 40 percent, she says. And anti-estrogen medicines like Tamoxifen can reduce risk 40 to 50 percent. However, if your risk is 85 percent, even if you reduce it by 40

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percent, it’s still significant. Prophylactic mastectomy can lower risk by 90 or 95 percent. “That sounds pretty damn good when you’re looking at a situation of high risk and you feel unsafe,” Weiss says.

PROS OF THE PROCEDURE The fact that a preventive mastectomy can eliminate a significant portion of the risk of breast cancer is its greatest benefit. “It’s a huge peace of mind thing,” says Dr. Deborah M. Capko, surgical oncologist and member of the Breast Surgical Service at Memorial Sloan-Kettering Hospital in New York and New Jersey. Women who have their breasts removed (well, 97 to 99 percent of their breasts – it’s virtually impossible to get all the tissue, Capko notes) can also reduce the amount of screening and testing – mammograms, ultrasounds, MRIs, biopsies – they do each year to detect cancer. These tests can cause anxiety, as each one has the potential to find something, and they’re also not much fun. For some women, preventive mastectomy is a better alternative than taking Tamoxifen, which can have menopause-like side effects and is not recommended for women who may become pregnant, Capko adds. And, in 10 to 15 percent of prophylactic mastectomy procedures, biopsy reveals that cancer was present in the breasts, even if it hadn’t been detected previously, Weiss says. CONS OF THE PROCEDURE The biggest drawback to preventive mastectomy is the fact that it’s a major surgical procedure. The risks of the surgery vary depending on the technique

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employed and the type of reconstruction chosen, but there’s a risk of bleeding and infection with any surgery, note Jacobs and Capko. And there’s also some postoperative pain to manage and temporarily reduced range of motion in the upper extremities, they report. “It’s not a cosmetic procedure like an augmentation,” Capko says. “You’re not just getting a new pair.” Post-surgical drains are in place for two or three weeks, and most women spend a few days recovering in the hospital, followed by a few weeks at home. And there are emotional and physical considerations. “Mastectomy is a loss, a change in your body,” Weiss says. “You’re sacrificing your breasts to be in healthier place, no longer at high risk.” You lose sexual function of the nipples even if you choose to retain them with a nipple-sparing mastectomy, she notes, and Jacobs adds that sensation across the chest is likely to be altered by the procedure because the skin is lifted. Finally, if the breast tissue is removed, breastfeeding will no longer be possible, Capko says.

perspective. Even those at highest risk don’t know if or when they’ll get breast cancer, and if a cancer does develop, it can be treated when found early with screening tests, Capko explains. Jacobs always talks to her patients about medications before they discuss preventive mastectomy. Tamoxifen can reduce risk by half, and that’s a tablet once a day for five years, she notes. “For some that’s a better option.” A person’s overall health should also be a factor in decision making, because women who smoke, are diabetic or have had radiation to their chest for treatment of Hodgkin’s disease have additional risk

Breast reconstruction may use tissue from your body, silicone implants or some combination of the two, but regardless of what you and your surgical team determine to be the best approach, “the majority of these surgeries are not one shot in the operating room and done,” Capko says. There will be additional reconstructive procedures needed. “Some people want it all done in the summer and to never have to think of it again. That’s not going to happen,” she says. “You won’t be happy [with the results] if you go in with that attitude.”

HOW TO MAKE A DECISION “A lot of patients select themselves,” Capko says. For women who are gene positive and have seen other family members go through cancer, “it’s often a relatively easy decision,” she says. “That person is a lot more proactive.” However, she adds, not every woman who is gene positive needs to have a bilateral mastectomy. “The only real time you need to do that is if you have cancers in both breasts that are beyond the capability of breast-conservation surgery.” So it’s important to weigh your options carefully and keep things in

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factors that may complicate the mastectomy and reconstruction surgeries, these experts note. They also recommend that a woman considering preventive mastectomy meet with a plastic surgeon so she can understand her best options and likely outcome for reconstructive surgery, which are impacted by her anatomy and the shape and size of her body. “We spend a lot of time talking about the patient’s expectations,” Capko says. “The patient needs to understand the procedure because if we can’t fulfill her expectations, she will always be disappointed.” A final decisionmaking factor is timing, these experts note. This is not a decision that should be made urgently. Because of increased genetic

screening, many women are learning they’re BRCA mutation-positive quite early in their lives. “But you don’t need to remove your breasts at 20,” Jacobs says. “Someone who’s at high risk needs to be vigilant 10 years before the age of the earliest diagnosis in her family.” If breast cancer runs in a woman’s family, but her relatives have been diagnosed in their 40s or 50s and she’s 25, she might decide to wait, Weiss notes. Some younger women elect to have children before considering bilateral mastectomy, Capko adds. And those who are gene positive may elect to remove their ovaries before their breasts. “[Preventive mastectomy] is always an option – that’s a great way of looking at it,” Capko says. “Once you find out you’re at high risk, you don’t have to decide today. You should feel you’re ready to make the decision because it’s right for you at that time.”

WHAT TO EXPECT IF YOU DO IT When a woman decides to move forward with a preventive mastectomy, a great deal of planning begins. The breast cancer surgical team and plastic surgery reconstruction team must coordinate on a time, and the surgery is usually scheduled at least a couple of months in advance. In the meantime, the patient will likely have breast imaging done, and she’ll meet with both surgeons to discuss procedures and make decisions about the type of reconstruction she’d like, says Capko. Smokers must stop smoking, says Weiss, and some patients may do a little physical therapy to prepare their abdomens if they’ll be using tissue from that area to reconstruct their breasts, Jacobs adds. They’ll also have additional counseling to make sure they understand the procedure and what to expect. The surgery itself can range from three to four hours if implants will be used for reconstruction to six to eight hours with reconstruction using body tissue. And it’s safe to estimate a week of recovery time for every hour of surgery, Weiss says. At Memorial Sloan-Kettering Hospital, patients can expect a 23-hour, overnight stay after this procedure, and

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at Johns Hopkins, patients may stay three days after an involved reconstruction. After that they recover at home. These experts say that at least one follow-up surgery (a much simpler procedure) will likely be required to replace the temporary tissue-expander implant with the larger final one, and additional adjustment procedures may be required to get the look and feel the patient desires for her new breasts. Long term, these women will still need annual breast exams to monitor the remaining tissue, and those with silicone implants will need to have them replaced after 10 or 20 years.

WHAT TO EXPECT IF YOU DON’T If surgery is not the right choice, the alternative is vigilant screening for those at increased risk for breast cancer: a breast exam conducted by a physician every six months, a yearly mammogram and perhaps even an annual MRI, Jacobs says. And again, taking Tamoxifen as a preventive measure is an option for women done with childbearing, she notes. Capko adds that ultrasounds may be useful for screening as well, and she suggests that younger women begin mammograms when they are 10 years younger than the youngest cancer diagnosis in their family. In addition to the screening benefits, annual testing provides a good opportunity for patient follow-up and assessment, Capko says. “We can evaluate how they’re feeling about surgery. Are you still happy with this [course of action]? Has anything changed?” Whatever decision a woman makes, it’s important that she do so with all the information she needs and after appropriate counseling, these experts say. “I don’t think it’s good to do surgery based on fear,” Capko says. “But if you do it based on knowledge and informed consent, it becomes a powerful tool for women.”

PREVENTATIVE MASTECTOMY: A TRUE STORY

hen Stephanie Spence’s older sister, Crystal Hildreth, called a little over a year ago to say she’d found a lump in her breast, Stephanie, then 41 and a mother of three living with her family outside Atlanta, Ga., sprang into action to reassure her. “I’d found cystic lumps before, so I was already having annual checks and mammograms,” she says. “They were all just cysts, and my mom had cysts, so I was sure my sister’s was just a cyst too.” But her sister’s was not a cyst. It was cancer. And her sister had tested positive for the BRCA2 gene mutation. The morning Stephanie got that phone call, she flashed back to her dad’s sister, who’d had breast cancer and passed away from ovarian cancer in her 30s. Then she remembered a story a friend at work had told her: his wife lost her sister to breast cancer in her 20s, so she elected to have a double mastectomy rather than experience that herself. “That was the first moment I thought about treatment for myself,” Stephanie says. Her sister said there was a 50-percent chance Stephanie had the gene too, so she called immediately to schedule genetic testing at a nearby hospital. “The test itself was so simple,” she recalls – just a quick swish of mouthwash and analysis of the sample – but the results were much more complicated.

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She returned from vacation in April 2012 and sat in her doctor’s office, waiting for the news. “It

didn’t really hit me until she opened the folder and said I had [a mutation],” she says. “Then it was a blur for the next 24 hours. I had up to an 87-percent risk of developing breast cancer, and up to a 44-percent risk of ovarian cancer.”

her experience with preventive mastectomy and helped Stephanie get in touch with the doctors she ultimately decided to use. “On our second date she showed me her breasts,” Stephanie says with a laugh. “Now we’re super close friends.”

Stephanie describes herself as a woman of action, not one to sit and ponder, so she wanted to make a decision right away. “I didn’t have cancer, but I did not want to get it,” she says. “My kids are my everything, and I’d breastfed all three, so my reaction was ‘Thank God we found out. Take it all away!’” But she was concerned about what her husband might think.

“Now I knew the results didn’t have to be scary,” she continues. “I’d seen someone who went through this and the results were beautiful.” This was very helpful, she remembers, because the journey was about to get a lot harder.

“This, our life, doesn’t work without you,” he told her. “This is easy. We’re going to get it done.” She was so thankful for his support and says the process of going through all of this has brought them closer, but even with the initial decision made, she remained concerned about how her breasts would look and feel post-surgery. Then she remembered a Facebook post she’d seen from a fellow mom a year or so before. “Hell yeah, they’re fake!” the woman had written. “My real ones almost killed me.” Though she didn’t know her all that well, Stephanie immediately reached out and asked if they could have lunch. The next day, they swapped stories. Stephanie is BRCA2 positive, and her friend, Jen, was positive for BRCA1. She shared

She cried through her first appointment with the plastic surgeon, but he put her in touch with several of his other patients who could talk with her about their reconstructions and what to expect from the surgery – “breast friends,” Stephanie now calls them. She had a terrible time deciding what sort of reconstruction to do. If you keep your nipple, you have to leave a little tissue with it, and some doctors think this is a risk for BRCA patients, she explains. And her sister’s doctor (they compared information and treatment options all along the way) thought Stephanie was too young to even consider a procedure involving her latissimus muscle to support implants. She did a lot of crying and struggling, but “it was mostly with strangers,” she says. “At home, I was very positive. I told the kids I was having surgery over dinner. We made it seem small.” She didn’t want them for a moment to be worried or afraid.

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But in her closet, packing to go to the hospital with her husband, Stephanie melted into a puddle. She still hadn’t decided on her final reconstruction options, and it just seemed all too much. “Have the eye of the tiger,” her husband told her. “Your scars will be a badge of courage.” And that got her to the place where she could do it, she says. Just hours before her surgery in June 2012, “when the doctor drew on me with a Sharpie,” she says, “that’s when I finally decided to keep my nipples.” Stephanie had a double mastectomy with immediate reconstruction using implants and her latissimus muscle, which surgeons pulled forward from its natural position in her back to support the implants. This made her surgery more complex, and more painful, but ultimately yielded very natural results. She recalls waking up in recovery, shocked that the procedure was over and feeling like an elephant sat on her chest. The plastic surgeon had put just enough fluid in her expander implants

to give her a little cleavage, like she’d had before. She also had four surgical drains, two in front and two on her back. She was in Atlanta’s Piedmont Hospital for four days, on a lot of pain medication, and the first night, in particular, was miserable, she recalls. Her husband stayed home to keep things normal for their children, so her mom stayed with her, rubbing her arm all night long and calling the nurse for more medication whenever possible. She didn’t have her kids come see her until day two or three, and before they arrived – despite the fact that she could barely lift her arms – she put on makeup and twisted her hair into its usual bun. “I was so determined for them not to see me as anything but tired,” she explains. “I didn’t want to scare them because there’s a solid chance my daughter [who is currently six] will go through this too.” Their visit lasted just long enough for them to collect the goodie bags she’d prepared for them and see that she was OK.

However, once she got home, she couldn’t hide. “My mom is just the opposite of me,” she says with a laugh. If one of her children appeared while her mom was changing her drains, “she treated them like little nurses.” She had them wash their hands and help, which made them feel empowered. The drains came out after a few weeks, and Stephanie has had two more (much simpler) procedures to get her new breasts just right. The third surgery was the charm, she reports, and now – a year later – “my results, according to my husband and all the girlfriends I’ve forced to look at them, are very beautiful.” However, this summer is the first time she’s really felt like her breasts are part of her, like she can wear a bathing suit and be comfortable. It was a long road to get used to her body again, and her back was swollen for months. “I’ve never regretted my decision for a second, but some moments were harder than others,” she says. To further reduce her risk of cancer,

Stephanie had a hysterectomy in May 2013, and she says she finally feels ready to get back to her life. “I’m ready to start walking, to start hot yoga, and just get back to normal.” She’s reduced her risk of breast cancer from 87 percent to less than 5 percent and says she feels very lucky to have had a choice in her treatment. “My aunt didn’t have a choice, and thankfully my sister caught it in time,” she says. “I think my sister got cancer first so I wouldn’t die from it,” she adds. And she’s thanked Crystal for that. “It made [my sister] feel better because she knew she’d been the alarm system for me,” Stephanie says. Crystal is now in remission and has had a double mastectomy and reconstructive surgery as well. Stephanie is now looking for ways she can be an alarm for others – her nieces, her daughter someday, even her Facebook friends. “[This experience has] brought our family closer together,” she says. “It gives you clarity on what’s important.”

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Cancer drugs are doing a lot of internal work to turn breast cancer patients into survivors, but it unfortunately comes with a price. Here’s a guide to the most common types of medicines, their side effects and the most effective ways to cope with the downsides.

BY BEV BENNETT CTW FEATURES

egaining your health is paramount when you’re being treated for breast cancer. And if side effects result from your prescribed drug protocol, well, you’ll grit your teeth and deal with them.

Different treatments may be associated with certain side effects. However, the likelihood, type and severity vary greatly with each patient, according to healthcare experts. By being informed, you can talk to your physician about managing any challenges that arise. Tools for relief include other medications, vitamins and stress-alleviating techniques along with exercise – the remedy for many ills. Although it’s helpful to know you could have side effects, it’s not beneficial to focus on potential issues, especially before you take a medication, according to Dr. Tara Sanft, assistant professor of medicine (Medical Oncology) at the Yale School of Medicine, New Haven, Conn. “Most people deal with side effects pretty well. I tell patients they don’t know whether they’ll suffer a side effect until they take the medication,” Dr. Sanft says. Your drug treatment may fall into one of three categories: hormone-blocking therapy, chemotherapy or targeted drugs. Hormone-blocking therapy may be used to treat breast cancers that are sensitive to hormones. Younger women who are treated with these drugs go into menopause. “There’s no therapy to prevent that,” says Janelle Mann, board certified oncology pharmacist, assistant professor of pharmacy practice, St. Louis College of Pharmacy, St. Louis, Mo. Anti-depressant drugs can be prescribed for hot flashes that may accompany menopause. CTW

The drugs may not eliminate the hot flashes, but make them more manageable, according to the pharmacist.

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Breast cancer patients who are past menopause may be treated with aromatase inhibitors. “Joint pain can be very common in women on aromatase inhibitors,” says Dr. Sanft, medical director of adult survivorship for the Yale Cancer Center Survivorship Clinic. Finding medications to relieve the pain is difficult; tolerating pain is the goal, she says.

Massage therapy and exercise are possibilities. Along with joint pain, decreasing bone density is associated with aromatase inhibitors. “We can treat women if they get into a dangerous zone. Weightbearing exercise staves off bone loss and helps improve quality of life,” Dr. Sanft says. Vitamin D may have the potential to both reduce joint pain and to promote bone health, according to Michelle C. Janelsins, assistant professor, University of Rochester Medical Center, Rochester, N.Y. “The key question is how much to take,” says Janelsins, who researches ways to alleviate symptoms related to breast cancer treatments. “It’s really important for women to have their vitamin D checked. We know that a lot of breast cancer survivors have suboptimal levels of vitamin D,” she says. Chemotherapy uses drugs to destroy cancer cells. Hair loss may be your worry if you’re undergoing chemotherapy. The good news is that your hair does grow back, though the texture and even color may be different after treatment is concluded, according to Mann. Many women report they experience “chemo brain,” the perception of not being as sharp as before, according to Dr. Sanft. Learning techniques for focusing and taking art therapy classes for mind stimulation may help, according to Mann. Fatigue may be harder to deal with.

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“Fatigue is common and women may underestimate it. Women think the treatment is over and they should feel normal. It can take months; up to a year for women to resume their energy levels,” Dr. Sanft says.

“Exercise can actually improve fatigue and may speed up recovery,” Dr. Sanft says.

PERMANENT COSMETICS, AREOLA RESTORATION AND SCAR CAMOUFLAGING

Physical activity is also being studied for its role in helping while chemotherapy is still going on, according to Janelsins. “There’s some evidence it may help patients handle a higher level of treatment,” she says. Again, as with vitamin D, the key is finding the optimal amount of exercise for each patient. Targeted drug treatment, which works against specific cancer cell abnormalities, is an interesting and growing area, according to Mann. Symptoms vary, but the more common complaints include diarrhea, headaches and heart muscle changes, she says. Mann recommends over-the-counter medications to combat diarrhea.

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But be prudent using an OTC headache remedy. It could mask a fever that’s part of an infection, according to Mann. Changes to heart muscle cells may require regular CTW

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QUANTIFYING THE SIDE EFFECTS Potential side effects are part of the conversation when you discuss breast cancer drug treatments with a physician. “How will it make me feel,” is the question Dr. Ethan Basch most often hears. Patients want to know how people like them did with a prescribed drug, he says. In return, Dr. Basch wants to give patients an honest appraisal of the benefits and risks of drugs so they can decide based on their own values and situation. Unfortunately, cancer drug labels don’t provide adequate information for those decisions, according to Dr. Basch, director, Cancer Outcomes Research Program, University of North Carolina at Chapel Hill. He is calling on companies to do a better job of collecting and sharing information on how their drugs will affect patients’ symptoms and quality of life. Without that knowledge, treatment may be more difficult for patients, according to the oncologist, author of a recent perspective piece on patient-centered drug development in oncology, published in the New England Journal of Medicine. “Patients want to know whether all the side effects are worth it. People want to know how people like them did with the drug,” Dr. Basch says. The cancer specialist is also working with the National Cancer Institute to develop a system for patients to report their own side effects. “It’s interesting that skeptics of collecting information from patients think patients don’t want to be bothered. [But] they’re pleased to answer questions about how they’re feeling,” he says.

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Moderating alcohol is also an important diet change, since alcohol intake has long been associated with breast cancer risk and recurrence, Thomson says. In addition, alcohol can exacerbate depression, which breast cancer patients and survivors can suffer from for an extended period of time. Diet and exercise always go hand-in-hand, but a recent study by researchers at the Fred Hutchinson Cancer Research Center found that only 34 percent of women met the U.S. physical activity guidelines two years after treatment, 39.5 percent at five years and only 21.4 percent after 10 years. But exercising during or after breast cancer treatments has many benefits, such as improving tolerance to treatments, increasing energy, reducing pain and preventing and managing lymphedema, says Andrea Leonard, president of the Cancer

Exercise Training Institute in Portland, Ore., and author of “Essential Exercises for Breast Cancer Survivors” (Harvard Common Press, 2001).

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“Anything they do to move is going to be a benefit,” she says. Walking included. “Walking is great,” she adds, as is stretching, yoga and even breast-cancer specific DVD workouts. But for more complex exercise routines, Leonard advises working with a trainer who is certified to work with cancer patients and can take into account variables like surgeries, reconstruction and treatments. “It’s not a cookie cutter workout,” she says. “It’s pretty complex.”

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Just about all breast cancer patients and survivors experience a common side effect: unsolicited advice. “Cancer support groups spend a lot of time on this topic because it is so ubiquitous and can be maddening,” says Dr. Ruth Steinman, a Philadelphia-area psychiatrist who has been working with cancer patients for more than 20 years. “I think it can be helpful to say something like, ‘I know your heart is in the right place and that your intentions are to help me, but it doesn’t help me to talk about this. Can we talk about something else?” Of course, finding someone to talk to is essential, whether it be for informational, emotional or practical support. According to Susan G. Komen for the Cure, the benefits of solid support include reduced anxiety, psychological distress and depression, and improved mood, self image and feelings of control. A support group comprised of other patients and survivors may be the key. A number of studies have found that support groups helped increase the quality of life for women dealing with breast cancer, although they did not extend their lives. CTW

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