Breast Cancer Awareness • 7B
www.crossville-chronicle.com • Friday, October 17, 2014
Cathleen Reid, yoga instructor, strikes a powerful pose. Reid taught yoga for six years before she was diagnosed with breast cancer. As she went through her treatments, her yoga class became a sanctuary for her.
Breast cancer risk in American women 1 out of every 8 women born today will be diagnosed with breast cancer at some time during her life. The strongest risk factor for breast cancer is age. A woman’s risk of developing this disease increases as she gets older. Other factors can also increase a woman’s risk of developing breast cancer, including inherited changes in certain genes, a personal or family history of breast cancer, having dense breasts, beginning to menstruate before age 12, starting menopause after age 55, having a first full-term pregnancy after age 30, never having been pregnant, obesity after menopause and alcohol use.
photo submitted
—from National Cancer Institute
Finding the joy in breast cancer B y H eather M ullinix Chronicle assistant editor
When Cathleen Reid was diagnosed with breast cancer, her world didn’t come to a stop. The mother of two, wife, fitness director and volunteer kept going full steam ahead in her treatment and her life, hoping to keep a sense of normalcy in an abnormal situation. “For me, it was trying to find the joy in what was going on,” Reid said. “The hardest part of hearing a diagnosis like this is finding how you can deal with it, and everyone deals with it differently.” She’s currently working on a book that recounts her experience with breast cancer and the toll it took on her and her family. “I wanted to title the book ‘Cancer Saved My Life,’” she said. “Cancer really did save my life. It made me stop and reassess how I was living my life, and it made me enjoy life more. There is always something to smile about and trying to find something. “I don’t want to ever do it again. It’s not that much of a blessing,” she laughed. “But it’s so easy to focus on ‘why did this happen to me? What did I do wrong?’” One of the joys and blessings she found in her cancer diagnosis was that it was breast cancer, which has been the subject of numerous research programs
Reid focused on positive feelings and keeping her life as normal as possible following diagnosis and is more understood than some other cancers because so many people have been touched by it. “Another thing I used to say to try and dismiss it was, ‘Yes, I have breast cancer. They’re treating me and I’m going to be fine. I don’t have something I have to live with forever,’” she said. “I just tried to put it in perspective. It was still scary.” One of the most frightening parts was to consider her own mortality in a way she hadn’t had to before. “I used to make up silly stories for my kids,” she said. “I wondered if they would remember about those stories. I wondered if they would remember me if I were to die.” Her children, age 12 and 16 at the time, were striving to support her in her treatment as best they could. Son Mack kept hand sanitizer with him at all times and would not let her open doors or touch anything in public after the doctors explained her treatment would make her susceptible to germs. Daughter Samantha, 16, tried to keep her mom from doing too much, instructing her to sit down and enjoy simple treats like green
tea and dark chocolates with chili peppers. She’d also use heated slippers to keep her mother in a chair instead of up cleaning. “My daughter was my caregiver,” Reid said, who at the time was living in Lubbock, TX, far from the rest of her family. “I was very lucky to have great kids, great friends and a great community.” Cancer treatment brings many changes in one’s life, including changes in appearance. One of the hardest challenges for Reid was when, 10 days after beginning chemotherapy, her hair began to fall out. “On the inside, that’s where I had changed. I lost the belief that everything would be OK,” Reid read from a portion of the book she is writing. “I wanted to retain that purity, that innocence.” She was determined to control when and where her hair fell out. She washed her hair and felt the hair falling toward the drain. “My hair, what people had always admired about me. My hair, my shield from criticism,” she wrote. “It sounds silly,” Reid said of the fear women
have of losing their hair. “They talk about your hair being your crowning glory in the Bible. But we all obsess about our hair, and that was my first thought when I was diagnosed with cancer.” See JOY page 9B
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8B • Breast Cancer Awareness
www.crossville-chronicle.com • Friday, October 17, 2014
Surgeons evaluate options with patients By Heather Mullinix Chronicle assistant editor
When someone finds a lump in their breast, or screening tests find areas of concern and in need of further investigation, surgeons are able to guide patients on the next steps of their diagnostic journey and remove cancerous tissue. “With the push for everyone to have mammograms, we find a lot more patients who need biopsies on areas of the breast that you can’t palpate,” said Rick Gibbs, general surgeon and president of the CMC medical staff. “One of the best ways is a stereotactic core needle biopsy where you are able to focus the biopsy on the spot that you see on the mammogram.” “The radiologists have gotten really good at recognizing things that are concerning and recommending biopsy. One of those is the deposition of calcium specks, which is a characteristic of some types of breast cancer.” At CMC, patients are seated for stereotactic biopsy procedures, which are also done under local anethestic as an outpatient procedure. “The accuracy of it is checked a couple of ways. You can take images of the breast after the biopsy to see if the abnormal area is gone,” Gibbs said. “And the breast tissue that’s biopsied is placed in a pathology cassette and imaged so that the things you see on the mammogram are contained in the
Gibbs specimen. “I think patients do well with it, and that’s one of the easiest ways for them to have biopsies done.” Fox cautions that a stereotactic biopsy or core needle biopsy is not intended to remove the entire lesion. “It is a diagnostic test, not a therapeutic procedure,” Fox said, adding a biopsy can only test for the presence of cancerous cells in the tissue extracted. “That’s why some opt for the complete removal of the area, which is then tested in pathology.” In that case, a biopsy done under sedation or general anesthesia is needed to remove the suspect area. The radiologist places a guidewire, using mammogram imaging, to help the surgeon go directly to the area of concern. “That’s our marker to go up to the operating room and remove the tissue at the end of the wire,” Fox said. Markers can be
Fox placed where the tissue is removed for future reference should additional tissue be needed or for future imaging. These type of biopsies are useful when the area of concern cannot be felt, and are also outpatient procedures. Should a patient have a new lump that can be felt, the localizing techniques are not needed. Fox noted that a biopsy removing the entire lesion is not the same as a lumpectomy, a surgical treatment for diagnosed breast cancer. “If we still don’t know if something is benign or malignant, we’ll go in and our goal will be to remove the entire area and get it looked at,” Fox said. If pathology reveals noncancerous cells, no further treatment is necessary. If cancer is found, a larger portion of breast tissue may be removed from around where the abnormality was found.
“We try to remove as little breast tissue as possible to cause the least amount of distortion of the breast tissue,” Fox said. “If we went in each time before we knew if something was benign or malignant and did a ‘lumpectomy,’ we might be causing some unnecessary distortion.” A lumpectomy is one method of surgical treatment of breast cancer, along with mastectomy, the removal of all breast tissue and skin. Often, lymph nodes are sampled to determine if cancer cells have made it to these interconnected glands that collect fluid and other materials. . “Part of the staging of breast cancer, in addition to the size and type of cancer, is the status of lymph nodes on that side,” said Fox. Testing can help determine the first lymph node that drains the breast fluid, the sentinel node, so that it can be dissected and, possibly, eliminate the need to remove all lymph nodes. The decision on whether to have a mastectomy or lumpectomy, which removes just the lump and a small portion of the breast, is often left to patient preference. “Some patients want it gone, with all of the breast removed, and to be done with it,” Gibbs said. “Other’s want to spare the breast and opt for that knowing they’re signing up for radiation treatments post opt. “Some of the younger women think about
reconstruction. As a surgeon, you want to operate in such a way that their reconstruction is as good as it can be, usually performed by a plastic surgeon.” If a patient wants to opt for a lumpectomy for the affected area, radiation treatment will follow to treat the remaining breast tissue. Radiation treatments are given five days a week over a course of six weeks, so ability to be at daily appointments is another factor in a patient’s decision on which type of surgery to pursue. Chemotherapy treatment is based on the size of the tumor and characteristics of the breast cancer, lymph node involvement and other factors. “It’s not an á la carte,” Fox said. “That treatment options includes a lumpectomy, lymph node study, probable radiation to the remaining breast and then possible chemotherapy based on the lymph nodes. That’s all rolled into one option.” A modified mastectomy removes all breast tissue and skin, but does not remove chest wall muscles. “For the majority of patients, we’ve learned that removing those muscles and nerves does nothing to improve their survival or to minimize the chances of recurrence,” Fox said. Occasionally, genetic testing may reveal a woman has genetic markers that greatly increase the odds of developing
breast cancer in his or her lifetime. Genetic testing is available through Covenant partner facilities, which patients can be referred to. A positive BRCA 1 or BRCA2 test does indicate increased risk for developing breast cancer in the opposite breast. “I have had patients who, for the reason they don’t want to worry about it anymore, have elected to have the other breast removed at the same time. It’s personal preference.” Gibbs said. Fox said, “We find that, the younger the individual, the more likely they are to choose that option, where an elderly man or woman, the interval time it might take for breast cancer to show up on the other side may not make that a relevant point.” Regardless of the option chosen, both Gibbs and Fox noted they perform surgery to increase the chance of successful reconstruction surgery following treatment. Fox said it was his recommendation patients wait until all treatment is complete to undergo reconstruction. “If a patient knows on the front end they desire reconstruction, my personal, professional recommendation is that they not have that done at the initial mastectomy,” Fox said. “They may not be sure what treatment they’re going to need postoperatively.” A symmetrical appearance can be affected by See OPTIONS page 9B
Komen works to impact the UC Susan G. Komen Upper Cumberland was formed in 2006 to combat breast cancer in the 14-county rural region. “We live here and we save lives here,” said Marie Ferran, Komen Upper Cumberland Board President. Since it was founded, the affiliate has granted more than $730,000 to local nonprofits that provide breast health education services, screening mammograms and diagnostic services, and survivor support services. The affiliate has also given more than $203,000 to support Komen National Research Grants. Ferran, who has a long history of working in the field of health care justice, first became involved with Komen Upper Cumberland when the organization was compiling its first community health profile, which is updated every four years to identify the unique needs of the service area. Ferran, who has worked for 30 years with a social service agency in the region, was able to provide much of the needed information and served as a key contact in the study. “That was the first time I knew we had an Upper Cumberland Komen Affiliate,” she said. “I’ve always been very impressed with Komen as an organization and the way it began with a sister’s promise,” Ferran said. Susan G. Komen was founded by Nancy Brinker in honor of her sister, Susan. Suzy was diagnosed with breast cancer in 1977 at the age of 33. Throughout her diagnosis, treatments and days in the hospital, her thoughts were on how to make life better for other women battling the disease. Susan died in 1980 at 36. Nancy, moved by Susan’s compassion for others and commitment to improve treatment for other women, promised she would do everything in her power to end breast cancer forever. “There is so much heart, so much sadness, and so much joy in the story of Nancy Brinker and her sis-
ter,” Ferran said. Shortly after that, Ferran joined the board and attended the Komen National Leadership Conference in Dallas, TX, which made a big impact on the new board member. “That was one of the most uplifting experiences of my entire professional life, and I’ve had a lot of great experiences,” she said. “I learned so much about Komen in this country, Komen as a global entity, and the work that Komen does.” But it was a meeting focusing on the research grants Komen awards each year that Ferran truly understood the work for a cure. “Research that is done with Komen dollars is done for breast cancer research, but that leads to breakthroughs in research for nearly every other kind of cancer,” she said. “It was an eye-opening experience to realize that our little
Upper Cumberland Affiliate raises money that stays locally for breast health grants, but 25 percent of the money raised is used for national research grants to find treatments and cures for breast cancer.” Komen is the largest nonprofit funder of breast cancer research, with more than $847 million invested since its founding in 1982. In 2014, research funding includes research in new drug therapies to combat triple negative breast cancer, a very aggressive subtype of breast cancer associated with poor prognosis and survival; understanding the mechanisms that control DNA repair in breast cancer to create novel cancer therapies; and continuing funding of previous research which led to the discovery of six subtypes of triple negative breast cancer. And while investing in science to find the cures is one of the key missions of
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the Affiliate, it also works to empower communities and ensure quality care for all through local grant programs. In fact, 75 cents of every dollar raised in the Upper Cumberland stays in the Upper Cumberland. “I think it’s wonderful to work with an organization that knows the money that we raise in our community, three-fourths of it stays right here to do the work that we know is needed on a local basis,” Ferran said. The Upper Cumberland Affiliate works with local nonprofit organizations, See komen page 9B
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Breast Cancer Awareness • 9B
www.crossville-chronicle.com • Friday, October 17, 2014
Focusing on long-term needs of survivors By R andy G riffith Tribune Democrat
As part of breast cancer awareness month, Reid, owner of CatFit Yoga, will offer free yoga classes Oct. 25, with donations supporting breast cancer awareness during the grand opening event from 8 a.m. to 4 p.m.
JOY
20 was the hardest. Your skin is raw and bleeding, • Continued from 7B and you’re tired because When the hair stopped radiation sucks your falling, she could still energy out. It’s hard. And feel strands and thought at the same time, my hair maybe she would look was growing back in a the same, with only thin- different color than it ner hair. was when it fell out.” “Maybe I would be After her experience, the exception. Maybe Reid wants to help othI wouldn’t lose all my ers get through their own hair,” Reid said. She exit- breast cancer experience. ed the shower, removed She’s writing the book, the towel from her head, tentatively titled “Jourlooked in the mirror and ney Beyond the C-Word,” screamed. to help caregivers and Her “superhero” durpatients find their own ing her treatment was path. Samantha, who heard her “The way I got yell from the bathroom through it was to keep and came to offer compushing at 100 miles per fort and support. hour,” she said. “She held me until I She was awarded her quit shaking. She told me black belt in Taekwondo I was strong. She told me after her second treatI was beautiful. She told ment. She volunteered me I was her hero,” Reid at Ronald McDonald said. House and Habitat for TogethHumanity. er, the two She worked “You still have to full time removed the last figure out how to at a gym few and part make the best of time for her strands of hair that even things like father. remained. Fitthat.” “I had ness and to be Cathleen Reid a healthy strong,” Survivor lifestyle she wrote. helped Reid “I couldn’t maintain a fall apart full schedule even duror I would die.” ing her treatment. She Regaining normalcy would schedule chemo was important to her, and treatments so that she she found help with that would have a day or so to through wigs. In fact, she recover before teaching had four. fitness classes. “They all had their “I would not change own personalities that my life for cancer,” she went along with them,” said. she said. “You still have Yoga had not been a to figure out how to discipline she had relmake the best of even ished taking over when things like that.” the gym needed someone Reid was 46 when to lead the classes, but she was diagnosed. She she soon came to see the had been getting regubenefits of it, especially lar mammograms since for those lifting weights. she was 27 years old due But when she was going to fibrocystic breast disthrough breast cancer ease. She had been busy treatment, her yoga class the year she was diagbecame a place of solace. nosed and had delayed “When I went through her regular mammogram cancer, I found that the by about six months, only place that the only which proved to be a place I felt completely blessing. normal and not a walk“If I had had the mam- ing breast cancer booth mogram on time, the was on a yoga mat,” she tumor may have been said. “The people who too small to detect,” she came to my classes then, said. Then, it would have they were such a strong had a year to grow and base for me. They never progress before her next looked at me with pity in mammogram, as well, their eyes. It was just a she said. place of acceptance.” “But they found it just Reid relocated to on the mammogram,” she Cumberland County a said. “I was sitting there few years ago. She now waiting, reading an old teaches yoga at her new magazine and they never studio, Catfit Yoga, and came back. Then they she’s interested in taking came in and told me they an active role in assisthad found something. I ing breast cancer patients can remember that feeland survivors. ing right now.” “I think sometimes She sought treatment people just want to at the Southwest Canknow someone else felt cer Center. She taught the same way they did, a number of classes as because you always think a fitness instructor and it’s just you,” Reid said. director of a gym, and “Everyone’s story, they she offered to teach free are all unique. It’s all yoga to the cancer center happening to you.” staff, who were always so The studio will be comforting and kind to holding an grand openpatients. ing event Oct. 25, and Chemotherapy was will offer yoga classfollowed by radiation, es throughout the day which was much harder and taking donations for for her, Reid said, who breast cancer awareness. had seven weeks of radiThe studio, at 231 E. ation treatments five days First St., Suite 105, will a week. be open 8 a.m. to 4 p.m. “During chemo, you live in a fog,” Reid said. n Heather Mullinix “But radiation, the first may be reached at hmultime I went, I thought, linix@crossville-chroni‘This is easy.’ But day cle.com.
Although rates of new cancer cases are shrinking, improved medical care is increasing the number of survivors. The American Cancer Society estimates that there are nearly 14 million cancer survivors in the country, with 18 million by 2022. While cancer workers are ready to celebrate the good news of better survival rates, there is an increased focus on special needs of the long-term survivors. “It is about quality of life,” said Susan Majoris, a nurse navigator at the M. Dorcas Clark M.D. Women’s Imaging Center in Indiana Regional Medical Center.
Closeness of care
“When a patient has completed treatment, maybe there is anxiety. Up until that moment, they have been followed closely by the cancer care team. The closeness of care is going away. “There is anxiety in wondering, ‘Am I really OK?’ ” The growing area of attention and research is called “survivorship,” and it recognizes more than psychosocial issues faced by long-term survivors. “People didn’t survive cancer for 15 or 20 years,” said Carol Harding of Oakland, a breast cancer survivor, retired nurse and facilitator of a cancer support group. “We don’t know what are the long-term side effects of receiving chemotherapy 20 years ago,” Harding continued. “We don’t know what we are going to find with that. It is a Pandora’s box.”
OPTIONS
• Continued from 8B other treatments, such as radiation, which can affect the appearance. All surgical options can be completed at Cumberland Medical Center, both surgeons noted, though plastic surgery and reconstruction are not currently available. “The technology available here and the capabilities of this facility are very good. We follow the same guidelines as bigger cities and hospitals,”
KOMEN
• Continued from 8B health care providers and community leaders to identify needs in the race for a cure. This year, the organization has funded large grants to •Tennessee Department of Health for “The BeST for Tennessee Women Project,” targeting counties with a high percent of uninsured or underinsured women, providing clinical breast exams and referring women to providers for mammograms and other diagnostics; •Cookeville Regional Medical Center, “Upper Cumberland Pink Ribbon Save a LIfe Project,” which provides breast cancer education, screening, diagnostic mammograms and
Success story
Breast cancer is one of cancer medicine’s success stories, with many forms now considered to be “curable.” An estimated 2.8 million breast cancer survivors account for 22 percent of all survivors – more than any other cancer site. Among women, 41 percent of all survivors had breast cancer. Many of those patients continue to struggle with anxiety and physical changes brought on by cancer treatment, Harding said. “Some of the larger issues would be fatigue from the chemotherapy and radiation therapy,” she said. “Some of these individuals cannot seem to get past that. Some are really struggling.” Success in limiting other side effects of therapy can actually add to the stress, she added.
A need for patience
Family members and friends need to be patient when their loved ones don’t bounce back and jump into daily living. “We look good after we survive cancer,” she explained. “People don’t understand why when it comes to testing, we become scared.” “Scared” may not convey the reaction. Medical oncologist Dr. Mark Pajeau at Memorial Medical Center has specialized training in psychology and compares it to post traumatic stress disorder associated with war zones. “I would see people have psychological issues going to the doctor,” Pajeau said. “They would freak out.” Gibbs said. Patients seeking surgical treatment for breast biopsy or breast cancer treatment may be referred by the Regional Breast Center, their primary care physician, the nurse navigator at CMC, or he or she can call the office for an appointment if they have a specific breast problem.
The reaction is a major issue for cancer survivors, who sometimes avoid the routine screenings and lifestyle changes that could prevent future cancers. The National Comprehensive Cancer Network has developed care standards for cancer survivors. The document notes the problem with screenings. “Cancer survivors with untreated distress disorders have poorer compliance with surveillance screenings and are less likely to exercise and quit smoking,” the document says. “Psychosocial screenings and care should be part of the new standard for quality cancer care and should be integrated into routine care across the trajectory of cancer.”
Not all bad news
It’s not all bad news, though, the network notes: “Cancer has positive effects on a significant portion of individuals, including strengthened relationships, a sense of gratitude or empowerment or an increased appreciation for life.” Improving quality of life for cancer survivors requires communication and education across the spectrum of care, but especially bringing in the primary care physicians, said Amy Riley a certified nurse practitioner with Pageau and Dr. Ibrihim Sbeitan at Conemaugh Cancer Care Center. Although patients continue follow-up visits with
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Those primary care physicians must be able to understand the additional issues cancer survivors face. “This is an area of oncology where there hasn’t been a lot of education,” Riley said. Numerous cancer groups are encouraging providers to develop survivorship care plans for patients when they are discharged from cancer treatment. The Institute of Medicine suggests the plans include guidelines to cover: • Prevention and detection of new cancers and recurrent cancer. • Surveillance for cancer spread, recurrence, or second cancers. • Intervention for consequences of cancer, its treatment and other symptoms, such as lymphedema, sexual dysfunction, pain and fatigue and psychological distress. Intervention should include stress experienced by caregivers and concerns related to employment and insurance. • Coordination between specialists and primary care providers to ensure that all of the survivor’s health needs are met. “We try to get to the point where they are going to take active control of their own health and stay healthy,” Riley said.
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breast ultrasound to medically under-served women; •YMCA Go Pink program to provide health and wellness guidance, education, encouragement and support for breast cancer survivors with a free 16-week program. The organization also grants smaller grants throughout the year that support the goal to save lives and end breast cancer forever, with education, screening, treatment support and survivor support services. To learn more about Komen Upper Cumberland, visitwww.komenuppercumberland.org. There, individuals can learn how to get involved through volunteering, donationing or participating in Komen events.
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10B • Breast Cancer Awareness
www.crossville-chronicle.com • Friday, October 17, 2014
CCHS, SMHS hold Pink Out games
photos by Walt Riches/Chronicle
Cumberland County High School athletes, students and community released balloons during the Oct. 3 home game against White County. Fans wore pink and had their faces painted.
W E SUPPORT BREAST CAN CER AW AREN ESS!
CCHS cheerleaders and cheerleaders with the Jr. Jets donned their pink T-shirts, pink hats and pink poms to cheer on their team.
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Stone Memorial High School held its annual pink out game to help raise awareness for breast cancer on Oct. 10 against Sequatchie County. The cheer squads showed their support for breast cancer awareness with pink T-shirts and pink poms.
Community health screening set
Cumberland Medical Center will be holding a community health screening event Nov. 10 from 7 a.m. to 10 a.m. at the Thunderbird Recreation Center at Lake Tansi. There will be free blood pressure, pulse oximetry readings and glucose finger sticks. Other tests will be available for a fee, including a complete blood count, blood typing, comprehensive metabolic profile, B12 test, hemoglobin A1c diabetic screening, lipid profile, PSA prostate screening, thyroid profile and Vitamin D screening. Call (931) 459-4CMC to pre-pay for any of these procedures.
Cancer Care Close to Home
Dr. David Tabor Cumberland Medical Plaza, Suite 340 Crossville, TN 38555 931-707-8808