Breast Cancer Awareness 2018

Celebrating courage

Pink is stronger than you think Sunday, October 7, 2018

INSIDE ■■Two years since Stage 4 breast cancer diagnosis, mother seeking normalcy. Page 2 ■■Faith, family, work and a strong will power help woman carry on cancer fight. Page 2 ■■An early diagnosis helped Gainesville woman undergo treatments and regain her health. Page 3 ■■Family’s support makes all the difference to 25-year-old Hall resident. Page 4 ■■Where to find help: Community resources for patients. Page 5 ■■3D mammograms allow for earlier detection. Page 6 ■■How breast cancer risk increases with age. Page 7 ■■Know breast cancer types, treatment options. Page 8 ■■Crowdfunding helps many pay large medical bills. Page 9 ■■BRCA gene can determine risk through DNA test. Page 9 ■■Survivors decorate their bodies at Sparkle and Celebrate Pink photo shoot. Pages 10-11

‘Let’s deal with it’

Georgia’s first lady shares about her Stage 1 diagnosis

BY J.K. DEVINE For The Times

For years, Georgia’s first lady, Sandra Deal, has routinely had an annual mammogram, which is an X-ray picture of the breast used to detect early signs of cancer. But in January 2018, her annual mammogram was anything but routine.

“My doctor arranged for me to see him and said they found a tumor and suspected it was malignant,” said Deal, wife of Gov. Nathan Deal for 51 years, in a clear matter-of-fact voice.

Her response was a decisive one, which sounds almost like a mantra.

“I said, ‘Let’s deal with it,’” Deal said. “I said ‘Let’s get it out and see what the situation is.”

Her doctors, based in Hall County, responded in kind.

Deal underwent surgery to remove the tumor, then followed it with chemotherapy and radiation treatments.

Deal said she didn’t worry about having breast cancer, because it was caught early and deemed Stage 1. That means cancer cells are evident but contained to the area where the first abnormal cells began to develop, according to the National Breast Cancer Foundation website.

“If other people have gone through it and survived, then I shouldn’t feel sorry for myself,” Deal said. “Other people have had serious cancer bouts and mine was at Stage 1. And since I had it, then I had to deal with it as best I could.”

Georgia’s first lady, a mother of four with six grandchildren, handled her cancer with grace and courage. In fact, she has shared parts of her journey to help other women not feel so alone.

One of the most prominent actions was when

‘If other people have gone through it and survived, then I shouldn’t feel sorry for myself. ’

■■Please see DEAL, page 4

NICK BOWMAN | The Times

Sandra Deal, wife of Gov. Nathan Deal, learned at the beginning of this year that she had breast cancer. She received her final radiation treatment in May.

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The Times, Gainesville, Georgia | gainesvilletimes.com

Sunday, October 7, 2018

Profile: Dallas Sage

‘I will get through it’

Two years since Stage 4 breast cancer diagnosis, mother seeking normalcy

BY JOSHUA SILAVENT

jsilavent@gainesvilletimes.com

D

SCOTT ROGERS | The Times

Dallas Sage first found out about her inflammatory breast cancer diagnosis after her daughter, Madelyn, was born in 2016. Since first telling her story in The Times that year, Sage said she has pushed through the ups and downs that often accompany a cancer diagnosis and corresponding treatment.

allas Sage has the kind of hardearned wisdom that can only come from direct experience.

“I keep telling myself it could be worse,” she said of her ongoing battle with cancer.

But there are days when Sage, 30, of Gainesville, would rather mask her reality and not be defined by her diagnosis.

Sage said she tries to avoid thinking about and discussing her condition as a way to emotionally cope. She tries to maintain a positive attitude and outlook instead of concentrating on the he cancer so that she doesn’t feel like she’s “living scan to scan.”

But reality is a harsh winter storm.

Since first telling her story in The Times in 2016, just after she was first diagnosed, Sage has weathered many trials and tests and treatments for inflammatory breast cancer. Hers is a rare and aggressive breed of cancer cells that block lymph vessels in the skin of the breast and can spread rapidly.

According to the National Cancer Institute, inflammatory breast cancer accounts for just 1 percent to 5 percent of all breast cancers in the United States.

For Sage, the rarity of her condition, and its advanced stage when she was first diagnosed, prompted an unconventional approach to treatment.

“I feel like a little bit of an experiment, since my treatment has been so unique,” she said.

“The doctors didn’t want to give me false hope so they explained my disease as incurable.”

But remission is possible. So with regular chemotherapy, spurts of radiation and some surgery, Sage fought off the breast cancer, even after it spread to her skin.

That was a pretty unbear-

able time, she said. The radiation for her skin left her with second-degree burns, or worse, and made it nearly impossible to wear some clothes, to put on a seat belt in the car, or hold her daughter, Madelyn, who is now 2« years old.

But she persevered, and a few clear scans showing no signs of cancer had her hopes sky high.

Then, in May, “They found a spot on my lung,” Sage said.

The cancer had spread again.

“Hearing that it was back was definitely very hard,” she said.

“But I know with the strength from God and constant support from my family and friends, I will get through it.”

She’ll find out in November when she travels to Houston, where she receives frequent treatment, if the radiation, which she described this time around as “a walk in the park,” has been effective in sending the cancer back into remission.

Until then, Sage fights for a sense of normalcy.

With her husband, Chad, who she met while attending Chestatee High School and married five years ago, Sage said she continues to try to limit the impact her cancer has on her daughter’s young life.

Madelyn attended her first Auburn football game recently, a point of pride for the doting parents who share a love for cheering on the Tigers, and she’s also now enrolled in gymnastics.

Last year, Sage told The Times, “Cancer has always been a terrifying word with me.”

And, yet, she continues to tell her story in the hopes that it will inspire someone else with cancer, or perhaps motivate others to donate to breast cancer research.

With her family, her community and her story, Sage carries on with a wisdom only matched by the strength of her faith.

Despite the toughest of circumstances, Sage said she feels such “grace and mercy” from God.

Profile: Natalie Donatelli

‘Being stubborn’ has helped

Faith, family, work and a strong will power help Donatelli carry on fight

BY JOSHUA SILAVENT

jsilavent@gainesvilletimes.com

S

tubbornness may not always be a good quality in a person, but it’s served Gainesville resident Natalie Donatelli

quite well.

“Cancer has picked the wrong person,” she told The Times one year ago, just after receiving a breast cancer diagnosis. The cancer then spread to her spine and was considered Stage 4.

Her prognosis was not good. Doctors told her a cure was unlikely — only remission.

But that appears to be the path she’s headed toward today.

“When I first heard the words, I thought it was a death sentence,” Donatelli, 37, said recently.

But her perseverance has shined just as she knew it would.

She underwent surgery, and she continues to receive chemotherapy every three weeks as “maintenance.”

“Some days I’ll even get chemo in the morning and go to work afterward,” said Donatelli, who has continued to work in hospice care.

She also receives bone scans every three to four months.

But she did not have to undergo radiation and no residual cancer has been detected recently.

“I think being stubborn and strong-willed has helped,” Donatelli said. “I’m not going to let it consume me.”

She has a lot to live for, after all,

which has been humbling despite her fierce attitude.

“I’m humbled pretty daily,” Donatelli said, adding that working with cancer patients who need to be admitted to hospice reminds her of the blessings and support she has from family, friends and God. And she’s also encouraged when she meets some individuals who have fought off cancer for 15 or 20 years.

“Each person’s journey is their own,” Donatelli said.

Her journey includes supporting a husband who attends nursing school at the University of North Georgia and will graduate in May. It also includes love for her parents, who have been champions for her needs, helping pay off medical bills, for example.

“I don’t know if God’s got (the bills) somewhere out there trapped or what,” Donatelli joked.

She has also witnessed so much love from the local community.

The football team her two sons play for had T-shirts made honoring Donatelli and she was tapped as an honorary captain for a game.

“Really, honestly, this is a phenomenal community,” she said.

And her young daughter, who Donatelli said is very open about discussing cancer because she attends school with a young girl fighting the disease, has been a source of inspiration and motivation.

“She tells me, ‘I’m thankful I still have you,’” Donatelli said. “We’ve made it through.”

SCOTT ROGERS | The Times

Natalie Donatelli was diagnosed in July 2017 with Stage 3 breast cancer. The disease spread to her spine, and doctors now consider it Stage 4. That means a cure is not possible, only remission.

‘This has made me realize I am worth something and I’m not focusing on what others think. I am valuable. I am important.’

Natalie Donatelli

Donatelli said her faith, which others might turn away from in times of mortal crisis, has actually drawn her closer to God during this medical ordeal.

“I think I actually intentionally spend more time with God,” she added. “When that day comes, and my battle is over, truly my battle

is not done because I’ll be going to my heavenly home.”

And she’s learned a lot about herself in living with cancer.

“I’ve always dealt with insecurities my whole life,” Donatelli said.

“This has made me realize I am worth something and I’m not focusing on what others think. I am valu-

able. I am important.”

Of course, the hardest part remains the impact her illness has or will have on her children and the prospect of making her husband a widower.

“But I know God will take care of them as he has done with me,” Donatelli said.

However, she has big plans in the works for a family vacation to Disney World in Florida.

“I would like to make that a reality,” she said. “I still feel I will win the battle, whether it’s three years from now or 10 years from now.”

CMYK The Times, Gainesville, Georgia | gainesvilletimes.com

Sunday, October 7, 2018

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Profile: Sonya Porter

‘Getting back to my old self ’

An early diagnosis helped Gainesville woman undergo treatments, regain her health

By Layne Saliba

ber for another mammogram, one year after her original diagnosis, to make sure all of the cancer has h e n S o n y a been removed.

Porter says “Chemo is bad, but radiation was the key to sur- bad, too,” she said. “The doctors viving breast are real convinced they got everyc a n c e r i s thing, though.” early detection, she’s not just parPorter was used to being the outroting an oft-repeated phrase; it’s going one around the office, always what saved her life. keeping her co-workers laughing Porter knows firsthand how her throughout the day. When she got own outcome could have been cancer, those days became less fremuch worse had she not been quent, but she never missed a day going for routine mammograms of work except when she undersince she was 40 years old. went chemo treatments. But PorBecause her sister, Bonnie ter said people could tell when she Cronic-Holcombe, has stage 4 was having a tough time. breast cancer, Porter made sure She said she wouldn’t have been to get checked often, knowing she able to get through her treatment also could be vulnerable to the without her work family. They disease. helped keep the office and her In November 2017, at age 50 — desk clean so she didn’t get sick. the same age her sister learned “There was a lot of Lysol,” Porshe had breast cancer — Porter ter said. was diagnosed with mucinous carIf she was ever feeling tired, cinoma of the breast they told her to take a nap or go “I got lucky,” said Porter, 51, home. It was a family she said she who works for North Georgia Med- was “blessed” to have. ical Transport.

“I have more energy now than I Because her cancer was caught used to,” Porter said. “A lot more early, doctors were able to remove than I used to. They said that’s the it and start chemotherapy right chemo coming out, so I’m getting away. After a biopsy was done, back to my old self.” however, doctors found more canGetting back to her old self cer, a different kind. Porter was means going camping with friends also diagnosed with invasive ductal and getting out in the garden tendcarcinoma, the most common type ing to her flowers. It also means of breast cancer. more bass fishing with her husAlthough she said she is always band, Tony. Even when she had tough and positive and has a lot of cancer, Porter and her husband life left to live, there were times would go fishing, but now it’s a little when she was worried, especially easier. when doctors first told her the “I stayed busy just to keep my tumor they found was cancerous. mind off of it,” Porter said. “I could “I thought I was going to die,” have just laid there, but I’m not one Porter said. “My first question was, to sit home ... I even bass-fished ‘How bad is it?’ Because you don’t with my bald head. I covered up in know until they get in there.” sunscreen head to toe.”

Porter underwent four rounds of There’s something peaceful chemotherapy and 21 straight days about being on the lake they both of radiation. Now she is healthy enjoy, she said.

Worried10/4/16 she may carrier again and will go back in NovemJEMC_Community_BraseltonCentennial_2_JEMC 4:02be PMa Page 1 lsaliba@gainesvilletimes.com

W

Austin STEELE | The Times

Sonya Porter just finished treatment for breast cancer and says she is regaining energy after undergoing chemotherapy.

‘I thought I was going to die. My first question was, “How bad is it?” Because you don’t know until they get in there.’

Sonya Porter

for breast cancer and perhaps pass it on to her daughter, Allison Little, Porter took the breast cancer susceptibility gene test. It’s a blood test that uses DNA analysis to identify harmful changes in either one of the two breast cancer susceptibility genes, according to the Mayo Clinic.

“It showed I was negative, so

hopefully I should not pass this on to my daughter,” Porter said.

The news of her cancer was at first kept from most friends and family; only her husband and sister knew. Her husband was there for comfort and support while her sister was able to answer questions since she was going through the same thing.

Proudly Supporting

Her daughter, though, was pregnant. Porter didn’t want to put any stress on her, so once she had the baby a month later, Porter broke the news and since has had Little there for support.

Porter finished treatment in June and is trying to get back to normal life. Her hair is growing, she’s trying to stay active and she’s going out for pizza with friends and family.

And when asked how she moves on after everything she’s been through, Porter responded with that same positivity and toughness she had before she was diagnosed.

“I just keep going,” she said.

Breast Cancer Awareness Month

Your Power. Your Community.

jacksonemc.com

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The Times, Gainesville, Georgia | gainesvilletimes.com

Sunday, October 7, 2018

Profile: Farrah Smith

‘It doesn’t just affect me’

Family’s support makes all the difference to 25-year-old Hall resident

By Megan Reed

Ladies’ Night out fundraiser

mreed@gainesvilletimes.com

L

earning you have breast cancer can be a shock for anyone, but for Farrah Smith, the news was especially surprising when she was diagnosed in July.

Smith, a lifelong Hall resident, is only 25 years old.

“It was gut-wrenching.

Just receiving the phone call, just thinking that you’re fixing to hear, ‘it’s nothing, we’ll take care of it,’ then hearing you have cancer,” Smith said. “My gut dropped. My heart sank. It was complete and utter fear in a way that I don’t know how to describe.”

Smith has always been close with her family, who live locally, and she married her husband, Will, in October 2017. That support network has been crucial as she undergoes treatment and adjusts to her diagnosis, she said.

“It feels good to know I’m not alone. Cancer, even though I’m the one dealing with it, doesn’t affect just me,” Smith said. “It’s my entire family, my whole surroundings, it affects everything. The fact that they can face it with me in such a positive way helps me to remain positive.”

Smith learned she has Li-Fraumeni Syndrome, a rare disorder that causes a predisposition to some cancers, due to a mutation in the tumor suppressor gene known as TP53. People with Li-Fraumeni have an approximately 50 percent chance of developing cancer before age 40, and up to a 90 percent chance by age 60, according to the Li-Fraumeni Syndrome Association.

Not much is known about Li-Fraumeni, including exactly how many people have the condition. But it is rare, and one U.S. registry of patients suggests that 400 people have the disorder, according to the National Institutes of Health.

Smith’s sister, Candice Malone, said part of the family’s fear is the unknown of Li-Fraumeni.

“We weren’t excited she had breast cancer, but we were glad it was breast

What: “Give Breast Cancer the Boot” Fundraiser for Farrah Smith When: 6-10 p.m.

Saturday, Oct. 20 Where: Grove Street Station, 601 Grove St., Gainesville Cost: $25 in advance or $30 at door More info: Purchase tickets online or email 2018ladiesnightout@ gmail.com

Photos By Austin STEEL | The Times

Above: Farrah Smith, 25, tapes up a flyer for the event, Give Breast Cancer the Boot, which will raise money to help her fight breast cancer. The event is set for Oct. 20 at Grove Street Station in Gainesville. Below: Smith walks around downtown Gainesville posting flyers with her mother Jonell Barber, center back, Candice Malone, right, and Scarlett Rose Malone.

cancer because we know so much about the research and the technology that they have,” Malone said. “We felt more comfortable with it being that.”

Jonell Barber, Smith’s mother, said the family has no history of breast cancer.

They did not know about Li-Fraumeni, either, and they felt blindsided by the diagnosis, especially due to Smith’s young age.

“A 25-year-old with breast cancer? You just have a false knowledge, you think that that is a disease that older women get,” Barber said. “We definitely had our eyes opened.”

According to data from the National Institutes of Health, the risk of getting breast cancer for women under 30 is about 1 in 1,500.

Malone said younger women who are diagnosed with cancer may face unique challenges because the diag-

DEAL ■■ Continued from page 1 Deal posted pictures on Twitter before and after she had her head shaved.

Deal said the doctors treating her at Northeast Georgia Medical Center prepared her for hair loss because of the chemotherapy treatments. When she noticed her hair was coming out each time she touched it, the decision was a simple one.

“I was leaving hair in the kitchen and the dining room and the bedroom,” Deal said. “I felt that was very unsanitary. So, I made an appointment to get my hair cut.”

Deal explained she wanted her head shaved by a professional. And her youngest daughter, Katie Deal, ordered her mother a wig. It was on hand at the hair salon, ready for the beauticians to cut and shape.

“She trimmed it up and made it look like the way I wore my hair,” Deal said. “I’ve been wearing my wig ever since.”

Deal plans to continue wearing her wig until her hair returns to a more natural length. But she said her hair is growing in white and curly.

Along with hair loss, Deal experienced a few other side effects from chemotherapy, including rashes, shingles and lack of energy.

But the hardest one was her weakened eyesight.

“About halfway through my chemo treatment, I had trouble seeing,” she said. “I couldn’t read very well. My eyes would water and wouldn’t focus.”

Deal contacted a doctor to have her eyes checked. The doctor

nosis comes with an abrupt lifestyle change. Her sister is more susceptible to illness due to her chemotherapy treatments, she said.

“For someone that’s young and wants to go out and wants to socialize, you can’t do that because you take the risk of getting sick,” Malone said. “She has to be

said the chemo was affecting her vision, and she would have to wait it out. This complicated some of her favorite duties and responsibilities as Georgia’s first lady.

“I was having trouble with my hand and brain working together,” she said. “I found I had trouble writing thank you notes.”

Fortunately, Miranda Williams, special assistant to the first lady, typed her notes at that time. Deal admitted not everyone dealing with cancer and its treatments have such a luxury.

Deal also had to decrease the number of events she attended as First Lady, because of her weakened immune system. She admitted her husband, Gov. Nathan Deal, was very protective of her and her health. She said he was concerned she may contract a cold or possible the flu while reading in schools or attending functions with several people.

“I had to detour my trips to the schools, and it was real frustrating to me,” she said. “I really wanted to get to all of the schools to read to the children.”

Deal has made literacy one of her primary causes since becoming first lady. It is not surprising since Deal is a retired school teacher.

“Learning to read is really important for the future of families and the state,” she said.

But Deal acknowledged by sharing her cancer from diagnosis to her final radiation treatment in May 2018, she has helped other women.

“My life is always open book,” she said. “If sharing my experience would help people go get mammogram, then I am willing to do that.”

‘I had to detour my trips to the schools, and it was real frustrating to me. I really wanted to get to all of the schools to read to the children.’

Sandra Deal

very careful.”

Smith, a 2011 West Hall High School graduate, goes to the Longstreet Clinic for her treatments. She spends most of her time with her family, who are helping her through the process.

“It’s nothing more than what you allow it to be. I refuse to let it be anything

other than just what it is,” Smith said.

Her husband, Will, is also staying by her side, and Smith said he is her “absolute rock.” The couple met while working together at Walmart, when Will helped her fix her broken car battery.

“If there is anything I need, he is there,” Smith said. “He doesn’t hesitate for anything. ... It’s indescribable, the kind of love that he has given me through this so far.”

Smith started working in the kitchen at Chattahoochee Country Club in February and quickly bonded with co-workers there, who she said have kept in touch and offered support.

And Barber said that while the family has been always been close, they are working to stay positive and support each other, bring

them together even more.

The family’s faith has also brought them strength, she said.

“This doesn’t surprise me at all with this family. We are so close anyway, and I think it’s brought us closer actually,” Barber said.

The family is also thankful that Smith found the lump and got checked.

Her lump was not as firm as what is usually associated with breast cancer, and cancer was not on her mind. But just to be sure, she made an appointment for a mammogram.

Malone said the family now wants to encourage other women to be proactive in seeking treatment.

“Being an advocate for yourself is the bigger picture here. You know your body better than any doctor ever will,” Malone said. “If you feel something is different, or if you feel something is wrong, it’s up to you to get it checked.”

The family is also helping organize a ladies’ night out fundraiser on Oct. 20 to help pay for Smith’s treatments. Next year, the family wants to reach out and help another person with cancer with the fundraiser.

Smith said that while dealing with cancer has been difficult, she doesn’t want her diagnosis to define her.

“The cancer is a part of me. I’m not a part of it,” she said. “That’s something I tell myself a lot, as a reminder that I know when this journey comes to an end, it comes to a winning end regardless. I’m just looking forward to the great victory.”

Photos by NICK BOWMAN The Times

Georgia first lady Sandra Deal reads “The Scarecrow’s Hat” to students on Tuesday, Sept. 25, at the McEver Arts Academy.

Deal has made early childhood literacy a top priority during her eight years as first lady.

CMYK The Times, Gainesville, Georgia | gainesvilletimes.com

Sunday, October 7, 2018

5

Where to find help: Resources for cancer patients The Longstreet Clinic Cancer Support Group

■■ What: Support group for all cancer patients, caregivers and survivors ■■ When: 6:30 p.m. the last Tuesday of every month ■■ Where: Longstreet Cancer Center waiting area, 725 Jesse Jewell Parkway, Gainesville

Northeast Georgia Health System Oncology Patient Navigators ■■ What: Provides cancer patients with guidance and support throughout their cancer journey, including helping to navigate the health care system and any challenges that may impede treatment.

■■ When: Navigators can be reached from 8 a.m. to 4 p.m.

Monday through Friday.

■■ More info: Registered nurse Lisa Bridges assists patients with breast cancer. Call 770-219-5857 or email Lisa.Bridges@nghs.com

Cancer Rehabilitation ■■ What: Northeast Georgia Medical Center’s cancer rehabilitation services treat the side effects of chemotherapy, radiation and other common treatments of cancer. Patients can consult with the staff to verify insurance benefits for specific plans.

■■ More info: 770-219-8200, www. nghs.com/cancer-rehabilitation

Clinical trials ■■ Northeast Georgia Medical Center partners with many national oncology groups to provide patients the opportunity to participate in nationwide clinical trials sponsored by National Cancer Institute and other established cancer institutions.

■■ More info: 770-219-8820, www.nghs.com/clinical-trials

Northeast Georgia Medical Center’s Financial Assistance

The Times file

Look Good Feel Better is an American Cancer Society program that teaches beauty techniques to help women cope with the physical changes they may experience after undergoing breast cancer treatment.

Cancer State Aid

Glory, Hope, and Life

■■ What: Provides financial assistance for cancer-related diagnostic testing, evaluations and treatment planning support, as well as cancer treatment support for patients whose prognosis and planned treatment are medically eligible for program funding.

■■ More info: Contact Lisa Hunsbusher at 770-219-1734 for eligibility requirements or visit dph.georgia.gov/cancer-state-aid-2

■■ What: Assists cancer patients, caregivers and families with a variety of financial, physical and emotional support services through resources, programs and activities.

■■ More info: 770-533-4705, www.gloryhopelife.org

Cancer Foundation

■■ What: Helps patients apply for public health coverage programs, discounts, payment plans or free care to eligible uninsured or underinsured patients for medically necessary care.

■■ More info: 770-219-1898, www. nghs.com/financial-assistance

■■ What: Assists patients in Northeast Georgia with rent/ mortgage, prescriptions not covered by insurance, utility bills, nutritional assistance, durable medical equipment and gas cards ($500 cap per patient each year).

■■ More info: 706-353-4354, www.cancerfoundationofnega.org.

Andre Kallab, MD

Salvation Army Project SHARE ■■ What: Provides emergency bill-payment assistance for people affected by illness, job loss or other unfortunate circumstances.

■■ M o r e i n f o : 7 7 0 - 5 3 4 7589, projectshareinfo.com/ where-to-apply

Chaplain services ■■ What: Northeast Georgia Health System offers chaplain visits, contact with personal pastors, devotional literature and

Padma Nadella, MD

April Reins, FNP-C

COMPASSIONATE CANCER CARE

Sunday chapel services.

■■ When: Chapels are available 24 hours a day, seven days a week.

Office hours are 9 a.m. to 4 p.m.

Monday through Friday.

■■ Where: NGMC Braselton and NGMC Gainesville ■■ More info: Gainesville office: 770-219-5077, after-hours 770-2191873; Braselton office: 770-8484928, after-hours 770-848-0735

Hospice of Northeast Georgia Medical Center ■■ What: Provides inpatient and outpatient hospice services for patients with life-limiting illnesses.

More info: 770-219-8888, www. nghs.com/hospice

HealingStrong ■■ What: Support group focused on natural strategies to heal and stay strong.

Saloni Tanna, MD

■■ When: 6 p.m. second Tuesday of the month ■■ Where: Natural Juice Cafe, 2480 Limestone Parkway, Gainesville ■■ M o r e info: www. healingstrong.com, teambutler■ champions@gmail.com

Look Good Feel Better ■■ What: American Cancer Society program that teaches beauty techniques to help women cope with some of the physical changes they may experience.

■■ More info: lookgoodfeel■ better.org, 800-395-5665

Team Maggie for a Cure ■■ What: Helps women fund fertility treatments and egg retrievals.

■■ M o r e info: www. teammaggieforacure.org

Christina Saurel, MD

Melissa Summerlin, ANP-C, ACHPN

• Board Certified Oncologists • Diagnosis and Treatment of all Types of Cancer • In-house Infusion Suite • Nutrition Support with Registered Dietitians • In-house Imaging

1240 Jesse Jewell Pkwy, SE | Suite 600 | Gainesville, GA 30501 Medical Plaza 1 | 1515 River Place | Suite 150 | Braselton, GA 30517 770-536-9864 | www.ngdc.com

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Sunday, October 7, 2018

The Times, Gainesville, Georgia | gainesvilletimes.com

3D offers vision for a cure

Photos courtesy of Northeast Georgia Health System | For The Times

A patient undergoes a 3D mammogram exam from technician Kourtney Farrow at The Imaging Centers of Northeast Georgia Medical Center. The device, seen below, allows for earlier detection of breast cancer.

Technology means earlier detection, fewer callbacks

By Pamela A. Keene

T

For The times

echnological advances in mammography mean better news for women getting screened for breast cancer.

Over the past five years, researchers have developed 3D Automated Breast Ultrasound and 3D mammogram options that can help detect breast cancers earlier, leading to better outcomes for treatment. Both are now available in Northeast Georgia.

“Our 3D Automated Breast Ultrasound, called ABUS, is a new screening technology that allows radiologists much better visibility of dense breast tissue during breast cancer screenings,” said Ashley James, mammography technologist and mammography tracking coordinator of radiology services at The Longstreet Clinic. “We’re one of only 200 clinics in the country to offer the ABUS technology.”

James said that the 3D ultrasound provides a much more detailed view as a supplement to a traditional 2D mammography.

“It’s especially effective for women who have dense breast tissue, and that’s about 40 percent of all women who are eligible to be screened,” she said. “Plus, it’s non-invasive and gives us more assurance of coverage of the entire breast.”

The Longstreet Clinic added the ABUS technology in April.

“Physicians are also happy for their patients to have the 3D ultrasound because it doesn’t involve radiation, and there’s a 24 percent better detection rate,” said Nichol Hughes, clinical coordinator.

“Right now, 35 states are required to report breast density to patients, and Georgia’s not one of those states. Breast density reporting is mandated in 35 states, and we’re hoping it will be soon in Georgia. In the meantime, we at The Longstreet Clinic are providing this voluntarily to patients.”

Dense breast tissue can hinder early detection of smaller breast lesions and cancers, and James explained that dense tissue is something that’s evident through imaging.

“It’s not something that can be felt, but when breast tissue is more dense, it can mask lesions,” she said. “By using the ABUS, cancers can be detected at an earlier stage, when they are smaller and easier to treat.”

The Imaging Centers of Northeast Georgia Medical Center have added 3D mammography for breast cancer screening in three locations. It was first offered at the Braselton campus in 2015 and was added at the Gainesville and Dawsonville locations in June of this year.

“Traditional mammograms give radiologists a flat, two-dimensional representation of the breast,” said Julie Pardue Presley, MD, of Gainesville Radiology Group and medical director of Women’s Imaging at NGMC. “The new technology creates a 3D image using many layers of the breast, so fine details are more visible and no longer hidden by the tissue above or below. The technology means radiologists have to do fewer callbacks for repeat exams because what appeared to be questionable in a traditional image may be very clear in a 3D image.”

Since it became available in Braselton, about 60 percent of the women who have breast screenings there have chosen 3D mammography. It can be specified on the physician’s orders for the screening or a patient can choose the new technology themselves.

The scheduling staff at the Imaging Centers of NGMC typically asks patients which method they prefer, 2D or 3D, and many are requesting the newer testing, which is covered by Georgia’s larger insurers and many private payers as well.

“This new 3D screening technology reduces the chance of being called back for a follow-up mammogram by 40 percent,” says Kourtney Farrow, women’s imaging coordinator of Northeast Georgia Health System. “It can certainly reduce the need for callback mammograms.”

The 3D mammogram process involves scanning the breasts in an arc, capturing 1 mm views that the computer generates into a 3D image of the breast tissue.

“It takes about the same amount of time as a 2D mammogram,” Farrow said. “And many of our patients say they feel less discomfort even though the compression is the same as traditional mammograms.”

Farrow said many patients are already educated about 3D mammograms through the internet and the media.

“When women make their appointment for their routine screenings, they can request the 3D technology, even if their physician hasn’t written an order for it,” she said. “Eventually it will become the standard of care for breast screenings.”

Courtesy of Longstreet Clinic | For The Times

An Automated Breast Ultrasound image displays breast density, which is key to detecting potential breast cancer.

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7

The risk increases with age

By Megan Reed

mreed@gainesvilletimes.com

T

he risk of developing breast cancer increases as women age, but the largest increase in risk happens when a woman enters

her 60s.

Fewer than 1 percent of women develop breast cancer in their 30s. That number becomes 3.56 percent for women in their 60s and 3.82 percent for women in their 70s, according to the National Cancer Institute.

Women should start getting annual mammograms when they turn 40 and conduct their own periodic self-exams in between, according to Dr. Andrew Johnson with the Longstreet Clinic.

Women receive physical breast exams during annual gynecological exams, and are encouraged to do monthly self-exams, according to the Longstreet Clinic.

However, women with a family history of breast cancer may benefit from genetic testing to determine if they are predisposed to breast cancer and can work with physicians to take preventative measures. MRI scans may be used in addition to mammograms for women who are at a higher risk.

“If it was a young woman who had a strong family history of breast cancer, or a genetic mutation that increased her risk of breast cancer very high, then we could discuss methods of breast cancer risk reduction with medications or surgeries,” Johnson said.

For younger breast cancer patients, there may be added social pressures if other women their age do not relate to what they are going through, Johnson said.

“They’re just in a completely different time in their life, where it comes as a huge shock. They’re expecting a time in their life where they’re going out, having fun, they oftentimes have young children,” Johnson said. “The changes that come with a cancer diagnosis, including needing chemotherapy and completely disrupting your life, as well as oftentimes losing your hair, are huge changes that lead to difficult times.”

Chemotherapy can also affect a woman’s fertility, so younger patients are often referred to a fertility specialist for egg preservation if they may want to have children later, Johnson said.

According to the Centers for Disease Control and Prevention, some risk factors for breast cancer cannot be changed, such as age, genetic mutations and family history. However, there are some steps women can take that may reduce their risk of breast cancer, such as regular exercise and limited alcohol consumption.

Courtesy of Longstreet Clinic | For The Times

A patient undergoes an Automated Breast Ultrasound exam at Longstreet Clinic. Mammograms are recommended annually for women over 40, while younger women are encouraged to get breast exams during their annual gynecological exams and conduct self-exams each month.

Breast cancer risk factors

Factors you can’t change Getting older. The risk for breast cancer increases with age; most breast cancers are diagnosed after age 50.

Genetic mutations. Inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2. Women who have inherited these genetic changes are at higher risk of breast and ovarian cancer.

Reproductive history. Early menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.

Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.

Personal history of breast cancer or certain non-cancerous breast diseases. Women who have had breast cancer are more likely to get breast cancer a second time. Some

non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.

Family history of breast cancer. A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.

Previous treatment using radiation therapy.

Women who had radiation therapy to the chest or breasts (like for treatment of Hodgkin’s lymphoma) before age 30 have a higher risk of getting breast cancer later in life.

Women who took the drug diethylstilbestrol (DES). It was given to some pregnant women in the United States between 1940 and 1971 to prevent miscarriage, have a higher risk. Women whose mothers took DES while pregnant with them are also at risk.

Factors you can change Not being physically active. Women who are not physically active have a higher risk of getting breast cancer.

Being overweight or obese after menopause. Older women who are overweight or obese have a higher risk of getting breast cancer than those at a normal weight.

Taking hormones. Some forms of hormone replacement therapy (those that include both estrogen and progesterone) taken during menopause can raise risk for breast cancer when taken for more than five years. Certain oral contraceptives (birth control pills) also have been found to raise breast cancer risk.

Reproductive history. Having the first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy can raise breast cancer risk.

Drinking alcohol. Studies show that a woman’s risk for breast cancer increases with the more alcohol she drinks.

Source: Centers for Disease Control and Prevention

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Sunday, October 7, 2018

The Times, Gainesville, Georgia | gainesvilletimes.com

Know breast cancer types

Photos by SCOTT ROGERS | The Times

Nicole Curtis has her vital signs taken Monday, Sept. 24, by certified medical assistant Stephanie Baseemah inside the infusion center at The Longstreet Clinic Cancer Center.

Treatment options determined by what kind is diagnosed

BY AMBER TYNER

atyner@gainesvilletimes.com

W

omen in the U.S. have about a 12 percent chance of developing breast cancer within their lifetime, according to the American Cancer Society. The type of breast cancer they may be diagnosed with could be one of many forms.

The cancer is first labeled invasive or noninvasive, depending on if it has spread to other tissues. From there, the most common breast cancer diagnoses a woman can receive are lobular carcinoma or ductal carcinoma, which refers to exactly where the cancer started within the breast, according to Dr. Andrew Johnson, hematology and oncology physician at Longstreet Clinic.

Invasive vs. noninvasive Invasive breast cancers spread to normal tissue. Noninvasive breast cancers present abnormal cells but do not appear to invade the surrounding tissue.

Johnson said invasive breast cancer is much more common and noted that 1 in 8 women in the U.S. will develop invasive breast cancer over the course of their life.

“If it is invasive breast cancer, then the next thing we look at is the size, whether or not there’s any lymph node involvement and then the hormone receptor status,” he said.

“The reason that we look at the hormone receptor status, as well as something called the HER2 gene, is because that will define how we treat that particular kind of breast cancer.”

He said the HER2 gene is “involved in cell proliferation and growth.”

“If a breast cancer is expressing that gene, we know that those breast cancers are more aggressive, and we have drugs that can specifically target that gene and treat those breast cancers,” he said.

Ductal carcinoma vs. lobular carcinoma Ductal carcinoma, as the name suggests, begins within the ducts of a breast, which are the tubes that carry milk. Lobular carcinoma, on the other hand, begins in the glandular tissues of the breast where milk is produced. Ductal carcinoma is the most common type, lobular carcinoma the second most common.

“They’re not exactly the same and they have different patterns of spread, but especially for early stage breast cancer, which is the vast majority of breast cancers that we see, there’s not very many differences,” Johnson said.

The symptoms of these cancers are also the same, such as a lump in the breast or redness.

“Symptoms of breast cancer can include a palpable lump in the breast, so a lump that you can feel,” he said. “Occasionally it can be associated with pain but often times they’re not painful. It can be associated with skin changes if it’s close to the skin, including redness. Oftentimes it’s deeper and not associated with skin changes. If it’s close to the nipple, nipple inversion can be a presenting feature.”

Nicole Curtis meets Sept. 24 with Dr. Andrew T. Johnson inside The Longstreet Clinic Cancer Center. According to Johnson, a hematology and oncology physician at Longstreet Clinic, the most common types of breast cancer are lobular carcinoma and ductal carcinoma.

‘Inflammatory breast cancer represents 1 to 5 percent of Mucinous breast cancer only appears as 1 all breast cancers diagnosed in the U.S. Compared with outMucinous of every 100 breast cancers and is typically seen in older women. other types of breast cancer, it tends to be diagnosed at “(It) tends to be slower growing,” he said. “(It’s) less likely to spread to lymph nodes, a younger age. And it often presents with swelling and but treated the same way as other invasive breast cancers.” redness that affects a third or more of the breast.’

Dr. Andrew Johnson, hematology and oncology physician at Longstreet Clinic

Other breast cancers There are numerous subtypes of breast cancer, but those are rare in comparison, Johnson said.

Inflammatory breast cancer Johnson said most inflammatory breast cancers are still invasive ductal carcinomas.

“Inflammatory breast cancer represents 1 to 5 percent of all breast cancers diagnosed in the U.S,” he said. “Compared with other types of breast cancer, it tends to be diagnosed at a younger age. And it often presents with swelling and redness that affects a third or more of the breast.”

He said this specific subtype is more aggressive and has to be treated with chemotherapy, surgery and often radiation.

Breast sarcoma Breast sarcoma, known as a phyllodes tumor or cystosarcoma phyllodes, “can either be cancerous or noncancerous, meaning some of these are benign,” Johnson said.

“They tend to occur in middle-age women or older.”

Adenoid Cystic Carcinoma Adenoid cystic carcinoma represents less than 1 percent of breast cancer, Johnson said. “That one tends to be more slow-growing and often treated with surgery alone,” he said.

Medullary breast cancer This type represents 2 to 5 percent of all breast cancer and tends to occur in younger women, Johnson said. It can be associated with the BRCA1 gene mutation and is usually treated similarly to other more common invasive cancers.

Diagnosis and treatment

To determine if a patient has any type of breast cancer, Johnson said a mammography and biopsy are performed.

“Either a patient has gone through routine annual mammography or if something new has come up and they haven’t had mammography, they’ll undergo mammography and/ or ultrasound,” he said. “And if something looks suspicious, then we’ll get a biopsy. And then that biopsy will let us know what’s going on.”

Johnson said the treatment is similar for ductal and lobular carcinoma.

“It really doesn’t change our treatment recommendations as much as one might think,” he said. “The staging and prognosis of both these breast cancers are similar.

The treatment is similar, however, (it) varies based upon hormone receptor status and whether or not the HER2 gene is positive or amplified.”

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9

A digital age answer for costs More Americans look to crowdfunding to help pay large medical bills

BY JOSHUA SILAVENT

jsilavent@gainesvilletimes.com

A

s health care costs grow and the number of uninsured Americans rises again with the uncertainty of the Affordable Care Act, more people are turning to “crowdfunding” websites to pay for medical bills and associated travel expenses to treat their conditions.

It’s a phenomenon ripe for the digital age, where a compelling story can go viral and attract the attention of strangers worldwide who are happy to chip in.

“We’ve certainly been aware of it ... the popularity as a strategy for helping cover medical or related bills,” said Laura Colbert, executive director of Georgians for a Healthy Future, a nonprofit consumer health advocacy organization. “I do think it indicates that we haven’t gone far enough in providing people with accessible, affordable care that’s close to home.”

According to the Centers for Disease Control and Prevention’s National Health Interview Survey, an estimated 29.3 million Americans were uninsured last year, an increase of 700,000 from 2016.

The uninsured rate in Georgia, meanwhile, grew to 13.4 percent in 2017, according to the U.S. Census Bureau, the fourth-highest rate in the nation.

Colbert said rising health care costs mean more employers and insurers are shifting the burden to employees and consumers, which may also play a role in the rise of crowdfunding.

GoFundMe, one of the largest crowdfunding channels on the Internet, reports that 1 in 3 fundraising campaigns on its site at any given time is related to medical expenses. Moreover, the website reports that it hosts more than 250,000 medical fundraising campaigns annually, generating more

than $650 million each year.

A recent keyword search for “breast cancer” on the GoFundMe site produced 245,844 related campaigns looking to raise tens of thousands and even hundreds of thousands of dollars.

The CEO of GoFundMe has confirmed that 1 out of every 3 GoFundMe campaigns running right now is to pay medical bills, which makes the site one of the biggest insurers in the country.

GoFundMe’s website reports that it is the leader in online medical fundraising, showcasing more than 250,000 campaigns per year, and raising more than $650 million per year.

There are other websites that have launched in recent years that deal exclusively with medical expense campaigns.

The dependence many Americans now have on crowdfunding their medical expenses may not be surprising when the amount of charity care the Northeast Georgia Health System provides is taken into account. Across its three hospitals, the health system gave more than $40.2 million in charity care for the 2017 fiscal year.

Patients who receive care at the health system’s physician offices may also receive charity care if they are uninsured.

NGHS also donated nearly $500,000 to help Good News Clinics provide care to indigent patients whose income is at or below the poverty line, as well as more than $1 million to provide primary care services at the public health department in Gainesville.

Good News Clinics reports that it’s 2017 fiscal year budget of 1.46 million provided nearly $24 million in free health care services for low-income patients with the support of partnerships, resource donations and volunteers.

The Longstreet Clinic in Gainesville also provides charity care to the tune of about $7.5 million to $8 million annually, according Mimi

A view of the GoFundMe web page.

‘I do think it indicates that we haven’t gone far enough in providing people with accessible, affordable care that’s close to home.’

Laura Colbert, executive director, Georgians for a Healthy Future

‘Certainly, people need help and need resources ... there’s limited checks and balances to make sure it’s a valid request.’

Mimi Collins, chief executive officer, Longstreet Clinic Collins, chief executive officer.

For example, Longstreet physicians partner with Good News Clinics and participate in a health access initiative that connects lowincome patients with specialty care.

Collins also is on the board of directors of Glory, Hope & Life, a local organization that provides support services for cancer patients, from respite and vacation to wigs and prosthetics.

And the clinic’s patient navigators are focused on reducing barriers and improving the quality of life of its cancer patients, specifically, for example, by helping pay power bills, rent, transportation

Women with BRCA gene can address cancer risk through DNA test

By Megan Reed

W

mreed@gainesvilletimes.com

omen who are genetically more likely to develop breast cancer may have some difficult decisions to make, but those with the BRCA gene mutation should approach those choices armed with the proper information, according to a Longstreet Clinic physician.

According to the National Cancer Institute, BRCA1 and BRCA2 are genes that produce tumor suppressor proteins that help repair damaged DNA. When one of those genes is mutated, DNA damage may not be repaired properly, and cells are more likely to develop additional mutations that can lead to cancer.

About 10 to 12 percent of women overall get breast cancer before age 90, according to Dr. Priscilla Strom with the Longstreet Clinic’s Breast Center. But for women with the BRCA gene, that risk can rise to about 70 percent, according to the National Cancer Institute.

However, Strom said she does not recommend people who have never had breast cancer get tested for the BRCA gene. Instead, a relative who has or had cancer should be tested, if they are alive and willing to do so.

Strom also advises against getting tested for the gene before age 25.

“If there is a person in her family with the cancer who has not been tested, the person with the cancer is the person who needs to get tested,” Strom said. “Most people with breast cancer do not have the gene, and if the person in your family who has breast cancer does not have the gene, the chance of you having the gene is essentially zero, so

‘Most people with breast cancer do not have the gene, and if the person in your family who has breast cancer does not have the gene, the chance of you having the gene is essentially zero, so there’s no reason for you to get tested.’

Dr. Priscilla Strom, Longstreet Clinic’s Breast Center

there’s no reason for you to get tested.”

Only about 5 percent of women who develop breast cancer have the BRCA gene, Strom said.

The BRCA gene mutation can be inherited from both the mother and father, so people should look at both sides of their families for a history of breast cancer. Each child of a parent who carries the mutation has a 50 percent chance of inheriting the mutation, according to the National Cancer Institute.

If someone does test positive for the BRCA gene, they have several options. They should increase screening for breast cancer, including getting MRIs rather than mammograms.

Women can also reduce their risk of getting breast cancer by taking an anti-estrogen medication such as tamoxifen.

The most permanent decision is getting a mastectomy proactively, which Strom said reduces the risk of developing breast cancer to about 1 to 2 percent.

To some, that option may seem extreme.

And Strom said she works to ensure her patients understand their options before deciding to get a mastectomy.

“I spend more time talking people out of mastectomies than I do talking them into mastectomies,” she said. “They come in here already having made their minds up.”

The BRCA gene can induce fear in people who have seen a loved one struggle with breast cancer. Strom said she understands why her patients may have an emotional connection to the issue.

“People do it out of fear,” Strom said.

“Part of my job is to ratchet that fear back down to reasonable levels, to say that, I understand that you saw your mother die of breast cancer, so I understand you don’t want to do that. But let’s think of other things, too.”

and some prescription drug costs.

Collins said the rise of crowdfunding is a symptom of three problems: rising health care costs, the growing number of uninsured Americans, and the vast number of “underinsured” patients.

“I struggle a little bit with it,” Collins said of the crowdfunding rage. “Certainly, people need help and need resources.”

But it’s a dilemma where “there’s limited checks and balances to make sure it’s a valid request,” Collins said.

Indeed, crowdfunding may be a new spin on traditional charity care, but it “raises a constellation of ethical and legal hurdles for

patients, clinicians, institutions, and society,” according to a recent article in the Journal of the American Medical Association.

Authors from Harvard Medical School wrote that crowdfunding can redirect medical services from patients most in need to those whose campaigns are “more vocal, photogenic or emotionally appealing.”

Crowdfunding also runs the risk of exposing sensitive, personal medical information, and it’s predisposed to fraud and exploitation.

There have been many examples of crowdfunded campaigns raising large sums of money for bogus causes.

But the need for crowdfunding may outweigh its potential downsides. Insurance frequently doesn’t cover all consumer medical expenses, some treatments may not be covered at all, and travel-related costs are commonly associated with severe conditions like breast cancer.

In 2015, the United States spent three times more on health care, according to the Organization for Economic Cooperation and Development, than 35 other countries with advanced economies, but doesn’t perform better in measures like life expectancy at birth.

“Our society tends to be pretty income-segregated,” Colbert said.

And while crowdfunding may assist in shrinking that gap, “You’ve got to be pretty well connected and computer literate” to make it work for you, she added.

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Sunday, October 7, 2018

Showing their sparkle

Photos by SHANNON CASAS | The Times

Leslie Rucker of Marietta has body paint applied before a photo shoot Sept. 30 at Mirrored Images Boudoir in Gainesville.

Breast cancer survivors celebrate their bodies at photo shoot

By MegaN Reed

mreed@gainesvilletimes.com

I

t was a glitter-filled afternoon designed to help women restore their self-confidence.

On Sept. 30, seven women traveled to Gainesville and met at Mirrored Images Boudoir on Georgia Avenue.

Some of them knew each other, and others were meeting for the first time for the Sparkle and Celebrate Pink photo shoot, but they had a com-

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Sparkle ■■ Continued from page 10 has bonded with cancer patients through her work as an emergency room nurse, and she wanted to find a way to help them through her photography.

“I wanted to give them a day that they could celebrate how beautiful they are and how strong they are,” Hyman said.

She said she wanted to help the women embrace their bodies, including their scars, and encourage them after what they had experienced.

“Some women have had reconstruction, others haven’t, some have more scars than others, but regardless, not only is it physically traumatizing but it is emotionally,” Hyman said.

Hyman recruited makeup artists and hairstylists to spend the day at her photo studio in Gainesville. For a few hours that Sunday, the space was filled with women helping each other get ready, taking photos, and bonding and sharing their stories.

Theresa Farmer traveled from Covington on Sept. 30 for the photo shoot. She said she first noticed a sore on her breast in January 2009, but it did not fit with what she knew about breast cancer. She went to the doctor in November 2009 and learned she had Paget disease of the breast, a type of cancer that involves the skin and is often associated with lumps in the breast as well.

“We’re told as women to look for lumps, we’re told as women to look for changes, but no one says that if you have a sore, you need to get that looked at,” Farmer said.

Farmer, who is now healthy, had a lump in her breast and had a bilateral mastectomy in 2010. She also went through chemotherapy as part of her treatment.

She said women should be proactive about their health, even if what they see does not seem like a problem at the time.

“It might seem like some insignificant, little itty bitty sore. It could be something. ...

I just thought it was nothing.

I thought they were going to send me to a dermatologist,” she said.

She said she appreciated the opportunity to meet other cancer survivors and celebrate each other free of judgment — “To help us women not be ashamed of us that have gone through this, and our bodies change so much, and the way we look and think,” she said.

‘I wanted to give them a day that they could celebrate how beautiful they are and how strong they are.’

Jenn Hyman, owner and photographer, Mirrored Images in Gainesville

Top photo: Leslie Rucker of Marietta has her photos taken

by Jenn Hyman of Mirrored Images Boudoir in Gainesville.

Above: Rucker has body paint applied by Natalka Tyniec.

At left: Theresa Farmer of Covington has body paint applied by Tyniec. Farmer had a lump in her breast and had a bilateral mastectomy in 2010.

She also went through chemotherapy and is now healthy.

Below: Freelance makeup artist Staci Gibbs applies makeup to Farmer while Kristi Purvis of The Teal Magnolia Salon in Cumming does her hair.

11

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