Think Pink! Breast Cancer Awareness 2018

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A Publication of The Daily Star, Wednesday, Oct. 3, 2018

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By Melissa Erickson More Content Now

ven if breast cancer doesn’t run in the family, experts agree mothers and daughters should talk about breast health and cancer prevention.

“Any time we can have a conversation about something, it makes us feel more in control of the situation.

Having conversations about breast cancer allows people to take control of their health,” said social worker and Ph.D. candidate Erin Nau, counseling and education coordinator at the Adelphi NY Statewide Breast Cancer Hotline & Support Program.

While moms raise their daughters offering parental advice and sharing healthy-living tips, discussions about illness or cancer may not come as naturally, Nau said. Having these difficult conversations can help women prevent cancer or extend their lives if

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Why moms, daughters should talk about breast health

they are diagnosed.

“We recommend women begin to develop a health relationship with their bodies and their breast health at a young age. Once a woman has gone through puberty, she can get to know the normal look and feel of her breasts. The best time to do so is after your period, when your breast tissue is most stable” starting at 18, said Dr. Deborah Lindner, chief medical

officer at Bright Pink, the national nonprofit focused on prevention and early detection of breast and ovarian cancer in young women.

“Be very clear about your medical history,” Nau said. Women with a family history of breast cancer — especially a first-degree relative such as a mother, sister or daughter — have a higher risk of developing the disease, Nau said.

A strong family history doesn’t mean a person will definitely get breast cancer, though, Nau said.

“Every woman should first assess her risk for breast cancer in order to determine the best prevention plan for their health,” Lindner said. “Everyone’s risk is unique, and therefore, their screening and reduction recommendations will be unique, too. Your risk is determined by a combination of factors including your lifestyle, your health history and your family’s health history.” -

Contributing Writer

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Dr. Caridad Fuertes, Bassett radiologist, discusses cancer care with a patient next to a 3D mammography.

to do with it,” she said, noting that screenings are recommended for women 40 and older, excepting those with genetic predispositions for breast cancer.

“Because it is so common, we can’t really predict who it will happen to, so perform monthly self breast exams,” Monahan said.

Learn more about available cancer services at basset.org. -

“Breast cancer is so common — it’s like one in every eight women — so, because of that, there’s been a lot more people coming forward and sharing stories. It’s still very nervewracking to hear a diagnosis, but we’ve made some great advances. Surgeries are smaller, less invasive and there are specialized tests we can do now to really tell a woman her chances of it coming back.”

Amie Monahan, Bassett RN and oncology navigator

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breast cancer diagnosis can send a woman reeling but, thanks to a network of nurse navigators, Bassett Healthcare has people in place to guide patients through individualized treatment plans.

“People used to think a breast cancer diagnosis was a death sentence, but it’s not,” Dara Hotaling, Bassett registered nurse and breast cancer navigator, said. “It’s like putting a puzzle together — everyone has to get all their pieces together before we can design a plan for them. So part of my job starts even before the diagnosis.”

Hotaling, who has been a navigator with Bassett for five years, said her one-on-one patient care begins with screenings. She meets with individuals when they come in for an initial mammogram, then again once a patient is called back for imaging, any possible biopsies and physician consultations and test analyses. Hotaling said she is also involved in the scheduling process, often calling patients and working around employment schedules, driving difficulties and even lodging needs.

“My biggest thing,” she said, “is that it’s nice to have a face — someone a patient can first see and know, ‘This is the person I’m going to see when I come back.’”

“It’s nice that (patients) can ask questions … and get established with someone who starts the process of what they’re going to need and stays with them from there,” she said. “You really do develop a rapport.”

Like Hotaling, Bassett RN and oncology navigator Amie Monahan emphasized that a breast cancer diagnosis doesn’t have to mean a loss of hope. Monahan has worked as a navigator for three years.

“Breast cancer is so common — it’s like one in every eight women — so, because of that, there’s been a lot more people coming forward and sharing stories,” she said. “It’s still very nerve-wracking to hear a diagnosis, but we’ve made some great advances. Surgeries are smaller, less invasive and there are specialized tests we can do now to really tell a woman her chances of it coming back.”

Monahan said she joins a patient’s journey once treatment is underway. The nurse navigator system, she said, is department-specific.

“The process we have at Bassett is that they’ll

see a breast surgeon first, then start discussing options and … in most cases, women need an appointment with oncology and radiation. My role is to help guide those patients through their treatment plan and make sure they’re comfortable.”

As with treatment, Monhan said, handling how to share a breast cancer diagnosis with family, friends and employers is highly individualized.

“A lot of it depends on what the person’s preference is,” she said. “It’s just whenever they feel most comfortable with telling people.”

“We always recommend telling close family members, especially children, once you have the most information about what the treatment plan is going be,” Monahan said. “And we have resources here that we can give patients to help with telling children. Just be honest.”

Hotaling said the earlier a diagnosis is shared, the sooner a support system can grow.

“The biggest thing is to tell people,” she said, “because they can support you once they know.

And I encourage patients, when they meet with the surgeon or doctors, to take someone with them. Don’t go by yourself; you’re not processing.”

Additionally, Hotaling said, Bassett supplies patients with a comprehensive packet of information detailing where to find support groups, recommended bras and wigs, supplies for after-cancer care, reconstructive surgery options and more.

A peer-led support group, Monahan said, meets monthly at the State University College at Oneonta.

“That’s run by people who are survivors,” she said, “and it’s not specific to a breast cancer diagnosis.”

According to Bassett literature, the group convenes the third Wednesday of every month from 4 to 5:30 p.m. in the Hunt Union Butternut Valley Room. For more information, call 607-436-3114.

The American Cancer Society-sponsored “Look Good, Feel Good” support group is available to women with any kind of cancer diagnosis hoping to address treatment-related skin, scalp and hair issues. Led by a cosmetologist-cancer survivor, the group meets every other month from 11 a.m. to 1 p.m. in Conference Room 1 of the clinic building at Bassett Medical Center in Cooperstown. Call 547-4963 for more information.

Monahan said preventative self-care is another vital consideration when it comes to breast cancer.

“Staying up to date with mammograms has a lot

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By Allison Collins

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Navigators guide breast cancer patients

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HELP How to a friend with cancer

By Melissa Erickson More Content Now

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ou may not be a doctor, but for someone who has breast cancer, a good friend is the best thing you can be.

“Support is a strong weapon in the fight against breast cancer,” said Brooke Parker Wingate, director of social media and educational outreach at the American Breast Cancer Foundation. “According to Psychology Today, a new study shows that supportive friendships during diagnosis, treatment and recovery can make a huge impact on the lives of those who have been affected by the disease. It improves patients’ quality of life, as well as their morale through the difficult treatment process. It also has the potential to increase survival for certain women, and those with strong social ties are less likely to have cancer re-occur.”

Not sure how to help?

“There are hundreds of things you can do,” said Sandy Finestone, a member of Komen’s Scientific Advisory Board and a breast cancer survivor who runs support groups. Here are just a few:

Share your journey If you’ve experienced breast cancer, share your knowledge and practical suggestions.

One way to help is to interpret the language of the medical community, which can be confusing to a person newly diagnosed, Finestone said. Additionally, sharing your success — being a survivor — can make someone feel safe and give her confidence, Finestone said.

Live life outside of cancer “Remember the best friend you had before they were diagnosed? They haven’t changed, just their health has,” Wingate said. “Although cancer is a big part of their lives, that doesn’t mean that’s the only thing they have going on or want to talk about. There is a life outside of cancer. Make sure your friend is being treated the same as they were before. Don’t ever be afraid to talk or learn about your friend’s cancer process, but remember that it doesn’t need to be your only topic of conversation.”

Visit the doctor together Being a good friend means accompanying

a friend to doctor’s appointments and taking notes.

A woman diagnosed with breast cancer is overwhelmed and not always hearing what the doctor says, Finestone said. Taking good notes is not only helpful, it’s crucial to her getting good health care.

Be specific Saying, “Let me know if there’s anything I can do” or “I’m here if you need to talk” sounds helpful, but really, it puts the effort on your friend, not yourself.

“Instead of having them ask you for favors, suggest your own,” Wingate said. For example: “I’m going to the grocery store; what do you need?” or “When’s your next checkup? I’m available to drive and keep you company.”

Go fish for a favor Fill a fish bowl, jar or vase with strips of paper that each list a small favor that would be appreciated, such as “pick up the dry cleaning” or “drive Joey to football practice,” Finestone said. Not only is it easy, it lets everyone off the hook.

“People truly want to help, but no one has time

to make dinner for someone else every night of the week. I can make dinner on Tuesday night, though,” Finestone said.

Lend an ear “There are a lot of important decisions that have to be made when you have breast cancer. Sometimes being able to talk them out to someone makes all the difference in what to decide,” Wingate said.

“Let them vent to you about how they are feeling, what decisions they need to make, or even the latest celebrity gossip they wanted to dish to you about.

There may be times that your friend won’t even want to talk, but just want your company.”

Notes and calls Make sure your friend continues to know she is important to you. Send brief but frequent notes or texts or make short regular phone calls, suggests the American Cancer Society. Ask questions and end with “I’ll be in touch soon.” Be sure to be in contact when it’s convenient for your friend and return messages promptly.

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Schedule a visit

Women struggling with breast cancer put on brave faces with their families and at work, Finestone said. A good friend will allow them to let down their guard, be vulnerable and show their fear.

Let her confide in you.

When a good friend says she’s frightened, your job is to answer back, “That’s normal.

I’m there for you.”

Cancer can be isolating, but make sure to schedule visits rather than just dropping by, according to the American Cancer Society. Try to arrange a visit when you can give a regular caregiver an opportunity to get out of the house.

Begin and end with a touch, hug or handshake. Be understanding if asked to leave.

Offer to bring a snack or treat so as not to impose, and refer to your next visit so your friend can look forward to it.

Small acts of kindness

“The perfect gift doesn’t have to be perfect at all. What are your friend’s favorite things to do? Eat? Use your best-friend knowledge to pick out fun things that show them you care,” Wingate said. “The smallest gifts can sometimes be the most meaningful. You know your friend better than anyone else. Cancer doesn’t have to be the theme of the gift in order for it to be personalized towards them.”

Run an errand; do a task

Hydrate for a cause During October, 20 percent of the retail price of the 17-ounce Bikini Pink S’well bottle is donated to the Breast Cancer Research Foundation. A partner of the not-for-profit organization since 2015, S’well has helped fund more than 700 hours of breast cancer research.

Follow her lead “The best thing a friend can do for a friend going through a hard time is to be respectful and follow their lead. Does your friend want to talk about it? Talk about it!

Is your friend avoiding the topic like the plague?

You better not bring it up,” said Molly Borman, founder and chief executive officer of Just Nips.

Just Nips are a fun gift for friends going through treatment and reconstruction, but the self-adhesive fake nipples can be worn by anyone or are a great conversation starter.

“Losing your nipples is one of the most under-discussed parts of certain breast cancer treatments, and we are all about normalizing that aspect as part of our commitment to body positivity and acceptance for all types of bodies,” Borman said.

Be creative

S’WELL

Some great ideas from the American Cancer Society: Clean a friend’s home for an hour every Saturday. Babysit her children. Return or pick up a library book. Buy groceries. Go to post office.

Help make to-do lists. Commit to taking her child to sports practice or music lessons.

Don’t delay Show your support by getting a mammogram.

“Early stage breast cancer is highly curable, so early diagnosis is important. In ALEX AND ANI fact, nearly 90 percent of all patients have early stage breast cancer,” said Dr. Dennis Citrin, medical oncologist at Cancer Treatment Centers of America, Chicago. “It is important that a woman, or man, does not delay when they feel an abnormality in their breast(s).”

Stay stylish Breast cancer is a cause that is close to the heart of jewelry designer Kendra Scott, whose company donates 20 percent of the purchase price of items in a specially chosen collection to the Breast Cancer Research Foundation, up to $50,000.

Think pink Alex and Ani’s new Pink Tulips charm bangle,

It’s OK to not be OK “Cancer affects more than just the individuals who have been diagnosed with the disease.

Breast cancer places an emotional toll on the family, friends and loved ones,” Wingate said. “If you are struggling to cope with a friend’s cancer, you are not alone. Talk to someone about how you’re feeling, what your concerns are and learn how to healthily process these emotions.

“It’s OK to not be OK, but often when people aren’t able to handle their friend’s sickness, they ignore or avoid the situation, abandoning their friend in their greatest time of need. Be there for yourself and talk to someone about your emotions, so you can be there for your friend.” -

How friends and family can help when a loved one has cancer What to Expect: • Shock of diagnosis of a life-threatening disease • Confusion with choices of surgery and treatment • Concerns about self-image due to surgery and treatment • Worry about reactions of friends and family members • Fear and uncertainty about the future

Do: • Listen • Offer specific help with household chores, meals, transportation, childcare, etc.

• Take cues from the person • Let feelings be expressed • Expect mood changes • Be there

Don’t: • Tell the person what to do • Avoid the person • Share horror stories • Be afraid of the person’s sadness; it’s normal.

— Information from the Adelphi NY Statewide Breast Cancer Hotline. Call 800877-8077 to speak with a breast cancer survivor on the hotline or visit http:// breast-cancer.adelphi.edu

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“Coming over to watch a movie when they aren’t feeling well, bringing over a homecooked meal, a donation to a cancer research organization (made in her name), a handwritten card or email are all simple ways to keep in touch and let your friend know you are thinking about them,” Wingate said.

JUST NIPS

$38, will brighten her day with its rosy hue and hopeful aroma. Twenty percent of the purchase price of each bracelet will be donated to the Breast Cancer Research Foundation. Available in gold or silver.

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Let her vent

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Regrowing and caring for hair after chemotherapy

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hemotherapy and radiation are common treatment options for people who have been diagnosed with cancer. While radiation may be targeted at specific areas, chemotherapy is systemic. This means it affects the entire body. As a result, as chemotherapy kills fast-growing cancer cells, it also kills or slows the growth of healthy cells, including hair cells, that divide and grow quickly, explains the National Cancer Institute.

When chemotherapy treatment is completed, the body is typically capable of regenerating new hair, but that can take some time. Women who consider their hair a large part of their identity may have strong concerns and fears regarding hair loss and what their hair may look like when it begins to regrow.

Understanding what to expect and what they can do to facilitate the regrowth of hair can help women better handle what lies ahead.

New hair typically begins to grow within one to two months of the last chemo treatment. Breastcancer.org says people who have undergone chemotherapy may notice soft fuzz forming on their head roughly two to three weeks after the end of chemo. This will be followed by real hair growing at its normal rate one month afterward. Two months after the last treatment, an inch of hair can be expected.

How hair grows back elsewhere on the body, such as the eyelashes, eyebrows and pubic area, varies from person to person. Experts at the Robert H. Lurie Comprehensive Cancer Center’s Dermatologic Care Center at Northwestern University in Chicago recommend speaking with a doctor if hair is not regrowing

quickly, which can be the result of low levels of iron or zinc or even thyroid problems.

To help the process along, some doctors suggest the use of supplements like biotin. The National Institutes of Health says biotin is a B vitamin found in many foods that helps turn carbohydrates, fats and proteins into energy.

There is some evidence that taking biotin can help thicken and speed up the growth of hair and nails, but more research is needed.

Rogaine¨, the baldness treatment, also may be advised, as it’s been shown to speed hair regrowth in breast cancer patients who have lost their hair, advises Health magazine.

It is not uncommon for hair grown after chemotherapy to look and feel different from hair prior to treatment. Someone who once had straight hair may develop a wavy mane afterwards. While drastic changes are not common, blonde hair may darken.

As hair grows in, certain areas on the head may grow faster than others. Working with an experienced stylist can help a person achieve a look that is evened out and stylish at any length. Rosette la Vedette, a headwear retailer and cancer resource, suggests making a first trip back to the salon a special experience with a glass of champagne. Cutting hair won’t make it grow faster, but it can help a woman return to a sense of normalcy.

It can be nerve-wracking to wait for hair to regrow after chemotherapy. But patience and understanding the road ahead can assuage any fears breast cancer patients may have about regrowing their hair. -

Although research has shown that support groups can be extremely helpful to women coping with breast cancer, sometimes it is not possible for a woman to travel to a group. To help, the Adelphi NY Statewide Breast Cancer Program has established an on-line group for women under the age of 40. This group meets on Tuesdays at 6 pm.

Says social worker Erin Nau, “This on-line group makes it possible for a woman no matter where she is located in New York State to come together with other young women coping with breast cancer, whether she is in a rural area where there are no groups, in a hospital or at home or work. All she needs is a cell phone to be part of the group.”

Nau asks women who are interested in joining the online group to call her at 516-877-4314. This group is supported by a SPARC grant from the International Association for Social Work with Groups.

The Adelphi NY Statewide Breast Cancer Hotline & Support Program, established in 1980, provides information and emotional support to breast cancer patients, their families and friends, and the community. The hotline number is 800-877-8077. You are not alone.

Online Support Group for Young Women with Breast Cancer

disease,” said Simon Knott, Ph.D., associate director of the Center for Bioinformatics and Functional Genomics at Cedars-Sinai and one of two first authors of the study.

The research from this study was conducted at more than a dozen institutions.

Apart from dietary restrictions, metastasis also could be greatly limited by reducing asparagine synthetase using chemotherapy drug L-asparaginase.

More research is needed as to whether similar results can be produced in human trials, making avoiding asparagine currently a helpful but not entirely foolproof method for preventing the spread of breast cancer to other areas of the body. -

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laboratory mice with triple-negative breast cancer could dramatically reduce the ability of the cancer to travel to distant sites in the body.

Asparagine is found in foods like asparagus, whole grains, soy, seafood, eggs, poultry, beef, legumes, and more. While reducing asparagine will not affect the original breast cancer tumor, it could stop cancer from showing up elsewhere in the body. Researchers suspect that many women with breast cancer do not lose their lives to the original breast cancer tumor, but instead they succumb to metastases or subsequent growths away from the primary site.

“Our study adds to a growing body of evidence that suggests diet can influence the course of the

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ealthy diets that include plenty of antioxidant-rich fruits and vegetables that can boost the body’s natural immune system can help people in their fight against cancer. While some foods, namely unhealthy, high-fat/high-caloric foods, are best avoided, women who have been diagnosed with breast cancer who want to prevent the spread of cancer to other areas of their bodies may want to cut some surprising foods from their diets.

Preliminary research now suggests limiting the consumption of asparagine, an amino acid, to dramatically reduce the ability of cancer to spread to other parts of the body. A study published in the journal Nature found that reducing asparagine consumption in

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Can diet prevent breast cancer from spreading?

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One key safeguard is for women to maintain a healthy weight, especially in midlife and later. After menopause, most of the hormone estrogen in a woman’s body comes from fat cells.

Estrogen can spur the growth of many breast tumors, and being overweight or obese can raise breast cancer risk.

Women may be especially vulnerable to breast cancer if extra pounds settle on their waist, rather than their hips and thighs.

These additional steps may help women reduce their risk for breast cancer, according to the American Cancer Society: • Avoid alcohol. Drinking is clearly tied to a heightened risk of developing breast cancer. In fact, your risk increases the more you drink; • Be active. A growing body of research indicates that exercise lowers breast cancer risk. Aim for 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week; • Carefully weigh the pros and cons of hormone therapy. Hormone therapy that uses both estrogen and progesterone can increase breast cancer risk. The short-term use of estrogen alone after menopause does not seem to raise the risk of developing breast cancer, but only women without a uterus may take estrogen alone. If a woman and her

“Most importantly, don’t be afraid to get screened for breast cancer. Screening mammograms are the best way to find cancer early and an early diagnosis offers us the best chance to save lives.”

Valerie Maddalone, family nurse practitioner with Bassett Healthcare Network

Regular mammograms (breast x-rays) can detect cancer in its early stages and give women a head start on potentially lifesaving treatment. If you have a heightened risk of breast cancer, ask your doctor if you need additional screening tests, such as an MRI scan.

Five facts you may not know about breast cancer Even though breast cancer is far too common, some facts about it may still surprise you. Here’s a look at five of them:

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1. Breast cancer is not the leading health threat to women.

Heart disease is actually far deadlier for women. Nationwide, breast cancer causes 1 in 31 female deaths every year. But coronary heart disease causes 1 in 8 female deaths.

2. Most breast cancer is not inherited. Only about 5 to 10 percent of all breast cancers appear to develop directly from gene defects — such as those in the BRCA1 or BRCA2 gene — passed on from a parent. What’s more, while having a close relative with breast cancer does raise your risk, less than 15 percent of women who get breast cancer have a family history of the disease.

3. A preventive mastectomy doesn’t completely eliminate the risk of breast cancer. Some women who are at high risk for getting breast cancer opt to have both breasts removed to avoid the disease. A preventive mastectomy can, in fact, reduce the risk of developing breast cancer by 90 percent or more. But some risk still remains, because even a mastectomy can’t remove all breast tissue.

4. Dense breasts are a risk. Women with dense breasts — breasts with more fibrous and glandular tissue and less fatty tissue — have up to twice the risk of breast cancer as a woman with average breast density. Dense breasts may also make mammograms less accurate. Ask your doctor if your breasts are considered dense — you can’t tell by touching them. If the answer is yes, the two of you can discuss whether you need additional imaging tests, such as an ultrasound or MRI. 5. The effects of a fatty diet aren’t clear. Many studies indicate that breast cancer is less common in countries where the typical diet is low in fat. But so far studies haven’t found a definitive link between higher fat diets, like those eaten in the U.S., and breast cancer.

Be active.

A growing body of research indicates that exercise lowers breast cancer risk. Aim for 150 minutes of moderateintensity or 75 minutes of vigorous-intensity activity each week.

4 5 Do you know the warning signs of breast cancer?

Ask a woman to name a sign or symptom of breast cancer, and chances are she’d say a lump in the breast. She’d be right, of course. A new lump or mass is the most common symptom of breast cancer. But it’s not the only one. And because it’s best to find breast cancer early, it’s important to know all the possible signs and symptoms of the disease.

Stay alert Being familiar with how your breasts look and feel is a key component of breast health. If you notice any of the following signs or symptoms in a breast, you should see a doctor right away: • A lump. Cancerous breast lumps tend to be hard, painless and irregular (rather than rounded) around the edges; • Swelling of all or part of a breast — or sometimes in the armpit or collarbone area — even if you can’t feel a lump; • Irritated or dimpled breast skin; • Breast or nipple pain; • A nipple that points inward; • Red, scaly or thickening nipple or breast skin; • Nipple discharge, which may be bloody or clear.

Any of these signs and symptoms,

including lumps, can be caused by things other than cancer. But only a doctor can tell for sure.

What happens next?

If you have a lump or breast change, your doctor will examine your breasts.

He or she may also order tests to take a closer look. These may include a diagnostic mammogram, which is just like having a screening mammogram except more x-rays are taken; a breast ultrasound, which uses sound waves to create an image of the inside of the breast; or a biopsy to check a sample of breast tissue for cancer It’s important to remember that breast changes are very common, and most are not cancer. But it’s crucial to get any follow-up tests your doctor orders.

Bassett Healthcare Network Family Nurse Practitioner Valerie Maddalone is a breast cancer specialist who travels throughout the Network’s eight-county service region seeing patients on Bassett’s mobile medical screening coach as part of the Cancer Services Program of the Central Region. To schedule a breast exam, mammogram or other cancer screening on the mobile medical coach, call (607) 433-3707.

Sources: U.S. Preventative Services Task Force; National Cancer Institute -

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Be as healthy as possible

doctor agree that hormone therapy is necessary to ease bothersome menopausal symptoms, such as hot flashes, it is best to take the lowest effective dose for the shortest possible time.

Because breast cancer can develop even with these precautions, the U.S. Preventive Services Task Force advises women at average risk of breast cancer to have mammograms starting at age 50. Some women may choose to be screened earlier based on family history, personal preference and insurance coverage. Discuss the recommendations with your provider.

“Most importantly, don’t be afraid to get screened for breast cancer,” said Valerie Maddalone, a family nurse practitioner with Bassett Healthcare Network. “Screening mammograms are the best way to find cancer early and an early diagnosis offers us the best chance to save lives.”

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f all the diseases we face as women, few may concern us more than breast cancer.

Almost certainly, you know someone — a loved one, a friend, a neighbor — whose MADDALONE life has been touched by the disease. As of yet, there is no sure way to prevent breast cancer, the second leading cause of cancer deaths among women in this country. Even so, there are clear steps women can take to reduce their risk. And October, which is nationally recognized as Breast Cancer Awareness Month, is the ideal time to take them.

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Your game plan for getting ahead of breast cancer

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What is triple-negative breast cancer?

By Melissa Erickson More Content Now

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“We define triple-negative breast cancer by what it isn’t. When you define something by what it is not, it’s harder to treat.”

Dr. Priyanka Sharma

reast cancer is a disease that gets a fair amount of attention, but not all breast cancers are the same. Triple-negative breast cancer is the rarest and most aggressive form of the disease, affecting only about 15 percent of all breast cancer patients.

“There are many different types of breast cancer, and clinically we group them according to three receptors: the estrogen receptor, the progesterone receptor and the human epidermal growth factor 2/neu (HER2) receptor. Breast cancers that lack these receptors are called triple-negative breast cancers,” said medical oncologist and breast cancer specialist Dr. Cesar Santa-Maria, assistant professor of oncology at Johns Hopkins University School of Medicine.

Overall, breast cancer affects 1 in 8 women in

her lifetime, said Dr. Priyanka Sharma, an oncologist studying triple-negative breast cancer at the University of Kansas Cancer Center in Kansas City.

A person faced with an illness often hopes for a definitive test that can reveal the medical issue and lead to treatment and a cure. For people with triple-negative breast cancer, that test doesn’t exist, Sharma said.

“We define triple-negative breast cancer by what it isn’t. When you define something by what it is not, it’s harder to treat,” she said.

What it is About 70 percent of breast cancers grow in response to estrogen or progesterone hormones. About 15 percent of breast cancers are HER2-positive. Triple-positive breast cancers occur when cancer cells test positive for estrogen and progesterone receptors as well as HER2 protein. Triple-negative breast cancers test negative for all three.

Other ways triple-negative breast cancers stand out are that they grow faster, are more likely to return after treatment with a poorer prognosis, and are more likely to affect women before ages 40 or 50. Triple-negative breast cancers are also more common in African-American and Hispanic women and those who carry the BRCA gene.

“Although triple-negative breast cancer is less curable than other forms of breast cancer, it is still a curable cancer,” Sharma said. With standard treatment of surgery, radiation and chemotherapy about “70 percent of patients with nonmetastatic (such as stage I, II or III) triple-negative breast cancers are cured. So you could say the survival rates are 70 percent,” she said.

Tailored treatment Targeted drugs like anti-estrogen agents and anti-HER2 drugs that work for the other three types of breast cancer won’t work for triple-negative breast cancer. Treatment requires a more tailored approach, and patients may benefit

from participating in a clinical trial, both experts agreed.

“I would encourage patients to discuss with their oncologists clinical trial options for those newly diagnosed with triple-negative breast cancer, whether in early or advanced stages. It is through research that we can bring about better treatments, and often clinical trials can provide access to novel agents that are not yet available in clinic,” Santa-Maria said.

To gather more information about the disease and what causes it, Sharma created a triple-negative breast cancer registry in 2011.

“The main goals of the registry are to improve our understanding of clinical and biological aspects of triple-negative breast cancers and genetic cancers. This registry is open at 13 locations in our region and has more than 900 participants,” Sharma said.

Within the umbrella of triple-negative breast cancer, Sharma believes subtypes exist. Once these are better understood, specific treatments can be created based on what is best for each woman, Sharma said.

“We are all very hopeful for the future. There are several new agents/targeted drugs that have shown promise in early studies,” Sharma said.

“Since triple-negative breast cancer is a heterogeneous disease we expect that over the course of time several different targeted drugs would need to be employed in clinic to improve outcomes for this subtype. In other words, there is no single triple-negative breast cancer. There are instead many different diseases in this subtype that may each require different, targeted drugs.”

Numerous treatment strategies are in the works.

“One promising area of research is to use immunotherapy. Immunotherapy can stimulate a patient’s own immune system, allowing the immune system to attack and kill cancer cells,” Santa-Maria said. Additionally, there is hope for using immunotherapy-based combinations, such as with chemotherapy, he said. -

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BIGSTOCK.COM

OCT. 3, 4 AND 5, 2018

Gene mutations that contribute to risk can also signal prostate, pancreatic cancers

By Melissa Erickson More Content Now

“Men who carry BRCA mutations are at higher risk for a variety of cancers including breast, prostate, pancreatic and melanoma.

In particular, males who carry BRCA2 mutations are at increased risk of often early and more aggressive prostate cancers.”

Dr. Christopher Childers, UCLA

H

aving a mother or daughter who carries a mutation on the BRCA1 or 2 genes puts women at an increased risk of developing breast and ovarian cancer. The same is true for men, although few men undergo genetic testing.

“Men are equally as likely as women to inherit a BRCA mutation,” said Dr. Christopher Childers, a resident physician in the department of surgery at the David Geffen School of Medicine, University of California-Los Angeles. “If a male has a BRCA mutation, his risk of breast cancer increases a hundredfold.”

A study published in JAMA Oncology in April found that few men are screened for BRCA genetic mutations. Analyzing data from the 2015 National Health Interview Survey, researchers found that men underwent testing for breast/ovarian cancer genes at one-tenth the rate of women.

It may be the first national study analyzing the rates of genetic cancer testing for both men and women, Childers said.

“Men who carry BRCA mutations are at higher risk for a variety of cancers including

breast, prostate, pancreatic and melanoma.

In particular, males who carry BRCA2 mutations are at increased risk of often early and more aggressive prostate cancers,” Childers said.

family,” she said. “It’s important for men to know that if their female relatives have ovarian or early breast cancers, that this may translate into a higher cancer risk for them, too.”

Check family history

Course of action

Previous studies have shown that men believe breast cancer is a female issue, but this couldn’t be farther from the truth, said genetic counselor Kimberly Childers, study co-author and regional manager at the Center for Clinical Genetics and Genomics at Providence Health & Services Southern California. The Childerses are married.

“The strongest risk factor for carrying a BRCA mutation is having a family member with a BRCA mutation. If your mother, father, sister, brother or child has a BRCA mutation, you have a 50 percent chance of having the mutation as well,” Kimberly Childers said.

Other factors that may indicate a high probability of carrying a mutation include a personal history of male breast cancer, pancreatic cancer or high-grade or metastatic prostate cancer, Kimberly Childers said.

“Men without a history of cancer may also be at risk of carrying a mutation if there is a strong history of these cancers in their

Men with a BRCA mutation are recommended to undergo clinical breast exams every year starting at age 35, Christopher Childers said.

“Once a BRCA mutation is identified, it is important that they ask their doctor to show them how to perform a self exam of their chest, learning what abnormal tissue might feel like and what could be of concern,” he said.

Most but not all breast cancers in BRCA-positive men occur after age 50.

Starting at 45, men with BRCA mutations are often recommended to undergo prostate cancer screening (prostate-specific antigen and digital rectal exams), Christopher Childers said.

If men are concerned about their risk they should discuss it with a primary-care provider or genetic counselor. To find a local genetic counselor, visit nsgc.org/ findageneticcounselor. -

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Breast cancer & men

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By Melissa Erickson

F After

BIGSTOCK.COM

Think Pink! - THE DAILY STAR

OCT. 3, 4 AND 5, 2018

More Content Now

MASTECTOMY

Large study follows reconstruction patients for info on outcomes

or women facing a mastectomy, information is the power to choose what is best for their health, well-being and quality of life.

A June study sponsored by the University of Michigan from a multicenter research consortium aims to help breast cancer patients make decisions about breast reconstruction while armed with the facts about the risks and rewards associated with different surgical options. The study, published in JAMA Surgery, followed 2,300 women who had breast reconstruction surgery and tracked their outcomes for two or more years to compare the most commonly used techniques, risks and complications for reconstruction.

Breast reconstruction after a mastectomy is associated with significant quality of life benefits. However, like all health-care interventions it has pros and cons, said Dr. Edwin Wilkins, professor and researcher at Michigan Medicine who was involved in the study.

There is no right answer to which is the best type of breast reconstruction surgery, said Dr. Andrea Pusic, chief of plastic surgery and reconstructive surgery at Brigham and

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Options and outcomes

Dr. Andrea Pusic

Myriad choices The Mastectomy Reconstruction Outcomes Consortium study provides women with valuable yet complicated and contradictory information, Wilkins said. There are trade-offs to whatever option a woman chooses.

For example, women who had flap (natural tissue) reconstruction were twice as likely to experience some sort of complication within two years, but the failure rate was among the lowest, Wilkins said. Women who made this choice were significantly more satisfied with their breasts and breast-related quality of life two or more years after surgery than those who had implants.

Some of these women reported feeling even more satisfied than their pre-surgery baselines, but others said tightness and pain in the abdominal wall persisted for years after surgery.

Breast reconstruction surgery has come a long way, Pusic said. In the past surgeons needed to take away more muscle, but now the standard is to disturb less for better outcomes.

There are at least six distinctly different breast reconstruction options, Wilkins said, and “there’s no one best option.” Giving women the information empowers them to work with their doctors to make good decisions, Wilkins said. -

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“Complications do happen. Close to 1 in 3 women has some sort of post-surgical complication.”

About 40 percent of women who undergo a mastectomy have breast reconstruction surgery, according to 2014 data released last year by the federal Agency for Healthcare Research and Quality.

The two main options for breast reconstruction are artificial implants filled with saline or silicone gel and flap surgery, also called autologous reconstruction, which uses a woman’s own tissue often from the abdomen. Both have risks and benefits. Breast reconstruction can be done immediately after mastectomy surgery or later as a second surgery depending on an individual’s preference and needs.

“Complications do happen. Close to 1 in 3 women has some sort of post-surgical complication,” Pusic said. Some were minor “bumps in the road” such as a wound infection; others were more severe and required a secondary surgery, Pusic said.

A 33 percent complication risk does sound high, but the complication rate for mastectomy alone is 20 percent, Wilkins said.

While complications are common, failure is not, Wilkins said.

“The risk of failure is extremely low,” Pusic said.

OCT. 3, 4 AND 5, 2018

Women’s Hospital in Boston.

“There is no single story,” Pusic said. The goal is to help women understand the pros and cons, to know they have choices and to recognize their options, she said.

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OCT. 3, 4 AND 5, 2018

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F

or 38 years, the Adelphi NY Statewide Breast Cancer Hotline & Support Program has been answering questions from people concerned about breast cancer. Here are some frequently asked questions.

Q. If my doctor tells me I have breast cancer, does that mean I’m going to die?

A. A diagnosis of breast cancer is not a death

sentence. When breast cancer is found early, the survival rate is high. That is why it is so important to practice early detection methods like annual mammograms, age 40 and over.

Q. How many women develop breast cancer each year?

A. About 1 in 8 U.S. women (about 12%) will

develop invasive breast cancer over the course of her lifetime. In 2018, an estimated 268,670 new cases of breast cancer are expected to be diagnosed in the U.S.

Q. What are the factors that put a woman at higher risk for breast cancer?

A. The two most significant risk factors are being female and getting older. The majority of women diagnosed with breast cancer have no other known risk factors.

Q. Am I at risk for Breast Cancer?

A. All women are at risk of developing breast

cancer. Speak to your health care provider who will talk with you about your family history and your own individual risk factors.

Q. As a Hispanic woman, should I be more concerned about breast cancer?

A. Although the incidence of breast cancer is

lower for Hispanic women, more Hispanic women are diagnosed at a later stage than white women, when cancer is harder to treat.

BREAST CANCER

Q& A A. Age is the number one risk factor for breast

cancer. Older women are much more likely to get breast cancer than younger women. Most breast cancers (about 80%) occur in women ages 50 and older. About 5% of all breast cancer cases occur in women under the age of 40. It is recommended that women start annual mammography at age 40.

Q. Can exercise reduce my risk for breast cancer?

A. Several studies indicate that women who

exercise at moderate to vigorous levels (3-4 hours per week) may reduce their risk level.

Q. Does what I eat affect my risk of getting breast cancer?

A. What we eat affects our health and well-be-

ing. Research is suggesting that a diet rich in fruits, vegetables and grains may play a role in reducing the risk of breast cancer. Moderation is the key.

Q. Is obesity a breast cancer risk factor?

A. Being overweight is linked to elevated risk, especially in older women.

Q. Does smoking increase my risk of breast cancer?

A. Studies suggest that smoking may increase your risk for breast cancer.

Q. As an African-American woman, should I be Q. Does drinking alcohol increase my risk of more concerned about breast cancer? breast cancer?

A. Although the incidence of breast cancer is A. Some studies suggest that drinking one or lower for African-American than white women, the mortality or death rate is higher.

Q. Do men get breast cancer?

A. Yes, male breast cancer makes up about one percent of all cases of breast cancer.

Q. Am I more at risk of developing breast cancer as I age?

more alcoholic drinks a day may increase your risk.

Q. I have family members who have had breast cancer. Should I have genetic testing?

A. Researchers have identified specific genes

linked to breast cancer. Tests are available for those who choose to find out if they have inherited the genetic changes that increase risk. A doctor or genetics counselor can provide more information

on the risks, benefits and consequences of genetic testing.

Q. How often should I get a mammogram?

A. If you are 40 or older you should get a mam-

mogram every year. If you are under 40 and have a family history of breast cancer or have other concerns about your personal risk, you should consult a trained medical professional about when to begin getting a mammogram.

Q. Why aren’t routine mammograms done on women under age 40?

A. Pre-menopausal women have dense breast

tissue that can make the evaluation of mammograms less sensitive. If a breast abnormality is found during a self-exam or regular physical, an evaluation may include the use of an ultrasound and a mammogram even in women under the age of 40.

Q. What is a screening mammogram?

A. A screening mammogram is an x-ray of the

breast used to detect breast changes in women who have no signs or symptoms of breast cancer. With a mammogram it is possible to detect micro-calcifications (tiny deposits of calcium which sometimes are a clue to the presence of breast cancer) or a tumor that cannot be felt.

Q. What if I’m uninsured and cannot afford a mammogram?

A. There are Cancer Services Partnership Programs across New York State that provide free or low cost mammography.

Call the Adelphi Statewide Hotline (800-8778077) for information about this and other government and local assistance programs.

Q. I know someone who has breast cancer.

How can I help?

A.

Be there to listen, let them express their feelings. Offer specific help with household chores, meals, transportation, childcare, etc. Take your cues from them; let them tell you what they need.

Let feelings be expressed. Be there.

Don’t tell them what to do. Don’t avoid them.

Don’t share horror stories. Don’t treat them like an invalid.

Above all, don’t avoid them and don’t be surprised if they have mood swings, or seem sad – it’s normal.

— Breast Cancer Q&A provided by Adelphi NY Statewide Breast Cancer Hotline & Support Program: 800-877-8077, http://breast-cancer.adelphi. edu -

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Pathology reports are documents that contain diagnoses after doctors have examined cells and tissues under a microscope. According to the National Cancer Institute, pathology reports, which play an important role in diagnosing and treating cancer, also may contain information regarding the size, shape and appearance of a specimen as it looks to the naked eye.

People who are diagnosed with breast cancer may receive pathology reports that indicate the presence of tumor necrosis. According to the nonprofit organization Breastcancer.org, the presence of tumor necrosis means that dead breast cancer cells were found within the tissue sample. Tumor necrosis, though it is often limited to a small area within the tissue sample, suggests a patient is battling an aggressive form of breast cancer.

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Did you know?

OCT. 3, 4 AND 5, 2018

“Knowledge is Your Superpower” is the message of the Adelphi NY Statewide Breast Cancer Hotline’s October outreach campaign, urging New Yorkers to use the resources that are available for screening and coping with breast cancer. Says Hillary Rutter, the director of the free hotline, “Our program can help people find out how to get a free or low-cost mammogram, learn about breast cancer programs in their community and talk to a breast cancer survivor on the hotline.”

New York State residents can call the hotline at 800-8778077 to find out how to get a free or low-cost mammogram in their communities or to get any answers to questions they may have about breast cancer.

Think Pink! - THE DAILY STAR OCT. 3, 4 AND 5, 2018

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