10 23 breast cancer

Breast Cancer Awareness • 3B

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Linda Presley is a 23-year survivor of breast cancer, diagnosed after her first mammogram in 1992. She urges women to make sure they get the recommended breast cancer screening.

Surviving and thriving after breast cancer

By Heather Mullinix Chronicle assistant editor

As Linda Presley was lying in a hospital bed in 1992 recovering from a mastectomy, she heard a news report reminding women they should start getting annual mammograms beginning at age 50.

She was 45.

“Had I waited until I was 50….” she said.

Presley had gone for her first mammogram just that November and a small tumor was found.

“It was smaller than a pea,” she said. “You couldn’t even feel it.”

She sought the expertise of breast specialists at St. Mary’s Hospital in Knoxville and learned she could have surgery but would not need further treatment, such as radiation, chemotherapy or ongoing treatment to block hormones.

“They were really up on the very latest in breast cancer treatment,” Presley said. “I learned a lot.”

Though she was a candidate for a lumpectomy, Presley said she wanted to go ahead and have a mastectomy.

“I didn’t want a lumpectomy. I said take it off,” she said.

She was able to speak with her surgeon and the plastic surgeon who would handle her reconstructive surgery, working hand-inhand with the breast surgeon.

Presley had no family history of breast cancer and she said she often wondered why she had developed the disease that, in 2015, still affects about one in eight women in the United States.

While a breast cancer diagnosis can be over-

whelming and surgery and treatment emotionally taxing, Presley said she felt blessed during her treatment.

“It was so early,” Presley said. “Breast cancer was like a plague. Every time you turned around, someone was being diagnosed.”

She leaned on her family and her faith, which were a comfort.

“I’m sure my faith was so strong that I didn’t worry about it, and that just grows faith when you can slide right through something like this,” Presley said.

After her treatment, she volunteered to work with Reach to Recovery, a program of the American See thriving page 4B

W e H ope that you join u s in the F ight A gain st B reast C an cer this M on th.

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4B • Breast Cancer Awareness

www.crossville-chronicle.com • Friday, October 23, 2015

Risk Reduction with Early Detection Every 4th woman in the world has breast cancer. Early detection can save your life.

Cancer terms to know Receiving a cancer diagnosis can be a life-changing event, and the impacts are both immediate and longterm. Upon being diagnosed with cancer, men and women may find themselves perusing their dictionaries to learn the meanings of certain terms related to their disease and treatments. The following are a handful of terms that men and women may encounter when they or someone they love is diagnosed with cancer.

• Acute: When cancer symptoms are acute, they begin and worsen quickly but do not last over an extended period of time.

• Benign: Describes tumors that are not cancerous.

• Carcinoma: A cancer that starts in the epithelial tissue of the skin or a cancer of the lining of the internal organs.

• Chemotherapy: The use of drugs to kill cancer cells. Chemotherapy drugs are often used in combination to fight cancer.

• In situ: Also called “noninvasive cancer,” “in situ” refers to cancer that has not spread to nearby tissue.

• Invasive cancer: Cancer that has spread outside the layer of tissue in which it started. Such cancer may grow into other tissues or parts of the body.

• Malignant: A term that describes tumors that are cancerous and capable of invading nearby tissue or spreading to other parts of the body.

• Metastasis: The development of secondary malignant growths away from the primary site of the cancer.

When cancer has metastasized, that means it has begun to spread to oth-

ers part of the body.

• Oncologist: Doctors who specialize in treating patients with cancer.

• Pathologist: Doctors who specialize in interpreting lab tests and evaluating cells, tissues and organs to diagnose disease.

• Sarcoma: A type of cancer that develops in the tissues that support and connect the body, including fat and muscle.

• Stage: A term used to describe how advanced a cancer is. Stages differ for each type of cancer, and the stage may shed light on where in the body the cancer is, whether or not is has spread and its effects on the body at the time of diagnosis.

• Tumor: Masses that form when cells start to change and grow uncontrollably.

History of mammogram technology Mammography remains one of the most popular and well-known diagnostic tools for breast cancer.

It is estimated that 48 million mammograms are performed each year in the United States and many others are conducted all around the world under the recommended guidance of doctors and cancer experts.

Mammography can be traced back more than 100 years to 1913, when German surgeon Albert Salomon attempted to visualize cancer of the breast through radiography. By the 1930s, the concept of mammography was gaining traction in the United States. Stafford L. Warren, an American physician and radiologist, began his own work on mammography, developing techniques of producing stereoscopic images of the breast with X-rays. He also championed the importance of comparing both breast images side-by-side.

Raul Leborgne, a radiologist from Uruguay, conducted his own work on mammography and, in 1949, introduced the compression technique, which remains in use today. By compressing the breast, it is possible to get better imaging through the breast and use a lower dose of radiation. Also, compression helps spread the structures of the breast apart to make it easier to see the individual internal components. Compression helps to pull the breast away from the

THRIVING

• Continued from 3B Cancer Society that trains volunteers to help women through their experience with breast cancer. The volunteers are all breast cancer survivors who can provide emotional support, help understanding options and assistance locating other support programs.

“We would take bras and prostheses to women who were dealing with breast cancer,” Presley said.

She said she tried to help patients understand

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Mammography can be traced back more than 100 years to 1913, when German surgeon Albert Salomon attempted to visualize cancer of the breast through radiography. chest wall and also to immobilize the breast for imaging.

Advancements in mammogram technology continued to improve through the 1950s and 1960s. Texas radiologist Robert Egan introduced a new technique with a fine-grain intensifying screen and improved film to produce clearer images.

In 1969, the first modern-

day film mammogram was invented and put into widespread use. The mammogram process was fine-tuned in 1972 when a high-definition intensifying screen produced sharper images and new film offered rapid processing and shorter exposure to radiation. By 1976, the American Cancer Society began recommending

mammography as a screening tool.

Through the years, mammography became a great help to women looking to arm themselves against breast cancer. Thanks to improvements in early detection and treatment, breast cancer deaths are down from their peak and survival rates continue to climb.

how blessed they were to have found the disease and begin treatment.

“I got to meet so many wonderful people,” Presley said. “I decided my diagnosis happened to allow me to have the opportunity to do that.”

She volunteered with the program for many years, though a growing family of grandchildren and, now, great-grandchildren, keeps her busy.

“I eventually said it was time to pass the blessing on to someone else,” she said.

Twenty-three years later,

Presley is an advocate for making annual mammograms and regular selfexams a priority. Women should be aware of how their breasts normally look and feel and report any new breast changes to a health professional as soon as they are found.

“It’s so important to have those mammograms,”

Presley said. “You can get them here. I was so truly blessed to have had the mammogram when I did.

“If it’s early, look how much better you are.”

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Breast Cancer Awareness • 5B

www.crossville-chronicle.com • Friday, October 23, 2015

Did you know?

Many abnormalities found on a mammogram are not necessarily cancer, but rather are benign conditions like calcium deposits or dense areas in the breast. If the radiologist or a doctor notes areas of concern on a mammogram, The Mayo Clinic says further testing may be needed. This can include additional mammograms known as compression or magnification views, as well as ultrasound imaging. If further imaging is not effective, a biopsy, wherein a sample of breast tissue is taken, will be sent to a laboratory for testing. In some instances an MRI may be taken when mammography or ultrasound results are negative and it is still not clear what’s causing a breast change or abnormality.

Chemo, hormonal treatments help stop spread of cancer cells, prevent recurrance B y H eather M ullinix Chronicle assistant editor

When a diagnosis of cancer is made, a medical oncologist can guide areas of treatment through powerful medication and long-term follow-up.

“Medical oncologists are oftentimes the captain of the ship when it comes to treating not only breast cancer patients but a lot of other cancer patients,” said Dr. Mark Hendrixson.

Patients may see an oncologist before they have surgery or after, depending on the type of breast cancer they are diagnosed with.

The oncologist will review testing, results of surgery, and other factors to help recommend treatment regimens. Lymph node testing that shows the presence of cancer cells generally means more aggressive treatment, including powerful medications that help to destroy cancer cells in other parts of the body, stop cancer from spreading to other parts of the body, slow cancer growth and relieve symptoms of cancer.

“Treatment is less and less one-size-fits-all,” said Dr. Dirk Davidson.

“When I came here 10 years ago, any woman I saw, of any age, who had a tumor a half-inch or bigger, even if the lymp nodes were negative, we generally said you really should take chemo because we really don’t know.”

Oncotype testing can also be used to help determine likelihood of recurrence in patients with early stage breast cancer. In this test, tumor samples are analyzed for the expression of 21 genes to provide a score for the patient that predicts the potential for breast cancer recurrence and the likelihood that chemotherapy would benefit the patient.

“Someone could come in with a large tumor and positive lymph nodes. In the past we would have said, ‘We’re going to hit you as hard as we can,’” Davidson said. “Now, we can take this test and it will tell us, pretty accurately, what their real risk of recurrence is so that they can make an educated decision.”

Sometimes, chemotherapy is used prior to surgery to help shrink large tumors or with advanced HER-2 positive

breast cancer.

“Most drugs enter the market in the metastatic setting,” Hendrixson said. “You wouldn’t put a newly diagnosed woman on experimental drugs when there are standard treatments. Most drugs enter through trials that have proven they are of benefit to women with advanced cancers.”

Those trials can show the drug has a great deal of promise for patients at all stage of the disease and become a commonly prescribed regimen, such as Herceptin.

“That drug was moved up into adjuvant therapy (treatment following surgery to lower the risk of cancer returning), and now all of the sudden, a whole group of women we though had a pretty bad prognosis were not that bad,” Davidson said.

“Just by getting this drug after their surgery, you could make their prognosis much better.”

There are additional drugs added to the regimen that have just become available in the past two years.

Those trials are also how Tamoxifen, a hormone blocking medication, entered the treatment regimen, showing that it slowed or stopped the growth of cancer cells in the body.

The typical treatment for breast cancer is intravenous with Cytoxan and Adriamycin. These drugs have been around for some time, with generic options available. Treatments are given, usually, with four rounds at three-week intervals followed by 12 weekly treatments, for a total of about six months.

Davidson suggests patients have their Vitamin D levels checked, as well, and take steps to remedy any deficiencies.

“If you fix it, your chances of a recurrence are going to be less,” Davidson said.

Bone-strengthening medications could also help, as well.

“Smaller studies have suggested this,” Davidson said.

Chemotherapy does have significant side effects, such as loss of hair, hot flashes, dry and sensitive skin, stomach upset and inflammation.

Some patients experience a mental fog, also called “chemo brain,” where their short-term memory seems unreliable. It can be a side effect of decreased female hor-

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mones as well as stress, fatigue, anxiety and other factors. For most, these symptoms resolve when treatment is complete.

“Quality of life is important,” Hendrixson said. “That’s a personal choice for the patient.

“Nothing is dictated.

Everything is discussed.

Patients always have the option of saying, ‘I don’t think that’s for me.’”

Hendrixson said.

Following chemotherapy, patients may be referred to radiation oncologists for radiation therapy, which lasts about six weeks. Then, they return to the medical oncologist for hormonal treatment.

“We manage patients through their hormonal treatments,” Hendrixson said of drugs that can block hormones that, in some patients, fuel the growth of cancer cells.

Tamoxifen, Arimidex, Aromasin and Femara are among the commonly used drugs that stop the hormones from getting to breast cancer cells.

Those will continue five to ten years, with studies showing a statistical advantage to the longer therapy.

“If you’re taking a pill and there’s no side effects, who isn’t going to take that advantage?”

Davidson said.

One form of breast cancer is the triple negative tumors, which are not receptive to hormones or HER-2. It’s an aggressive form of cancer that is treated with chemotherapy aggressively.

Metastatic breast cancer is cancer which began in the breast but has spread to other organs in the body. It is also called stage IV or advanced breast cancer.

About 10 percent of new diagnosis are stage IV breast cancer. Though the disease has spread, the drugs used to fight breast cancer are used to help slow progression of the disease and treat symptoms.

Davidson said, “You might first put people on drugs and control it for a number of years without needing chemotherapy.”

He doesn’t recommend combinations of drugs in most cases, which can lead to more harsh side effects.

“You can pick an agent and use it as long as it works or they have side effects,” Davidson said.

“If you find agents that aren’t toxic to them individually, they live a lot better.”

Hendrixson said, “We do have a lot more options today than we did five or seven years ago. “Hopefully with continued genomic testing, small molecule drugs, we’ll have the ability to let women live even longer with a better quality of life.”

The medical oncologist is with his patient throughout treatment and into survivorship, helping to spot possible recurrence early and spearhead long-term follow up.

Starting out, patients are see every three months following the completion of chemotherapy. That decreases over time to six months for the duration of hormonal therapy and two years afterward. After that, patients can continue to be seen on a yearly basis for a follow-up.

“People are at risk for second malignancies,” Hendrixson said. “Breast cancer is one of the few cancers we do see that can crop up past that five-year magic window.

It’s uncommon, thank goodness, but it does happen. That’s why I think it’s good to be vigilant for women who have had breast cancer.”

One concern for patients is if their loved ones will be at risk for developing cancer, particularly daughters. Hendrixson said more women can access genetic testing for the BRCA1 and BRCA2 gene mutation, an uncommon mutation that dramatically increases the chance of developing breast and ovarian cancers or dealing with recurrent cancer.

“Anyone under 50 who is diagnosed really should have that testing done,” Hendrixson said.

“It not only helps them, it helps their immediate descendants as well as even nieces know if they are potentially at risk.” n Heather Mullinix may be reached at hmullinix@crossville-chronicle.com.

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Life after breast cancer The moment a person receives a breast cancer diagnosis, his or her life changes immeasurably. The roller coaster of emotions begins, and suddenly this person is thrust into a schedule of doctor’s appointments, treatments and visits from friends and family.

The World Cancer Research Fund International says breast cancer is the second most common cancer in women and men and is the most frequently diagnosed cancer among women in 140 of 184 countries worldwide.

Despite that prevalence, the five-year relative survival rate for women diagnosed with localized breast cancer (cancer that has not spread to the lymph nodes or outside the breast) is 98.5 percent, says the American Cancer Society. Survival odds increase as more is learned about breast cancer and more people take preventative measures, including routine screenings.

Today, there are nearly three million breast cancer survivors living in the United States.

Breast cancer treatments may last anywhere from six months to a year. Adjusting after treatment may not come so easily at first. But adjustments are easier with time, and many cancer sur-

vivors continue to live life to the fullest in much the same way they did prior to their diagnosis.

When treatment ends, patients often still have fears about the cancer, wondering if all of the cancerous cells have been destroyed and worrying about recurrence. But focusing on the present and all of the things you now can do with health on your side is a great way to put your fears behind you.

Many cancer survivors must still visit their doctors after treatments end.

Doctors still want to monitor patients closely, so be sure to go to all followup appointments and dis-

cuss any symptoms or feelings you may be having.

Side effects may continue long after radiation or chemotherapy has ended. Your doctor may have suggestions for coping with certain side effects or will be able to prescribe medications to offset these effects. Follow-up appointments should gradually decrease the longer you have been cancer-free.

It’s not uncommon to feel differently after cancer treatment, as your body has been through quite a lot.

Many women still experience fatigue, and sleep or normal rest doesn’t seem to make it abate. Realize this is normal, and how long it

will last differs from person to person. It can take months or years for you to experience your “new normal.” Things do not happen overnight. While your hair may grow back quickly, it may take some time for you to feel like yourself again.

Exercise routines or other lifestyle changes may help you overcome fatigue or make it more manageable.

Speaking with others who have survived breast cancer can help. Join a support group or reach out to others through social media.

Getting a first-hand account of what can be expected the first year after treatment can assuage anxiety.

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Treating cancer pain Pain is not always a side effect of cancer, but many people do experience pain while battling this potentially deadly disease. People who have been diagnosed with cancer should know that they don’t have to accept pain as a normal part of their disease, and there are plenty of options at their disposal to alleviate their pain.

According to the American Cancer Society, all pain can be treated, and most of it can be controlled or relieved. How physicians treat pain will depend on the type of pain and its cause, but the following are some options doctors may discuss with their patients who are experiencing pain.

• Medication: The type of medication doctors prescribe will depend on a host of factors, including the level of pain their patients are dealing with.

Non-opioids like acetaminophen, aspiring or ibuprofen may be used to treat mild to moderate pain, though patients who are having

surgery or receiving chemotherapy may need to steer clear of non-steroidal, anti-inflammatory drugs (NSAIDs) like aspirin and ibuprofen because they can slow blood clotting. Opioids, which include oxycodone and morphine, may be prescribed for moderate to severe pain. Pain caused by swelling or pressure may be treated by prescription steroids, such as prednisone and dexamethasone.

• Surgery: The ACS notes that surgery may be an option to reduce pain associated with cancer. Nerve pathways carry pain impulses to the brain, but when these impulses are interrupted, they never make it to the brain and the feelings of pain and pressure cannot be felt. To block these pathways, neurosurgeons may cut nerves, but such surgery is irreversible, so cancer patients should expect their physicians and surgeons to explore other avenues before recommending surgery.

• Epidural: An epidural is a method of pain relief in

which medicine is injected into the space around the layers of the spine. Doctors may implant a pump so they can get pain medicines right around the nerves, and the treated area may experience numbness or weakness as a result.

• Nerve block: Another way to treat pain associated with cancer is via a nerve block, a procedure in which a local anesthetic is injected into or around a nerve. If doctors do not choose that option, the anesthetic, which is often combined with a steroid, may be injected into the space around the spinal cord to block pain.

While the injection makes it impossible for the nerve to relay pain to the brain, the nerve block may cause muscle paralysis or a loss of all feeling in the affected area.

Managing pain associated with cancer can be difficult, but patients dealing with such pain can discuss the many pain treatment options at their disposal with their physicians.

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