Breast cancer by Dennis Warden

BREAST CANCER 6 Ways to Reduce Breast Cancer Risk Real Stories from Chemo Survivors

Angelina’s Your Decision

How to Support Your Loved One’s Fight Local Breast Cancer Survivor Deb Donatti

What You Need to Know About Preventative Mastectomies

Change Your Life, 1 Habit at a Time Wednesday, October 16, 2013 Page 1B-16B

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Wednesday, October 16, 2013 • Page 2B

From the Mouths of Survivors

By Dawn Klingensmith CTW Features

wo-time cancer survivor Ted Griggs describes himself as a “guy’s guy.” He was big and muscular at his healthiest, tipping the scales at 219 pounds. An assistant vice president at JPMorgan Chase by day, he does security on occasion for the Dallas Cowboys. Yet chemotherapy brought him to his knees – in pain and in prayer. In fact, despite having pancreatic cancer – one of the deadliest – he opted out of his last round of chemo against his doctor’s advice.

“I felt like my body just couldn’t take it anymore,” says Griggs, who dwindled to 164 pounds in treatment and describes it as “the worst hangover combined with the worst flu, with food poisoning thrown in on top of that, times a hundred.”

Real people discuss what it’s actually like to undergo chemotherapy, and offer tips on how to survive and cope.

Having passed the critical five-year remission mark, Griggs’ decision seemingly did no harm. But looking back, he says skipping his final course of chemo is not something he would do again. He would draw on his previous experience and find new ways to endure. Here’s how Griggs and five others got through chemotherapy.

Count your blessings. “I don’t want to sound corny, but I was grateful – if someone in my family had to get cancer, I was glad it was me,” says Griggs, of Bedford, Texas. “I am a man of faith. I never said, ‘Why me?’ I never questioned my faith. My wife and two daughters, three brothers, my parents and nieces and nephews were all looking to me to see how I would handle going through something as painful as this was. I got strength from God and my family. We’re a tight little group. I didn’t want to leave them early. My strongest advice is to get right with God and get a support system – family, friends, a church group, a cancer support group.”

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Wednesday, October 16, 2013 • Page 3B The love of friends and family taught breast cancer survivor Pam Haschke of Arlington Heights, Ill., that …

While Betsy Butterworth of Oak Park, Ill., welcomed help and support from family and friends, when it comes to chemo, she says it’s OK to …

Creature comforts can be curative. “They tell you you’re going to lose your hair. They prepare you for that. But in my particular case, when it started to fall out of the follicles, it was like thousands of pin pricks across my scalp. I wasn’t prepared for it,” Haschke says. “When friends and family found out I was having chemotherapy, they knitted or crocheted caps for me, for the hair loss. These brought comfort and relief from the pain. I don’t think there’s any science behind it, but when someone is thinking of you and your recovery and offers you a handmade gift like that, I think there’s a psychological benefit. After my experience I started Halos of Hope, an all-volunteer nonprofit organization that distributes free handmade caps to chemotherapy patients.”

New York-based psychologist Paulette Kouffman Sherman, a breast cancer survivor, also relied on the support of loved ones and says treatments go faster if you …

Bring a chemo buddy. “Chemotherapy can be an all-day thing. It’s important to occupy your mind in a good way,” says Sherman, who recommends bringing a laptop, DVDs and reading material as well. “I had books and meditations, and my husband was there to talk to. You can also pray or ponder some deeper questions about what you want to accomplish as your legacy. I wanted to help other women going through cancer and wrote four books, which was part of my healing process.”

Take a solo journey. “The first time I had chemotherapy, they wanted me to bring somebody. After that, I realized I preferred to be alone. I found the process to be very personal,” Butterworth explains. “Chemotherapy is hard, and I had to get ready for it mentally. It was a 40-minute drive and on the way I listened to Led Zeppelin’s ‘Kashmir’ and ‘Ramble On’ because both songs are about journeys, and I considered chemotherapy a journey inward. My friends and family really wanted to be there for me, but I was really honest with them. I told them I appreciated their support but I felt like I needed to do it alone. It’s almost a spiritual moment, when you need to focus on getting cured. I’d also advise people to stay away from online message boards because they can end up scaring you more than they help. Some people totally isolate themselves and stop working, which I don’t recommend. I think it’s important to keep up your normal routine as much as you’re able and to live your life.”

While Butterworth found message boards upsetting, Kathy Kanavos, a breast cancer survivor who divides her time between Massachusetts and California, says they’re a good way to …

Learn from others’ experiences. “Chemotherapy patients tend to have a depth of empathy that others lack, so the information they share is delivered gently,” says Kanavos, adding that she needed more information than doctors were giving. “I became an e-patient. I did

research and connected with people online who were going through the same thing. CancerConnect.com was a good source of peer support, and I got a cancer mentor through the R.A. Bloch Cancer Foundation. It was once of the mentors who told me to exercise to help with insomnia caused by steroids in the chemo drugs – I was so jittery I couldn’t sleep. You pick up all sorts of tips like that. I had one rule. I would ask people, ‘Does this have a happy ending?’ when they started to talk about their mom’s aunt’s friend’s experience. If not, don’t tell me. It’s important to keep your spirits up.”

Alternative therapy may help with side effects. “The fatigue, for me, was absolutely horrible. I would get up and slump on the couch and at some point it would occur to me that I was hungry and should probably eat,” says Szablya, a peritoneal cancer survivor. “But then I would think about the effort it would take for me to stand up, walk to the fridge, open it, take something out and make something. I would imagine this scenario 30 or 40 times before I would get up and do it. Dealing with the fatigue, acupuncture was very helpful. As for the pain, I smoked medical marijuana and it absolutely went away. I’d always thought medical marijuana just made people not care, but it took the pain away with no side effects.” ©CTW Features

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Wednesday, October 16, 2013 • Page 4B

To Prevent or Not to Prevent? mutation, which is another risk factor. Genetic mutations – BRCA1 and BRCA2 – account for only about 5 percent of breast cancers, but among those who have them, the risk of developing cancer can be as high as 85 to 87 percent, reports Dr. Marisa Weiss, founder and president of breastcancer.org. A strong family history without a BRCA mutation may yield a risk of 30 to 40 percent, Jacobs notes.

By Jessica Royer Ocken CTW Features

t certainly was Angelina Jolie’s revelation of her preventive double mastectomy in the May 14, 2013, New York Times that got the general public talking about preventative mastectomies. However, since genetic testing has become more widely available in the last 10 to 15 years, more and more women are being tested for BRCA1 and BRCA2 gene mutations, the presence of which significantly raises a woman’s risk for developing breast and ovarian cancers, explains Dr. Lisa Kay Jacobs, of the Johns Hopkins Breast Center in Maryland. Increased genetic awareness has likely led to the steady rise in mastectomies performed in the last 10 years (including those in women who have not been diagnosed with cancer), as has the growing number of women who want to be “proactive” and “avoid dealing with cancer,” she notes.

Angelina Jolie’s double mastectomy made headlines, as did the swell of support – and criticism – of her choice. So, how do you know if a preventative mastectomy is right for you?

However, a mastectomy – and a double mastectomy in the case of preventive procedures – is an involved surgery and not a choice to be made lightly. “It’s a personal decision even with the highest risk, because it is prevention,” Jacobs says. “When you talk about prevention, you want to compare the risk of the procedure to the benefit to be gained.” So, the place to begin is with an accurate assessment of a woman’s risk for breast cancer. The higher her risk, the greater potential benefit from a preventive mastectomy.

Who’s a candidate? The general population’s risk of developing breast cancer over a lifetime is 12 percent, Jacobs says. Factors raising a woman’s risk include a family history (particularly among immediate female relatives) of breast and/or ovarian cancer before menopause and any male family members with breast cancer. Family histories don’t often take the father’s side into account, but breast and ovarian cancers among female relatives on the father’s side can indicate the presence of a genetic

So if you have an elevated risk and want to lower it, explore all your options, Weiss urges. Lifestyle adjustments like getting to a healthy weight, exercising, quitting smoking, limiting alcohol consumption and avoiding unnecessary radiation might reduce your risk by 40 percent, she says. And anti-estrogen medicines like Tamoxifen can reduce risk 40 to 50 percent. However, if your risk is 85 percent, even if you reduce it by 40 percent, it’s still significant. Prophylactic mastectomy can lower risk by 90 or 95 percent. “That sounds pretty damn good when you’re looking at a situation of high risk and you feel unsafe,” Weiss says.

Pros of the procedure The fact that a preventive mastectomy can eliminate a significant portion of the risk of breast cancer is its greatest benefit. “It’s a huge peace of mind thing,” says Dr. Deborah M. Capko, surgical oncologist and member of the Breast Surgical Service at Memorial Sloan-Kettering Hospital in New York and New Jersey. Women who have their breasts removed (well, 97 to 99 percent of their breasts – it’s virtually impossible to get all the tissue, Capko notes) can also reduce the amount of screening and testing – mammograms, ultrasounds, MRIs, biopsies – they do each year to detect cancer. These tests can cause anxiety, as each one has the potential to find something, and they’re also not much fun. For some women, preventive mastectomy is a better alternative than taking Tamoxifen, which can have menopauselike side effects and is not recommended for women who may become pregnant, Capko adds. And, in 10 to 15 percent of prophylactic mastectomy procedures, biopsy reveals that cancer was present in the breasts, even if it hadn’t been detected previously, Weiss says. Cons of the procedure The biggest drawback to preventive mastectomy is the fact that it’s a major surgical procedure. The risks of the surgery vary depending on the technique employed Prevention • Continued on page 6B

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Wednesday, October 16, 2013 • Page 6B reduce risk by half, and that’s a tablet once a day for five years, she notes. “For some that’s a better option.” A person’s overall health should also be a factor in decision making, because women who smoke, are diabetic or have had radiation to their chest for treatment of Hodgkin’s disease have additional risk factors that may complicate the mastectomy and reconstruction surgeries, these experts note.

Prevention • continued from page 4B and the type of reconstruction chosen, but there’s a risk of bleeding and infection with any surgery, note Jacobs and Capko. And there’s also some post-operative pain to manage and temporarily reduced range of motion in the upper extremities, they report. “It’s not a cosmetic procedure like an augmentation,” Capko says. “You’re not just getting a new pair.” Post-surgical drains are in place for two or three weeks, and most women spend a few days recovering in the hospital, followed by a few weeks at home. And there are emotional and physical considerations. “Mastectomy is a loss, a change in your body,” Weiss says. “You’re sacrificing your breasts to be in healthier place, no longer at high risk.” You lose sexual function of the nipples even if you choose to retain them with a nipple-sparing mastectomy, she notes, and Jacobs adds that sensation across the chest is likely to be altered by the procedure because the skin is lifted. Finally, if the breast tissue is removed, breastfeeding will no longer be possible, Capko says. Breast reconstruction may use tissue from your body, silicone implants or some combination of the two, but regardless of what you and your surgical team determine to be the best approach,

“the majority of these surgeries are not one shot in the operating room and done,” Capko says. There will be additional reconstructive procedures needed. “Some people want it all done in the summer and to never have to think of it again. That’s not going to happen,” she says. “You won’t be happy [with the results] if you go in with that attitude.”

How to Make a Decision “A lot of patients select themselves,” Capko says. For women who are gene positive and have seen other family members go through cancer, “it’s often a relatively easy decision,” she says. “That person is a lot more proactive.” However, she adds, not every woman who is gene positive needs to have a bilateral mastectomy. “The only real time you need to do that is if you have cancers in both breasts that are beyond the capability of breastconservation surgery.” So it’s important to weigh your options carefully and keep things in perspective. Even those at highest risk don’t know if or when they’ll get breast cancer, and if a cancer does develop, it can be treated when found early with screening tests, Capko explains. Jacobs always talks to her patients about medications before they discuss preventive mastectomy. Tamoxifen can

They also recommend that a woman considering preventive mastectomy meet with a plastic surgeon so she can understand her best options and likely outcome for reconstructive surgery, which are impacted by her anatomy and the shape and size of her body. “We spend a lot of time talking about the patient’s expectations,” Capko says. “The patient needs to understand the procedure because if we can’t fulfill her expectations, she will always be disappointed.” A final decision-making factor is timing, these experts note. This is not a decision that should be made urgently. Because of increased genetic screening, many women are learning they’re BRCA mutation-positive quite early in their lives. “But you don’t need to remove your breasts at 20,” Jacobs says. “Someone who’s at high risk needs to be vigilant 10 years before the age of the earliest diagnosis in her family.” If breast cancer runs in a woman’s family, but her relatives have been diagnosed in their 40s or 50s and she’s 25, she might decide to wait, Weiss notes. Some younger women elect to have children before considering bilateral mastectomy, Capko adds. And those who are gene positive may elect to remove their ovaries before their breasts. “[Preventive mastectomy] is always an option – that’s a great way of looking at it,” Capko says. “Once you find out you’re at high risk, you don’t have to decide today. You should feel you’re ready to make the decision because it’s right for you at that time.”

What to expect if you do it When a woman decides to move forward with a preventive mastectomy, a great deal of planning begins. The breast cancer surgical team and plastic surgery reconstruction team must coordinate on a time, and the surgery is usually scheduled at least a

couple of months in advance. In the meantime, the patient will likely have breast imaging done, and she’ll meet with both surgeons to discuss procedures and make decisions about the type of reconstruction she’d like, says Capko. Smokers must stop smoking, says Weiss, and some patients may do a little physical therapy to prepare their abdomens if they’ll be using tissue from that area to reconstruct their breasts, Jacobs adds. They’ll also have additional counseling to make sure they understand the procedure and what to expect. The surgery itself can range from three to four hours if implants will be used for reconstruction to six to eight hours with reconstruction using body tissue. And it’s safe to estimate a week of recovery time for every hour of surgery, Weiss says. At Memorial Sloan-Kettering Hospital, patients can expect a 23-hour, overnight stay after this procedure, and at Johns Hopkins, patients may stay three days after an involved reconstruction. After that they recover at home. These experts say that at least one follow-up surgery (a much simpler procedure) will likely be required to replace the temporary tissue-expander implant with the larger final one, and additional adjustment procedures may be required to get the look and feel the patient desires for her new breasts. Long term, these women will still need annual breast exams to monitor the remaining tissue, and those with silicone implants will need to have them replaced after 10 or 20 years.

What to Expect If You Don’t If surgery is not the right choice, the alternative is vigilant screening for those at increased risk for breast cancer: a breast exam conducted by a physician every six months, a yearly mammogram and perhaps even an annual MRI, Jacobs says. And again, taking

Tamoxifen as a preventive measure is an option for women done with childbearing, she notes. Capko adds that ultrasounds may be useful for screening as well, and she suggests that younger women begin mammograms when they are 10 years younger than the youngest cancer diagnosis in their family. In addition to the screening benefits, annual testing provides a good opportunity for patient follow-up and assessment, Capko says. “We can evaluate how they’re feeling about surgery. Are you still happy with this [course of action]? Has anything changed?” Whatever decision a woman makes, it’s important that she do so with all the information she needs and after appropriate counseling, these experts say. “I don’t think it’s good to do surgery based on fear,” Capko says. “But if you do it based on knowledge and informed consent, it becomes a powerful tool for women.” ©CTW

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Wednesday, October 16, 2013 • Page 7B

IF YOU HAVE BREASTS, YOU HAVE RISK Deb is expecting surgery and radiation treatments when she has finished with chemo. A good support system can make a huge difference to someone battling a major illness. “It makes the most difference to me, when people simply say that they care. Not that they are ‘sorry,’ not that

someone - God or the doctors - will ‘fix’ things so I should keep hope. Just knowing I am important to them, and they care means the most to me,” Deb admits. “When you find yourself sick like this, sometimes God or doctors and what they can do does not seem nearly as important as just knowing that you matter to the people around you.”

Deb Donatti, before chemo, after hair loss and with a wig. hit me out of nowhere,” Deb admits.

BY LINDA TREST GASCONADE COUNTY REPUBLICAN

eb Donatti of Owensville is only 47 years old and has no known family history of breast cancer. She was stunned when she learned she had the disease last July. Deb now offers this advice, “I would ask other women to be aware of your risk. I had believed, with no history of breast cancer on either side of my family tree four generations back, that it was not something I should worry about. The truth is that one in six women will find they have breast cancer, and 85 percent have no family history. The facts are, if you have breasts, you have risk! See your doctor for routine visits, do your own monthly exams (I did not) and see your doctor at the first sign of anything suspicious. You could save your life!”

Sometimes she finds herself crying for no reason, angry because she can’t do something that she would like to do, or jealous of others who have not had their life interrupted by a disease such as hers. Sadness sneaks up on her as she contemplates the future and she feels helpless as she sees others struggling with cancer. “ I want to ‘fix’ it for them as badly as I want to for me,” she notes. Most shocking of all was the feeling that she had somehow let herself and her family down by becoming sick.

“It makes the most difference to me, when people simply say that they care.”

The day she received her diagnosis, she and her husband, Jim, sat their three children down and explained what was happening. “They live here, I am their mom, and this is going to be something they will need to live with as well. I definitely believe that being honest has been the best decision for our family, no matter what their ages.” Things moved quickly. Within days of finding a lump she had a biopsy, less than two weeks after that she had diagnostic surgery, and in another week her first chemo treatment. From that point on breast cancer has made itself known in every aspect of Deb’s life. “I found right away that I had a lot less control over the emotions of this process than I had believed I would. The grief, fear, anger... all the feelings that accompany such a traumatic illness, have often

Trying to be proactive, Deb began researching the disease on her own looking for any advice to beat the disease. She began taking vitamins and supplements that she read were helpful in cancer treatment. These include cinnamon, high dose vitamin D, turmeric, hemp seed, flax and noni juice. She checked with her doctor before adding anything to her regimen. Deb also receives acupuncture treatments to manage pain. She says, “While I can’t recommend a specific thing for others, I absolutely feel you should explore all types of options, and work with your doctor to find what can best help you.” She found a specialist in nearby Washington who also has an office at the breast center in St. Louis where she gets her chemo. She says the acupuncture has been very helpful in managing her pain.

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Wednesday, October 16, 2013 • Page 8B

The SixPrevent Defense Ways to Reduce Your Risk of Breast Cancer By Camille Noe Pagan CTW Features

ust 10 percent of breast cancers are due to genetic factors. The rest? “They’re related, directly or indirectly, to lifestyle,” says Dr. Marisa Weiss, president and founder of BreastCancer.org, who is a breast cancer survivor herself. While that may sound like cause for concern, Dr. Weiss says it’s actually empowering: “Whether you’ve never been diagnosed or you’ve had the disease in the past, there’s plenty you can do to reduce your risk.” Here are six positive steps to take today:

moving 1 Numerousget studies have shown that

women who exercise reduce their likelihood of being diagnosed, or re-diagnosed, with breast cancer. Among the evidence, University of

North Carolina, Chapel Hill researchers found that two hours of daily physical activity (from working out as well as activities like household chores), reduced women’s odds of breast cancer by a notable 30 percent. New research from the University of Minnesota suggests that exercise helps by allowing the body to break down estrogen, the hormone that plays a major role in the disease’s development. Tight on time? “Every little bit makes a difference,” says Dr. Kathy J. Helzlsouer, director of prevention and research at Mercy Medical Center in Baltimore. “I tell all of my patients to look for free moments; for example, I always take the stairs instead of the elevator. It adds up throughout the day.”

go easy on alcohol 2 Alcohol consumption increases risk of

breast cancer – and the more women drink, the higher their odds, show

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Fat tissue increases the production of estrogen. Researchers believe that may be why women who are overweight or obese are at a higher risk for breast cancer. Fortunately, losing just five percent of body weight – if you weigh 170, that’s eight and a half pounds – lowers postmenopausal women’s blood levels of estrogen and reduces breast cancer risk by 22 percent, according a study from the Fred Hutchinson Cancer Research Center in Seattle. “The closer you can get to a body

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studies. That’s not to say you should never have a cocktail again, “but keeping your intake to no more than three to five drinks a week is a good idea, both for breast cancer and overall health,” Dr. Weiss says. (One drink is the equivalent of one and a half ounces of liquor, five ounces of wine, or 12 ounces of beer).

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Wednesday, October 16, 2013 • Page 9B

Researchers haven’t found a way to prevent breast cancer yet – but until they do, there’s plenty you can do to lower your risk. Here’s how.

The human spirit is stronger than anything that can happen to it.

— C.C. Scott

mass index (BMI) of 25 or lower, the better,” Dr. Helzlsouer says. Go to CDC.gov for a free BMI calculator.

kick butts

Smoking gets a bad rap because of lung cancer, but it’s a major breast cancer risk, too, stresses Dr. Maurie Markman, national director of medical oncology at the Cancer Treatment Centers of America. “Even secondhand smoke is dangerous,” Dr. Markman says. “Smoke is a carcinogen that damages tissue and triggers cell abnormality.” If you need to kick the habit, don’t go cold turkey; research shows that using smoking cessation aids – such as counseling, nicotine patches, gum and/or medication – more than triples your chances of success. Visit SmokeFree.gov for free resources.

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Women who have at least one child in their twenties are less likely to develop breast cancer than those who give birth later; those who breastfeed for two years of their lives, total, are also less likely to have breast cancer for similar reasons. Researchers aren’t sure why, but it may be related to a reduction in overall estrogen exposure.

Hope

stay in close contact with your doctor

When it comes to prevention, “One size does not fit all,” says Dr. Nancy Klauber-DeMore, a surgical oncologist and professor of surgery at the University of North Carolina School of Medicine. “Women should talk to their physicians about their health history, family history and lifestyle to figure out their individual risk, then tailor their approach accordingly.” If you have a first-degree relative who’s had breast cancer, or a genetic risk factor such as the BRCA1 or BRCA2 gene, your doctor may recommend extra steps, such as bi-annual screenings (including physical exams, mammograms and/or MRIs), or preventive medication like Tamoxifen. If you’ve had breast cancer in the past, “perhaps the most important thing you can do is to stay the course with your treatment,” Dr. Helzlsouer says. “No one’s better equipped to help you with that than your physician.” ©CTW Features

It is estimated that more than 200,000 women in the United States will be diagnosed with breast cancer this year, but we find hope in knowing that there are more than 2.9 million breast cancer survivors in the U.S. today. Great strides have been made in early detection and treatment of breast cancer, and these survivors are living proof.

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Wednesday, October 16, 2013 • Page 10B

What to Expect When You’re Ingesting Cancer drugs are doing a lot of internal work to turn breast cancer patients into survivors, but it unfortunately comes with a price. Here’s a guide to the most common types of medicines, their side effects and the most effective ways to cope with the downsides. By Bev Bennett CTW Features

egaining your health is paramount when you’re being treated for breast cancer.

And if side effects result from your prescribed drug protocol, well, you’ll grit your teeth and deal with them. Different treatments may be associated with certain side effects.

However, the likelihood, type and severity vary greatly with each patient, according to healthcare experts. By being informed, you can talk to your physician about managing any challenges that arise. Tools for relief include other medications, vitamins and stress-alleviating techniques along with exercise – the remedy for many ills.

cially before you take a medication, according to Dr. Tara Sanft, assistant professor of medicine (Medical Oncology) at the Yale School of Medicine, New Haven, Conn.

Although it’s helpful to know you could have side effects, it’s not beneficial to focus on potential issues, espe-

Your drug treatment may fall into one of three categories: hormoneblocking therapy, chemotherapy or

“Most people deal with side effects pretty well. I tell patients they don’t know whether they’ll suffer a side effect until they take the medication,” Dr. Sanft says.

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Wednesday, October 16, 2013 • Page 11B targeted drugs. Hormone-blocking therapy may be used to treat breast cancers that are sensitive to hormones. Younger women who are treated with these drugs go into menopause. “There’s no therapy to prevent that,” says Janelle Mann, board certified oncology pharmacist, assistant professor of pharmacy practice, St. Louis College of Pharmacy, St. Louis, Mo. Anti-depressant drugs can be prescribed for hot flashes that may accompany menopause. The drugs may not eliminate the hot flashes, but make them more manageable, according to the pharmacist. Breast cancer patients who are past menopause may be treated with aromatase inhibitors. “Joint pain can be very common in women on aromatase inhibitors,” says Dr. Sanft, medical director of adult survivorship for the Yale Cancer Center Survivorship Clinic. Finding medications to relieve the pain is difficult; tolerating pain is the goal, she says. Massage therapy and exercise are possibilities. Along with joint pain, decreasing bone density is associated with aromatase inhibitors. “We can treat women if they get into a dangerous zone. Weight-bearing exercise staves off bone loss and helps improve quality of life,” Dr. Sanft says. Vitamin D may have the potential to both reduce

joint pain and to promote bone health, according to Michelle C. Janelsins, assistant professor, University of Rochester Medical Center, Rochester, N.Y. “The key question is how much to take,” says Janelsins, who researches ways to alleviate symptoms related to breast cancer treatments. “It’s really important for women to have their vitamin D checked. We know that a lot of breast cancer survivors have suboptimal levels of vitamin D,” she says. Chemotherapy uses drugs to destroy cancer cells. Hair loss may be your worry if you’re undergoing chemotherapy. The good news is that your hair does grow back, though the texture and even color may be different after treatment is concluded, according to Mann. Many women report they experience “chemo brain,” the perception of not being as sharp as before, according to Dr. Sanft. Learning techniques for focusing and taking art therapy classes for mind stimulation may help, according to Mann. Fatigue may be harder to deal with. “Fatigue is common and women may underestimate it. Women think the treatment is over and they should feel normal. It can take months; up to a year for women to resume their energy levels,” Dr. Sanft says.

up recovery,” Dr. Sanft says. Physical activity is also being studied for its role in helping while chemotherapy is still going on, according to Janelsins. “There’s some evidence it may help patients handle a higher level of treatment,” she says. Again, as with vitamin D, the key is finding the optimal amount of exercise for each patient. Targeted drug treatment, which works against specific cancer cell abnormalities, is an interesting and growing area, according to Mann. Symptoms vary, but the more common complaints include diarrhea, headaches and heart muscle changes, she says. Mann recommends over-the-counter medications to combat diarrhea. But be prudent using an OTC headache remedy. It could mask a fever that’s part of an infection, according to Mann. Changes to heart muscle cells may require regular consultations with a cardiologist. Prescription medications are available to help with this, Mann says. ©CTW Features

Counter-intuitive as it seems, exercise is an antidote. “Exercise can actually improve fatigue and may speed

Quantifying the Side Effects

Potential side effects are part of the conversation when you discuss breast cancer drug treatments with a physician.

rage u o c n e e W everyone to…

“How will it make me feel,” is the question Dr. Ethan Basch most often hears. Patients want to know how people like them did with a prescribed drug, he says. In return, Dr. Basch wants to give patients an honest appraisal of the benefits and risks of drugs so they can decide based on their own values and situation. Unfortunately, cancer drug labels don’t provide adequate information for those decisions, according to Dr. Basch, director, Cancer Outcomes Research Program, University of North Carolina at Chapel Hill. He is calling on companies to do a better job of collecting and sharing information on how their drugs will affect patients’ symptoms and quality of life. Without that knowledge, treatment may be more difficult for patients, according to the oncologist, author of a recent perspective piece on patient-centered drug development in oncology, published in the New England Journal of Medicine. “Patients want to know whether all the side effects are worth it. People want to know how people like them did with the drug,” Dr. Basch says. The cancer specialist is also working with the National Cancer Institute to develop a system for patients to report their own side effects. “It’s interesting that skeptics of collecting information from patients think patients don’t want to be bothered. [But] they’re pleased to answer questions about how they’re feeling,” he says.

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Wednesday, October 16, 2013 • Page 12B

Ask the Expert: Eva Dubin Gives Back Founder of The Dubin Breast Center at The Mount Sinai Medial Center, Dubin fights to treat others the way she wanted to be treated. By Lisa Iannucci CTW Features

er doctor simply told her, “You have breast cancer and I think you need a mastectomy,” and hung up. Eva Dubin, once a model with an illustrious career, a Miss Universe finalist and a board certified internist and founder of The Dubin Breast Center at The Mount Sinai Medical Center, New York City, knew that wasn’t the way to treat a patient. She was about to face the fight of her life and she knew that she deserved better. It was 2002 and Dubin, who had just had her third child, had not had a

mammogram in more than a year. “Once I had it they told me it was fine, but called me up an hour later because they saw something, but weren’t sure it was important or just deodorant on the film,” says the now 52-year-old. Her risk factors for breast cancer were minimal. She was 34 when she had her first child, but no one in her family had ever had any form of cancer, so the odds were in her favor. That is, until the doctor called with the diagnosis no woman wants to hear. “It was shocking,” she says. “I had just helped one of my closest friends go through the exact same cancer diagnosis. I was super busy with a 7, 5 and 1 year old and this was out of nowhere.”

One call changed her life forever. “I was scared I would have an advanced stage of breast cancer, I wouldn’t see my children grow up and I’d be dead in a year or two,” she says. As a physician, she knew too much about cancer and test results. “I knew exactly what needed to be confirmed. I also remember grabbing on to any cancer survivor who survived for more than two years and hoped I would become one of them. I loved talking to them because it was very encouraging and I tried focusing on the positive.” She consulted with multiple doctors who could coordinate her care. She was diagnosed with an early stage of breast cancer, but it was decided that a mastectomy was what she needed to do. “I didn’t need chemo, but I knew I didn’t want radiation,” she says. Dubin has lived a wonderful life, traveling the world as an international model, but medicine was her calling.

Photo courtesy Stefan Andersson

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Wednesday, October 16, 2013 • Page 13B Dubin says, “Breast cancer today has a very good prognosis. We find breast cancer earlier, and we have very high survival rates. Don’t panic, and go to someone who specializes in breast cancer. It’s a journey that, at the end of the day, will make you a stronger, better person.” Dubin says it changed her life for the better. “All of a sudden, I was faced with the fact that something was affecting my life and I started appreciating my life, friends and family on a level I wasn’t aware of before. I’m humble and thankful for every day.” Today, Dubin is healthy and makes sure to get checked every six months. “I get nervous though, but I’m not walking around looking for lumps and bumps.” For more information, visit www.dubinbreastcenter.org ©CTW Features

The Dubin Family, from the left: Jordan, Celina, Maya, Glenn and Eva Years earlier, she made a conscious decision to complete her pre-medicine program in Sweden. “When I was younger, I was fascinated by hospitals,” she says. “I loved the smells and the sounds and I could see myself taking care of people. When I got older I knew I needed to go into the field so I could learn more. It was always fascinating to read about your body and it was interesting being a mix of a detective and a scientist. It was a right fit for me.” But she also was drawn to the life of a model. “I wanted to see the world and make money, so I figured I would take off one year, but one turned into four,” she says. “It was very hard to stop. I was having a good time traveling, but an opportunity came up to go back to school and I took it.”

“Breast cancer today has a very good prognosis. We find breast cancer earlier, and we have very high survival rates. After her experience with breast cancer, Dubin decided that it was time to give back. “My husband, Glenn, and I looked into doing something for the hospital and we suggested creating a breast cancer center,” she says. The couple donated $16 million to create The Dubin Breast Center at The Mount Sinai Medical Center. “I had no intention to enter into the breast cancer field,” she says. “But it’s very unusual to have the experience of being philanthropist, patient and physician. It makes me very invested in the place because it carries our name.” The Dubin Breast Center is a multidisciplinary facility that includes oncofertility, nutrition, and mental health counseling, in addition to massage therapy, acupuncture and other complementary services, all under one roof. The center offers 3D mammography and new procedures like seed localization, which allows surgeons to better target and remove breast tumors. “Our goal for The Dubin Breast Center is to provide patients with seamless care,” she says. “From breast cancer screening to diagnosis to treatment and survivorship, patients receive personalized, comprehensive care in a welcoming, private and reassuring setting.” She says that she is obsessed with keeping the place clean. “We don’t use wall to wall rugs and I almost want to ask patients to take their shoes off,” she laughs. “But I want it to be clean, and the quality of care inside the center is the most important thing. All of our doctors are hand-picked and the best of the best. I’m most proud of the personnel we have hired.” She meets with every employee to ask them how they are doing and how they can make the center better. “I meet with patients too,” she says. “They have a different experience than I had and I want to hear what their ideas are.” To those women who are going through treatment or were just diagnosed

October is

Saluting Survivors Encouraging Awareness Remembering Loved Ones During National Breast Cancer Awareness Month, we stand together in our support for a cure and our support for the women who are faced with the disease. By encouraging breast cancer research and raising awareness of the importance of early detection, we can all help save lives. For more information about breast cancer prevention, early detection and support for a cure, please visit the National Breast Cancer Foundation online at: www.nationalbreastcancer.org.

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Wednesday, October 16, 2013 • Page 14B

Ask the Expert: Thank You For Being a Friend Letty Cottin Pogrebin, author of “How to Be a Friend to a Friend Who’s Sick” shares advice on helping a friend through an illness By Rachel Graf CTW Features

or one reason or another, sickness tends to render people awkward and uncomfortable. Even with long-time friends, visitors might be unsure how to treat them in light of their sickness. It might be difficult to find a balance between the desire to be considerate and sympathetic and the desire to pretend nothing has changed. The disconnect between how patients want to be treated and how they are treated prompted Letty Cottin Pogrebin to write her book “How to Be a Friend to a Friend Who’s Sick” (PublicAffairs, 2013). Pogrebin was recently treated for breast cancer and says she was often shocked by how friends acted toward her. “I wanted to say, ‘Stop treating me like cancer girl,’” Pogrebin says. “‘Treat me like a normal friend who happens to be going

through something hard.’” In her book, Pogrebin offers proper etiquette advice for treating someone when they’re sick. She covers topics such as what to say, how to act and what types of gifts to bring. If you have a friend or loved one who is sick, you might be asking yourself the very same questions that Pogrebin answered for us. Q. Visiting a friend in the hospital can be hard. How should we approach the situation so it isn’t uncomfortable? When talking to a friend who is going through treatments, establish absolute honesty the minute you hear the diagnosis. If you establish honesty from the beginning, you don’t have to worry about whether you’re being intrusive or offensive because you’ve established a policy. In terms of how to behave, kindness equals empathy plus action. You have to be able to listen to their needs, as well as actually help with those needs. If you’re unsure how to help, tell your friend that you want to be helpful but really don’t

know how to be. Q. When is offering to help helpful and when is it degrading? Offering help is never degrading but it may be infantilizing. People don’t want to be treated as helpless. I recommend that you should ask directly how you can help. You should add that you genuinely mean it. Otherwise, people will assume you’re just saying it to be polite. Q. What are the best ways to comfort a friend? Bringing gifts can be comforting to patients, but be sure the gifts are thoughtful. Chances are, she’s not going to eat all that fruit, but she may be really excited if you give her a certificate for a

manicure or pedicure. Take time to think about what you will bring, and ensure that whatever you choose will really help her feel good. Q. Should you ever try to relate to the patient through experiences of your own or of someone you know? Some people immediately respond by citing their own experience with illness, or they’ll start recommending treatments, vitamins and so on. None of this is helpful to a patient. Your story is your story; your illness and your response to it are unique to you. Try not to be self-referential in your remarks to any patient unless she specifically asks for your experience with the same disease. Q. How do you know when to step back? Friends should be alert to a patient’s body language, facial expressions and the type of response they give to your questions. If they try to slough off your question with a short, nondescriptive answer, that’s your signal to back off. Not everyone wants to be interviewed about their illness, treatment or condition. They may consider your questions to be intrusive or they may simply be tired of talking about their problem. No one wants to become their illness in the eyes of their friends. Q. What’s the best way to end your visit or talk? This goes back to what I was saying earlier about honesty. Ask your friend to tell you when to leave. You need to tune into the cues of the patient. If I had to give an answer for how long to say, I would say long enough to show that you care, but not as long as you think. ©CTW Features

Standing Together in the Fight Against Breast Cancer Statistics indicate there will be more than 256,000 new cases of breast cancer diagnosed in American and Canadian women this year, and breast cancer is the second leading cause of cancer death in women of both countries. Thanks to early detection and treatment advances, survival rates have improved dramatically, but much room for progress remains. As diagnosis and treatment options continue to evolve, medical experts agree that early detection is a key factor in overcoming the disease, and performing a monthly breast self-exam is often vital to detecting abnormalities,

including lumps or tenderness, in the breasts that may indicate illness. Take steps to protect yourself against breast cancer during Breast Cancer Awareness Month by initiating healthy lifestyle changes, beginning monthly breast self-exams, and talking to your doctor about the appropriate clinical breast exam and screening mammogram schedule for you.

October is Breast Cancer Awareness Month. These local sponsors join us in raising awareness of the importance of early detection in the fight against breast cancer and the importance of continued support for breast cancer research. Medic & Medicaaid certifiedre

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