BREAST CANCER AWARENESS MONTH
‘Gotta have friends:’ Breast cancer patients forge bonds MELODY PARKER
Breast cancer is a diagnosis no one wants to hear. It’s a club no one wants to join. Once it happens, there is an immediate connection with other members. Having a support system of family and friends can help cancer patients cope with the diease and treatment, experts say. But it also helps to know someone who has “been there, done that,” someone willing to share their story and offer encouragement and advice. “It’s tough stuff to wrap your head around — from the diagnosis and treatment to something like losing all your hair. Your perspective changes when you get to hear other stories,” says Sarah Corkery, who has battled both stage 0 and stage 1 breast cancer. She was diagnosed at age 36. Corkery was the first person Traci McCausland called when
she received her diagnosis of breast cancer in May. “I was on my way home from the clinic and texted one of our [mutual] friends to send me her contact number. She was the only person I knew in my age group who had had breast cancer, and she was the first person I reached out to,” recalls McCausland, 39. “She called me, and we spoke for 45 minutes on the phone. Mostly I cried.” Although Corkery herself was “dealing with my big fat reality” — living at Hope Lodge in Iowa City, where she was living while receiving daily radiation treatments for six weeks and eight weeks of chemotherapy, she wanted to be more than just a listening ear for McCausland. “I don’t sugar-coat anything. When I share my story, I just put it out there. I’m all for honesty,” says Corkery, who is naturally upbeat and forthright. “Breast cancer
have a history of cancer. Her maternal grandmother was 41 and her aunt was 39 when they were diagnosed with cancer, and her mom died of uterine cancer when Corkery was 14. In 2012, Corkery was referred to a high-risk clinic in Iowa City by her OB-GYN. The mother of three underwent a mammogram and breast MRIs, and something suspicious was found in her left breast. Later, a biopsy revealed stage 0 cancer contained in a single milk duct. Although she did not test positive for HER2 (human epidermal growth factor receptor 2), she chose “to be aggressive about it and opted for a double mastecMATTHEW PUTNEY, COURIER PHOTO EDITOR tomy and breast reconstruction in Traci McCausland, left, and Sarah Corkery bonded over their mutual the same surgery,” she says. “Evbattles with breast cancer. eryone’s choices are different, and that was mine.” patients need to have a support ence, but may have made different Chemotherapy or radiation was system, and it’s important to talk choices.” to women who share this experiWomen in Corkery’s family Please see BONDS, Page H2
BREA AST CANCER KNOWS NO AGE. Schedule your mammogram today. 319 9.272.7080 I WheatonIowa.org/mammogram 00 1
H2 | Sunday, September 24, 2017 BREAST CANCER AWARENESS
BY THE NUMBERS In Iowa, there will be 2,400 new breast cancer diagnoses and an estimated 380 deaths from it.
New cases in the U.S.
Five-year relative survival rate
91 percent White women
82 percent African American women
99 percent Five-year survival rate for localized stage
Register now for 11th Pink Ribbon Run GABBI DEWITT
Ride for BPT
For the Courier
EDAR FALLS — The 11th AnC nual Pink Ribbon Run is Oct. 7. The 5K run/walk will begin at 8 a.m. at the Cedar Falls Community Center, 528 Main St. The event raises money to benefit the Beyond Pink TEAM, a breast cancer coalition in the Cedar Valley, which provides support to women living with a breast cancer diagnosis. Registration is $35 and can be done at www.beyondpinkteam. org. For the third consecutive year, the race is presented Oakridge Realtors and University of Iowa Community Credit Union, which allows registration fees to be used ot help individuals, organizers say. The committee covers race expenses through sponsorships, including Community Auto as survivor sponsor for the third year. Conmunity Auto will cover the race registration fee for any breast cancer survivor. Martin Brothers will provide light refreshments following the race, and coupon cards will be provided by downtown merchants. Giving pink beads to survivors — one strand for each year since diagnosis — is a tradition. Tina Wendel of Sumner, a 25-year breast cancer survivor, will be wearing 25 strands as she participates in the run with her daughters since 2010. “I felt it was important to teach them compassion for strangers and to help others that are going through a struggle,” Wendel says. She hopes that when newly diagnosed women participate, they feel supported. “I just want the women who are early in their fight to know there is hope. You can survive, and you can live a full and complete life.” Jodie Muller of Cedar Falls, appreciates that message. Diagnosed in October 2016, she has participated in the run before; this year as a survivor. “It will be an emotional experience. I am proud to be a survivor. It is only one year, but I am thankful and blessed to have come this far,” she says. Seeing women like Wendel give Muller hope. “When I was newly diagnosed, it was terrifying. You know, at least intellectually, that people survive. But seeing women out there who are longterm survivors offers something that I think is so important, and sometimes hard to find — hope. And perhaps a little faith and trust that things will be OK.” Muller has put together her own group, Team North Star, to participate in the race. Last year 800 participants signed up for the run, and the committee donated more than $37,000 to the Beyond Pink
CEDAR FALLS — A WOW Ride to Support Breast Cancer will take place at Oct. 4. The ride begins at 5:45 p.m. at Fourth and Main street. Following the ride, socializing is planned at The Pump Haus. Registration is $25 at www. eventbrite.com. Participants are encouraged to wear pink, and costumes are welcome. All proceeds will go to the Beyond Pink TEAM.
Find out more Interested in learning more about the Beyond Pink TEAM?
Jodie Muller, right, with BPT member Jeanne Olson, has begun volunteering with the Beyond Pink TEAM.
TEAM. Since the race began 11 years ago, the committee has donated more than $258,000 to BPT. Funds help local families facing a breast cancer diagnosis. Last year BPT awarded 78 grants
totaling more than $51,000 to women in seven counties. The assistance can be used for groceries, gas, utility expenses, medical costs, etc. To become a sponsor or receive a registration form by mail, call
Bonds From H1
unnecessary. This year she found a lump on her left side, diagnosed as stage 1 breast cancer. After the tumor was removed, she underwent chemotherapy and radiation. “And I kept working … Veridian has a location in Iowa City, and I was able to work there. My employer has been very supportive, and I was happy I could continue to work. Having Traci hear my story, I felt the need to reassure her. My first choice didn’t pan out for me, but I reduced my risk as much as possible, and I don’t regret it.” Her husband, Chris, took care of their three children, now ages 10, 8 and 4, throughout treatment. Currently, she has blood work done every three months and takes oral medication. “Chris took care of ev-
Join BPT for their Annual Celebration of Accomplishments from 5 to 6:30 p.m. Nov. 2 at the Community Foundation of Northeast Iowa, 3117 Greenhill Circle, Cedar Falls.
Traci McCausland, seated, at the ‘Farewell to Hair’ party she had at KJ & Kompany in June, where she chopped her hair and sent it to Chemo Diva in Florida. The hair will be made into a halo wig for McCausland. Her friend and fellow breast cancer patient Sarah Corkery, is in the white shirt and wearing glasses. erything for me and allowed me to work on my health. I was a grumpy patient, too, and he was amazing,” Corkery says, smiling. McCausland was diagnosed with Stage 2 cancer after her biopsy. Her husband Kent was with her for the diagnosis, and she appreciates his “logical
and level-headed mind” in asking pertinent questions of her caregivers. He, too, has stepped in to do laundry, prepare meals and care for their boys, ages 8 and 4, and he is actively involved with her treatment. A very social person, McCausland has brought her friends along for the
Community Main Street at 2770213. In 2016, the Beyond Pink TEAM put that money to work by awarding 78 grants to women in seven counties, with support that totaled over $51,000. Jodie says the support she received from the Beyond Pink TEAM went beyond financial, “I received a grant that helped to cover some of my medical copays — those expenses really add up in a hurry! But, what I think helped me, maybe even more than the funds, was the feeling that there was someone out there that cared.” Money from the Pink Ribbon Run is put into a fund at the Northeast Iowa Community Foundation. The Beyond Pink Fund, as it is named, began awarding grants in 2008. Grants are given to women or men facing a breast cancer diagnosis who are in need of assistance in Black Hawk County and surrounding
journey, including chemo treatments in Iowa City. She also threw a party for 25 women at KJ and Kompany hair salon after deciding to become a “chemo diva” — a woman who shaves off her hair before cancer treatment can cause it to fall out. Her hair was collected and sent off to make a halo wig which she can wear with a hat, scarf or cap. Her sister donated an additional 7 inches of hair. “There were catered mimosas and matching T-shirts. Traci wanted to have a good time with it. It’s a big part of Traci’s personality, just who she is, ” says Corkery. McCausland smiles, explaining, “That’s where I feel best, surrounded by my people, my family, my friends, people who love you and care and who want to help you. It means so much to me. I decided to bring them along for the ride.’’ Chemotherapy treatments end in mid-October, and she is scheduled
counties. The assistance can be used for groceries, gas money, utility expenses, medical costs, etc. Along with being a great route to run or walk, there will be special recognition for breast cancer survivors before the race begins, and also during the program afterward. There is no Tshirt guarantee for registrations after September 22. To become a sponsor or to have a registration form mailed to you call Community Main Street office at 319-277-0213. Online registration is available by going to the Beyond Pink TEAM website atwww.beyondpinkteam.org . The Pink Ribbon Run is organized by a committee of volunteers from the community. All funds raised are donated to the Beyond Pink TEAM. To become a sponsor or to have a registration form mailed to you call Community Main Street office at (319) 277-0213.
for a double mastectomy on Nov. 16. McCausland and Corkery have become fast friends. “There are lots of similarities between us. We’re both working moms, we were both 20 Under 40 recipients. Sarah is a go-getter, and we know a lot of the same people,” says McCausland, who is founder of Follow Your Strengths and one of the first Gallup-certified strength coaches in Iowa. “My dad met Sarah, and says she is spunky and full of life, and that makes me
feel good. I tell everyone she has been a godsend to me. It’s like the huge bonus of having a tour guide in a foreign land versus relying on Google and strangers. She’s been amazing,” McCausland says. Along with another friend, they have formed the Three Amigas to participate in the annual Pink Ribbon Run on Oct. 7 in downtown Cedar Falls. Afterwards, McCausland plans to have a big party at her house to celebrate her last chemo treatment and Sarah’s birthday.
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Sunday, September 24, 2017 | H3
BREAST CANCER AWARENESS
Local advocates active in national mission to eliminate breast cancer MELODY PARKER
A pink ribbon is the internationally recognized symbol for breast cancer awareness. But the National Breast Cancer Coalition has a much bigger mission: Breast Cancer Deadline 2020. “We need something more than hope. We’ve set a deadline of Jan. 1, 2020, to know how to end breast cancer. Hope is a wish. The deadline is a commitment,” says the NBCC. It is time to move from awareness to prevention, NBCC maintains. The Beyond Pink TEAM has been actively involved in the campaign, says the TEAM’s advocacy council chairperson Christine Carpenter, who also serves as an NBCC board member. BPT member Lori Seawel also serves as an NBCC board member. “Public policy at the national level effects everything to do with breast cancer at the local level, including what the treatments, are, hospital rules, who pays for what, what research gets done … it impacts every aspect of breast cancer,” explains Carpenter, who is a breast cancer survivor. Tapping into the power of grassroots action and advocacy groups, NBCC is using the 2020 deadline as a tool to aim resources and research toward uncovering the knowledge necessary to end breast cancer. They reach out to policy makers, businesses, community organizations, health groups and citizens in their efforts. A main NBCC focus, Carpenter says, is the Artemis Project which focuses on: Primary prevention: How do we stop people from getting breast cancer? Prevention of metastasis: How do we stop people from dying of breast cancer? “Part of that is working on developing a preventive breast can-
Members of the Beyond Pink TEAM advocacy council at Sen. Charles Grassley’s office in Washington D.C., in 2016. cer vaccine,” she says. Researchers have identified 10 antigens or biomarkers that may be found in breast cancer patients and clinical work is moving ahead on vaccines for early-stage breast cancer, for example, and other types of breast cancer. “But they’ve never been tried together in one immunization. We’re working with the FDA to look toward clinical trials, but that takes time.” The second part is understanding how to prevent breast cancer metastasis. “What we’ve been doing is looking at tumor dormancy … why some breast cancers go dormant for 10, 15 or 20 years, then come roaring back and spreading into other organs. If we could figure out what kept it dormant all those years, we could keep it dormant for 50 or more years and prevent metastasis,” Carpenter explains. “We’re certainly making progress. What we’re doing is innovative and out of the box. People are surprised to hear that there is work on a preventive vaccine.” Fran Visco, president of NBCC, praises BPT involvement in a letter sent to its members. “Advo-
cate leaders working in their state and local communities to forward Breast Cancer Deadline 2020 — our initiative to know how to end breast cancer by 2020 — are essential to our success. And there is no group of advocates more committed to doing what it takes to end breast cancer than the Cedar Valley Cancer Committee: Beyond Pink TEAM! Time and again, NBCC calls on Iowa’s advocate leaders — to seek Deadline 2020 endorsements from Presidential candidates, or solicit support and leadership from the state congressional delegation for our legislative and public policy priorities, to work with researchers or share the experiences and success strategies that have worked to expand knowledge and to change the conversation and focus to ending breast cancer. Time and again you have delivered! … The energy, compassion and commitment you bring to our work is commendable and worthy of replication and recognition,” she writes Several BPT members are involved in phase 1 clinical trials, including Jacque Bakker, who
joined BPT in 2011. She attended an NBCC leadership summit in 2012 and heard a presentation on breast cancer immunization by Keith Knutson, Ph.D. Returning home, she sought out clinical trials and was eligible a vaccine trial at Mayo Clinic created to study the safety and immune response to a vaccine used in patients previously treated for HER2 positive breast cancer, like Bakker’s cancer. “I wanted to be part of this progress and in February 2013, I was enrolled as a participant in a Phase I Vaccine Trial. I received a vaccine monthly for 6 months, then intermittent blood work, test and physical exams for over a total of 30 months,” Bakker says. Knutson spoke at the Ignite the Cancer Conversation in 2016 in Cedar Falls, presenting the results of this vaccine trial. “He showed the patients on a graph and the very good immune response seen with the vaccine. This was great news. The hope is that this vaccine will become available to prevent recurrence of HER2 positive breast cancer,” she explains. Many BPT members, including Bakker, Kristin Teig-Torres and
Gowri Bertrabet Guldwadi have traveled to Washington, D.C., to participate in NBCC’s Advocate Leadership Summit, Project LEAD. It is a seven-day retreat and workshop. “As a Project LEAD graduate you become an educated advocate and you become part of the Influence. Trained advocates become a voice that can influence decisions about breast cancer that affect all of us,” says Bakker, who has attended the summit on four occasions. “Being a part of the commitment to end breast cancer is very important to me and my fellow BYPT members. Imagine a world without breast cancer.” Guldwadi attended the NBCC summit in 2015 and 2017, and recently participated in Project LEAD. “Through these experiences, I realized that our risk of breast cancer has gone up, not down, despite our advances in research and technology, our efforts in building awareness, and our innovative, sophisticated screening mechanisms,” she says. Her experience, Guldwadi explains, helped her learn that “arming ourselves with the right knowledge is the best form of preparation to be a good advocate, and that understanding how to speak about it is even more critical.” BPT’s advocacy council posts national alerts on a Facebook page to encourage members and others to contact their legislators to gain their support or interest in such topics as funding being at risk for various program, such as the Department of Defense Breast Cancer Research Program. At the same time, BPT’s “Ignite the Cancer Conversation” has “ignited the conversation to make people aware of what is happening in research and public policy to help end breast cancer,” Carpenter says.
Breast cancer risk, prevention and detection Breast cancer develops from cells in the breast. The most common sign of breast cancer is a new lump or mass, but most are benign. Other signs include a generalized swelling of part of the breast (even if no lump is felt), skin irritation or dimpling, nipple pain or discharge, redness or scaliness of the nipple or breast skin, or a spontaneous discharge other than breast milk. Provided here is key information on risk factors, prevention and detection of breast cancer.
Who is at risk?
Gender: Being a woman is the greatest risk factor for breast cancer. However, men can also develop breast cancer. Age: The risk of developing
breast cancer increases with age. Most invasive breast cancers are primarily found in women age 55 or older. Heredity: Breast cancer risks are higher among women with a family history of the disease. Having a first-degree relative with breast cancer increases a woman’s risk. Having more than one first-degree relative who has or has had breast cancer before age 40 or in both breasts increases the risk even more. However, most women with breast cancer don’t have a first-degree relative with the disease. Other risk factors: Post-menopausal hormone therapy with estrogen and progesterone therapy
Being overweight, especially excessive weight gain after menopause More than one alcoholic drink daily Physical inactivity Long menstrual history Never having children, or first live birth after age 30
Some risk factors can’t be changed, such as age, race, family history and reproductive history. And while it’s not known how to prevent breast cancer, women of average risk can take steps to further reduce their risk. They include: Reduce alcohol use Breastfeed Engage in regular physical
GET SCREENED Mammograms do not reduce the risk of developing breast cancer, but significantly decrease the risk of dying from breast cancer.
Mammograms should be done every year beginning at age 40 – earlier if there is a strong family history or other risk factors.
activity Maintain a healthy weight
The earlier breast cancer is found, the better the chances for successful treatment. A mammogram often can show breast changes that may be cancer before physical symptoms develop. The American Cancer Society recommends the following guidelines for early detection: Women ages 40-44 should have the choice to start annual mammograms. Women ages 45-54 should get mammograms every year. Women 55 and older should switch to mammograms every two years, or can continue annual screening.
Screening should continue as long as a woman is in good health and expected to live 10 more years or longer. All women should be familiar with the benefits, limitations and potential harms linked to breast cancer screening. An MRI to screen for breast cancer is recommended for women at high risk, including women with a family history of breast or ovarian cancer. Also at high risk are women whose lifetime risk is 20 to 25 percent or greater based on family history, a known breast cancer gene mutation and women who were treated with radiation to the chest area when they were between the ages of 10 and 30. Source: American Cancer Society
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H4 | Sunday, September 24, 2017BREAST CANCER AWARENESS
BRCA gene mutations are uncommon MAYO CLINIC
enetic testing for the gene G mutations associated with breast cancer, called BRCA1 and BRCA2, is offered to people who are likely to have inherited one of the mutations, based on their personal and family medical history. There are other newer genetic tests that may be available, too, depending on a person’s family cancer history. BRCA gene mutations are uncommon. Affecting only about 1 percent of the population, they are responsible for approximately 5 to 10 percent of breast cancers. Because of their rarity, testing everyone for them isn’t necessary or recommended. If you’re concerned you might have one of these mutations, ask your doctor to help you assess your overall risk. The first step in determining the possibility of a BRCA mutation is gathering a comprehensive family history. Your doctor would want to know if anyone in your family has had breast cancer or other types of cancer. If you have a first-degree relative with the disease—a parent, sibling or child—that has more of an impact on your risk than other relatives who have breast cancer, such as aunts or cousins. If you have a male relative with breast cancer, that could raise your risk
more significantly, too. The age a relative was diagnosed with cancer also makes a difference. People who have a BRCA gene mutation tend to develop breast cancer at a younger age than people who do not. If someone in your
family had breast cancer before 50, that may increase the possibility a genetic mutation could be involved. Typically, a family with BRCA will show a pattern of breast cancer that affects multiple family members over several generations
diagnosed with breast cancer at young ages. But other cancer diagnoses should be reviewed, too. Ovarian, pancreatic or prostate cancer at a young age also could point to a hereditary predisposition to breast cancer.
Breast cancer myths vs. truth Sometimes it can be difficult to separate the truth from myths when the subject is breast cancer. The National Cancer Institute addresses some of the more common myths.
ple and areola. Men carry a higher mortality than women do, primarily because awareness among men is less and they are less likely to assume a lump is breast cancer, which can cause a delay in seeking Myth: Finding a lump in treatment. your breast means you have breast cancer. Myth: A mammogram Truth: According to the can cause breast cancer to National Cancer Institute, spread. only a small percentage of Truth: A mammogram, percentage of breast lumps or x-ray of the breast, curturn out to be cancer. But rently remains the gold if you discover a persistent standard for the early deteclump in your breast or no- tion of breast cancer. Breast tice any changes in breast compression while getting a tissue, it should never be mammogram cannot cause ignored. It is very import- cancer to spread. Accordant that you see a physician ing to the National Cancer for a clinical breast exam. Institute, “The benefits of He or she may possibly or- mammography, however, der breast imaging studies nearly always outweigh the to determine if this lump is potential harm from the of concern or not. radiation exposure. MamTake charge of your health mograms require very small by performing routine doses of radiation. The risk breast self-exams, estab- of harm from this radiation lishing ongoing commu- exposure is extremely low.” nication with your doctor, The standard recommengetting an annual clinical dation is an annual mambreast exam, and schedul- mographic screening for ing your routine screening women beginning at age 40. mammograms. Base your decision on your physician’s recommendaMyth: Men do not get breast tion and be sure to discuss cancer; it affects women any remaining questions or only. concerns you may have with Truth: Quite the con- your physician. trary, each year it is estimated that approximately Myth: If you have a family 2,190 men will be diagnosed history of breast cancer, you with breast cancer and 410 are likely to develop breast will die. While this percent- cancer, too. age is still small, men should Truth: While women also check themselves pe- who have a family history of riodically by doing a breast breast cancer are in a higher self-exam while in the risk group, most women shower and reporting any who have breast cancer changes to their physicians. have no family history. StaBreast cancer in men is tistically only about 10% of usually detected as a hard individuals diagnosed with lump underneath the nip- breast cancer have a family
history of this disease. If you have a first degree relative with breast cancer: If you have a mother, daughter, or sister who developed breast cancer below the age of 50, you should consider some form of regular diagnostic breast imaging starting 10 years before the age of your relative’s diagnosis. If you have a second degree relative with breast cancer: If you have had a grandmother or aunt who was diagnosed with breast cancer, your risk increases slightly, but it is not in the same risk category as those who have a first degree relative with breast cancer. If you have multiple generations diagnosed with breast cancer on the same side of the family, or if there are several individuals who are first degree relatives to one another, or several family members diagnosed under age 50, the probability increases that there is a breast cancer gene contributing to the cause of this familial history. Myth: Breast cancer is contagious. Truth: You cannot catch breast cancer or transfer it to someone else’s body. Breast cancer is the result of uncontrolled cell growth of mutated cells that begin to spread into other tissues within the breast. However, you can reduce your risk by practicing a healthy lifestyle, being aware of the risk factors, and following an early detection plan so that you will be diagnosed early if breast cancer were to occur.
BRCA1 or BRCA2 is detected in your DNA, you will definitely develop breast cancer. Truth: According to the National Cancer Institute, regarding families who are known to carry BRCA1 or BRCA2, “not every woman in such families carries a harmful BRCA1 or BRCA2 mutation, and not every cancer in such families is linked to a harmful mutation in one of these genes. Furthermore, not every woman who has a harmful BRCA1 or BRCA2 mutation will develop breast and/or ovarian cancer.But, a woman who has inherited a harmful mutation in BRCA1 or BRCA2 is about five times more likely to develop breast cancer than a woman who does not have such a mutation.” For people who discover they have the harmful mutation, there are various proactive measures that can be done to reduce risk. These include taking a hormonal therapy called Tamoxifen or deciding to take a surgical prevention approach which is to have bilateral prophylactic mastectomies, usually done with reconstruction. Most women will also have ovaries and fallopian tubes removed as well since there is no reliable screening test for the early stages of developing ovarian cancer.
Myth: Antiperspirants and deodorants cause breast cancer. Truth: Researchers at the National Cancer Institute (NCI) are not aware of any conclusive evidence linking the use of underarm antiperspirants or deodorants and the subsequent develMyth: If the gene mutation opment of breast cancer.
If your family history suggests the possibility of a BRCA gene mutation, consider meeting with a genetic counselor before you make any decisions about testing. A genetic counselor can use your family history to calculate the family’s risk of hereditary breast cancer more specifically. He or she can help you fully understand the pros and cons of genetic testing. A genetic counselor also can offer guidance on the ideal individuals in the family to be tested first. If genetic testing is recommended for you, you decide to have it done, and you learn that you do have a BRCA gene mutation, your risk for breast cancer would be much higher than normal. In women without BRCA, the odds of getting breast cancer are 1 in 8. For people with a BRCA mutation, lifetime risk for breast cancer ranges from 50 to 80 percent. With that in mind, women who carry the mutation should be referred to a breast health specialist or breast center to determine how often they should be screened for breast cancer and review possible medical and surgical treatment options that are available to them, based on their individual circumstances.
FDA approves treatment for HER2positive breast cancer NATIONAL CANCER INSTITUTE
n July 17, the Food O and Drug Administration (FDA) approved neratinib (Nerlynx™) to prevent recurrence in patients with early-stage HER2-positive breast cancer who have finished at least 1 year of post-surgery trastuzumab (Herceptin®) therapy. In the international randomized clinical trial that led to the approval, about 94 percent of patients who received one year of adjuvant neratinib were alive without their disease returning, compared with just under 92 percent of women who received a placebo. Despite the approval, several factors — the modest reduction in the recurrence rate, the fact that data on overall survival are not yet available, and the high rate of side effects — mean that neratinib is unlikely to be widely used by these patients, explained Alexandra Zimmer, M.D., of the Women’s Malignancies Branch in NCI’s Center for Cancer Research. However, she added, “the use of neratinib could be considered in patients with early-stage HER2-positive breast cancer and clinical features that indicate a higher likelihood of relapse,” such as larger tumors or cancer cells found in the axillary lymph nodes. Breast cancers that overexpress the HER2 protein (HER2-positive cancers) tend to be ag-
gressive. The availability of drugs that target HER2 has significantly improved survival for patients with HER2-positive disease. Unfortunately, any cancer cells remaining after surgery may develop resistance to the initial HER2-targeted treatment. Neratinib was developed to overcome this resistance by targeting the HER2 signaling pathway in a different way than trastuzumab and other HER2-targeted agents. In the trial that led to neratinib’s approval, more than 2,800 women who had already completed up to two years of adjuvant treatment with trastuzumab were randomly assigned to receive one additional year of neratinib or a placebo. After two years of follow-up, the women in the neratinib group had a 33 percent reduced risk of a recurrence of their disease: 70 women in the neratinib group experienced a recurrence, compared with 109 women in the placebo group. “It’s important for patients to realize that FDA approval doesn’t mean the drug is now indicated for every HER2-positive breast cancer patient after one year of trastuzumab treatment,” Zimmer said. “It’s another option for therapy that’s available, and patients should carefully discuss it with their doctors, to consider benefit versus side effects in every case.”
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BREAST CANCER AWARENESS
Tips for understanding diagnosis
Mastectomy patients have option for reconstruction NATIONAL CANCER INSTITUTE
hat is breast reconstruction? W Many women who have a mastectomy — surgery to remove an entire breast to treat or prevent breast cancer — have the option of having the shape of the removed breast rebuilt. Women who choose to have their breasts rebuilt have several options for how it can be done. Breasts can be rebuilt using implants (saline or silicone). They can also be rebuilt using autologous tissue (that is, tissue from elsewhere in the body). Sometimes both implants and autologous tissue are used to rebuild the breast. Surgery to reconstruct the breasts can be done (or started) at the time of the mastectomy (which is called immediate reconstruction) or it can be done after the mastectomy incisions have healed and breast cancer therapy has been completed (which is called delayed reconstruction). Delayed reconstruction can happen months or even years after the mastectomy. In a final stage of breast reconstruction, a nipple and areola may be re-created on the reconstructed breast, if these were not preserved during the mastectomy. Sometimes breast reconstruction surgery includes surgery on the other, or contralateral, breast so that the two breasts will match in size and shape. One factor that can affect the timing of breast reconstruction is whether a woman will need ra-
diation therapy. Radiation therapy can sometimes cause wound healing problems or infections in reconstructed breasts, so some women may prefer to delay reconstruction until after radiation therapy is completed. However, because of improvements in surgical and radiation techniques, immediate reconstruction with an implant is usually still an option for women who will need radiation therapy. Autologous tissue breast reconstruction is usually reserved for after radiation therapy, so that the breast and chest wall tissue damaged by radiation can be replaced with healthy tissue from elsewhere in the body. Another factor is the type of breast cancer. Women with inflammatory breast cancer usually require more extensive skin removal. This can make immediate reconstruction more challenging, so it may be recommended that reconstruction be delayed until after completion of adjuvant therapy. Even if a woman is a candidate for immediate reconstruction, she may choose delayed reconstruction. For instance, some women prefer not to consider what type of reconstruction to have until after they have recovered from their mastectomy and subsequent adjuvant treatment. Women who delay reconstruction (or choose not to undergo the procedure at all) can use external breast prostheses, or breast forms, to give the appearance of breasts.
Breast cancer is extremely complex and not a one-size-fits-all disease. It’s classified into different types based on the unique biology of each tumor, including the size, whether and where it’s spread, how it looks under the microscope and what’s causing it to grow at the cellular level, according to the American Cancer Society. Understanding the various biological features is critical, as they help determine treatment decisions and directly affect patient outcomes. These tips may help patients more fully understand how to approach a breast cancer diagnosis. 1. Strength in numbers: The news of a cancer diagnosis can be incredibly overwhelming to patients and their loved ones. Make the most of the first few doctor appointments by bringing a friend outside of the immediate family to ensure the information is being absorbed and the right questions are being asked. 2. Build a support team: In addition to family and friends, it’s important to have a strong health care and surrounding support team. Seek out nurse navigators,
local breast support groups and financial assistance to ensure you’re properly informed and have all the resources you need. Do not hesitate to consider a second opinion until you feel 100 percent confident in your health care team and treatment plan. 3. Understand your diagnosis: Learning about your specific type of breast cancer is essential because the unique biology of your tumor can directly impact your breast cancer journey. Knowing the four S’s—stage, size,
status and subtype -of your tumor can help you better understand your diagnosis and the treatment options available to you. 4. Ask questions, then ask more: Consider asking your doctor the following questions: Are you eligible for clinical trials? Are there special treatments geared toward your specific type of breast cancer? Do I need surgery? Does surgery have to be the first step? Being actively involved can help ensure each patient receives the best treatment option for them.
Breast cancer screening tool aids detection A breast cancer screening tool developed at Mayo Clinic may benefit women with dense breasts. It’s called molecular breast imaging, and research shows the technology detects more breast cancers in this group of women than mammography. Up to half of women have dense breast tissue. MBI is a test that uses a radioactive tracer and special camera to find breast cancer. Rather than simply taking a picture of a breast, molecular breast imaging is a type of functional imaging. This means the pictures it creates show differences in the activity of the tissue. Tissue that contains cells that are rapidly growing and dividing, such as cancer cells, appears brighter than less active tissue. During MBI, a small amount of
radioactive tracer is injected into a vein in your arm. The tracer attaches to breast cancer cells that can then be detected using a camera that detects the gamma radiation released by the tracer. Molecular breast imaging may be used to screen for breast cancer in women with dense breast tissue. MBI, when combined with a breast X-ray (mammogram), detects more breast cancers in women with dense breast tissue than a mammogram alone. Breast tissue is composed of milk glands, milk ducts and supportive tissue (dense breast tissue) and fatty tissue. Women with dense breasts have denser breast tissue than fatty tissue. Both dense breast tissue and cancers appear white on a mammogram, which may make breast
cancer more difficult to detect in a woman with dense breasts. Studies show combining molecular breast imaging and a mammogram results in finding 3 times more breast cancers than a mammogram alone. Although molecular breast imaging isn’t approved by the U.S. Food and Drug Administration for breast cancer screening, there is evidence of its benefits in detecting cancers in women with dense breasts. Molecular breast imaging may help doctors evaluate a breast lump or an unusual area detected on a mammogram. Molecular breast imaging may be used in women for whom an MRI is recommended, but can’t be performed, such as those with allergies to the contrast material.
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H6 | Sunday, September 24, 2017 BREAST CANCER AWARENESS
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