What is Breast Cancer

Breast cancer is a malignant cancerous growth that begins in the tissues of the breast. Breast cancer is the most common cancer in women, but it can also appear in men.  Breast cancer affects one in eight women in the U.S. Cancer occurs as a result of abnormal changes in the genes responsible for regulating the growth of cells and keeping them healthy.  Normally, the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out.   A changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.  Breast cancer is always caused by a genetic abnormality.  However, only 5-10% of cancers are due to an abnormality inherited from your mother or father. 
About 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process.   Breast cancer is a malignant tumor that has developed from cells in the breast.  Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple.  In situ is a Latin phrase meaning in place, or in this instance, it means the abnormal cells are contained in one place (not spread into other tissue.)  DCIS does not always progress to invasive cancer, where the cells invade breast tissue outside the ducts. DCIS accounts for 85-95% of breast cancers.

What is the Best Age to Begin Mammograms?

Regular mammograms can help detect breast cancer early but the suggested age to begin doing mammograms is more confusing than ever.
A few years ago, a government taskforce recommended that women begin regular mammograms at 50 instead of 40.  Now, a new study contradicts that advice by saying starting mammograms sooner could dramatically cut the number of breast cancer deaths.
Researchers at Harvard University found that 71 percent of breast cancer patients had not had a mammogram prior to diagnosis and half were under 50 years old, which seems to support the American Cancer Society’s recommendation that women get yearly mammograms once turning 40.   The changing recommendations are confusing for many women and some say that it’s difficult to keep up with the constant changes.
For those who are not at high risk of breast cancer, clinical breast exams are recommended every two to three years starting in your 20s; however, those with family members who have been diagnosed may wish to speak with their doctor about a more aggressive screening option.

Chemotherapy

The use of chemotherapy for the treatment of cancer began in the 1940’s with the use of nitrogen mustard.  In the attempt to discover what is effective in chemotherapy, many new drugs have been developed and tried since then. Chemotherapy is used most often to describe drugs that kill cancer cells directly, and these drugs are sometimes referred to as “anti-cancer” drugs.
Today’s chemotherapy uses more than 100 drugs to treat cancer.  There are even more chemo drugs still under development and investigation.  Various chemotherapy drugs are available to treat breast cancer.  Breast cancer chemotherapy is made of powerful drugs that target and destroy fast-growing breast cancer cells.  The drugs may be used individually or in a combination to increase the effectiveness of the treatment.  Breast cancer chemotherapy is frequently used along with other treatments for breast cancer, such as surgery.  Chemotherapy may also be used as the primary treatment when surgery isn’t an option.  Chemotherapy can help you live longer and reduce your chances of recurrence. It also carries the risk of side effects.  Some of the side effects are temporary and mild but others more serious, and sometimes permanent.  Your doctor can help you decide whether chemotherapy for breast cancer is a good choice for you.  Chemotherapy drugs are given intravenously or orally for treating breast cancer.  The drugs enter the blood stream and travel to all parts of the body, thus reaching cancer cells that may have spread beyond the breast.
Chemotherapy is given in cycles of treatment; and the entire chemotherapy treatment generally lasts several months to one year, depending on the type of drugs given.  A period of recovery is granted after the chemotherapy is finished.
Your doctor considers a number of factors to determine whether and what kind of chemotherapy would be of benefit to you.  The higher your risk of recurrence or metastasis, the more likely chemotherapy will be of benefit. In some cases, characteristics of the breast cancer itself may suggest other more beneficial treatments.  Discuss your own treatment goals and preferences with your doctor.
Factors commonly considered include:
Tumor size and grade. The more advanced the tumor, the more likely chemotherapy may be useful in destroying any stray cancer cells.
Lymph node status. If breast cancer cells were found in your lymph nodes during or before surgery, this is an indication of a higher risk of metastasis and thus an indication for chemotherapy.
Age. Some studies suggest that breast cancer which occurs at a young age is more aggressive than is breast cancer that develops later in life. Thus, doctors may opt for adjuvant chemotherapy when treating younger women to decrease the chances of the cancer spreading to other areas of the body.
Previous treatments. Whether you’ve had chemotherapy before may affect your current treatment regimen.
Chronic health conditions. Certain health problems, such as heart disease or diabetes, may affect your choice of chemotherapy drugs.
Hormonal status. If your breast cancer is sensitive to the hormones estrogen (ER) and progesterone (PR), hormone therapy — with drugs such as tamoxifen, fulvestrant (Faslodex) or aromatase inhibitors (Arimidex, Femara, Aromasin) — may be a better option for post-surgical adjuvant therapy or they may be considered in addition to chemotherapy.
HER2 status. If your breast cancer produces (expresses) too much of a growth-promoting protein known as human growth factor receptor 2 (HER2), your doctor may recommend drugs that specifically target this protein — trastuzumab (Herceptin), lapatinib (Tykerb) — in addition to chemotherapy.

Breast Cancer and Ductal Carcinoma in situ

Typically, breast cancer screenings are performed to catch the disease in the early stages. If the disease is found, either through screening or recognized signs and symptoms, further tests are performed to determine the extent of the disease.
In 2011, 288,130 new cases of invasive breast cancer were diagnosed in women in the U.S. Almost 25% of all new breast cancers diagnosed in the United States are Ductal carcinoma in situ.
What is Ductal carcinoma in situ?
Ductal carcinoma in situ (DCIS) is also known as intraductal carcinoma. DCIS is a relatively new diagnosis and is a term used to describe cells that are growing inappropriately inside the ducts of the breast.  Those cells look like cancer cells under the microscope.  They are abnormal cells that have not spread into the surrounding fatty breast tissue or to any other part of the body.  They are totally confined to the duct and therefore non-invasive.
DCIS began being diagnosed more readily when mammography became a routine part of medical care.   More than 24% of all new breast cancers diagnosed in the United States are DCIS.
How do cancer cells work?
Most breast cancers arise in cells that line the ducts and lobules of the breast.  When cells in the lining of breast ducts are growing inappropriately, it’s called hyperplasia.  When they grow inappropriately and do not appear normal under the microscope, they are called atypical hyperplasia.
Are DCIS cells the same as cancer cells?
DCIS cells are different than actual cancer cells.  They lack the biological capacity to metastasize or spread elsewhere in the body, like cancer cells do.  So are you wondering why DCIS cells fall into the category of cancer cells?
Some DCIS cells can change genetically and become true cancers, and you should not ignore a DCIS diagnosis because science doesn’t know yet which DCIS cells will change and become invasive–and which will remain DCIS.
Are you diagnosed DCIS?
If you are diagnosed with DCIS it is important to know how aggressive or risky your cell type is because there are different kinds of DCIS.  For example, Comedo-carcinoma considered to be an early stage of breast cancer, is considered more aggressive and high-grade than cribiform, which is considered low-grade.  By defining the type of DCIS, it’s easier to define your treatment options, which in turn affects whether DCIS becomes invasive breast cancer.
A diagnosis of DCIS depends on the pathologist, and the diagnosis may be controversial.  Therefore, second, independent opinions are always important.
Whether your doctor refers to DCIS as cancer or pre-cancer, it requires careful treatment and follow-up to avoid the possibility of an invasive breast cancer developing.
Stay abreast of your health with daily self examination and regular check-ups.

To Mammo or Not To Mammo; That’s the Question

Most of the women who undergo routine mammogram screenings for breast cancer will never actually derive any real benefit from the radioactive procedure, but the majority of those who end up testing positive for tumors as a result of mammography will undergo needless treatments for malignancies that never would have led to any health problems.
These unsettling findings from a review recently published in the journal, The Lancet, found that for every woman whose life is supposedly saved as a result of early detection, three others undergo invasive surgery, toxic chemotherapy, or immune-destroying radiation treatments for benign tumors that never would have resulted in fatality.
This shocking information represents one more setback for the practice of mammography, which is still touted by the mainstream medical system as the premier method by which women have the best chance of not dying from breast cancer.  Not only are women not being told about the significant radaioactive risks associatied with getting mammograms, but they are also not being told that the procedure often detects noncancerous tumors.
According to the review of the study done in the U.K., 1,307 women avoid dying from breast cancer every single year in the U.K. as a result of being screened for breast cancer.  But another 3,971 women every year also end up opting for unnecessary, expensive, and highly-toxic treatment procedures for benign tumors as a result of mammography, which causes many of them to suffer irreparable damage to their immune health.
According to a similar study released early this year from Norway, as many as 25 percent of the breast cancers detected by mammography would have never even caused any health problems during the women’s lifetimes.  At the same time, mammography alsofails to detect as many as 10% of harmful breast turmors, indicating that it is a highly unreliable, and very toxic, breast cancer detection method that needs to be effectively phased out of mainstream use.
“Once you’ve decided to undergo mammography screening, you also have to deal with the consequences that you might be over-diagnosed,” says Dr. Metter Kalager, a breast surgeon at Telemark Hospital in Norway about the widespread problem of breast cancer over-diagnosis. “By then, I think, it’s too late. You have to get treated.”
The truth is that we’ve exaggerated the benefits of screening and we’ve ignored the harms.  Mammography helps some people but it leads others to be treated unnecessarily.

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• Breast Cancer
• My Breast Cancer Journey Blog

June 8, 2013

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Complementary Treatments for Breast Cancer

Studies have shown that breast cancer patients may receive benefits from complementary medicine.  Relaxing therapies can help calm the mind and reduce anxiety but there is no conclusive evidence to show that they can affect the physical progression of the disease.
Therapeutic techniques are not part of conventional medicine but complementary therapies can be either combined with or integrated into a conventional medical treatment.  Alternative medicine and complementary medicine are not the same.  Alternative medicine is used instead of conventional medicine.
Complementary medicine includes techniques such as herbal medicine, acupuncture, massage, support groups, and yoga.  These techniques are often referred to as holistic medicine; and the holistic approach addresses how disease affects the whole person: physically, emotionally, spiritually.  Keep in mind that complementary medicine is not a replacement for conventional medicine.
Although it might help you to add yoga, tai chi, or massage therapy to your regular treatment plan, you should never replace any part of your regular treatment such as surgery, chemotherapy, radiation, hormonal treatment with something else.  Studies have found that more than 70% of breast cancer survivors have used at least one complementary technique.
Complementary Medicine Treatments:
Acupuncture
Acupuncture is an alternative medicine methodology originating in ancient China that treats patients by manipulating thin needles that have been inserted into acupuncture points in the skin.
Aromatherapy
Aromatherapy is the practice of using the natural oils extracted from flowers, bark, stems, leaves, roots or other parts of a plant to enhance psychological and physical well-being.
The inhaled aroma from these oils is widely believed to stimulate brain function.  Essential oils can also be absorbed through the skin, where they travel through the bloodstream and can promote whole-body healing.  It is used for a variety of applications, including pain relief, mood enhancement and increased cognitive function.
Chriopractic Therapy
Chiropractic therapy focuses on the relationship between the body’s structure and the body’s function.  Doctors of chiropractic mostly use a type of hands-on therapy called manipulation. Chiropractic therapy is used most often to treat musculoskeletal conditions and problems with the muscles, joints, bones, and connective tissue such as cartilage, ligaments, and tendons.  The basic concepts of chiropractic therapy can be described as follows:
The body has a powerful ability to heal itself.  The body’s structure (mainly the spine) and its function are closely related, and this relationship affects health.
Chiropractic therapy is given with the goal of normalizing the relationship between structure and function and helping the body as it heals.
Guided Imagery
Guided Imagery advocates maintain that the imagination is a potent healer that has long been overlooked by practitioners of Western medicine.  Imagery can relieve pain, speed healing and help the body subdue hundreds of ailments, including depression, impotence, allergies and asthma.  We can recall events from our past or childhood; and we do that with images, sounds, smells, taste, etc. Images and other senses communicate from the brain to other organs.  Imagery was used in ancient civilizations and has been considered a healing tool in virtually all of the world’s cultures and is an integral part of many religions.
Journaling
Journaling is a term coined for the practice of keeping a diary or journal that explores thoughts and feelings surrounding the events in one’s life.  When used as a stress management and self-exploration tool, journaling allows the writer to gain valuable self-knowledge because it allows the clarity of thoughts and feelings.  It improves cognitive functioning. It strengthens the immune system, preventing a host of illnesses.  It also counteracts many of the negative effects of stress.
Massage
The basic goal of massage therapy is to help the body heal itself and to increase health and well-being.  Massage is one of the oldest, simplest forms of therapy.  Massage improves circulation and posture. It lowers blood pressure, relaxes muscles, and helps in pain management.  Massage also improves flexibility and breathing, relieves tension headaches, strengthens the immune system, and it decreases depression
Meditation
Meditation originally was meant to help deepen understanding of the sacred and mystical forces of life, but today, meditation is commonly used for relaxation and stress reduction and is considered a type of mind-body complementary medicine.  It produces a deep state of relaxation and a tranquil mind.  During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress.  This process results in enhanced physical and emotional well-being, producing a sense of calm and balance that benefits both the emotional well-being and the overall health.  A growing body of scientific research supports the health benefits of meditation but some researchers believe it’s not yet possible to draw conclusions about the possible benefits of meditation.
Music Therapy
Music Therapy is an established health profession.  Music Therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a professional who has completed an approved music therapy program.  The certified music therapist assesses the strengths and needs of each client and provides the indicated treatment including creating, singing, moving to, and/or listening to music.
Progressive Muscle Relaxation
Progressive Muscle Relaxation is a relaxation technique used to release stress.  ProgressiveMuscle Relaxation is the tensing and then relaxing each muscle group of the body, one group at a time.  It can relax the muscles, lower the blood pressure, heart rate, and respiration.  Progressive muscle relaxation may be done sitting or lying down.  This technique is simple but it may take several sessions to master it.
Reiki
Reiki therapy is the process of healing using the power of energy.  There are no medicines or tools involved.  Reiki therapy works by transferring energy from the practitioner and directing it toward the patient.  The energy is summoned through the proper visualization of Reiki symbols and these symbols are simply representations of the energy, not the main source of the healing power itself.
The Power of Prayer
Studies have found that spirituality is very important to the quality of life for persons with cancer. The psychological benefits of prayer may include reduction of stress and anxiety, promotion of a more positive outlook, and the strengthening of the will to live.  Faith is also thought to improve coping and provide comfort during illness.  It can help find the meaning in life when dealing with cancer even when the disease cannot be cured.

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Breast Cancer Surgery

Breast cancer surgery is the mainstay of breast cancer when the tumor is localized. Patients are roughly divided into high risk and low risk cases, and each risk category follows different rules for therapy. Treatment possibilities include radiation therapy, chemotherapy, hormone therapy, and immune therapy. Management of breast cancer is undertaken by a multidisciplinary team based on national and international guidelines.
Depending on the staging and type of the tumor, your surgeon may recommend a lumpectomy. Lumpectomy techniques are increasingly utilized for breast-conservation cancer surgery. Studies indicate that for patients with a single tumor smaller than 4 cm, lumpectomy may be as effective as a mastectomy. If the entire breast needs to be removed, that’s called a mastectomy.
For the following reasons, a mastectomy may be the preferred treatment in certain instances:
Two or more tumors exist in different areas of the breast.
The breast has previously received radiotherapy.
The tumor is large relative to the size of the breast.
The patient has had a connective tissue disease which can complicate radiotherapy.
The patient lives in an area where radiotherapy is inaccessible.
The patient is apprehensive about the risk of local recurrence after lumpectomy.
Standard practice requires the surgeon to establish that the tissue removed in the operation has margins clear of cancer, indicating that the cancer has been completely excised. If the removed tissue does not have clear margins, further operations to remove more tissue may be necessary.

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Cancer Specialists

Medical Oncology is a subspecialty of internal medicine.  Doctors who specialize in internal medicine treat a wide range of medical problems.  Medical oncologists treat cancer and manage the patient’s course of treatment.  A medical oncologist might also consult with other physicians about the patient’s care or refer the patient to other specialists.  Most physicians who treat people with cancer are medical doctors and they have an M.D. degree, or osteopathic doctors who have a D.O. degree.  The basic training for both types of physicians includes 4 years of premedical education at a college or university, 4 years of either medical school to earn an M.D. or D.O. degree, and postgraduate medical education through internships and residences. This training usually lasts 3 to 7 years.  Physicians must pass an exam to become licensed to practice medicine in their state.  Each state has its own procedures and general standards for licensing physicians.  When choosing a doctor for your cancer care, you will probably find it helpful to know some of the terms used to describe a doctor’s training and credentials.
Hematology is also a subspecialty of internal medicine.  Hematologists focus on diseases of the blood and related tissues.
Radiation Oncology is a subspecialty of radiology.  Radiation oncologists specialize in the use of radiation to treat cancer.
Surgery is a specialty that pertains to the treatment of disease by surgical operation.  General surgeons perform operations on almost any area of the body.   Physicians can also choose to specialize in a certain type of surgery.
Specialists are physicians who have completed their residency training in a specific area.  Independent specialty boards certify physicians after they have fulfilled certain requirements.  These requirements include meeting specific education and training criteria, being licensed to practice medicine, and passing an examination given by the specialty board.  Doctors who have met all of the requirements are given the status of “Diplomate” and are board certified as specialists.  Doctors who are board eligible have obtained the required education and training but have not completed the specialty board examination.After being trained and certified as a specialist, a physician may choose to become a subspecialist. A subspecialist has at least one additional year of full-time education in a particular area of a specialty. This training is designed to increase the physician’s expertise in a specific field.  Specialists can be board certified in their subspecialty as well.Almost all board-certified specialists are members of their medical specialty society.  Physicians can attain Fellowship status in a specialty society, such as the American College of Surgeons (ACS) if they demonstrate outstanding achievement in their profession.  Criteria for Fellowship status may include the number of years of membership in the specialty society, years practicing in the specialty, and professional recognition by peers.

Chemo Brain and More Chemo Brain

Research has proven that breast cancer survivors can experience problems with certain mental abilities several years after treatment, regardless of whether they were treated with chemotherapy plus radiation or radiation only.   In fact, there are indications that there may be common and treatment-specific ways that cancer therapies negatively affect cancer survivors’ mental abilities.
To compare the effects of different types of cancer treatment on such mental abilities, a study examined 62 breast cancer patients treated with chemotherapy plus radiation, 67 patients treated with radiation only, and 184 women with no history of cancer.  Study participants completed neuropsychological assessments six months after completing treatment and again 36 months later, which is further out from the end of treatment than most previous studies of this type.
The study confirmed that chemotherapy can cause cognitive problems in breast cancer survivors that persist for three years after they finish treatment. In addition, the investigators found that breast cancer survivors, who had been treated with radiation and not chemotherapy, often experienced problems similar to those in breast cancer survivors treated with both chemotherapy and radiation.  (They did not find that hormonal therapy, such as tamoxifen, caused cognitive difficulties.)
These findings suggest that the problems some breast cancer survivors have with their mental abilities are not due just to the administration of chemotherapy. The findings also provide a more complete picture of the impact of cancer treatment on mental abilities than studies that did not follow patients as long or look at mental abilities in breast cancer survivors who had not been treated with chemotherapy.  This study gives voice to the many women who believe that they suffer from chemo brain.

Reconstructive Breast Surgery

Most women aren’t aware of their breast reconstruction options following a mastectomy.  Are you?  Reconstructive breast surgery is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance, and size following a mastectomy.  Two kinds of implants are approved for reconstruction.  They are saline and silicone breast implants and  they come in a variety of sizes, shapes, and textures.   All methods of breast conservation surgery will leave some asymmetry and imperfections, so you must keep that in mind.
Immediate breast reconstruction begins at the time of the mastectomy and it’s standard of care for most patients.  In most cases, it spares the patient additional stages of surgery that may be a result of delayed breast reconstruction.  The primary drawback of immediate reconstruction is that it requires a longer surgery and a longer recovery time than with just a mastectomy.  The reconstruction may become comprised if radiation treatments are needed following surgery.  Many options are available for repair of these defects and restoration of symmetry.
There are three main steps in any breast reconstruction:
Creation of a new breast mound
Touch-ups of the reconstruction and possible modification of the opposite breast  in patients having a mastectomy of one side.  This is optional.
Creation of a new nipple and areola.  This is optional.
It is important to know that not all patients are candidates for all types of reconstruction.  However, most breast cancer survivors who have had a complete or partial mastectomy are candidates for breast reconstruction.  The type of reconstruction you undergo will be decided by you and your surgeon.
Here are some questions  to consider:
What are the risks and benefits of this procedure?
Will this procedure meet my reconstructive goals?
How many surgeries are involved with this procedure?

Breast Cancer Screenings Assessment

There are more clinical practice guidelines available to physicians than for any other medical procedure for breast cancer screening.   A new study in the Journal for Healthcare Quality reports that when different clinical guidelines exist, physicians choose recommendations from multiple, sometimes conflicting, sources.  Research analysts with the American College of Obstetricians and Gynecologists assessed ob-gyn physicians’ use of multiple guidelines following issuance in 2009 of breast cancer screening recommendations by the U.S. Preventative Services Task Force.  The Task Force guideline stated that physicians should not routinely recommend annual breast cancer screening for women under the age of 50 but, instead, allow them to make their own independent decisions. These recommendations contradict guidelines published by ACOG and the American Cancer Society (ACS), which call for annual breast cancer screening beginning at age 40.   In 2009, ACOG recommended breast cancer checks every two years but revised its recommendation in 2011 to advocate annual screening.
The ACOG researchers surveyed 224 ob-gyns to investigate how they utilize multiple breast cancer screening guidelines and evaluate the impact of the 2009 USPSTF recommendations on their practices.   Results showed that 83.5 percent of the physicians surveyed said they were influenced by more than one breast cancer screening guideline, and 42 percent reported making at least one practice change after release of the USPSTF recommendations. Seventeen percent said they were influenced by the USPSTF recommendations and 73 percent were influenced by the ACOG and ACS guidelines.
Other key findings of the study found that:
• Physicians agree with multiple breast cancer screening guidelines that sometimes conflict
• Individual recommendations are followed from multiple guidelines
• Doctors who follow conflicting guidelines tend to practice more conservatively
• Practices changed after the USPSTF guidelines and the most common change was discussing pros and cons of mammography before recommending it for women under 50.
The authors explained that existence of multiple guidelines can cause doctors to avoid using them, but evidence in this study refutes that assertion as 84 percent of physicians said they were influenced by two or more guidelines for breast cancer screening.
The study also showed doctors will not accept new guidelines based on their opinion of the guideline-issuing organization alone, but make practice decisions from individual recommendation statements.
 What is the Journal for Health care Quality?
The Journal for Healthcare Quality (JHQ) is the first choice for creative and scientific solutions in the pursuit of healthcare quality.   JHQ is peer reviewed and published six times a year.  It publishes scholarly articles targeted to leaders of all healthcare settings, leveraging applied research and producing practical, timely, and impactful evidence in healthcare system transformation covering topics in: quality improvement, patient safety, performance measurement, best practices in clinical and operational processes, innovation, leadership, information technology, spreading improvement, sustaining improvement, cost reduction, and payment reform.
About NAHQ
The National Association for Healthcare Quality was founded in 1976 and covers a full spectrum of healthcare specialties.  The NAHQ is an essential and interactive resource for quality and patient safety professionals worldwide.  NAHQ’s vision is to realize the promise of healthcare improvement through innovative practices in quality and patient safety.  NAHQ’s 12,000-plus members benefit from cutting edge education and NAHQ’s unique collective body of knowledge, as well as opportunities to learn from a diverse group of professionals.  These resources help assure success for implementing improvements in quality outcomes and patient safety, navigating the changing healthcare landscape, and serving as the voice of quality.

We Are the Survivors

Life has bestowed the title of warrior or survivor upon many of us.  In truth, there’s little difference between a warrior and a survivor.
Warriors have been tried by economic hardships, broken relationships, discrimination, and health issues—the same as survivors have.   Though our courage is often tried, the warriors survive.   Our survival is an empowerment both to ourselves and to the others who will also soon bear the title of warrior or survivor.   Warriors carry on with the hope that the future will be better because of our efforts, that we’ll gain more strength as time goes on, and that we  can somehow help those who struggle for their own individual survival.  We  carry on as we acknowledge the strength in our growing numbers; and we carry on because our own survival, and also for theirs.   We honor those who were less fortunate than we.  We honor those who lost battle.

Metastatic Cancer

A primary cancer is the original tumor that develops within the body.  Localized cancer means that the cancer is confined to the original site.  Regional spread means the cancer has either grown into surrounding tissues or nearby lymph nodes.  Metastatic cancer occurs when cancer spreads from the original tumor to a new part of the body.  For example, breast cancer can form a new tumor in a different part of the body such as the bones.  The cancer cells in the second tumor are the same as the cells in the primary cancer.  They are breast cancer cells–not bone cancer cells. So the second cancer is called metastatic breast cancer or secondary tumor.  The term metastatic cancer is usually only used for cancer that has spread to distant organs or distant lymph nodes.
As cancer cells divide, they can invade and grow directly into surrounding tissue or structures.  But, they can also break off from the original tumor and enter the bloodstream or lymphatic system.  All cancers have the potential to spread, and cancer can spread almost anywhere in the body.  The most common sites of metastases are the bone, brain, liver, and lung.Whether metastases will develop depends on many factors such as the type of cancer, the grade of the cancer, the length of time the cancer has been present, and the location of the primary tumor.  Some types of cancer tend to spread to certain parts of the body.  For instance, breast cancer most often spreads to the bones, liver, lung, or brain.  Colorectal cancer tends to spread to the liver.  Lung cancer often spreads to the brain, bones or liver. Prostate cancer tends to spread to the bones.
Low-grade cancer cells are less aggressive and are less likely to metastasize.  High-grade cancer cells are more aggressive and are more likely to metastasize.  The risk of metastasis increases the longer a tumor is in the body and the ability of the cancer cells to create a blood supply in a new location because a cancerous tumor needs to set up a blood supply to grow.Each type of cancer has a particular way that it spreads.  Many metastases develop in the first area of blood vessels that cancer cells come to after leaving the primary tumor.  When cancer cells leave the primary tumor, the lungs are one of the first places metastatic cells can be carried to by the bloodstream.  This may explain why metastases form in the lungs.
Some people may have no or few symptoms related to their metastasis.  Therefore, a metastatic cancer may only be discovered during a routine examination or test.  Symptoms of metastatic cancer will depend on the particular location and size of the metastasis.Regular checkups and reporting new symptoms are the best ways to detect metastatic cancer early.  Diagnostic tests will be done if the signs and symptoms of metastatic cancer are present, if the result of a follow-up test is abnormal or if the doctor suspects a metastasis. The types of tests done will depend on the area of the body where doctors suspect the cancer has spread.

Breast Cancer and High Blood Pressure

A recent study showed that women who had been taking calcium-channel blockers to treat high blood pressure for more than 10 years were 2.5 times more likely to have breast cancer, compared with women who did not use blood pressure medication, or who used other types.  However, it should be cautioned that the study is preliminary and further studies are needed before recommendations are made.  So, continue taking your medications but the findings are interesting, to say the least.
About 1,900 women with breast cancer participated in the study, as well as about 850 women with no cancer who served as the control group.  The researchers didn’t find a link between an increased breast cancer risk and other types of high blood pressure medications, such as beta-blockers or diuretics, according to the study published in the Journal of the American Medical Association.
Medications for treating high blood pressure, called antihypertensives, are the most commonly prescribed drugs in the United States.  An estimated 678 million prescriptions were filled in 2010, including 98 million prescriptions for calcium-channel blockers, the researchers said.
A professor in epidemiology at Boston University noted in an editorial that this is not the first time that the specter of a link between [calcium-channel blockers] and breast cancer risks have risen.
But previous studies had yielded mixed results. They did not have a sufficient number of participants, or did not investigate long-term use of antihypertensives.  The professor said that the study “is a very well-done study and therefore there appears to be a hypothesis that now needs to be confirmed.”  She also said that the study isn’t at a stage where women should be panicking about taking these drugs. The study shows a link, but does not prove a cause-and-effect relationship between the drugs and breast cancer.
Calcium-channel blockers work by slowing the movement of calcium into muscle cells, which dilates blood vessels, reduces the force of the heart’s contractions and slows the heartbeat.  Doctors may consider how the patient responds to different medications, and their other conditions.  There are people who don’t tolerate some of the other classes of medications, and respond well to calcium-channel blockers.
However, if patients are concerned, and because there are several classes of hypertensives, patients can certainly discuss their options with their physician, and look into alternative blood pressure treatments.  Be sure to discuss your concerns with your doctor.
The next step in the current research would be to look at more groups of people who take blood pressure medications, as well as to better understand the underlying mechanism by which the calcium-channel blockers may affect cancer risk, the researchers said.
Antihypertensives only came on the market in the past few decades, so there has not been sufficient number of long-term users of these medications.
We are now getting to the point where we have enough people who’ve been exposed to these medications for long periods of time to evaluate such long-term potential risks.

Vitamin C and Cancer

The Food and Drug Administration doesn’t require proof that dietary supplements are safe or effective, as long as they don’t claim that the supplements can prevent, treat, or cure any specific disease; and most supplements have not been tested to find out how they interact with medicines, foods, or other herbs and supplements.  Even though some reports of interactions and harmful effects may be published, full studies of interactions and effects aren’t often available.
Vitamin C supplements are generally considered safe.  Doses higher than 1,000 mg can cause diarrhea, nausea, heartburn, belly pain, and stomach cramps in some people, but the safe upper limit of vitamin C for adults is considered to be about 2,000 mg.  Most oncologists routinely recommend that people with cancer avoid gram-size doses of vitamin C during treatment.
Vitamin C is an essential vitamin the human body needs to function well.  It is a water-soluble vitamin that cannot be made by the body, and must be obtained from foods or other sources. Many studies have shown a link between eating foods rich in vitamin C, such as fruits and vegetables, and a reduced risk of cancer.
Vitamin C is also an antioxidant, a compound that helps block the action of unstable molecules known as free radicals, which can damage cells.  Vitamin C is thought by some to enhance the immune system by stimulating the activities of natural killer cells and anti-cancer agents.  Some claim that the vitamin can prevent a variety of cancers from developing, including lung, prostate, bladder, breast, cervical, intestinal, esophageal, stomach, pancreatic, and salivary gland cancers, as well as leukemia and non-Hodgkin’s lymphoma.  Vitamin C is also said to prevent tumors from spreading, help the body heal after cancer surgery, enhance the effects of certain anti-cancer drugs, and reduce the toxic effects of other drugs used in chemotherapy.
Vitamin C is water-soluble, which means that the body uses what it needs and eliminates the rest.  Small amounts of vitamin C are needed for healthy skin, tendons, ligaments, bones, cartilage, and blood vessels, and for the healing of wounds and injuries.  It also helps to body absorb iron from foods.  A shortage of vitamin C causes scurvy, a disease marked by fatigue, fragile blood vessels bleeding, which can be fatal if not treated.  Vitamin C deficiency is very rare among people who eat a reasonably balanced diet.
Many scientific studies have shown that diets high in fruits and vegetables reduce the risk of developing cancers of the pancreas, esophagus, larynx, mouth, stomach, colon and rectum, breast, cervix, and lungs.  Many of these studies show people who eat foods to get a high level of vitamin C have about half as much cancer as those who have a low intake of these foods. Likewise, people with higher blood levels of vitamin C tend to have a lesser risk of developing cancer than do people with lower levels.  However, studies that observed large groups or people and clinical trials of vitamin C supplements have not shown the same strong protective effects against cancer.
Some oncologists believe that taking high doses of antioxidant vitamins may actually interfere with the effectiveness of radiation and some chemotherapy drugs.  However, no randomized clinical trials have yet been done in humans to test the effect of Vitamin C supplements during radiation therapy or chemotherapy.  Although high doses of vitamin C have been suggested as a cancer treatment, the available evidence from clinical trials has not shown any benefit.
The American Cancer Society recommends eating a variety of healthful foods, with most of them coming from plant sources, rather than supplements. It’s best to get vitamins and minerals from foods but supplements may be helpful for some people, such as pregnant women, women of childbearing age, and people with restricted food intakes.   If a supplement is taken, choose a balanced multivitamin/mineral supplement that contains no more than 100% of the “Daily Value” of most nutrients.

What Is The Difference Between IBC and Recurrent Breast Cancer?

What is inflammatory breast cancer?  The breast looks red and swollen and feels warm when inflammatory breast cancer occurs.  The redness and warmth occur because the cancer cells block the lymph vessels in the skin.  The skin of the breast may also show a pitted appearance. Inflammatory breast cancer may be stage IIIB, stage IIIC, or stage IV.  Treatment of inflammatory breast cancer may include the following:  Systemic chemotherapy.  Or systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy.  Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given.  Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment may also be a treatment.
What is recurrent breast cancer?  Recurrent breast cancer is cancer that has recurred (come back) after it has been treated.  The cancer may come back in the breast, in the chest wall, or in other parts of the body.
Treatment of recurrent breast cancer in the breast or chest wall may include surgery (radical or modified radical mastectomy), radiation therapy, or both.  Systemic chemotherapy or hormone therapy may also be applied and a clinical trial of trastuzumab (Herceptin) combined with systemic chemotherapy may be used.

New Categorization for Cancers??

Cancers are categorized according to the tissue in which they originated, such as breast, bladder or stomach cancer. But tissues are composed of different types of cells.
Recently, researchers examined tumor samples of 12 different cancer types and concluded that the diagnosis would improve in about 10% of cancer cases if they tumors were defined by the cellular and molecular features, rather than the tissues in which they tumors originated. This would mean more accurate diagnosis in about 1 in 10 people.
The researchers reported particularly significant findings in bladder and breast cancers. At least three different subtypes of bladder cancer were identified, including one that was nearly identical to a form of non-small cell lung cancer called lung adenocarcinoma, and another most similar to squamous-cell cancers of the head and neck and of the lungs. Bladder cancer patients in treatment have often responded very differently when treated with the same systemic therapy for their seemingly identical cancer type, and the new findings may explain why that is.
The researchers confirmed known differences between two forms of breast cancers called basal-like and luminal. But they also discovered that these differences are significant and that basal-like breast cancers, commonly referred to as triple-negative, are a distinct class of tumor. Basal-like cancers are highly aggressive and more common among black and younger women.
Basal-like cancers do arise in the breast but, on the molecular level they have more in common with ovarian cancers and cancers of squamous-cell origin than with other subtypes of breast cancer. This is the first time ever anyone has been able to point to important molecular features shared by basal breast cancer. They also found that different cancer types have very similar immune signatures, a factor that may be relevant clinically with the rise of new immune therapies.
Further research could reveal that as many as 30 to 50 percent of cancers need to be reclassified, according to researchers.

Pink Washing

Pink washing has bothered me for many years now but I haven’t publicly complained about the over-saturation of pink ribbons until now.
Some breast cancer survivors, such as myself, craft pink ribbon products for breast cancer awareness. We’ve been through the breast cancer battle and we have a true desire to help others navigate the muddied waters of breast cancer. We breast cancer survivors aren’t large corporations with tons of money backing us. Nor do we have huge funds for marketing strategies. We are merely a group of women who know what’s up–and we attempt to help those who are afraid or don’t understand how to go forward after receiving a breast cancer diagnosis.
The disgust with pink washing seems to come from large corporations who spend millions per year on “public health education” or “administrative costs.” Case in point: a well-known charitable organization shows board members “reported salaries” as being less than $100,000 per person per year. But the company’s records neglect to mention the huge bonus that is paid per person. In particular, one vice president received a bonus or over $400,000.
It seems that directors of some charitable “non-profit” organization make more than most doctors, lawyers, or even politicians. You need to also see where the rest of the annual revenue goes because the wording is tricky.
And, if the charitable organization has a catch phrase, you really have to wonder how much money that organization paid for that catch phrase.
These campaigns for breast cancer awareness and breast cancer education are great forms of advertising for the organizations that are already making millions from the breast cancer patients/survivors.
Now, if these so-called charities were intent on using the funds to find a cure for breast cancer, I think the process would be farther along; wouldn’t it? Or am I being naive? I mean there’s plenty of public health education and there’s a huge emphasis on the importance of screening for early detection of breast cancer.
So, ask yourself if the charitable organizations with the loudest voices have your well-being at heart or if their bottom line is the profit the company takes away from the breast cancer campaign.
Unfortunately, we’re in the era of Big Pharma and there are giant charities that rely on Big Pharma by supplying them with money that will create a toxic cure for all cancer patients. But that’s all in the small print; and at least one major charitable organizations holds stock in a pharmaceutical company. Coincidentally, the pharmaceutical company makes educational grants to the charitable giant.
The duplicity is disgusting.
We’re locked into supporting charities that advertise finding a cure for breast cancer but they’re actually promoting breast cancer via chemotherapy drugs, which will keep us locked into a cycle of toxic cancer treatments.
I’ve been a breast cancer survivor for nearly 20 years now and I’ve seen everything. I’ve seen pink cupcakes and pink cakes, pink watches, pink galas, and pink sweat suits. I’ve seen football players speak on behalf of breast cancer patients and their personal breast cancer trials. I’ve heard the breast cancer charities with their representatives speak on t.v. about their good intentions, their fundings, etc.
There is one constant with breast cancer: breast cancer is a scary, tricky business. You need to personally be aware and be careful about where you give your money and what goes into your body.
If you’re tired of the pink washing and these million dollar companies, you can react by keeping your money or buying local—or buy from someone who has had a breast cancer experience—not some faceless company that has the money to promote breast cancer awareness.
And, if you’ve been recently diagnosed with breast cancer, you’ll find lots and lots of conflicting reports out there.
Go to your local hospital’s library. You can begin your breast cancer journey by reading about breast cancer there. That was the beginning of my own personal journey.
Breast cancer is a difficult road with lots of conflicting advice. As one friend told me, “Be careful because there are a lot of voices out there”. Make certain that you’re supporting the voice that supports you. I wish you well.

Accelerated Partial Radiation

Have you heard of accelerated partial radiation before?
Women who are diagnosed with early-stage breast cancer often choose to have the cancer removed by lumpectomy, and they usually have radiation therapy after surgery as well.   Radiation therapy after lumpectomy lowers the risk of the cancer recurring and it makes lumpectomy as effective as mastectomy.  Radiation can be delivered to the entire breast, whole-breast radiation, or to just the area of the breast where the cancer was located, partial-breast radiation.  Traditional whole-breast radiation typically lasts 5 days a week for 4 to 6 weeks; and the unintentional exposure of nearby healthy tissue (lungs or heart, for example) to is a factor to consider as well.
One of the newer ways to deliver radiation is accelerated partial-breast radiation.   This is a new technique that delivers a more focused and intense  therapy over a shorter period of time.
3-D conformal external beam radiation (3DCRT) is one type of accelerated partial-breast radiation.  3DCRT starts with a planning session.   A special MRI or CAT scan of the breast is done and is used to map out small treatment fields for the area at risk.  The type and distribution of radiation is designed to maximize the dose to the area that needs to be treated and avoid or minimize radiation to tissue near the area.  The radiation is delivered with a linear accelerator, the same machine used in traditional whole-breast radiation, twice a day for 1 week.
A study has found that women diagnosed with early-stage breast cancer and had 3DCRT after lumpectomy had worse cosmetic results than women who got traditional whole-breast radiation after lumpectomy.  The study was published online on July 8, 2013 by the Journal of Clinical Oncology.
In the RAPID trial, researchers randomly assigned 2,135 women diagnosed with either early-stage breast cancer or DCIS to get either 3DCRT (1,070 women) or whole-breast radiation (1,065 women) after lumpectomy.  Before they received any radiation therapy, all the women were assessed by a trained nurse using a cosmetic rating system for breast cancer.  After radiation therapy, the women were again assessed by a trained nurse at 2 weeks, 3 months, 6 months, 12 months, and then once a year.
The rating system compared the treated and untreated breast for:

• size and shape
• location of the nipple and areola
• how the surgical scar looked
• whether or not there was an enlargement of small blood vessels on the skin
• overall appearance of the breasts

The researchers then compared cosmetic results and side effects between the two types of radiation.
The researchers found that women who had 3DCRT had worse cosmetic results than women who had whole-breast radiation:

• Before radiation, 18.9% of women who would get 3DCRT had fair or poor cosmetic results compared to 17% of women who would get whole-breast radiation.
• Three years after radiation, 29% of women who had 3DCRT had fair or poor cosmetic results compared to 16.5% of women who got whole-breast radiation.
• Five years after radiation, 32.8% of women who had 3DCRT had fair or poor cosmetic results compared to 13.4% of women who got whole-breast radiation.

Looking at side effects, the researchers found that women who had 3DCRT were more likely to have telangiectasia and breast induration (hardening or thickening of the skin) than women who had whole-breast radiation.  About a quarter of the women in both groups had mild to moderate pain after radiation.  Very few women in either group had severe pain.
While other ongoing studies have suggested that accelerated partial-breast irradiation is safe, none of these other studies have reported on cosmetic results.  Since the cosmetic results and side effects were worse with 3DCRT than whole-breast radiation, the researchers recommended that 3DCRT not be routinely used unless it’s part of a clinical trial.  More research with long-term follow-up is needed so doctors know for sure that accelerated partial-breast irradiation is a good alternative to whole-breast radiation.
If you’ve been diagnosed with early-stage breast cancer and lumpectomy followed by radiation therapy will be part of your treatment, ask your doctor about the radiation therapy options that make the most sense for your unique situation, including:

• the characteristics of the cancer (size, location, lymph node involvement)
• your personal preferences
• the experience level and results of the doctors who will administer your radiation therapy

Deciding between Lumpectomy and Mastectomy

When a woman is faced with breast cancer, there are two choices available: lumpectomy and mastectomy.
Lumpectomy is less invasive than mastectomy and it allows a woman to save her breast. Mastectomy involves removal of the entire breast.
Most women, when offered the choice between the two, prefer the less invasive lumpectomy Generally, lumpectomy results in a good cosmetic look. And, if you want to keep your breast, you may decide to have lumpectomy followed by radiation.  However, in rare cases, when a larger area of tissue needs to be removed, lumpectomy can cause the breast to look smaller or distorted.  There are types of reconstructive surgery available for both lumpectomy and mastectomy.  If you need to have a large area of tissue removed and two breasts of matching size are very important to you, you and your doctor will need to decide which surgery is best for your situation.
Research shows that women who live in the United States are more likely to have mastectomies than women who live in other countries.  In the Midwestern and southern parts of the U.S., mastectomies are very common.
Lumpectomy followed by radiation is likely to be equally as effective as mastectomy for women with only one site of cancer in the breast and a tumor under 4 centimeters.  Clear margins are also a requirement (no cancer cells in the tissue surrounding the tumor).
Lumpectomy has a few potential disadvantages:
Radiation therapy is likely to be scheduled for 5 to 7 weeks of radiation therapy– 5 days per week after lumpectomy surgery to make sure the cancer is gone.
Radiation therapy may affect the timing of reconstruction and possibly your reconstruction options after surgery.  Radiation therapy also may affect your options for later surgery to lift or balance your breasts.
There is a somewhat higher risk of developing a local recurrence of the cancer after lumpectomy than after mastectomy.  However, local recurrence can be treated successfully with mastectomy.
The breast cannot safely tolerate additional radiation if there is a recurrence in the same breast after lumpectomy.  This is true for either a recurrence of the same cancer, or for a new cancer.  If you have a second cancer in the same breast, your doctor will usually recommend that you have a mastectomy.
One or more additional surgeries may be needed after your initial lumpectomy.  During lumpectomy, the surgeon removes the cancer tumor and some of the normal tissue around it (called the margins).  A pathologist looks to see if cancer cells are in the margins.  If there are cancer cells, more tissue needs to be removed until the margins are free of cancer. Ideally, this is all done during the lumpectomy, but analyzing the margins can take about a week.  So sometimes after the pathology report is done, the margins are found to contain cancer cells and more surgery (called a re-excision) is needed.
Some women may want the entire breast removed because it provides a greater peace of mind regarding the recurrence of breast cancer.  Radiation therapy may still be needed, depending on the results of the pathology.
Mastectomy means that the woman will have a permanent loss of her breast and that she will have to have additional surgeries if she chooses to have her breast reconstructed. A mastectomy takes longer than a lumpectomy and is more extensive. It also has more post-surgery side effects and a longer recuperation time.
The choices are personal so be sure to weigh your decision carefully after you’ve talked with your doctor.

PALB2 Gene Mutations

Last year, actress Angelina Jolie allowed the public to see into her private life when she announced that she underwent a prophylactic mastectomy after testing positive for a BRCA mutation. Mutations in the same genes also increase the risk of ovarian cancer.
Now, research shows that another gene, PALB2, when mutated, results in a one in three chance of developing breast cancer by age 70. This makes the mutated PALB2 nearly as a high a risk for breast cancer as the BRCA1 or BRCA2 mutations. PALB2 (Partner And Localizer of BRCA2) binds to and co-localizes with BRCA2 in DNA repair. But mutations in PALB2 have been identified in approximately 1-2% of familial breast cancer and 3-4% of familial pancreatic cancer cases. Researchers found that women who carried rare mutations in PALB2 had on average a 35 percent chance of developing breast cancer by the time they were 70 years old. The risks were highly dependent on family history of breast cancer and other factors of course, but knowing what your own breast cancer risks are is important. BRCA1 and BRCA2 are widely known as breast cancer risk genes. Women with a mutation in one or both often decide to have their breasts removed so they do not develop the disease.
The PALB2 mutation doesn’t make people certain to develop cancer, but it’s another piece of information to help women make proper informed choices about how they may help to minimize their own risk. Breast cancer is the most common cancer in women worldwide.

New Treatment Plan for Triple Negative Breast Cancer

Researchers at The Pennsylvania State University College of Medicine have discovered that a biological pathway that can be modulated in human triple-negative breast cancer cells to inhibit proliferation.   Approximately 15 to 20% of all breast cancers are designated as triple-negative meaning that the cancer cells lack estrogen and progesterone receptors, and do not overexpress human epidermal growth factor receptor (HER-2), thereby limiting responsiveness to approved therapy.   One in eight women in the U.S. will develop invasive breast cancer,  and more than 39,000 deaths occur annually.
The researchers recently demonstrates that exposure of human breast cancer cell lines to OGF in vitro repressed growth within 24 hours in a receptor-mediated and reversible manner.  Treatment with low dosages of the opioid antagonist, LDN, provoked a compensatory elevation in endogenous opioids, OGF; and receptors that interact for 18-20 hours daily following receptor blockade to elicit a robust inhibition of cell proliferation.   OGF is an endogenous neuropeptide and there are minimal or no side effects.  The mechanism of action for OGF is upregulation of the p21 cyclin-dependent inhibitory kinase pathway that delays passage through the cell cycle.  OGF also confers some level of protection against paclitaxel treatment, a standard breast cancer therapy.
A dosage of 10-8 milograms of paclitaxel given alone caused marked apoptosis, but resulted in 60% less cell death when given in the presence of OGF. In patients, paclitaxel often is accompanied by side effects that reduce compliance.
This discovery provides preclinical evidence for a new, safe, and effective therapy for breast cancer patients, especially for those with limited therapeutic approaches other than surgery.   Women with triple-negative breast cancer have few options because their tumors lack the necessary hormonal receptors.   Data from these studies may open new doors for treatment of this population of women. Moreover, the OGF-OGFr axis is present in all types of breast cancer cells suggesting that this pathway provides additional avenues for treatment of this commonly diagnosed cancer.
This research has been ongoing for 3 decades as the researchers have attempted to find an effective alternative for treatment of breast cancer.

Breast Cancer Survivors and Heart Failure

There is higher rate of heart failure among breast cancer survivors than has previously been reported. 12,000 women were studied, and a report found that the women had a 20 percent risk of developing heart failure over just five years if they got a common chemotherapy regimen.  This is compared to just 3.5 percent of breast cancer patients who did not get chemo.
Clinical trials of breast cancer patients have shown that the drugs can damage the heart and cause higher rates of heart failure. They generally demonstrate about a 4 percent increase in heart failure over three to five years for women getting chemo. Clinical trials usually involve a select group of patients who are healthy in other ways.
Each drug raised the risk on its own, but the combination greatly raised heart failure rates.
It is important to note that these rates do vary by age.  The rates are much lower in the younger women. More than 40 percent of the women over the age of 75 who got a combination of an anthracycline and Herceptin also developed heart failure within five years and 13.7 percent of the breast cancer patients that age who did not get chemo developed heart failure.
The study highlights a growing problem. The American Cancer Society estimates there are 12 million cancer survivors alive in the United States now. As many cancer patients survive their disease and lead ever-longer lives, they find they must fight second battles against the long-term effects of the treatments that saved their lives. Even so-called targeted therapies, which were designed to better target tumor cells while leaving healthy tissue alone, have been shown to cause long-lasting damage.
And as they leave the care of a specialized oncologist and return to day-to-day care, they may not know they’re at special risk of other conditions – and their primary care doctors may not be aware, either. The American Society of Clinical Oncology has been warning about the problem for years, and released research at its annual meeting last June showing that 94 percent of primary care doctors didn’t know about the potential long-term effects of drugs commonly used to treat breast and prostate cancer.
Breast cancer is the leading cancer killer of U.S. women, after lung cancer. It is diagnosed in more than 220,000 women a year, according to the American Cancer Society, and will kill nearly 40,000 this year. About 20 percent of cases are a kind called HER-2 positive, and Herceptin was formulated to especially target this kind. It’s very effective and has saved thousands of lives, but it was known to also damage the heart, although doctors don’t understand just how.
Heart failure is also very common. The National Heart, Lung and Blood Institute estimates 4.8 million Americans have congestive heart failure, which is a chronic condition in which the heart doesn’t pump blood effectively. Half of patients with heart failure die within five years, and 400,000 people get newly diagnosed every year.
So what can women do if they’ve had chemo for breast cancer and want to watch their hearts?
Cardiologist Dr. Larry Allen of the University of Colorado in Denver, who also worked on the study, said they first of all need to be educated about what drugs they have taken and what the side-effects are.
“Second, patients should ask about what heart tests may be indicated before, during, and after treatment,” Allen said in a statement. These may include tests of how well the heart is pumping blood – tests that most women won’t get during a routine physical or well-woman visit.
“Third, in addition to allowing doctors to monitor for heart problems, patients can monitor themselves for worsening heart function by understanding how heart problems may present — including shortness of breath especially when lying flat, leg swelling, palpitations/heart fluttering, and exercise intolerance (these symptoms can represent non-heart disease too, but generally warrant additional evaluation),” Allen added.
“Unfortunately, it is unknown if medications that are typically used to treat heart failure (such as beta-blockers and ACE inhibitors) might protect against heart damage from certain chemotherapy drugs.

Breast Cancer and Latina Women

Despite increased breast cancer awareness outreach efforts in Latina communities since the Nation Cancer Institute (NCI) report in its Cancer Bulletin (vol. 4/no. 15, April 17, 2007), breast cancer is still the most commonly diagnosed cancer in Latina women in 2013.

Recent studies and statistics show that, when compared to white women, Latinas have lower breast cancer rates.   But, they are more likely than whites to be diagnosed at a later stage, when the cancer is more advanced and harder to treat.

Even with an early diagnosis,  Latina women are more likely to have tumors that are larger and harder to treat than white women; and they also seem to get breast cancer at younger ages.  Researchers are not sure why these differences happen.

In 2007, NCI reported that despite equal access to health care services, differences persist in the size, stage, and grade of breast cancer for Hispanic women compared with non-Hispanic white (NHW) women. The study compared 139 Latina women and 2,118 NHW women with breast cancer who were all established members of the Kaiser Permanente Colorado health plan. The Latina women were diagnosed at a younger age; at a later stage of disease; with larger, higher grade tumors; and with less treatable estrogen-and progesterone-negative tumors, reported the investigators led by Dr. A. Tyler Watlington at the University of Colorado Health Sciences Center.

“The results of this study confirm those of many previous studies that breast cancer presents differently in Latina women,” the researchers noted.

“Previous research has suggested that the differences may be due to socioeconomic factors, especially lack of or inadequate health insurance and less access to care among low-income Latina women. However, the current study shows that “these differences were apparent even among a group of Latina women with equal access to care and similar health care utilization,” researchers added.

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When a woman is faced with breast cancer, there are two choices available: lumpectomy and mastectomy.
Lumpectomy is less invasive than mastectomy and it allows a woman to save her breast. Mastectomy involves removal of the entire breast.
Most women, when offered the choice between the two, prefer the less invasive lumpectomy Generally, lumpectomy results in a good cosmetic look. And, if you want to keep your breast, you may decide to have lumpectomy followed by radiation.  However, in rare cases, when a larger area of tissue needs to be removed, lumpectomy can cause the breast to look smaller or distorted.  There are types of reconstructive surgery available for both lumpectomy and mastectomy.  If you need to have a large area of tissue removed and two breasts of matching size are very important to you, you and your doctor will need to decide which surgery is best for your situation.
Research shows that women who live in the United States are more likely to have mastectomies than women who live in other countries.  In the Midwestern and southern parts of the U.S., mastectomies are very common.
Lumpectomy followed by radiation is likely to be equally as effective as mastectomy for women with only one site of cancer in the breast and a tumor under 4 centimeters.  Clear margins are also a requirement (no cancer cells in the tissue surrounding the tumor).
Lumpectomy has a few potential disadvantages:
Radiation therapy is likely to be scheduled for 5 to 7 weeks of radiation therapy– 5 days per week after lumpectomy surgery to make sure the cancer is gone.
Radiation therapy may affect the timing of reconstruction and possibly your reconstruction options after surgery.  Radiation therapy also may affect your options for later surgery to lift or balance your breasts.
There is a somewhat higher risk of developing a local recurrence of the cancer after lumpectomy than after mastectomy.  However, local recurrence can be treated successfully with mastectomy.
The breast cannot safely tolerate additional radiation if there is a recurrence in the same breast after lumpectomy.  This is true for either a recurrence of the same cancer, or for a new cancer.  If you have a second cancer in the same breast, your doctor will usually recommend that you have a mastectomy.
One or more additional surgeries may be needed after your initial lumpectomy.  During lumpectomy, the surgeon removes the cancer tumor and some of the normal tissue around it (called the margins).  A pathologist looks to see if cancer cells are in the margins.  If there are cancer cells, more tissue needs to be removed until the margins are free of cancer. Ideally, this is all done during the lumpectomy, but analyzing the margins can take about a week.  So sometimes after the pathology report is done, the margins are found to contain cancer cells and more surgery (called a re-excision) is needed.
Some women may want the entire breast removed because it provides a greater peace of mind regarding the recurrence of breast cancer.  Radiation therapy may still be needed, depending on the results of the pathology.
Mastectomy means that the woman will have a permanent loss of her breast and that she will have to have additional surgeries if she chooses to have her breast reconstructed. A mastectomy takes longer than a lumpectomy and is more extensive. It also has more post-surgery side effects and a longer recuperation time.
The choices are personal so be sure to weigh your decision carefully after you’ve talked with your doctor.

Does Old Age Become Me?

I tossed out my rollerblades 3 years ago because of the fear of falling, and I don’t play golf as often as I used to either.   My life recently became a sedentary involvement that consisted of eating more and exercising in my dreams.   My good-intentioned daughter suggested water aerobics but my vanity couldn’t stand the idea of exposing the public to my old-aged “ickiness” or vice versa, so I discarded that idea.  Then, lo and behold, wouldn’t you know it---she gave me a membership to a fitness club.
I was beginning to feel that I’d earned my old age, out-of-shape body.  Aside from fact that my size 6 jeans didn’t fit any more, I felt that I could live with things as they were; and that second piece of cheesecake was just as delicious as the first, a rumor that I’d heard before but never truly believed!!!
Out of respect for my daughter, I put on my old-lady knickers and waddled off to the geriatric exercise class.  My first impression of the group wasn’t good.  Everyone in the class had white hair and looked old.  Never mind that my hair is white now and I’m old too---( We’re forever young in our own minds.) 
I was really tempted to make a bee line out the door during the first class but I remembered the feeling of wanting to flee another time when I went to a Mary Kay meeting with a friend and endured the song “I’ve got that Mary Kay feeling deep in my heart—“.
 I didn’t have that Mary Kay feeling deep in my heart at any time in my life, and I didn’t want to hang around geriatric exercise class to watch sagging old people exercise either.
And then, another lo and behold hit me.  That first day, as the geriatric exercise class progressed, it became increasingly obvious that many of these old people were semi-agile and quite coordinated—and I--- well, I just wasn’t either.  I couldn’t keep up with the old folks.
After class, I left with my old-lady towel in hand, realizing what I’d allowed myself to become and semi-determined to change it. 
I still don’t look forward to going to exercise classes but I go; and I’m slightly more agile and coordinated than before but I’m never going to make Letterman’s Top 10 for the fittest old people in Miami.
Geriatric exercise class has not only improved my icky-old body but it’s given me a new perspective on old people as well.
Two days ago, there were a lot of complaints prior to the class.   30 people are allowed to attend per session and evidently more than 30 had shown up.  We have to sign in each time we arrive and there was vicious rumor circulating that some didn’t use the sign-in sheet but went to class anyway.  Thus, there were too many old people in the old peoples’ exercise class that day.  Imagine the horror!
Really, imagine the horror.
This horror of horrors prompted a wave of anger among the white haired people at the gym that day, and it was a little frightening.  It seemed quite petty to me.  The pettiness took me to the next question on my mind: why do old people act so childish?
It’s true what is said about the comparisons of youth and old age.  I remember my dear Uncle Bill in his old age.  He had dementia and was often childlike, although not in the sweet enduring way that children can be.  We do seem to revert back as we age, and it’s never pretty.
One white haired woman groveled, “We’re adults.  We shouldn’t act like children.”
But we do.  And in large groups, or groups of 30 or more, anger isn’t handled very well.  Groups are good for Mob dancing, fireworks, and weddings.  They’re less useful for anger management.
Ah, but I digress.  I guess that’s another privilege afforded the young and the old.
So what’s the take-away from all this exercising and white haired observation?  
Life continues to teach us lessons no matter what our age is.
 Exercise is an oxymoron--good for us but generally unenjoyable.
Pettiness doesn’t work well with certain skin complexions or hair colors, so make sure you can wear it fashionably before buying it.
Look out for angry white haired people, particularly if there are more than 30.
Live and learn and vice versa.

Breast Cancer and Exercise

Research shows that exercise can reduce the risk of breast cancer recurrence, as well as reducing the risk of developing breast cancer if you’ve never been diagnosed.
A 2010 review concluded that exercise is safe during and after all breast cancer treatments as long as you take any needed precautions and keep the intensity low.  It improves physical functioning, quality of life, and cancer-related fatigue.  There also is evidence that exercise can help breast cancer survivors live longer and lead a more active life.
Exercise can lower your risk of breast cancer recurring, as well as help you maintain a healthy weight, ease treatment side effects, boost your energy, and more!

Inflammatory breast cancer tends to be diagnosed at younger ages when compared to other cancers; and it’s more common and diagnosed at younger ages in African-American women than in white women.  The median age at diagnosis in African-American women is 54 years, compared with a median age of 58 years in white women.  It’s also  more common in overweight women than in women of normal weight.
Often times, treatments such as tamoxifen aren’t effective against inflammatory breast tumors because they are hormone receptor negative.   Inflammatory breast cancer can strike men as well as women, but usually it strikes at an older age.    Remember that inflammatory breast cancer is a very rare, but aggressive type of cancer and it’s important to always notice any changes in your breast whether you’re a male or female.  Because this disease is so relatively rare, people with inflammatory breast cancer are encouraged to enroll in clinical trials in which new treatments are being tested simply to take any advantage such medicine or techniques may offer in conjunction with those currently in use.   This disease accounts for only one to five percent of all breast cancers diagnosed in the United States.  Typically there’s no lump to be felt, and the disease escapes diagnosis until it has progressed to stage III or IV, at which point it has already spread only to nearby lymph nodes, stage III,---or to other tissues as well, stage IV.
Inflammatory breast cancer usually progresses rapidly, often in a matter of weeks or months.  Symptoms include swelling and redness that affect a third or more of the breast.  The skin of the breast may also appear pink, reddish purple, or bruised.  In addition, the skin may have ridges or appear pitted, like the skin of an orange.  These symptoms are caused by the buildup of lymph fluid  in the skin of the breast.   This fluid buildup occurs because cancer cells have blocked lymph vessels in the skin, preventing the normal flow of lymph through the tissue.  Sometimes, the breast may contain a solid tumor that can be felt during a physical exam, but, more often, a tumor cannot be felt.
Other symptoms include a rapid increase in breast size; sensations of heaviness, burning, or tenderness in the breast, or a nipple that is inverted.   Swollen lymph nodes may also be present under the arm, near the collarbone, or in both places.
Inflammatory breast cancer can be difficult to diagnose.  Often, there is no lump that can be felt during a physical exam or seen in a screening mammogram.  In addition, most women diagnosed with inflammatory breast cancer have dense breast tissue, which makes cancer detection in a screening mammogram more difficult.   Also, because inflammatory breast cancer is so aggressive, it can arise between scheduled screening mammograms and progress quickly. The symptoms of inflammatory breast cancer may be mistaken for those of mastitis or another form of locally advanced breast cancer.
There are published guidelines to help you choose the best course of treatment and how the disease is diagnosed.

Cure Cancer

Cure Cancer
Our childhood days are filled with playing, eating, talking about more playing, and enjoying things that we like to do.  None of us grasp the concept of time in our youth.  As we age, time becomes more valuable to us and we understand the concept of time slightly better.
For those who must endure cancer though, the concept of time is wholly realized.  For them, time is a crash course lesson in living and dying.  A cancer patient doesn’t know if there will be a tomorrow, and the future is uncertain in a way that the average person doesn’t comprehend. 
A major cancer charity was founded over 100 years ago with the promise that the organization would cease once a cure for cancer was found.  A century ago, and there’s still no cancer cure!  How many people do you suppose have died of cancer during that hundred years?  How many people have mourned the loss of a loved one?  How many tears have been shed?
Each year, there are galas and events to raise money to cure cancer.  There are research foundations, each independent from the other; and they all cry for more money.  I’ve personally seen pink ribbon cakes in October for breast cancer awareness; and major corporations are now involved in the war on cancer because it’s chic and lucrative to support cancer awareness.
And still, there’s no cure for cancer!
A friend died of cancer in 1992.  Just before his death, he told me that he’d “hung on” to life because he believed that there will be a cure in his lifetime.  That was over 20 years ago.
Isn’t it time to end cancer now?  Please make your friends and neighbors aware that we have a war and cancer is the enemy.

Including men in breast cancer trials

The FDA wants drug companies to include men in breast cancer clinical trials because there’s surprisingly limited knowledge on male treatment methods.
Male breast cancer doesn’t have the activists or advocates like female breast cancer has.  Male breast cancer is a less known and less spoken about breast cancer than female breast cancer.  It’s one hundred times less common among men than among women.
In 2014, an estimated 2,360 men in the United States will be diagnosed with invasive breast cancer, resulting in about 430 deaths.   But the limited pool of victims has heightened the burden on those affected.   Males comprise about 1% of the diagnosed breast cancer cases in the United States each year and they are seldom included in clinical trials and research. 
“Men have historically been excluded from breast cancer trials,” said Dr. Tatiana Prowell, a breast cancer scientific lead at the FDA’s Office of Hematology & Oncology Products, on the FDA’s website this past June. “We are actively encouraging drug companies to include men in all breast cancer trials unless there is a valid scientific reason not to.”
“There’s more of a stigma for men to report anything in their breast,” Dr. Meyers said. “[Men] aren’t really thinking ‘breast cancer’ when they feel a lump.”
It’s possible that successful treatment of breast cancer could differ between males and females  but that isn’t truly known because of the lack of males in clinical trials.
Male exclusion is particularly problematic at a time when many modern and promising breast cancer drugs are available only through clinical trials.   There’s an uncertainty also regarding  the hormonal involvement in breast cancer.
While the survival rate, stage-for-stage, is similar for males and females, men do face a unique set of problems, Dr. Meyers continued. “The biggest problem with male breast cancer is not being aware [until] a later stage. In addition, because males do have less breast tissue, if the tumor is not picked up right away there might be a greater risk of locally advanced breast cancer—which carries a poor prognosis.”
Increased male enrollment in clinical trials might redress another issue, too: awareness. “There’s more of a stigma for men to report anything in their breast,” Dr. Meyers said. “[Men] aren’t really thinking breast cancer when they feel a lump, and they’re sometimes embarrassed by it.
The FDA is trying proactively steering drugmakers to include males in the clinical trials, and that’s something that is not seen very often, particularly in oncology

Lymphedema

Lymphedema occurs when too much lymph collects in any area of the body.  Lymph is a clear thin fluid that circulates throughout the body to remove wastes, bacteria, and other toxins from the body’s tissues; and edema is the buildup of excess fluid.  Lymphedema is a potential side effect of breast cancer surgery and radiation therapy that can appear in some people during the months or sometimes years after treatment ends.
If lymphedema develops in people who’ve been treated for breast cancer, it usually occurs in the arm and hand, and sometimes it affects the breast, underarm, chest, trunk, and/or back
Many women with breast cancer have had at least two or three lymph nodes removed under the arm– depending upon which procedure as done.  If you’ve had a sentinel lymph node biopsy they’ve probably removed two or three nodes, but if you’ve had an auxillary lymph node dissection, the number can be significantly higher.  If the cancer has spread, it has most likely moved into to those underarm lymph nodes first because they drain lymph from the breast.   Surgery and radiation can cut off or damage some of the nodes and vessels through which lymph moves, and over time, the flow of lymph can overwhelm the remaining path ways, and the result is a backup of fluid into the body’s tissues.
Doctors believe that when the lymph system is disrupted by breast cancer treatments, the body compensates and adapts by finding another way to get rid of toxins, extra fluids, and proteins.
With fewer lymph nodes as a result of breast cancer, the proteins and wastes do not get filtered out of the lymph as efficiently as they once did.  Gradually, waste and fluid can build up in the tissues of the arm, hand, breast, chest, or trunk.  One or more of these areas may be affected. The result is typically mild lymphedema, which can get worse if it’s not treated.  Typically, with those who develop lymphedema, the symptoms generally appear within 3 years after surgery– although many cases appear 3-5 years after treatment.  (There aren’t longer term studies to estimate the risk after five years, but there are existing cases of lymphedema developing many years or even decades after treatment.)
Sometimes, first symptoms are sometimes triggered by a specific event, such as overuse of or injury to the arm.  If your lymphatic system is already having a hard time keeping up with the processing of fluids and toxins, a single event that sends more blood pumping through your arm than usual can trigger the body into lymphedema.  More blood means more fluid in the tissues, which also means more lymph entering the lymphatic system.  Even a cut, even a very small one,  allows bacteria to get into the hand or arm.  The lymph drains to the underarm lymph nodes that are responsible for straining out the bacteria and setting your body’s immune system into action. But fewer nodes are now available to do this work, so the immune response is slower. The bacteria have the chance to start multiplying in the lymph fluid — a perfect environment because it’s filled with nutrients they can thrive on.  The cut gets infected and the lymphatic system is even more overwhelmed.  The lymph has so much debris in it that it starts to clog the system. The fluid can’t get where it needs to go and starts pooling in the tissue.