Think Pink - Breast Cancer Awareness

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A Publication of The Daily Star, Wednesday, Oct. 4, 2017

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Awareness Some content provided by Gatehouse Media LLC, and distributed by King Features. Reproduction in whole or in part without prior written permission is strictly prohibited. Opinions expressed in the publication are those of the authors and do not necessarily represent those of publication management. ©2017 GATEHOUSE MEDIA. ALL RIGHTS RESERVED

Gene mutations and breast cancer Only about 5 to 10 percent of all breast cancers diagnosed in the United States are due to inherited gene mutations known to increase risk, according to the American Cancer Society.

By Melissa Erickson More Content Now

I

n the fight for a cure for breast cancer, BRCA1 and BRCA2 get a lot of attention, but many people don’t understand how these genes’ mutations affect their risk of developing the disease.

BRCA1 and BRCA2 (short for BReast CAncer 1 and 2) are human genes that produce tumor-suppressor proteins, according to the National Institutes of Health. These proteins help repair damaged DNA and play a role in cell growth and cell division.

These are genes we all have in our bodies. It’s when these genes have mutations — or mistakes — that a person’s risk rises for developing breast and other forms of cancers,

according to Memorial Sloan Kettering Cancer Center.

Only about 5 to 10 percent of all breast cancers diagnosed in the United States are due to inherited gene mutations known to increase risk, according to the American Cancer Society. BRCA mutations affect men, too. Men with BRCA2 mutations are at an increased risk for getting prostate cancer.

A new study published in JAMA reveals how much having “breast cancer genes” increases the risk of cancer. Women with genetic mutations in the “breast cancer genes” have about a 70 percent chance of developing breast cancer in their lifetimes. The findings are based on an analysis of nearly 10,000 women with mutations in either the BRCA1 or BRCA2 gene.

The risk of developing breast cancer varies — it can double — depending on specific mutations within the genes, the study found. Having close family members with breast cancer also increased risk.

Other key findings: • Among women who had not been diagnosed with breast cancer before the study, those with BRCA1 mutations faced a 72 percent chance of developing breast cancer by age 80, and the BRCA2 carriers had a 69 percent chance of developing breast cancer by age 80.

• The rate of new breast cancer cases increased rapidly among younger women, but leveled off around ages 30 to 40 for BRCA1 carriers and 40 to 50 for BRCA2 carriers.

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w Red, inflamed breast A swollen and sometimes warm, red breast should be evaluated promptly, Bevers said.

Inflammatory breast cancer is a rare but aggressive disease. Swelling and redness affecting one-third or more of the breast is cause for concern. Smaller changes, like the size of a half-dollar, are probably not breast cancer, “but get it diagnosed,” Bevers said.

WEDNESDAY, OCT. 4, 2017

Some of the signs of potential breast cancer:

w Peeling, scaling

w Dimpling of the skin

POTENTIAL

SIGNS

OF

BREAST CANCER

By Melissa Erickson More Content Now

F

eeling a lump in the breast is a classic sign of breast cancer, but there are other less-well-known signals that can tip off potential trouble.

“The hope is that women know their own bodies and would find a mass before it becomes palpable, but the truth is that radiologists can find tumors so small — 3, 4 or 5 millimeters — that it’s rare to be able to feel a small tumor before it can be discovered by mammogram,” said Dr. Therese Bevers, medical director of the Cancer Prevention Center at MD Anderson in Houston and an expert in breast cancer screenings.

Today, breast self exams are not widely recommended, but that doesn’t mean you should stop investigating your breasts, Bevers

“You know how your breasts look and feel. If something feels different, have it checked out.”

Dr. Therese Bevers

said. The keywords now are “breast awareness.

You know how your breasts look and feel. If something feels different, have it checked out,” Bevers said.

Women themselves discover “a substantial amount of breast cancer because nobody knows a woman’s body as well as she does herself,” said Dr. Rachel Brem, director of breast imaging and intervention at The GW Medical Faculty Associates in Washington, D.C. “Women have to understand that mammograms are imperfect. Fifteen percent of breast cancers cannot be seen on mammograms. The death rate of breast cancer has decreased 35 percent in the past few decades, and mammograms are one part of that. They’re one tool in our toolbox, but there’s other things like MRIs, diagnostic ultrasounds and molecular breast imaging,” Brem said. “We have many kinds of technology; no one size fits all.”

“A dimpling on the skin of the breast like a pimple that doesn’t heal” can also be a sign of breast cancer, Brem said. The nipple may also become retracted because there’s a tumor pulling it inward, Bevers said. The dimpling might be subtle and noticeable only at certain times, for example, when you stand in front of a mirror and raise your arms to brush your hair, Bevers said.

w Nipple discharge Most nipple discharge is not breast cancer, but it is of more concern if it is spontaneous, from one breast only, or clear rather than milky or greenish, Brem said. Nipple discharge may not have a high suspicion rate, but have it checked out.

w Mass in the armpit An ancillary mass in the region, such as a lump in the armpit, could be breast cancer in the lymph nodes, Bevers said. “Not all lumps in the armpit are breast cancer. It could be an ingrown hair, but it needs to be checked out,” she said.

w A thickening If your breast feels firmer than before, that change should be evaluated by a doctor. “If it’s a change to you, it doesn’t matter what you can see or feel,” Bevers said. Use your awareness of your breasts. If something doesn’t feel normal, get it checked out.

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Flaky, peeling or scaling skin on the breast could be a sign of Paget’s disease, a type of breast cancer, or it could be minor skin irritation, Bevers said. Watch for whether the skin changes only occur in one breast, often starting in the nipple area, and spread from there.

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Regional ACS office provides

support to cancer patients

By Allison Collins Contributing Writer

O 4Think Pink! - THE DAILY STAR

n Sunday, Oct. 15, the streets of Binghamton will run pink with the many survivors, supporters, family and friends affected by breast cancer during the city’s annual

American Cancer Society Making Strides Against Breast Cancer Walk.

The walk, equal parts celebration and memorial, is the major yearly event presented by the regional branch of the nation-wide organization formed in 1913.

Lauren Ferraro, community development manager with the ACS

Contributed

From left, Janis Liepins, who lost his wife to breast cancer, 10-year breast cancer survivor Patty Lewis and friend Mark Zimmerman celebrate after last year’s Making Strides Against Breast Cancer Walk in Binghamton.

office in Johnson City, said Making Strides is something organizers and participating teams plan yearround in anticipation of National Breast Cancer Awareness Month each October.

Breast cancer is, according to the American Cancer Society, the most common type of cancer afflicting women, after skin cancer.

“It’s our biggest breast cancerrelated event of the year,” Ferraro said of the walk, noting that last year’s event generated $145,000 in funding for breast cancer research.

Nationally, 250 Making Strides events were held in 2016, raising more than $60 million.

The Broome County walk, Ferraro said, is meant to “celebrate survivorship and team unity.”

“Teams fundraise throughout the year and then come together for the 5K … and we celebrate,” she said.

Participation, she said, is free, with attendance ranging from 4,000 to 5,000 people.

In the lead-up to the Oct. 15 walk, Ferraro said, the Johnson City ACS partners with several local college affiliates and community businesses to raise awareness and visibility of the event and the cause.

“We do different things on (college) campuses to help spread the word (and) we work with sponsors that do breast cancer-specific fundraisers,” she said. “It all culminates around this month … then throughout the year, we work to build up to next year’s October.” She noted that, in 2016, the Johnson City ACS office presented 23 events; this year, the office will host 20.

Year-round, Ferraro said, her office strives to offer “unparalleled” patient programming, services and outreach efforts across the 11-county area it serves. And, while the Making Strides event makes a significant fiscal impact, the human bonds forged through ACS

“One of our breast cancerspecific programs is called Reach to Recovery and it matches a breast cancer survivor with someone who’s facing a similar diagnosis.

About 11,000 such partnerships are forged annually. It offers the kind of understanding and support that only somebody else touched by (breast cancer) can.”

Lauren Ferraro, Community Delevelopment Manager, Johnson City ACS

programming are “unquantifiably meaningful,” she said.

“One of our breast cancer-specific programs is called Reach to Recovery and it matches a breast cancer survivor with someone who’s facing a similar diagnosis,” Ferraro said.

About 11,000 such partnerships are forged annually, she said. “It offers the kind of understanding and support that only somebody else touched by (breast cancer) can,” she said.

Locally, 108 patients were served through Reach to Recovery in 2016.

Additionally, Ferraro said, the ACS offers its Look Good Feel Better program to help women undergoing cancer treatments cope with appearance-related aspects of treatment. A free public service begun nearly 30 years ago, Look Good Feel Better pairs licensed cosmetologists and trained volunteer cosmetologists with cancer patients to address exterior issues such as make up,

5 WEDNESDAY, OCT. 4, 2017 Think Pink! - THE DAILY STAR

Participants in the ‘Making Strides Against Cancer’ walk displayed signs last year in Binghamton. skincare and hair.

Whether it be a chemo-induced puffy face or full-blown hair loss, Ferraro said, “(Look Good Feel Better) is a workshop to cope with those side effects.” More than 500 women in the geographic area covered by the Johnson City officer partook the workshops last year.

Feedback from the two programs, Ferraro said, has been so consistently positive that, especially in Otsego and Delaware counties, programming is expanding all the time.

“Because of the response to programs developing in our area, we’ve been able to get more volunteers to run more classes in more areas,” she said. “Once one woman touches it

and has such a great experience, it kind of just passes between (other women. It’s really starting to expand just by word-of-mouth into Delaware and Otsego counties.”

And, because all volunteers are cross-trained in other ACS programming, Ferraro said, mentors can point breast cancer survivors and patients to tailored support groups, thereby fostering an entire, comprehensive network of care.

For medical services, Ferraro said, the regional ACS office typically acts as a facilitator, linking rural patients to the nearest centers or, in some cases, bringing mobile services to patients in their neighborhoods.

“If a patient is in need of a service,

we provide them with services in their area through this office,” she said.

“We set up programs at hospitals or local centers in (a patient’s) area, so they can be more readily available to people who otherwise might not be able to (receive services).”

The breadth of the area covered by the Johnson City office is significant in and of itself, but especially given the rural population of its 11 counties.

“Our region expands about seven hours end to end,” she said. She listed Allegany, Broome, Chemung, Chenango, Cortland, Delaware, Otsego, Schuyler, Steuben, Tompkins and Tioga as counties served by the regional ACS office.

See SUPPORT, Page 6

Contributed

6 WEDNESDAY, OCT. 4, 2017 Think Pink! - THE DAILY STAR

SUPPORT n Continued from Page 5 Ten-year breast cancer survivor Patty Lewis of Endicott credits ACS services and programming, along with a support system of friends and family, with helping her emerge from her diagnosis cancer-free.

Noting an initial sense of fear and uncertainty following her diagnosis, Lewis said, the regional ACS office, located at the time in Endwell, was her first stop.

“You don’t know what to do, who to call or who to talk to,” Lewis said. “So, I thought of the American Cancer Society and when I was leaving (the doctor’s) that day. I stopped at their office and talked with a lady. I left two hours later.”

Lewis, now a spokesperson for survivorship and a veteran Look Good Feel Better attendee, added, “If there was anything they could do to help me or be there to give me some guidance, they were there.”

Lewis said she attended the Look Good Feel Better workshop roughly four months into her treatment. “It helps you meet other people going through the same thing,” she said. “It teaches you how to tie scarves … and ways to improve what maybe you’re doing or not doing. They take the time (and) make you feel good by the time you’re done with class.”

Lewis is also a veteran Making Strides participant, having walked for the past 11 years. Viewing the

event as a chance to “give back,” Lewis said she typically fundraises more than $2,500 annually.

“It’s an outreach (opportunity) to give support to new people going through it for the first time and to see people you only see once a year and (ask) how they’re doing and catch up on their cancer status,” she said.

Lewis said support, such as that enabled by her involvement with ACS, is key. “I tell all my friends and even strangers to go to the ACS for help and support,” she said. “I had great support from family and friends through whole ordeal and even now still … That was a big plus, knowing that you’re out there alone.”

Lewis’ advice to newly diagnosed cancer patients is to stay strong and positive, but accept and allow emotional responses, too.

“It doesn’t hurt to cry, laugh, scream or just let your feelings be felt and talk to people about it,” she said. “Don’t be afraid to ask questions.”

For more information on work the American Cancer Society is doing in the region, visit cancer.org or call 1-800-227-2345.

For more information on or to register for the upcoming Making Strides Against Breast Cancer Walk in Binghamton, visit makingstrideswalk.org/Binghamton or find ‘Making Strides Against Breast Cancer-Binghamton, NY’ on Facebook.

Did you know?

Men have a small amount of breast tissue, and that means they can be affected by breast cancer. According to the American Cancer Society, men’s breast tissue has ducts, but only few, if any, lobules. That’s because men do not have enough female hormones to promote the growth of breast cells. Breast cancer can be separated into several types based on what the cancer cells look like under the microscope. They can be in-situ, meaning non-invasive or pre-invasive. They also may be invasive types that have spread to the ducts in the breast tissue. Breast cancer is about 100 times less common among men than among women. Only about 2,600 new cases of invasive breast cancer will be diagnosed in men this year. But men who feel lumps or other anomalies in the area around the nipple should consult their physicians.

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What you should know

“Women shouldn’t have an over-optimistic expectation that a mammogram will keep you from dying from breast cancer.”

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ighly trained radiologists can detect small cancers so early through mammography that there now may be an overdiagnosis of small tumors, which can lead to unnecessary treatment, according to a Yale Cancer Center study.

“Radiologists are so skilled at finding tiny little tumors. It’s the price we pay. They’re finding a lot of small cancers that will never become large and life-threatening,” said Dr. Donald Lannin, professor of surgery at Yale School of Medicine and lead author on the paper.

Many small cancers have an excellent prognosis because they are inherently slow-growing and treatable, such as with a lumpectomy, Lannin said. Early detection doesn’t

Dr. Donald Lannin, Yale School of Medicine

necessarily increase survival rates because these cancers will not grow large enough to become significant within a patient’s lifetime, he said.

In contrast, large tumors that cause most breast cancer deaths often grow so quickly that they become dangerous before they can be detected by screening mammography.

Diagnosis not a death sentence Before mammography it was thought that all cancers were lifethreatening, and if cancer was detected earlier — when it was smaller — it would lead to higher survival rates, Lannin said.

Yet today mammograms only

decrease breast cancer mortality rates by 19 percent, Lannin said.

“We would expect it to be higher, maybe 50 or 75 percent. We hoped for three decades to cut the risk by more,” he said.

As the science of mammography has accelerated diagnosis, radiologists are detecting “three times the amount of small cancers,” many of which are not life-threatening, Lannin said.

Previously, the medical community knew that there were differences in tumor growth rates but thought that the differences were small. What’s new from the Yale study is, researchers found that a large percentage of cancers grow quickly and another

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By Melissa Erickson

“Women shouldn’t have an over-optimistic expectation that a mammogram will keep you from dying from breast cancer,” Lannin said. Often, aggressive cancers can be physically felt before a mammogram can detect them, Lannin said.

He does not suggest women skip mammograms. Instead, they should “have some perspective” when faced with a diagnosis of a small breast cancer tumor, “which probably has a pretty good prognosis,” Lannin said.

The American Cancer Society suggests women 45 to 54 schedule a mammogram every year and after age 55 every two years, depending on health and family history.

Beyond that, treatment depends on the age of the patient and the biology of the cancer, Lannin said.

For a woman in her 50s diagnosed with a small slow-growing tumor, the cancer probably would have been diagnosed in her 70s without mammography, Lannin said. But a woman in her 70s diagnosed with a small slow-growing tumor may die of something else before the cancer grows large enough to be detected or be life-threatening, Lannin said.

The biology of the breast cancer also determines its treatment, Lannin said. Treatment depends on factors such as grade (how fast it grows), hormone receptors (how favorable the status of the estrogen and progesterone receptors are) and molecular testing. Those things determine how aggressively the cancer should be treated, Lannin said.

WEDNESDAY, OCT. 4, 2017

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large percentage of cancers grow slowly, Lannin said.

“There’s a lot of bad breast cancers and also a lot of good breast cancers,” Lannin said. The diverse character of breast cancer explains both how mammography leads to overdiagnosis and also why it is not more effective.

8 WEDNESDAY, OCT. 4, 2017

Contributing Writer

OCTOBER schedule mammogram

Contributed

Mammograms, shown, are one of several cancer screenings provided through the Bassett Cancer Center’s mobile medical screening coach. help navigate all those things that you just can’t do,” she said .

Bassett nurse navigator Amie Monahan explained that the concept of nurse navigators was introduced in the early 1990s in New York City before catching on in and, eventually, becoming a requirement for American College of Surgeons Commission on Cancer accreditation, which Bassett Cancer Institute perennially maintains.

Monahan deals specifically with patients newly diagnosed with breast, colon, rectal and lung cancer. The number of breast cancer patients she sees is “about even” with lung cancer patients, she said. Kelly Morris, a 13-year Bassett employee and oncology nurse, echoed, “Breast (cancer) is a good majority of the patients that we treat.” “(A nurse navigator’s) role … is to identify any barriers to patient care and be available to (patients) if they have questions or concerns,” Monahan said. “We help educate about diagnoses and treatment options and act as second set of ears.”

A nurse navigator’s duties, Monahan said, include going into consultations with patients, helping to facilitate future appointments and reiterating what a doctor said during a given consultation or appointment.

“The mobile medical coach received the Healthcare Association of NYS Community Health Improvement Award in 2014 in recognition of the impact it has had on access to cancer prevention (and) detection in the rural eight-county region we serve.”

Karen Huxtable-Hooker, Bassett Public and Media Relations Director

underinsured patients.

Huxtable-Hooker said that Bassett also has a small, full-time fleet of transport vans used for getting patients otherwise unable to travel to and from appointments.

For medical oncologist Dr. Eric Bravin, who has been with Bassett since 2001, the Bassett Cancer Institute’s geographic reach paired with its resources makes for a good place to work and provide care.

“We have a very good model for delivering cancer care to a rural population,” Bravin said. “We stand out in terms of availability of modern, good clinical trials.”

Saying, “We have a lot to offer,” Bravin listed a dedicated, on-staff breast cancer surgeon, radiation oncologists and medical oncologists, breast care coordinators and, again, a “big roster of clinical trials” among Bassett’s

cancer-related distinctions. Through the trials, Bravin said, Bassett doctors are constantly exposed to and are vetting new treatment methods, new equipment and new drugs.

Huxtable-Hooker agreed, saying, “We’re very lucky for the resources that we have.”

Despite “harrowing moments,” Conkling said, Bassett cancer center employees are dedicating their lives to cancer-related services and care because they believe in their work and the network behind it.

“I think the nurses and administrative (staff) and anyone that works in the (cancer center) is doing what they’re doing because they love it,” she said. “Our patients are very grateful and it’s such an honor to take care of them. It’s a way of life.”

To learn more about the Bassett Cancer Institute, visit bassett.org.

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T

hough the nationally accredited Louis Busch Hager Cancer Center at Bassett Healthcare in Cooperstown has, for decades, offered innovative treatment options, programming and award-winning patient services, to hear members of the eightcounty network’s cancer care team discuss their work, it becomes apparent that what distinguishes the center is its very feeling, human-driven approach.

Twelve-year Bassett employee and public and media relations director Karen Huxtable-Hooker said, despite existing in a rural setting with services spread across a 5,600-square-mile area, since the center’s inception in the late 1940s, Bassett’s cancer center has been reliably providing care with an emphasis on compassion.

“Everybody from registration to patient care to clinicians who diagnose and treat and follow patients after diagnoses — they are, to a person, compassionate, extremely skilled and they just care so much about the patient and their family,” she said. “That makes such a difference.”

One of’s most noteworthy patient services, Huxtable-Hooker said, is its nurse navigator program.

“With any cancer diagnosis, a nurse navigator is just enormously important,” she said, explaining that a nurse navigator lends expertise and advocacy to recently diagnosed cancer patients during what can often be an overwhelming and confusing time.

“When you’re dealing with a surprise diagnosis, you don’t digest everything and a nurse navigator just stays with you through that whole process to

Barriers, she said, can concern health insurance, financial means, transportation, physical limitations relating to accessing treatment, communication, poor health literacy and more.

Through it all, she said, nurse navigators remain available and invested.

“From the first diagnosis, we help (a patient) transition into the cancer center and follow them very closely until comfortable in their treatment plan,” she said. She said nurse navigators will also prepare a post-treatment “survivorship” care plan for those patients lucky enough to emerge from their treatment bound for remission.

“We always keep communication open,” Monahan said, “and the patient is always welcome to call us anytime.”

Bassett Health Care Network’s mobile screening coach, which falls under the auspices of the cancer center, is another example of the network’s -minded services, Huxtable-Hooker said. Because of the distance covered by the coach, she said, its services have proven integral in early detection and prevention among underserved populations.

“The mobile medical coach received the Healthcare Association of NYS Community Health Improvement Award in 2014 in recognition of the impact it has had on access to cancer prevention (and) detection in the rural eightcounty region we serve,” she said.

Increasing access, she said, means saving more lives and increasing patients’ chances of survival.

Christine Conkling, a medical oncology nurse and the community outreach manager responsible for overseeing Bassett’s mobile screening unit, said she has witnessed its life-saving impact first-hand. Conkling has been with Bassett for 31 years and its cancer center for five.

“We’ve had some patients say they do not feel they would’ve been able to have screening any other way than through our coach,” Conkling said. The coach travels annually to Bassett’s regional primary care centers, other in-network locations and special events.

While the mobile screening program has been around for decades, a new, RV-model coach outfitted with updated equipment replaced a smaller, van-style predecessor in June 2017 after a one-year hiatus.

“We’re lucky we can take it on the road,” Conkling said. She said the coach offers Pap smears, cervical cancer screenings, mammograms and colorectal cancer screenings for uninsured and

WEDNESDAY, OCT. 4, 2017

By Allison Collins

9

Bassett’s cancer center brings cutting-edge services to rural area

The Bassett Cancer Center’s recently updated mobile medical screening coach is pictured in this undated photo.

Contributed

10 WEDNESDAY, OCT. 4, 2017

SHINING through Helping women learn new beauty tricks during chemo

By Melissa Erickson

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osing your hair is a common side effect of chemotherapy, yet it can be incredibly traumatic. There are beautiful ways to cope.

Hair should grow back after treatments are done, said Linda Whitehurst, a 28-year volunteer with Look Good Feel Better, a program that provides beauty workshops to improve self-esteem and quality of life for women undergoing chemotherapy, radiation and other cancer treatments.

Teaching women how to cover their heads with colorful scarves is one way to help them build their confidence and self-esteem.

“It’s all about the transformation and finding normalcy,” Whitehurst said.

Women going through a difficult time “don’t want to stand out. They want to fit in,” said Deborah Flynn, manager of the Friends’ Place at Dana-Farber Cancer Institute in Boston.

Whether done in a workshop, by watching YouTube videos or simply by practicing in front of a mirror, there are endless possibilities to creatively manage the effects of hair loss.

Scarves are a trendy alternative to wigs and hats, Flynn said.

“Wigs can be hot, and hats are not for everyone. Scarves are fashionable,” Flynn said.

They can be intimidating to someone who is not used to wearing them. Here are some of the experts’ tips for how to tie, drape, twist and wrap a headscarf, as well as how to pick what’s right for you.

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Take a 30-by-30-inch square scarf. Fold it into triangle. Pull the front of the scarf over the forehead and knot the ends over the point in the triangle. Pull a bit of excess fabric above the knot to achieve a fuller look.

You can also add a pair of socks to make it look like there’s hair underneath, Flynn said.

Feeling rosy Once your tried a basic babushka, try the rosette turban. Use a large square or oblong scarf folded into a triangle. Place scarf on head with both ends to one ear and knot. Twist one end tightly and wind around knot. Tuck in the end and repeat with other end. If need be, hold ends in place with bobby pins.

Stay stable Cotton scarves stay in place better than silky ones, Flynn said. “For even more traction, wear a cotton beanie under the scarf to keep it in place,” she said.

For more information

Good choices Scarves made of crinkled fabric are also good because they don’t wrinkle, Whitehurst said. Other popular choices include tie-dyed or batik scarves with lots of color.

Look Good Feel Better is supported by the American Cancer Society and the Professional Beauty Association. Its beauty programs are available across the United States. Visit lookgoodfeelbetter.org and type in your ZIP code to find a free program near you. Or, call 1-800-395-LOOK (5665) and get a self-help kit that includes a video with scarf-tying tips mailed to you for free.

Not too far down When placing a scarf on the forehead, avoid putting it too far down or else you’ll end up with “the Cabbage Patch look,” Whitehurst said. Instead place it up near the hairline.

Scrunch the look “It’s hard to look at a beautiful scarf laid out flat and see what it will look like on. Take the scarf and roll it around in your hand. Scrunch it up in a coil to get a better idea of what it will look like when you’re wearing it,” Whitehurst said.

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“When patients are diagnosed with cancer, there’s this rush to get through the treatment process. But for patients with early-stage breast cancer, they have some time to decide on their treatment choice.”

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Dr. Lauren P. Wallner, University of Michigan

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hen facing a breast cancer diagnosis, there’s strength in numbers. A new study finds that half of women relied on three or more people to help them process breast cancer treatment options.

“The big takeaway is that most women with early-stage breast cancer are involving multiple people — not just a spouse or partner — but other family, friends and colleagues to help them make informed decisions,” said Dr. Lauren P. Wallner, assistant professor of general medicine and epidemiology at the University of Michigan and lead author of the paper, published in the journal Cancer.

The size of a woman’s support network matters.

“People faced with a new cancer diagnosis are still processing the

decision-making.

How you can help Offer to go with to an appointment and take notes. “It is incredibly helpful to have another set of eyes and ears,” Wallner said. information. They are often scared and overwhelmed. They are not able to grasp all the details. It’s helpful to have support, someone with them who can help weigh the pros and cons of what the doctor is saying and the different treatment options,” Wallner said.

Larger support networks were associated with more deliberation about treatment, which is critical as treatment options become more complex, Wallner said. More deliberation suggests patients are thinking through pros and cons, discussing it with others and weighing the decision carefully. The more people a woman has supporting her, the better her decisions are, Wallner said.

“When patients are diagnosed with cancer, there’s this rush to get through the treatment process. But for patients with early-stage breast cancer, they have some time to decide on their treatment choice,” Wallner

said. “The idea that women are discussing their options more with their family and friends and potentially thinking through that decision more carefully is reassuring. Engaging these informal support networks could be a way to prevent women from rushing into something.”

The study found that only 10 percent of women said they had no personal decision support network. Nearly three-quarters said their support network talked with them about their treatment options and frequently attended their appointments.

African-American and Latina women reported larger networks than did white women. Women who were married or partnered also reported more support.

Even among women without a partner or spouse, many had large support networks. Women reported children, friends, siblings, parents and other relatives were involved in their

Help with research “If you’re internet-savvy, help do research and track down information,” Wallner said.

Just be there “On a basic level, just being present lets the patient know she is not alone,” Wallner said.

Doctors need to involve others “Physicians should be aware that women want to include others in their treatment decisions,” Wallner said.

A woman without a support network may need extra help or information during the decision process.

“It starts with something as simple as physicians asking patients who is helping them make their treatment decisions.

That can then guide the conversation, such as the amount of resources the physician provides and to whom they communicate that information,” she said.

One of the main concerns women have after surviving a breast cancer diagnosis is the risk of infertility. Susan G. Komen says both chemotherapy and hormone therapy can impact fertility and decrease the window of time a woman has to have children.

This is a particular concern for young women who have been diagnosed with breast cancer. Chemotherapy can damage the ovaries, while tamoxifen, a commonly used hormone therapy, can cause irregular periods or stop the menstrual cycle altogether.

Both of these treatments also may bring on natural menopause earlier than usual, according to the International Breast Cancer Study Group.

Waiting game According to the American Cancer Society, some doctors advise breast cancer survivors to wait at least two years after finishing treatment before they try to get pregnant. No research yet indicates that getting pregnant will make women more susceptible to the cancer coming back, nor will pregnancy increase the risks of birth defects or other long-term health concerns in children born to women who have had breast cancer.

Breastfeeding after cancer Depending on the type of breast cancer treatment they receive, many women are still able to breastfeed. However, if radiation or surgery has affected breast health, milk production may be affected and the baby may have difficulty latching on. Using a breast pump to express milk may be an option.

However, commercially produced infant formulas also can provide the nutrition growing babies need.

Choosing to have children after breast cancer is a personal decision. Thanks to medical advancements, the possibility to conceive and raise a family is strong.

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Infertility risks and preserving fertility

Young women can opt to have their unfertilized eggs or embryos frozen and stored prior to starting cancer treatment. It’s important to meet with a fertility specialist early on to discuss options.

WEDNESDAY, OCT. 4, 2017

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ore women are diagnosed with breast cancer than any other cancer. For many women, one of the more frightening aspects of a breast cancer diagnosis is the potential impact the disease can have on an area of the body often associated with femininity and motherhood.

Cancer.net indicates the five-year survival rate for breast cancer if the cancer is only in one breast is 95 percent. That rate dips to 85 percent if the cancer has spread to the lymph nodes. Even though this is great news, women may worry about the long-term implications of post-cancer life, particularly how they relate to future pregnancy plans.

Early detection and improvements in treatment have markedly decreased the numbers of breast cancer-related fatalities. However, the therapies used to treat breast cancer can affect fertility and a woman’s ability to have a successful pregnancy.

While pregnancy after cancer treatment is often safe for both the baby and mother, women should still educate themselves about the potential effects of breast cancer treatment with regard to pregnancy.

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Pregnancy possible after breast cancer

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Study finds many double mastectomies unnecessary

By Melissa Erickson More Content Now

W

omen with earlystage cancer in one breast are increasingly choosing double mastectomies — even if they are at low risk of developing breast cancer in the other, healthy breast, a new study published in JAMA found.

Nearly half of women with early-stage breast cancer consider having a double mastectomy, and one in six received it.

“That one in six breast cancer patients chose bilateral mastectomy is really striking.

We knew it was increasing, but I don’t think many of us realized just how frequent this is,” said study author Dr. Reshma Jagsi, professor and deputy chair of radiation oncology at the University of Michigan.

Myths and facts The procedure is known as contralateral prophylactic mastectomy, in which the

“For a woman with average risk of developing a breast cancer in the second breast, a contralateral prophylactic mastectomy does not increase survival rates.”

Susan Brown, Susan G. Komen

healthy breast is removed along with the cancerous breast. It’s an aggressive form of treatment that is recommended for women “who are at a very high risk of developing a new breast cancer” such as those with BRCA 1 or 2 mutations, family history or other risk factors, said Susan Brown, senior director of education and patient support for Susan G. Komen.

Especially concerning is the lack of knowledge about the procedure and its benefits, Brown said. Many women diagnosed with early-stage breast cancer decide on the most aggressive treatment with the belief that it will increase their rate of survival, Brown said.

“For a woman with average risk of developing a breast cancer in the second breast, a contralateral prophylactic mastectomy does not increase

survival rates,” Brown said.

Among patients who considered double mastectomy, only 38 percent knew it does not improve survival for all women with breast cancer, the study found.

Other misinformation muddies the decision-making process. For example, some patients think having a mastectomy on a healthy breast will stop them from having to undergo chemotherapy or other targeted therapies, but that is not true, Brown said.

“Contralateral prophylactic mastectomy will only reduce the risk of breast cancer developing in the healthy breast, but it doesn’t reduce the risk of breast cancer returning in the original breast or coming back later in another part of the body,” Brown said.

What you need to know “Every surgery we perform

can have potential complications. These need to be discussed and need to be taken into account carefully before decisions are made,” said Dr. Virginia Kaklamani, a medical oncologist and head of the breast cancer program at University of Texas Health San Antonio.

It’s important to understand the risks and benefits of treatment and how likely treatment is to positively affect survival rates, Brown said. There may also be post-operative complications, additional costs, and issues related to long-term suffering and quality of life, Brown said.

In the study, almost all patients said peace of mind motivated them to choose double mastectomy.

“They are afraid of another breast cancer, of more biopsies of going through this again,” Kaklamani said.

In these circumstances, a double mastectomy “can avoid years of anxiety and ongoing fears. For some women that’s a great benefit,” Brown said.

15 WEDNESDAY, OCT. 4, 2017

MOVING FORWARD

It can be difficult, but exercise is key during cancer fight

By Melissa Erickson More Content Now

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E

xercise helps keep a body healthy and lowers risk of some diseases. For women with cancer, physical activity can do many things, including control weight, improve mood, boost energy, increase sleep, and be fun and social — as long as exercise is done safely.

It is well-documented that physical activity benefits patients with cancer, both during and after treatment. Exercise helps patients combat physical and psychological impacts of cancer treatment, giving them a sense of well-being, control, stress reduction and empowerment.

So why aren’t more oncologists discussing exercise with their patients? A focus group study from Gundersen Health System in Wisconsin found that 95 percent of patients surveyed felt they benefited from exercise during treatment, but only three of the 20 patients recalled being instructed to exercise.

The investigators interviewed nine practitioners plus 20 patients 45 and older with two kinds of cancer: non-metastatic cancer after adjuvant therapy and metastatic disease undergoing palliative treatment, both across multiple tumor types. While the sample size is small, the study provides an understanding of how the group as a whole has the potential to influence the practice of physical activity

A focus group study from Gundersen Health System in Wisconsin found that 95 percent of patients surveyed felt they benefited from exercise during treatment, but only three of the 20 patients recalled being instructed to exercise. recommendations.

The results indicated that exercise is perceived as important to patients with cancer, but physicians are reluctant to consistently include recommendations for physical activity in patient discussions, said Dr. Agnes Smaradottir, medical oncologist and lead investigator of the focus group study, which was published in the Journal of the National Comprehensive Cancer Network in May. A key finding was that physicians expressed concerns about asking patients to be more

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physically active while undergoing arduous cancer treatments.

“Regular exercise has been a part of the breast cancer treatment plan for years,” Smaradottir said. “Exercise regularly from the day you are diagnosed and beyond and have exercise be an important part of your life. Carve out time for exercise at least every other day. It is that important.”

For breast cancer patients, Smaradottir’s recommendations for exercise are: • 150 minutes a week (30 minutes a day, five days a week) of moderate exercise or 75 minutes of vigorous activity.

• In addition, two to three sessions per week of strength training that includes major muscle groups and stretching.

• For women who have never

exercised, start slower, working up to the goal of 150 minutes a week.

• For women already exercising, continue the exercise plan with adjustments during chemotherapy and radiation.

Before starting an exercise regime, talk to your doctor about weight loss, weight management and what types of exercise are safe for you to do. Walking is probably the simplest, easiest and the most inexpensive way to remain fit.

Studies presented at the American Society of Clinical Oncology conference reported that just 25 minutes of brisk walking every day not only cuts the risk of cancer but also helps people battling the disease.

For moderate exercise, try walking briskly at a pace where you are able to talk but not sing, Smaradottir said.

MORE . .

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d out how to get a free or low-cost mammogram.

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1 in 8 women will receive a breast cancer diagnosis during their lifetime.

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800-877-8077

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in 8 women will receive a breast cancer diagnosis during their lifetime.

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breast-cancer.adelphi.edu

KE TIME FOR YOU. SCHEDULE A MAMMOGRAM TODAY!

Contact the Adelphi Breast Cancer Hotline MAMMOGRAM TODAY! o findMAKE out TIME howFOR to YOU. get aSCHEDULE free or Alow-cost mammogram.

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