Breast Cancer Awareness • 5B
www.crossville-chronicle.com • Friday, October 30, 2015
Did you know?
Breast cancer can affect both men and women and is one of the most common forms of cancer. Thanks to increased awareness and screenings, many cases of breast cancer are diagnosed early and treated successfully. BreastCancer.org says that invasive ductal carcinoma, or IDC, is the most common form of breast cancer, accounting for about 80 percent of all breast cancers. The American Cancer Society says that, although IDC can affect women of any age, it is most common among women age 55 or older. The good news is that this type of cancer is highly curable, provided it has not spread outside of the ducts to other breast tissue. Survival rates for any breast cancers diagnosed in the early stages are excellent.
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Tricia Evans, with her granddaughter and right hand, Azia Evans, who gave her so much strength during her battle with breast cancer, is assured that the support of all those who have been touched by breast cancer, otherwise known as “the bosom buddy sisterhood,” can bring you through anything.
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By Rebekah K. Bohannon Beeler Chronicle correspondent
Tricia Evans was casually getting settled in for bed on a normal Thursday night this past May just before Mother’s Day weekend when she discovered a lump in her breast. “I immediately knew instinctively this was not a cyst,” said Evans, breast cancer survivor, who determined, “in the same moment, I also knew I was going to be okay.” A flood of thoughts continuously flowed throughout her next days as she attempted to stay focused and calm. She felt an instant sense of dread at the barrage of impending medical appointments and knew she would have to have her breast removed. “There’s nothing scarier than that,” said Evans, who called her called her doctor the very next day. “She asked me who did I want to be my surgeon and I had no idea,” said Evans, who had not even had time to adjust to what was happening long enough to research and consider it. Evans’ doctor personally recommended Knoxville Comprehensive Breast Center and made an appointment for her and she was in their office the following Wednesday, less than a week later after having discovered the lump. “It was boom, boom, boom,” said Evans, in regards to the whirlwind that her life had become in a matter of moments. “I encourage you to have somebody with you [at the appointments] because there is so much information that we are not going to retain it all.” Evans’ significant
other, Rob Patton, was there with her, going to every appointment and consultation, being her moral support and a helpful extra set of ears to absorb and remember all the information. Her cancer surgeon had a huge dry erase board that he had diagrams and wrote everything down for her and took pictures of it to send with her so she’d be able to reference the information whenever she needed it. Evans was very surprised at the amount of medical advancements that are available now to treat breast cancer compared to 20 years ago and was uplifted by the options and people that showed up for her. Evans’ team of medical team included three doctors who collaborated with each other on her case. She opted for a double mastectomy in July of this year, with a surgical tag team to prepare for reconstruction. Her doctors were incredible
and understanding, making themselves available day or night for extra support. Her surgery went well but she wasn’t nearly prepared for the lengthy recovery. Patton’s mother wanted to stay with Evans and took care of her post surgery. “She had me sleep in her king sized bed with her so if I needed her she would be right there,” Evans remembered endearingly. Her granddaughter, Azia, whom Evans is raising, was a source of undeniable strength for her. The 11–year-old was mature and hopeful and comforting beyond her years. Azia was staying with her other grandparents for the summer but, upon returning home, did whatever she could to make sure her grandmother was comfortable. “Azia, when I first told her, she immediately jumped in my arms and held me. I didn’t panic See buddies page 6B
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6B • Breast Cancer Awareness
www.crossville-chronicle.com • Friday, October 30, 2015
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ACS recommends changes to mammogram guidelines The American Cancer Society’s new breast cancer screening guidelines recommend that women start screening later and get fewer mammograms, but the change is unlikely to affect insurance coverage anytime soon. The updated guidelines, which were published in the Journal of the American Medical Association this week, recommend that women who are at average risk for breast cancer start annual mammograms at age 45 and continue until age 54, then reduce screening frequency to once every two years. They should continue on that schedule as long as their life expectancy is at least 10 years. The ACS also no longer recommends that women receive manual clinical breast exams. The previous guidelines, which had been in place since 2003, recommended annual mammograms and clinical breast exams starting at age 40 for women who were at average risk. The update was two
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• Continued from 5B and she didn’t panic, and that was huge. I saw a strength in her eyes. We are a team,” said Evans. “She was incredible, amazing help. When she came home a few weeks later after the surgery and she was right there, she took charge. She would get things for me and carry my purse and open all the doors. She’d tell me, ‘No, you’re not going to open that door. Don’t you pick that up, don’t lift that, I’m going to get your purse.’ That stuck with me and moved me. It touched my heart and tickled me all at the same time and it made me smile.” “People came out of the woodwork for me. I had no idea how much I was loved, cared about, thought about and had no idea how many people have breast cancer or had breast cancer. It’s so encouraging,” said Evans. “A very, very good friend of mine, she was my bosom buddy, she encouraged me and she called me. And all these other people kept calling and giving me words of encouragement and that I wasn’t alone. It’s still absolutely frightening because it’s you, it’s the ‘C’ word. It’s absolutely true that more than the surgery, more than cancer, it is an emotional roller coaster. And that’s the hardest thing.”
Move unlikely to affect insurance coverage soon, experts say years in the making and reflects the society’s current thinking based on an analysis of existing science and changing technology, among other things, says Kirsten Sloan, the ACS Cancer Action Network senior director of policy. The society concluded that even though women in their early 40s can benefit from breast cancer screening, they are more likely than older women to get false positive results, which can lead to unnecessary — and sometimes harmful — additional testing and procedures. The new guidelines on their own likely won’t change insurer and employer decisions regarding coverage of screening for breast cancer, experts agree. Under the health law, health plans are required
to cover preventive services that are recommended by the U.S. Preventive Services Task Force, a nonpartisan group of medical experts, without charging consumers anything out of pocket. The only exception is for plans that have grandfathered status under the law. The task force’s breast cancer screening guidelines are slightly different than those from the American Cancer Society. The task force recommends mammograms to screen for breast cancer for women at average risk every two years starting at age 50 and continuing until age 74. The task force is revising the guidelines, but a proposed recommendation is similar to the existing one. The new ACS guidelines now more closely
Part of the emotional roller coaster was pain and the other was worry. Evans had to deal with the highs and lows and try to stay strong and positive in the middle of the whirlwind. “There was one day in particular, I was still in a little pain, still but it wasn’t just that, it was I was an emotional wreck, and I just stayed at home all day and cried,” said Evans. “And that’s okay. It’s okay to cry, but you’ve got to stay positive because of so much of people’s illnesses can come from worry. Basically what I said to myself about this cancer was, ‘I’ve got this and I’m going to kick its butt.’ That’s what you’ve got to do. You’ve got to stay strong and get a little mean and a little aggressive. That’s a part of that emotional roller coaster.” Two of her co-workers who were also fighting breast cancer pulled together with Evans in the bosom buddy sisterhood that will never be shaken. “The biggest thing that I can think of is just to talk,” advised Evans. “Talk as much as you can because that is going to help a person understand and get a better grip on things and what to do. Never stop talking. The people will come from everywhere and they are by your side. They help carry this with you. Even though it is you, they are right there with you.
It is so frightening but it becomes a little dimmer. I see my coworkers [who are also fighting breast cancer] and they are strong, strong, strong women. It makes you strong.” “Early detection; you have got to have the breast examination and I definitely encourage it,” said Evans. “It’s going to feel different than the regular lumps you have in your breast. It’s just different and you know instinctively that it’s something else. I will forever and a day now have an oncologist. And that’s scary, but that’s how it is. It’s exhausting and it’s frightening, but this too shall pass and you’re going to be fine. You really will. That was the biggest thing. I’m going to be fine and stronger for it.” She also had four lymph nodes removed to biopsy, which came back negative. Therefore, Evans was not required to take chemo or radiation as part of her treatment regimen. She does take the chemo pill, however, for five to 10 years. But, she has responded well to the medication without any immediate side effects. She still has the reconstructive surgery to go.
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align with the task force’s recommendation to start screening at age 50. However, both groups’ guidelines also say some women may choose to be screened earlier than the recommended age — but that the decision should be an individual one. “In most cases, health plans are already covering mammograms for women age 40 to 50 when recommended by a doctor,” said Clare Krusing, a spokeswoman for America’s Health Insurance Plans, an insurer trade group, in an email. Health plans examine medical guidelines and evidence from a variety of sources when developing coverage rules. “The recommendations will give plans a different framework for evaluating those coverage decisions moving forward, particularly if more and more doctors, providers [and] researchers release recommendations that align with those coming out from the ACS,” says Krusing.
“It’s going to be tough but I see this huge bright light at the end of the tunnel and it is phenomenal. I feel wonderful and my energy is great,” said Evans. For Evans, being positive was a huge part of her fight and recovery. Raising her granddaughter as a single parent, working full time and being confronted with breast cancer invigorated her already positive attitude. “It’s a day at a time,” said Evans. “I’m very blessed. My coworkers were wonderful and everyone was so supportive. And all of that is a day at a time and you find a way to do it all, and you do. Let’s make this day as fabulous as possible and revel in it.” Bosom buddies to the core, Evans reminded, “There’s a common thread that you have with certain people that is a whole other community. You’re not a stranger. You may have never met them before but when you discover they’ve gone through the same thing, you’re not a stranger and immediately become a sister or a sibling. There’s a strength that we don’t even realize that we gain.”
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Breast Cancer Awareness • 7B
www.crossville-chronicle.com • Friday, October 30, 2015
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CMC offers targeted radiation therapy option close to home By Heather Mullinix Chronicle assistant editor
Targeted radiation treatment is another step in the treatment of breast cancer, used following surgery to fight any cancer cells that may be left in or around the breast. Not all patients will need radiation treatment, though it can be part of treatment in cases where a patient has elected to have a lumpectomy to remove a tumor and radiation to conserve the breast or, in a few cases, after mastectomy “We offer external beam radiation therapy here,” explained Dr. Zach Fowler said. “The conventional treatment is a sixand-a-half-week course, with 33 treatments.” Fowler and Dr. Grant Clark are the radiation oncologists serving the Regional Cancer Center at Cumberland Medical Center. Radiation therapy requires treatments Monday through Friday over the course of several weeks. CMC is able to provide that service to patients in the area, saving time and energy in driving to other regional centers. “The benefits of radiation treatment depend on the cancer stage and other treatments they are having,” explained Fowler. “Of course, the gener-
al rule is the earlier it is found, the more successful treatment is. That’s why we want women to get their screening mammograms.” In some cases, additional treatments may be necessary, but Fowler said that happens only rarely. A less common regimen includes 16 treatments, but there are nine criteria patients must meet to be candidates for this treatment. “It’s not done very often,” Fowler said. Another type of radiation treatment is partial breast radiation, which is not offered in Crossville. If a patient needs that treatment, however, the CMC Regional Cancer Center’s affiliation with Thompson Cancer Survival Centers allows for easy referral to sites in Knoxville offering that service. Studies over the past 30 years or more have established the benefits of radiation therapy following a lumpectomy for patients who wish to conserve their breast, Fowler said. But patients can still reap the benefits of a mastectomy following lumpectomy and radiation therapy, if needed. “There’s no penalty for trying to go the breast conservation route initially,” he said. Patients often ask if it is
safe for them to be around other people following treatments. “There is no lasting radioactivity,” said Fowler. Radiation treatment takes about 15 minutes, most of which is spent adjusting patients on the table. The beam is on for just a few minutes. CMC offers an Elekta Synergy linear accelerator. “It gives us a very good range of photons and electrons to use for treatment,” Fowler said. “It gives us a lot of control over the depth we treat and minimizes the hot spots on the skin, letting us put the radiation where it needs to go to get good coverage of the areas at risk.” T he tech nolog y includes an on-board portable imager that offers medical imaging to help map the target area each week, or more often if necessary. “It used to be we had to take X-ray films and get them developed. That’s all gone now. It’s all digital,” Fowler said. He is able to compare imaging from earlier treatments at the machine or at his desk or the simulator in radiology or when planning the treatment. “We have access to it all over our department,” he said.
The daily treatments are used because it allows the rapidly reproducing cancer cells to be damaged by the radiation while normal cells have time to recover before the next treatment. It limits exposure to normal cells and decreases side effects. Fowler and Clark meet with patients and review the side effects they may experience before they begin treatment. “We go through that in detail when I first see them and all through their course,” Fowler said. Radiation treatment does have short-term and long-term side effects that are possible, including skin reaction around the breast and under the arm, fatigue and, rarely, nausea. “That’s uncommon,” he said. Skin changes can be long-lasting, with skin taking on the appearance of a sun tan or becoming tough. The soft tissue could contract, and the combination of surgery and radiation could lead to the treated breast being smaller than before. “It’s a fairly easy treatment to go through for the patient,” Fowler said. “The skin reaction is the most common side effect for patients, so we always cover skin care recomSee therapy page 8B
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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 fiveyear 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 survivors 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 worry-
ing 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 follow-up appointments and discuss 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 See AFTER page 8B
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8B • Breast Cancer Awareness
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Raising awareness of metastatic breast cancer — one tutu at a time (BPT) - Hearing a doctor utter the words “breast cancer” often leaves women with dozens of initial questions: “How will I manage all of the demands of daily life while in treatment? How will it affect me physically? How do I tell my family?” But a diagnosis of metastatic breast cancer, the most advanced stage of the disease after it has spread to other parts of the body, can be particularly difficult. “There’s a real dark side to cancer. Like many women with this disease, I experience fear, sadness and physically feel the impact of my diagnosis,” says Linda Carey, who was first diagnosed with breast cancer in 2003 and metastatic breast cancer in 2006. Shortly before Carey’s first diagnosis with breast cancer, her husband Bob started a personal photography project - The Tutu Project - to express his feelings about some significant life changes, including the Careys’ move from Arizona to Brooklyn, NY. When Carey was diagnosed, the project evolved into a way to help make her laugh and allowed her to shift her focus away from her cancer journey. Over the years, the project has further evolved into a way for the Careys to provide support to others. Through the Tutu Project, Bob photographs himself wearing only a pink tutu in a variety of poses and settings around the world - walking through fields, standing atop the Grand Canyon and even jumping across the Brooklyn Bridge - all in the hope of offering inspiration, laughter and perhaps a smile while in chemotherapy, while raising funds to cover incidental costs not
THERAPY
• Continued from 7B mendations.” Patients are advised to limit their sun exposure and avoid shaving or using chemical deodorant during treatment. Loosefitting clothing helps decrease irritation and avoiding heavily chlorinated water, such as from public pools or hot tubs, is recommended. On the mornings of treatments, skin should be free of oils or lotions.
AFTER
• Continued from 7B 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
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To help create awareness of metastatic breast cancer and find strength and solidarity in these experiences, Carey is encouraging women to participate in the nationwide #MBCStrength photo and story-sharing campaign. covered by health insurance for those living with breast cancer. Bob notes, “This can be a very scary road to travel. But Linda’s cancer has taught us that life is good, dealing with it can be hard, and sometimes the very best thingno, the only thing-we can do to face another day is to laugh at ourselves, and share a laugh with others.” Carey says she relies on finding the humor in the little things and the support of friends and family to get her through the toughest times. The approximately 175,000 American women living with this advanced form of breast cancer often face challenges distinct from those diagnosed with an earlier stage. For many like Carey and her husband Bob, the desire to share their stories and connect with other members of the metastatic breast cancer community is an essential part of the journey. “In those moments when I feel alone or afraid, I use journaling or drawing to help express my
emotions, negative or positive. These are my forms of self-therapy and I can’t begin to describe the value that they have added to my life.” To help create awareness of metastatic breast cancer and find strength and solidarity in these experiences, Carey is encouraging women to participate in the nationwide # MBCStrength photo and story-sharing campaign. Women with metastatic breast cancer can share their own photos and stories that capture the essence of their journey living with MBC on Twitter using the hashtag #MBCStrength or on Facebook. Photos posted on the Facebook page will be considered for a display in Times Square on Oct. 13, 2015, Metastatic Breast Cancer Awareness Day. Ca rey’s personal account is also featured at www.MyMBCStory.com, an educational website tailored for women with metastatic breast cancer developed by AstraZeneca with input from breast cancer advocacy organiza-
tions LBBC and Metastatic Breast Cancer Network. Those who share their stories on Facebook also have an opportunity to be featured on the site, which in addition to first-person stories also provides tools and information tailored to women with metastatic breast cancer and their loved ones. Educational resources are important for many women facing a metastatic breast cancer diagnosis, because despite the wealth of information available about breast cancer, there are very few resources specific to metastatic disease. “As the fight continues for more metastatic breast cancer resources, research and financial support, my hope is that we and the broader community do not lose sight of one key truth: our disease may not be curable but it’s up to us how we choose to live our lives.” To read stories from women living with metastatic breast cancer visit www.MyMBCStory.com.
Prior to meeting with the radiation oncologists, patients have expressed anxiety because they don’t know what to expect as they move into the new stage of treatment. “Once they see them, their stress levels decrease greatly,” said Trish Vaughn, nurse navigator at CMC. “They know what’s going to happen. I think you do an excellent job with the patients I talk with because their questions are answered. They feel very com-
fortable about coming because they know what to expect.” Transportation can be a barrier to some patients, as they have to be at their appointments five days each week. The Cancer Center does have some assistance available to help patients with the cost of gas. Those funds come from community donations and through fund-raising efforts of the Lake Tansi Women’s Golf League and the Fairfield Glade Ladies 18-Hole League.
There is also an apartment available near the hospital where patients can stay during their treatments, and the Cancer Center fund also helps supply that need with the assistance of Mayberry’s Furniture in Crossville and the Fairfield Glade Rotary Club, which assisted in the renovation and furnishing. n Heather Mullinix may be reached at hmullinix@crossville-chronicle. com.
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 firsthand account of what
can be expected the first year after treatment can assuage anxiety.
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