Breast Cancer Awareness, 2018

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Children & Cancer How to talk to kids about cancer

Survival Rates Good news as survival rates soar

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What is breast cancer? breastcancer.org

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reast cancer is an uncontrolled growth of breast cells. To better understand breast cancer, it helps to understand how any cancer can develop.

Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and keeping them healthy. The genes are in each cell’s nucleus, which acts as the “control room” of each cell. 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. But over time, mutations can “turn on” certain genes and “turn off” others in a cell.

That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.

A tumor can be benign (not dangerous to health) or malignant (has the potential to be dangerous). Benign tumors are not considered cancerous: their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body. Malignant tumors are cancerous. Left unchecked, malignant cells eventually can spread beyond the original tumor to other parts of the body.

The term “breast cancer” refers to 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. Less commonly, breast cancer can begin in the stromal tissues, which

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include the fatty and fibrous connective tissues of the breast.

Breast Anatomy Over time, cancer cells can invade nearby healthy breast tissue and make their way into the underarm lymph nodes, small organs that filter out foreign substances in the body.

If cancer cells get into the lymph nodes, they then have a pathway into other parts of the body. The breast cancer’s stage refers to how far the cancer cells have spread beyond the original tumor (see the Stages of breast cancer below for more information).

Breast cancer is always caused by a genetic abnormality (a “mistake” in the genetic material). However, only 5-10% of cancers are due to an abnormality inherited from your mother or father. Instead, 85-90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and the “wear and tear” of life in general.

There are steps every person can take to help the body stay as healthy as possible, such as eating a balanced diet, maintaining a healthy weight, not smoking, limiting alcohol, and exercising regularly (learn what you can do to manage breast cancer risk factors). While these may have some impact on your risk of getting breast cancer, they cannot eliminate the risk.

Developing breast cancer is not your or anyone’s fault. Feeling guilty, or telling yourself that breast cancer happened because of something you or anyone else did, is not productive.

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How I managed social anxiety after breast cancer Rosie Mankes \\ breastcancer.org

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he lady with the sultry voice on the navigation system in our car announces that we will arrive at our final destination in 5 minutes. Suddenly and quite unexpectedly, my heart starts to pound and I begin to sweat. I silently try to calm myself down but after a minute or two of trying, I turn to my husband and say, “Dan, I’m not sure if I can do this.” He is totally taken aback and pulls the car over to the side of the road.

Today should be a happy day. Today my husband and I are attending the wedding of one of my closest friends’ sons. It will likely be a wonderful party with lots of good food, wine, and dancing. But for me, it’s also the first time I’m attending a fancy social event following my double mastectomy. It’s the first time I’m getting dressed up in big girl clothes with high heels to head out for a night on the town. Sounds like fun, doesn’t it?

Through the months leading up to the wedding, I was excited to have something to look forward to. After all, for close to 2 months, I was restricted by my surgery and the downtime for healing. What I didn’t realize is that this was one of the first times that people — not close friends, but other people — were going to see me after my surgery.

One thing I know for certain is that things have changed as a result of my surgery. Let me explain. Before the double mastectomy and before anything ever happened with my breasts, people looked into my eyes when they greeted me. Since then, friends and acquaintances have looked down at my breasts first and then looked up to meet my eyes. Some may think I am being overly sensitive or paranoid, but I’m not. Trust me, as a small B cup before surgery, my breasts weren’t a source of interest to anyone.

But now they are, and that makes me feel uncomfortable and different than before. I even notice close friends paying extra attention to my chest at times. Most have embraced me and been elated and encouraged by my strength during this journey. But I wouldn’t be totally honest if I didn’t say, in some cases, that when some people greeted me, it seemed like they felt sorry for me. And this created anxiety.

As we sat on the side of the road, I told Dan I didn’t want to go to the party.

But this clearly wasn’t an option since it would be terribly disappointing to my friend and to me as well. So after a brief but intense discussion, off we went. We arrived at the venue, the valet opened my car door, and out I went on shaky legs into the hall. I grabbed a glass of champagne, which calmed me down somewhat.

The apprehension I was feeling totally knocked me off balance. I am not a socially anxious person; I LOVE a good party. I tried to look at myself introspectively to see what was happening and how I could soldier through these feelings. I asked myself, “What are you afraid of? Why are you worried about the people and what they might think when they see you?” Frankly, the only people I really knew were the immediate family of the groom. The others were merely acquaintances at best. I reasoned with myself, saying things like, “You are a guest at this party. You’re not the mother of the groom. All eyes are not going to be on you!” Still, I was unsettled, but with a lot of positive self-talk and deep breathing, I made it through the ceremony and headed into the cocktail hour.

That’s when I realized that I needed to identify the people I was afraid to see, visualize the encounter in my

BREAST CANCER AWARENESS mind (sort of role-play it), and map out how I would react.

After all, it’s really up to me how I choose to react. So that’s what I did during the cocktail hour. I identified the people I was worried about seeing at the reception. I visualized their sideways glances downward when they saw me — and what I thought they might be thinking as they looked at me. I decided that they were really inconsequential and I should not care what they did or thought. More positive self-talk and visualization, and it was time to head into the reception.

Exactly what I feared would happen did happen. We arrived at our assigned table and sure enough, I was greeted by these people in exactly the way I thought I would be. They looked down at my chest, which gave me that vulnerable “I am different” feeling, and then they looked up. But I got through it, because I’d anticipated what would happen beforehand. It happened and it was over.

But the story doesn’t end here. While making my way across the room to congratulate my friend on her son’s wedding, a woman — a total stranger — walked up to me and said, “I just have to tell you, I’m on the board of directors for the top fashion design school in New York,

October 2, 2018 | 5 and I must say that by far you are the best dressed woman here and you carry the look so well.” You can only imagine how fast my jaw dropped to the ground. Whoa, I did not see that one coming! My reaction: I briefly told her the background of the earlier story, hugged her, and thanked her for being there for me that night.

Beyond that, we danced, we ate, and we drank at the reception, but most importantly, we celebrated a beautiful milestone with our dear friends.

After the wedding, I did experience similar social anxiety three more times at other events, but I knew that there was a chance that might happen so I was better prepared for the feelings. As a result, the anxiety was not as hard to manage.

As a footnote, I recently came across a photo of my husband and me (at the beginning of this blog) at the wedding, which coincidentally occurred just about a year ago. The photo was taken after I had settled down later in the evening, after all of the anticipatory anxiety. I’m not one to compliment myself often, but I must admit that I looked pretty good that night. I’m very happy I did not give in to my initial impulse to leave the party!

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How to talk to children about cancer MetroCreative

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o parent wants to hear that their child has cancer, but such is the reality for thousands of parents each year.

According to the nonprofit foundation CureSearch for Children’s Cancer, nearly 16,000 children are diagnosed with cancer each year.

Survival rates for childhood cancers have improved dramatically over the last halfcentury, increasing from just 10 percent to nearly 90 percent in that time period.

Parents should be encouraged by such statistics, but many may still wonder how to speak to children about their cancer diagnosis.

The National Cancer Institute notes that children will learn a lot from their parents’ tone of voice and facial expressions, so it’s important to remain calm when

speaking to kids about cancer. Openness and honesty also are important, as it will inspire children to trust and confide in their parents as they battle their illnesses. The NCI also notes that age-related suggestions may help parents speak with their children about cancer.

Less than one year old Children who are less than one year old won’t be capable of understanding they have a disease, so the NCI advises parents of such youngsters to comfort them by holding them and gently touching them. Skin-toskin contact is ideal, and during treatment, parents can bring familiar items from home, such as toys or a blanket, to make kids feel more comfortable. Children less than one year old find their parents’ voices soothing, so speaking and singing to children during treatment sessions can comfort them as well.

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1- to 2-year-olds

6- to 12-year-olds Children between the ages of six and 12 will understand that medicine helps them heal, so such kids will likely want to cooperate when receiving treatment. Kids in this age group will want to know what to expect and will likely have many questions, so parents should try to have as many answers about their children’s disease as possible. Parents who are stumped by kids’ questions can look up answers together with their children.

Children in this age group understand things they can see and touch, so bring along some items they can safely play with during treatment. In addition, let kids choose the flavor of their medicines when possible.

Prepare kids ahead of time if treatment will involve something that hurts, such as an injection. Failing to prepare them in such instances may make them fearful and anxious throughout the rest of their treatments.

Teenagers

3- to 5-year-olds

The NCI notes that teenagers who have been diagnosed with cancer may be preoccupied with how their disease has changed their lives and separated them from their friends.

Parents can make an effort to ensure their teenage children stay as connected to their friends as possible. Teenagers also should be included in treatment decisions.

Help children in this age group better understand their treatment by asking doctors if kids can touch the models, machines or supplies, including tubes and bandages, ahead of time. Prepare kids beforehand for potentially painful parts of their treatment, and try to distract them by reading to them during procedures. Kids in this age group also may be comforted by holding a favorite toy or stuffed animal.

Parents can help children diagnosed with cancer understand their disease in various ways. More information is available at www.cancer.gov.

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Menopause and cancer risk MetroCreative

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enopause occurs when a woman’s reproductive cycle is over and she can no longer produce offspring. For many women, menopause occurs around age 50.

While menopause itself is not a risk for breast or other cancers, it’s important to know that some symptom treatments and other factors can increase the risk for cancer among menopausal women. The North American Menopause Society says that a woman going through perimenopause and menopause may experience various symptoms, which can range from hair loss to food cravings to hot flashes to vaginal dryness. The National Institutes of Health indicates some women undergo combined hormone therapy, also called hormone replacement therapy, or HRT, to help relieve menopausal symptoms such as hot

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flashes and osteoporosis. This therapy replaces estrogen and progestin, which diminish in a woman’s body after menopause sets in. However, NIH’s Women’s Health Initiative Study has found that women undergoing HRT have a higher risk of breast cancer, among other conditions.

WebMD says evidence suggests that the longer a woman is exposed to female hormones, whether it’s those made by the body, taken as a drug or delivered by a patch, the more likely she is to develop breast cancer.

That means that HRT can increase breast cancer risk and also indicates that the longer a woman remains fertile the greater her risk for certain cancers. Females who began menstruating before age 12 or entered menopause after age 55 will have had many ovulations. This increases the risk of uterine, breast and ovarian cancers, states the American Society of Clinical Oncology. It also may impact a woman’s chances of developing endometrial cancer.

Gaining weight after menopause can also increase a woman’s risk of breast cancer, states the MD Anderson Cancer Center. Therefore, maintaining a healthy weight or even losing a little weight can be beneficial.

Women who enter menopause are not necessarily at a higher risk for breast cancer, but some factors tied to menopause can play a role. Females who want to lower their risk for various cancers are urged to eat healthy diets, quit smoking and maintain healthy body weights.

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Breast cancer stages MetroCreative

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hen receiving treatment for breast cancer, women will learn about cancer staging. According to the nonprofit organization Breastcancer.org, determining the stage of the cancer helps patients and their doctors figure out the prognosis, develop a treatment plan and even decide if clinical trials are a valid option.

Typically expressed as a number on a scale of 0 through IV, breast cancer stage is determined after careful consideration of a host of factors. The staging system, sometimes referred to as the TNM system, is overseen by the American Joint Committee on Cancer and ensures that all instances of breast cancer are described in a uniform way. This helps to compare treatment results and gives doctors and patients a better understanding of breast cancer and the ways to treat it.

Breastcancer.org notes that the TNM system was updated in 2018, but before then was based on three clinical characteristics: 路 T: the size of the tumor and whether or not it has grown into nearby tissue 路 N: whether the cancer is present in the lymph nodes 路 M: whether the cancer has metastasized, or spread to others parts of the body beyond the breast While each of those factors is still considered when determining breast cancer stage, starting in 2018, the AJCC added additional characteristics to its staging guidelines, which make staging more complex but also more accurate. 路 Tumor grade: This is a measurement of how much the continued on page 13

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Survival rates soar MetroCreative

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breast cancer diagnosis can be a devastating blow.

Upon receiving such a diagnosis, people may begin to ask questions about treatment and the impact cancer may have on their personal lives. Many people who are diagnosed with cancer also begin to wonder about their mortality.

An estimated 266,120 new cases of invasive breast cancer and 63,960 new cases of non-invasive, or in situ, breast cancer are expected to be diagnosed among women in the United States this year, according to Breastcancer. org. According to the latest statistics presented by the Canadian Breast Cancer foundation, 26,300 women and 230 men had been diagnosed with breast cancer in Canada in 2017.

The good news is that breast cancer incidence rates

began decreasing in 2000 after increasing for the previous two decades. In addition, death rates from breast cancer have been decreasingly steadily since 1989.

The National Cancer Institute says that the change in age-adjusted mortality rates are an indicator of the progress being made in the fight against breast cancer.

The most recent SEER Cancer Statistics Review released in April 2018 indicates cancer death rates among women decreased by 1.4 percent per year between the years of 2006 and 2015. The American Cancer Society says that decreasing death rates among major cancer types, including prostate, colorectal, lung, and breast cancers, are driving the overall shift in survival. The ACS says breast cancer death rates among women declined by 39 percent from 1989 to 2015. That progress is attributed

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to improvements in early detection and treatment protocols. For anyone doing the math, over the last 25 years or so, 322,000 lives have been saved from breast cancer.

A similar scenario has unfolded in Canada. Breast cancer mortality rates in Canada recently decreased to 21.4 percent, down from 21.8 percent in 2011, states data from the Canadian Cancer Society.

Currently, the five-year survival rate for breast cancer among Canadians is 87 percent, and the five-year net survival in the United States is 85 percent.

Increased knowledge about breast cancer, early detection through examinations and mammography and improved treatments are helping to drive up the survival rates of breast cancer. Although this does not make diagnosis any less scary, it does offer hope to those recently diagnosed.

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Learning breast anatomy is important for health MetroCreative

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he well-known breast cancer advocacy and research group Susan G. Komen indicates that, according to the most recent data available, 1.7 million new cases of breast cancer occurred among women worldwide in 2012. Western Europe, North America and northern Europe have the highest breast cancer incidences in the world, according to the International Agency for Research on Cancer and the World Health Organization.

Women diagnosed with breast cancer may want to begin their treatment journeys by educating themselves on the anatomy of the breast so they can better understand their disease and how it develops.

The structure of the breast is complex and comprised of fat, glandular tissue, connective tissue, lobes, lobules, ducts, lymph nodes, blood vessels, and ligaments. The following is a breakdown of the common components of the breast.

· Fat cells: The female breast is largely fat cells called adipose tissue. This tissue extends from the collarbone down to the underarm and across to the middle of the rib cage. The main purpose of adipose tissue is to store energy in the form of fat and insulate the body.

· Lobules: Each breast contains several sections that branch out from the nipple. Lobule glands make milk and are often grouped together to form lobes. There may be between 15 and 20 lobes in each breast, says the Cleveland Clinic.

Each lobe has roughly 20 to 40 lobules.

· Ducts: Connecting the lobules are small tubes called ducts. The

ducts carry milk to the nipples of the breasts. There are around 10 duct systems in each breast, each with its own opening at the nipple.

· Nipple: The nipple may be the most recognizeable part of the breast. It is in the center of the breast. The lobules will squeeze milk into the ducts, which then transfer it to the nipples. Most nipples protrude outward, but according to Health magazine’s medical editor Roshini Rajapaksa, MD, some women have flat or inverted nipples. The nipples do not have a singular hole for the milk to come out like an artificial bottle nipple. Rather, there are many lactiferous duct outlets in each nipple that correspond to the ducts in each breast.

· Lymph system: Snaking through the adipose tissue are lymph vessels and nodes. The lymph system distributes disease-fighting cells and fluids as part of the immune system, states the National Breast Cancer Foundation, Inc. Bean-shaped lymph nodes in fixed areas through the system filter abnormal cells away from healthy tissue. · Areola: The areola is pigmented skin surrounding a nipple. The areola contains tubercles called Montgomery’s glands, which secrete lubricating materials to make breastfeeding more comfortable.

Changes in any areas of the breast may be indicative of cancer. That is why women are urged to understand their breasts’ “normal” appearance and feel so they can recognize any changes and address them with a doctor right away.

BREAST CANCER AWARENESS Breast Cancer Stages continued from page 9

cancer cells look like normal cells. · Estrogen- and progesterone-receptor status: This indicates if the cancer cells have receptors for the hormones estrogen and progesterone. If cancer cells are deemed estrogen-receptor-positive, then they may receive signals from estrogen that promote their growth. Similarly, those deemed progesterone-receptor-positive may receive signals from progesterone that could promote their growth.

Testing for hormone receptors, which roughly two out of three breast cancers are positive for, helps doctors determine if the cancer will respond to hormonal therapy or other treatments. Hormone-receptor-positive cancers may be treatable with medications that reduce hormone production or block hormones from supporting the growth and function of cancer cells. · HER2 status: This helps doctors determine if the cancer cells are making too much of the HER2 protein.

HER2 proteins are receptors on breast cells made by the

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October 2, 2018 | 13 HER2 gene. In about 25 percent of breast cancers, the HER2 gene makes too many copies of itself, and these extra genes ultimately make breast cells grow and divide in ways that are uncontrollable. HER2-positive breast cancers are more likely to spread and return than those that are HER2-negative. · Oncotype DX score: The oncotype DX score helps doctors determine a woman’s risk of early-stage, estrogenreceptor positive breast cancer recurring and how likely she is to benefit from post-surgery chemotherapy.

In addition, the score helps doctors figure out if a woman is at risk of ductal carcinoma in situ recurring and/or at risk for a new invasive cancer developing in the same breast.

The score also helps doctors figure out if such women will benefit from radiation therapy or DCIS surgery.

Determining breast cancer stage is a complex process, but one that can help doctors develop the most effective course of treatment.

More information is available at www.breastcancer.org.

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Regrowing and caring for hair after chemotherapy MetroCreative

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

When chemotherapy treatment is completed, the body is typically capable of regenerating new hair, but that can take some time. Women who consider their hair a large

part of their identity may have strong concerns and fears regarding hair loss and what their hair may look like when it begins to regrow. Understanding what to expect and what they can do to facilitate the regrowth of hair can help women better handle what lies ahead.

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

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the last treatment, an inch of hair can be expected.

How hair grows back elsewhere on the body, such as the eyelashes, eyebrows and pubic area, varies from person to person. Experts at the Robert H. Lurie Comprehensive Cancer Center’s Dermatologic Care Center at Northwestern University in Chicago recommend speaking with a doctor if hair is not regrowing quickly, which can be the result of low levels of iron or zinc or even thyroid problems.

To help the process along, some doctors suggest the use of supplements like biotin. The National Institutes of Health says biotin is a B vitamin found in many foods that helps turn carbohydrates, fats and proteins into energy. There is some evidence that taking biotin can help thicken and speed up the growth of hair and nails, but more research is needed. Rogaine®, the baldness treatment, also may be advised, as it’s been shown to speed hair regrowth in breast cancer patients who have lost their hair, advises Health magazine.

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

As hair grows in, certain areas on the head may grow faster than others. Working with an experienced stylist can help a person achieve a look that is evened out and stylish at any length. Rosette la Vedette, a headwear retailer and cancer resource, suggests making a first trip back to the salon a special experience with a glass of champagne.

Cutting hair won’t make it grow faster, but it can help a woman return to a sense of normalcy.

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

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