A Special Supplement to The
Herald-Citizen
October 18, 2015
SUCCESS & INSPIRATION
PREVENTION
SURVIVING DIAGNOSIS
Local survivors share their stories
How to conduct a breast self-exam
What to expect after treatment
2 — HERALD-CITIZEN, Cookeville, Tenn. — www.herald-citizen.com — Sunday, October 18, 2015
BREAST CANCER AWARENESS
Laura Militana | Herald-Citizen
Pictured with a few of the items that will be up for auction at the upcoming Pink Gala, in front, from left, are Amy Ellis and Brenda Floeter, and in back, Diana Dughi, Amanda Scott, Michelle Zellner, Judy Phillips and John Bell, Pink Gala chairman and executive director of the Cookeville Regional Charitable Foundation.
Pink Gala set for Oct. 24 By LAURA MILITANA HERALD-CITIZEN Staff
COOKEVILLE — With the Pink Ribbon of Hope Save-a-Life Mammogram project, there’s no excuse for women who are uninsured or underinsured to not get a mammogram. Sara Carr of Cookeville can attest to that. “My friend died of breast cancer and her experience encouraged me to start getting mammos,” she said. She did not have her mammogram on a yearly basis, but then she found out about the Pink Ribbon of Hope program and took advantage of it.
“That program is here for those women to use.” The program is celebrating its ninth year this year while the Pink Gala, the event that raises needed funds for the program, is celebrating its seventh year. “The Gala allows us to expand the program,” Michelle Zellner, director of the Imaging Center at Cookeville Regional Medical Center, said. “There are some 500 women a year served through this program.” The Pink Ribbon of Hope is also supported by a $25,000 annual grant from Susan G. Komen. “We need the Gala to grow this program
and help more women,” John Bell, executive director of the Cookeville Regional Charitable Foundation, said. Thanks to the proceeds of the Gala, the program is expanded to fund biopsies and even surgery for women who are unable to pay for those procedures. This program is open to all women (and men) in the Upper Cumberland region. “All they have to do is call the Women’s Imaging Center and the scheduler can get them connected with the program,” Zellner said. It is recommended that women 40 and older get their mammogram annually. The Pink Gala is set for Oct. 24 at the
Leslie Town Centre. Tickets and tables are still available. It will begin with a cocktail hour and include formal dancing until an elegant dinner of lobster, steak and other delicacies are served. An auction of unique items and experiences will also take place. Items to be auctioned off include an Orion Cooler made by Jackson Kayak, a trip to Key West, a Disney package, Fall Creek Falls zip line package, a catered pontoon luncheon rental on Center Hill Lake, jewelry, art, naming opportunities for the Women’s Center flower garden and more. For more information or to order tickets, call 931-783-2003 or visit www.cookevilleregionalcharity.org.
HERALD-CITIZEN, Cookeville, Tenn. — www.herald-citizen.com — Sunday, October 18, 2015 — 3
BREAST CANCER AWARENESS
Breast cancer survivor in remission six years now By LAURA MILITANA HERALD-CITIZEN Staff
COOKEVILLE — Nancy Judd was afraid to get her annual mammogram. Even though she was past due for it, she got it anyway. “It’s a good thing I did, too,” she said. “I was diagnosed with non-invasive DCIS in one breast.” According to breastcancer.org, ductal carcinoma in situ (DCIS) is the most common type of non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts, carcinoma refers to any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs, and in situ means “in its original place.” DCIS is called “non-invasive” because it hasn’t spread beyond the milk duct into any normal surrounding breast tissue. DCIS isn’t life-threatening, but having DCIS can increase the risk of developing an invasive breast cancer later on. She had no symptoms, but is grateful it was caught early. “My grandmother died from breast can-
cer and it was horrible,” she recalled. Even though she received treatment at Vanderbilt, she found support through Cookeville Regional Medical Center, where she is also employed. “I remember it being a normal day, but when the phone rang and it was someone with results from the mammo, that is a scary feeling,” she said. “Thankfully, the breast care navigator here at the hospital walked me through the treatment options.” She went to Vanderbilt and had a mastectomy done, but no chemo. “It was caught very early,” she said. Her treatment took nearly a year, but cancer never really leaves her mind. “It may be in remission physically, but mentally, it’s always there,” she said. “It never leaves your mind.” She is also grateful for the support she has received from the local Komen group and the Go Pink! program at the YMCA. “My recent exam is clear,” she said. And her advice for women is to get the mammogram done. “You just have to,” she said. “There’s no excuse.”
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BREAST CANCER AWARENESS
Local Komen board meets with CEO COOKEVILLE — Members of the Komen Upper Cumberland board recently had the chance to meet with Komen’s president and CEO during a seminar presented by the Vanderbilt-Ingram Cancer Center and Susan G. Komen Greater Nashville. Dr. Judith Salerno spoke at the Impact on Breast Cancer Research and Clinical Care Seminar, held Oct. 5. “Investing in early career scientists, increasing focus on metastatic breast cancer and improving health equity across the country are the top priorities of Susan G. Komen” Salerno said. “I hope, as the leading breast cancer organization, we can step up and make a difference.” Komen has set aside about 50 percent of its 2015 grant awards for early career scientists. “There are a lot of blind alleys, but there are a lot of serendipitous findings, too,” Salerno said. “We have to go where the science leads us. That’s how we make advances.” Komen awards three types of research grants that can help bridge the funding gap recently graduated researchers and faculty may face as they start their breast cancer research: career catalyst research grants, postdoctoral fellowship grants and graduate training in disparities research. “You have a home in breast cancer research and we want to make sure you’re supported,” Salerno said. “I believe continuity in breast cancer research is critical to success.” Komen has funded more than $11 million in research grants for projects at Vanderbilt University, with the organization having invested more than $889 million in research since it was formed in 1982. The 2015 research grants portfolio spans the cancer continuum from prevention to treatments for aggressive and metastatic disease. “We know that we have to help fill that gap,” Salerno said of the federal funding. “But we can’t do it alone. We received hundreds of applications with good science from good scientists, but there are only so many we can fund.” Research is fundamental to Komen’s mission to end breast cancer forever, but that mission also includes community advocacy and public policy work. “Eighty cents of every single dollar goes to our mission program,” Salerno said. Komen Upper Cumberland founding board president Eileen Stuber says, “Vanderbilt is doing some exciting, cutting edge research and hearing them speak made it clear that real progress is being made and will continue to be made. Komen’s support has been and continues to be so important
President and CEO of the world’s largest breast cancer organization Judith Salerno visited Vanderbilt University Medical Center recently and Susan G. Komen Upper Cumberland board members, from left, Dr. Harry Stuber, Eileen Stuber, Nancy Himell and Heather Mullinix, were there to meet her. as the largest non-government funder of Tennessee, African American women have is often a time of celebration for breast cana higher mortality rate from breast cancer cer survivors, and that great strides have breast cancer research.” Local Komen affiliates, including Susan than their white counterparts with the same been made (the five-year survival rate for a G. Komen Upper Cumberland, keep 75 stage disease. Nationally, the disparity is 44 patient with early stage cancer is at 99 percent), the number of women and some men cents of every dollar raised to support local percent. “While we know that we’re making great who die from the disease every year recommunity non-profit grants that offer an array of services such as screening mammo- strides, we’re not there yet,” Salerno said. mains at 40,000. “There are people who are dying of this grams for underinsured or uninsured pa- “But we know from the work that we’ve tients, diagnostic testing, survivor support done that we can make a difference. In disease, living with it every day knowing programs and support of nurse navigators Chicago, through a program we funded, that there is no cure,” Salerno said of we’ve reduced the disparity gap by 34 per- metastatic breast cancer. “We have to adat area hospitals. The remaining 25 cents is used only for cent in six years. Those are real lives dress their needs.” Over 33 years, Komen has invested $147 saved.” national research grants. Reasons for the disparity in health out- million in 400 grants focusing specifically “It’s because of the work people do in communities that we see the impact of those comes are complicated, Salerno said, point- for metastatic breast cancer. “We’re not limiting our commitment to funds and what the needs are,” Salerno said. ing to issues of genetics, socioeconomics, “That’s what makes our organization, built cultural issues and more. Further, each com- the laboratory,” she said. “We have to do more. We have joined with 29 other organmunity’s issues will be unique. on grassroots, so powerful.” Salerno has launched a national health eq- izations in the Metastatic Breast Cancer AlThat community involvement has shown there are disparities in healthcare for people uity initiative that will include roundtable liance where we hope to address what are among the general population and under- discussions with community leaders in the significant needs of day-to-day living with served communities, those who are under- 10 cities identified with the highest rate of breast cancer and listening to the voice of women and their families who are telling insured or un-insured or those who have disparity. Memphis leads the list. Salerno acknowledged that while October us what we need to do.” poor access to health care. For example, in
HERALD-CITIZEN, Cookeville, Tenn. — www.herald-citizen.com — Sunday, October 18, 2015 — 5
BREAST CANCER AWARENESS
Go Pink helps those fighting breast cancer By MEGAN TROTTER HERALD-CITIZEN Staff
COOKEVILLE — Clydean Butler of Cookeville got her first cancer diagnosis 23 years ago. She had been painting her ceiling and noticed the area underneath her left arm became sore. At first, she shrugged it off, thinking it was the movements she used during painting that caused the pain. However, when the pain returned two weeks later, she decided to have a doctor take a look. Doctors found it to be breast cancer. “I was so shocked,” Butler said. After a mastectomy at Vanderbilt, Butler went through chemotherapy and came out cancer-free. She stayed that way until about 11 1/2 years ago, when doctors found cancer in her other breast. “I went for a regular checkup, and the girl told me that we needed to do an ultrasound. They told me I had cancer in the right breast.” Another mastectomy and more chemo, and now Butler is cancer-free again. Now, she’s involved in the YMCA’s Go Pink program to not only get help herself, but to help others, many of whom are going through cancer treatment for the first time. “A friend took me to see a relative of hers who was just really, really down and sick,” Butler said. “When I went, I still had drainage tubes hooked up to me. She said, ‘If you can come all the way from Cookeville to Westmoreland with drain tubes, then I need to get up off the couch and get my life going.’ She told me, ‘You really saved my life.’ That meant so much to me.” Those currently battling breast cancer or those who have had breast cancer in the past can sign up for the free six-month program. They receive complete access to the YMCA, nutrition counseling from a registered dietitian, personal training ses-
Clydean Butler, a participant in the Komen Go Pink program for breast cancer survivors and fighters, goes through her daily exercise program at the YMCA. Ty Kernea | Herald-Citizen
sions with a Pink Ribbon-certified trainer, and regular exercise classes and educational seminars. “It’s a wonderful program. Anyone who’s had breast cancer really needs to join,” Butler said. “It’s just one big family. Everyone’s problems are all of our problems — we try to help whoever needs help. For example, if we have someone in the program who is sick and can’t prepare their food, we take turns taking them food. It’s such a caring group. We support each other. That’s what its all about — support.” For more information about the program, contact Jenny Thacker at (931)528-1133 or jenny@pcfymca.org, or visit http://pcfymca.org/programs/go-pink-program/.
6 — HERALD-CITIZEN, Cookeville, Tenn. — www.herald-citizen.com — Sunday, October 18, 2015
BREAST CANCER AWARENESS
History of mammogram technology
Through the years, mammography became a great help to women looking to arm themselves against breast cancer.
Mammography remains one of the most popular and wellknown 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 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.
Preparing for your mammography visit Annual mammograms are widely recommended for women beginning at age 40. Some estimates suggest that more than 48 million mammography screenings are performed in the United States every year. Whether it is a woman’s first mammography or her twentieth, preparing for the appointment can ease anxiety and make the experience go more smoothly. The following are some guidelines to consider when preparing for a mammography visit. • Choose a reputable and certified facility. Select a radiology center that is certified by the FDA, which means it meets current standards and is safe. Many women also prefer to select a facility that
is covered by their health insurance. Plans usually allow for one mammogram screening per year. • Time your visit. Schedule the mammogram to take place one week after your menstrual period if you have not reached menopause. Breasts are less likely to be tender at this time. Also, schedule your visit for a time when you are not likely to feel rushed or stressed. Early in the day works best for many. • Dress for the occasion. Two-piece ensembles enable you to only remove your shirt and bra for the examination. A blouse that opens in the front may be optimal. Some facilities require you to wear a
paper gown for the exam. • Watch your grooming practices. You’ll be advised to abstain from wearing powder, perfume, deodorant, ointment, and lotions on the chest or around the area. These substances may look like an abnormalities on the mammogram image, potentially resulting in false positive diagnoses. • Take an OTC pain medication. Mammograms are not necessarily painful, but they can put pressure on the breasts, which creates discomfort. Breasts are compressed between a plastic plate and the imaging machine. This spreads out the tissue and helps create a clearer picture. If your breasts are tender, medications like
acetaminophen or ibuprofen taken an hour before the appointment may ease discomfort. • Expect a short visit. Mammogram appointments typically last around 30 minutes. The technician will mark any moles or birthmarks around the breasts so they can be ignored on the imaging. You’ll be asked to hold your breath as the images are taken. If the images are acceptable, you are free to go. But new images may be needed in some instances. Mammograms are now a routine part of women’s preventative health care. The procedure is simple and appointments are quick and relatively painless.
HERALD-CITIZEN, Cookeville, Tenn. — www.herald-citizen.com — Sunday, October 18, 2015 — 7
BREAST CANCER AWARENESS
Knowing and recognizing the signs of breast cancer As with many types of cancer, breast cancer is most successfully treated when it is detected early. Over the previous quarter century, death rates for breast cancer have been on the decline, a positive development that Breastcancer.org, a nonprofit organization dedicated to providing reliable, complete and up-to-date information about breast cancer, suggests is a byproduct of the heightened awareness of breast cancer over the last 25 years and the increasing emphasis placed on breast cancer screening. Understanding the symptoms of breast cancer also can help women battle and defeat this potentially deadly disease. While the presence of any of the following symptoms does not necessarily mean breast cancer is present, the appearance of the following should be enough to inspire women and even men to visit their physicians for thorough examinations and screenings. • Changes in the feeling of the breast or nipple: A change in how the breast or nipple feels could be indicative of a larger problem. If the nipple is especially tender and this persists for an extended period of time, exercise caution and discuss this change with your physician. Similarly, if a lump or thickening develops on or near the breast or underarms, speak with your physician. • Changes in appearance of the breast: A lump or thickening in the breast may affect the appearance of the breast. Another visible symptom of breast cancer is a change in the skin texture or an enlargement of pores in the skin of the breast, which may appear similar to dimpling, not unlike an orange peel. Swelling or shrinking of the breast, especially when such symptoms appear on just one breast, may also indicate breast cancer. In addition, some women with breast cancer notice a sudden asymmetry with their breasts despite their breasts previously being symmetrical, and such a development should immediately be brought to the attention of a physician. • Changes in the appearance of the nipple: A nipple that appears different also may be a sign of breast cancer. Some women with breast cancer have noticed a nipple turned slightly inward or inverted prior to their breast cancer diagnosis. Skin of the nipple, as well as that of the breast and areola, which is the dark circle
Even women who are a picture of health can develop breast cancer, highlighting the importance women must place on recognizing and detecting the symptoms of this often curable disease. of skin around the nipple, may also become red, scaly or swollen when breast cancer is present. • Clear or bloody discharge from the nipple: Women who are breastfeeding often notice a milky discharge from their nipple after breastfeeding. Such discharges are normal. However, when a woman who is not breastfeeding notices the presence of a clear or bloody discharge from her nipple, such a development should be brought to the attention of a physician. Any of the aforementioned signs and symptoms may be a sign of infection or the presence of a cyst, both of which are less severe than the presence of breast cancer. But the success rates of treating cancers that are detected early is such that any potential symptom of breast cancer warrants an immediate discussion with a physician.
She
BELIEVED
SheCOULD SO SHE DID
Susan Johnson, Realtor, Survivor
8 — HERALD-CITIZEN, Cookeville, Tenn. — www.herald-citizen.com — Sunday, October 18, 2015
BREAST CANCER AWARENESS
Race for the Cure 2015 Photos
Ty Kernea | Herald-Citizen
Men and women of all ages participated in the 2015 Komen Upper Cumberland Race for the Cure.
Ty Kernea | Herald-Citizen
The parking lot around the stadium at Tennessee Tech was scattered in pink Ty Kernea | Herald-Citizen as the Komen Upper Cumberland group held their annual Race for the Cure Young participants encourage racers with a dance before the race. in September.
HERALD-CITIZEN, Cookeville, Tenn. — www.herald-citizen.com — Sunday, October 18, 2015 — 9
BREAST CANCER AWARENESS
([SHULHQFH 0DWWHUV Premier Diagnostic Imaging leading the way in mammography for the Upper Cumberland since 1999. Because your health is important to us, Premier was the ƓUVW WR EULQJ \RX 'LJLWDO 0DPPRJUDSK\ DQG WKH ƓUVW WR Ty Kernea | Herald-Citizen
Race committee members, from left, Tony McBroom, Karen Brown and Christy Norton were all smiles at the Komen Upper Cumberland Race for the Cure, held in September.
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Ty Kernea | Herald-Citizen
Ashley Wright and Marie Ferran, Komen Upper Cumberland Affiliate president, pause for a photo during the 2015 Race for the Cure.
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10 — HERALD-CITIZEN, Cookeville, Tenn. — www.herald-citizen.com — Sunday, October 18, 2015
BREAST CANCER AWARENESS
Race for the Cure 2015 Photos
Ty Kernea | Herald-Citizen
Escorts for the start of the Race for the Cure, from left, are Daniel Sukowski, Erik Seering and Jackson Hamblen.
Ty Kernea | Herald-Citizen
Becky Magura counts down the start of the race.
Ty Kernea | Herald-Citizen
Ty Kernea | Herald-Citizen
Shawna Green, Charity Norrod, Debbie Stinson (survivor) and Lindsay Live music entertained runners on the race path during September’s Race Cameron Gross enjoy the camaraderie during September’s Race for the Cure. for the Cure.
HERALD-CITIZEN, Cookeville, Tenn. — www.herald-citizen.com — Sunday, October 18, 2015 — 11
BREAST CANCER AWARENESS
Cancer therapy and coping with hair loss A breast cancer diagnosis can catch a person off-guard and drum up all types of feelings. Many people diagnosed with cancer become anxious about treatment and any potential side effects it may produce. Hair loss is one side effect widely associated with cancer treatment, though not all cancer patients will lose their hair. For example, Breastcancer.org notes that patients undergoing radiation therapy for breast cancer will not lose the hair on their heads because radiation is a localized treatment. Hair loss in the area of treatment, such as under the arms or on the breast itself, may occur. But hair loss on other areas of the body is more likely to occur as a result of chemotherapy treatment, as chemotherapy affects the entire body. Chemotherapy targets rapidly dividing cells. Hair follicles are some of the fastest-growing cells in the body and chemotherapy targets fast-growing cancer cells. Various studies show that many women fear losing their hair more than losing a breast, as breast loss can be concealed more easily than hair loss. However, there are ways to cope with hair loss, particularly through the use of wigs and head coverings. • Ask your doctor to write a prescription for a wig, which may be covered by your
health insurance. If you are covered, that can help to offset the cost of the wig. • Start shopping for a wig early on — even before hair loss occurs. As you get further along into treatment, you may feel fatigued and not up to shopping for wigs. • Choose a color that is similar to your natural hair color. This will help the wig look more natural. • If possible, purchase more than one wig so you have a backup or another style choice. • Visit a wig store at least once for a proper fitting so you will know what to look for. Wigs come in different cap sizes. Once you know your size, you can consider shopping for wigs online. • Human hair wigs are more expensive, but they can be more durable than synthetic wigs and offer more styling choices. However, synthetic wigs can usually be worn out of the box and require less daily styling. • Head wraps and hats are an alternative when you need a break from wearing a wig. Choose a variety of options so you can coordinate with your clothing. Having a quality wig and comfortable head wraps at the ready can make dealLosing hair due to cancer treatment is sel- ing with hair loss easier. dom easy. Being prepared for the transition by having a quality wig and comfortable head wraps at the ready can make dealing with hair loss easier.
Does breast size affect cancer risk? Breast size alone is not a major risk factor for breast cancer. Various factors may increase a woman’s risk of developing breast cancer. But the size of a woman’s breasts may not help doctors determine the gravity of that risk. Researchers have uncovered connections between some genes that determine a woman’s breast size and those involved with breast cancer, but those discoveries are not enough to determine a definitive link. Scientists at commercial DNA testing service 23andMe in California have found a correlation between the genes that determine whether a woman will wear a B cup or a D cup bra and the genes associated with breast cancer risk. Data from more than 16,000 female customers who had their genetic makeup examined was analyzed, particularly single nucleotide polymorphisms, or SNPs. SNPs are variations in DNA that may or may not have impact on predisposition to certain traits or illnesses. The researchers identified seven SNPs as “significantly associated” with breast size, three of which had previously been linked to breast cancer risk. Doctors say that it is unlikely breast size alone will dictate propensity for breast cancer. Others have argued the DNA study was preliminary and possibly flawed because it
failed to account for complete information, such as breast density, participants’ weight or alcohol consumption — all factors that can contribute to breast cancer risk. Excess body weight, which can contribute to larger breast size, may be a more likely culprit in the correlation between cup size and cancer. The American Cancer Society says that as many as 20 percent of all cancerrelated deaths were impacted by excess body weight. Being overweight or obese is clearly linked with an increased risk of breast cancer, especially in women past menopause, but not necessarily in women of childbearing age. The reasons for this are unclear. There is not a large enough body of evidence to link large breast size to an increased risk of breast cancer. It’s true that larger breasts have more breast cells susceptible to mutation, but many surmise that genetics and lifestyle factors are more likely than breast size to elevate a woman’s breast cancer risk. Women concerned with breast cancer risk should complete a family history and speak with their doctors to address their concerns. Frequent self-examinations as well as routine physicals can make women more familiar with their breasts and more likely to recognize if anything is amiss.
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BREAST CANCER AWARENESS
Breast self-exam guidelines In addition to scheduling clinical screenings and mammograms, women should routinely examine and massage their breasts to detect any abnormalities. These breast self-exams can be an important part of early breast cancer detection. Although many women are aware that they should become familiar with their bodies, many are unsure about just how frequently they should conduct breast examinations. Experts at Johns Hopkins Medical center advise adult women of all ages to perform self-examinations at least once a month. That’s because 40 percent of diagnosed breast cancers are first detected by women who feel a lump. Establishing a regular breast self-exam schedule is very important. Begin by looking at the breasts in a mirror. Note the size and appear-
ance of the breasts, and pay attention to any changes that are normal parts of hormonal changes associated with menstruation. Breasts should be evenly shaped without distortion or swelling. Changes that should cause concern include dimpling, puckering or bulging of the skin. Inverted nipples or nipples that have changed position, as well as any rash or redness, should be noted. In addition, the same examination should be done with arms raised over the head. The breasts should be felt while both lying down and standing up. Use the right hand to manipulate the left breast and vice versa. Use a firm touch with the first few fingers of the hand. Cover the entire breast in circular motions. The pattern taken doesn’t matter so long as it covers the entire breast. All tissue, from the
front to the back of the breast, should be felt. The same pattern and procedure should be conducted while standing up. Many women find this easiest to do while in the shower. It is important not to panic if something is detected. Not every lump is breast cancer. And bumps may actually be normal parts of the breast, as certain areas can feel different than others. But bring any concerns to the attention of your doctor. Breast self-exams are a healthy habit to adopt. When used in conjunction with regular medical care and mammography, self-exams can be yet another tool in helping to detect breast abnormalities. Doctors and nurses will use similar breast examination techniques during routine examinations.
Breast reconstruction after mastectomy Apart from certain skin cancers, breast cancer is the most common form of cancer among women, particularly American women. It does not segregate based on race and ethnicity or even gender, as men can be diagnosed with breast cancer as well. Depending on the location of the cancer, its pervasiveness and the patient’s family history, various breast cancer treatments are available. A combination of radiation and chemotherapy may be necessary, but surgery may ultimately be the best option. Cancer removal surgery involves the surgical removal of breast tissue. Sometimes the nipple and the skin can be spared, but other times the entire breast and even the lymph nodes under the arm must be removed. Many women who undergo mastectomy procedures choose to have some sort of postsurgery breast reconstruction. Breast reconstruction employs plastic surgery to restore a breast to near-normal shape and appearance following a mastectomy. A few different procedures may be needed to reconstruct the breast, and surgery on the other breast may be done to improve symmetry.
According to Cancer Treatment Centers of America, many women are eligible to begin reconstruction at the time of mastectomy, which can reduce the number of surgical procedures women must endure and can eliminate time spent without a breast. Types of reconstructive surgery Reconstructive surgery generally falls into two different groups: Implant-based and autologous flap reconstructions. With implant-based reconstruction, a permanent implant is inserted to reform the breast. Some women may need to use a tissue expander for several weeks prior to the insertion of an implant. The tissue expander is gradually filled with fluid and helps stretch the skin to create a space for the implant. Others may not need the tissue expander and can have the implant inserted immediately. This is called a single-stage reconstruction. The majority of breast implants used today are filled with sterile saline, but silicone gel implants also are available. Autologous flap reconstructions use tissue from the stomach, back, thighs,
or buttocks to rebuild the breast. Fat, muscle and skin may be taken from the donation area of the body and used to rebuild the breast. A combination of body tissue and implant is sometimes necessary to perform the reconstruction. Nipple and areola reconstruction After the breast has been reconstructed, patients may want to have a nipple and areola added for a more natural look, particularly if these parts of the breast were removed in the original mastectomy. Skin grafting, in which skin is taken from elsewhere on the body to best match the color and texture of the breast, is often used to reconstruct the nipple and areola. Sometimes a nipple sharing reconstructive technique is used if the healthy breast has a large nipple and areolar complex. Tattoos to create the appearance of an areola and nipple may be designed to forgo the need for skin grafting. What to expect In the early stages of treatment, patients will meet with plastic surgeons to develop the best plan of action. To-
gether they will discuss goals for reconstruction and how many procedures may be necessary. The potential risks and a prognosis will be discussed. Women should realize that, while breast reconstruction has advanced and can successfully rebuild the breast, there are some side effects. Visible incision lines will likely be present on the breast and any area of the body that provided donor tissue. The reconstructed breast may not be exactly symmetrical to the other breast, provided no work was done on the healthy breast. The reconstructed breast will not have the same feel and sensation as it once did, and healing may take several weeks, during which the breast shape and position will improve. A breast cancer diagnosis and subsequent surgery for treatment can be life-altering. Thanks to advancements in plastic surgery, many women can opt for reconstruction and restore their figures to resemble what they were prior to being diagnosed. More information about breast reconstruction is available at http://breastreconstruction.org and www.cancer.org.
HERALD-CITIZEN, Cookeville, Tenn. — www.herald-citizen.com — Sunday, October 18, 2015 — 13
BREAST CANCER AWARENESS
Life after breast cancer — What to expect
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 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 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 follow-up appointments and discuss any symptoms or feel-
It can take months or years for to experience your “new normal” after breast cancer.
ings 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 cancerfree. 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
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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.
October is Breast Cancer Awareness Month Preventing Breast Cancer Is Not In Your Hands. Early Detection is.
14 —HERALD-CITIZEN, Cookeville, Tenn. — www.herald-citizen.com — Sunday, October 18, 2015
Breast cancer is the most common form of cancer in American women, and the American Cancer Society estimates that more than 200,000 women will be diagnosed with the disease this year. Early detection is the best line of defense when it comes to battling breast cancer. That’s why breast self-exams should become part of every woman’s monthly routine once she reaches age 20. Women are also urged to have a clinical breast exam by a physician every three years. Women over age 40 should schedule a clinical breast exam as well as a mammogram annually. By performing monthly self-exams, women become more familiar with how their breasts look and feel, making it easier to detect any changes. Any of the following changes should be immediately brought to a doctor’s attention:
• Development of a lump which is often painless. • A nipple that has changed position or become inverted. • Nipple discharge other than breast milk. • Dimpling, puckering or bulging of the skin. • Redness, soreness, rash or swelling. This message brought to you by your friends at the
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BREAST CANCER AWARENESS
Ty Kernea | Herald-Citizen
A crowd of participants gather before this year’s Race for the Cure.
Hormone replacement therapy can elevate breast cancer risk Upon reaching a certain age, women go through the natural process of menopause. This change typically occurs when a woman reaches her late 40s or early 50s. The transition to menopause happens over several years and results in fluctuations of hormone levels in a woman’s body. During this transition, many women experience a variety of symptoms, from mood changes to hot flashes to vaginal dryness. These symptoms can be so severe they impact daily activities and can impede quality of life. Hormone replacement therapy, or HRT, may be prescribed to alleviate the side effects of perimenopause and menopause. However, HRT is not without risks, including an increased chance of developing breast cancer. According to The Mayo Clinic, HRT, which includes medications containing female hormones to replace the ones the body no longer makes naturally after menopause, used to be a standard treatment for women with severe symptoms. In the largest clinical trial to date, a combination estrogen-progestin pill was found to increase the risk of certain serious condi-
tions, including blood clots, heart disease, stroke, and breast cancer. This type of therapy also may make a woman’s breasts appear more dense on mammograms, making breast cancer more difficult to detect. When undergone for more than a few years, HRT has been confirmed by multiple studies to increase the risk for breast cancer. Women concerned about HRT and cancer risk, especially those with a significant family history of breast cancer, generally want to avoid the use of hormone therapies. But what is a person who is experiencing many side effects of menopause that can be so easily remedied by hormone therapy to do? Research into HRT alternatives has discovered a host of natural treatments that can provide relief. Soy Soy offers some promising results, especially with regard to relieving hot flashes. Soy is very high in phytoestrogens, or plant estrogens. Red clover and flaxseed are other sources of plant estrogens. Phytoestrogens are less potent than pharmaceutical estrogen, and scientists believe
they do not contribute to breast cancer in the way natural or pharmaceutical estrogen may. Black cohosh Black cohosh is a member of the buttercup family and is a perennial plant native to North America. Preparations of black cohosh are made from the roots and underground stems. Black cohosh has long been used by natives of North America to treat malaise, gynecological disorders, rheumatism and other conditions. Black cohosh is now sold as an herbal remedy to alleviate hot flashes and excessive sweating in menopausal women. The National Institutes of Health awarded more than $7 million to the University of Illinois to study the efficacy of black cohosh and other herbs in treating certain symptoms of menopause. Dong quai This herb is in the celery family and native to Asia. In Chinese medicine, dong quai has been considered a “female ginseng” because of its way of balancing the female hormonal system. As such, dong quai has long been used to relieve the
symptoms of premenstrual syndrome and menopause. According to the University of Maryland Medical Center, researchers are unsure if dong quai acts like estrogen or blocks estrogen in the body, as studies have produced mixed results. Lifestyle changes Women may need to dress more lightly, use a water atomizer to spray their bodies to cool down and keep their bedrooms cold to alleviate hot flashes. Vaginal estrogen If vaginal dryness and pain during intercourse are the primary symptoms, vaginal estrogen rings or suppositories may be necessary. These provide estrogen directly to the affected area while only allowing very low levels to enter the bloodstream. In turn, vaginal estrogen may not increase breast cancer risk in the same way as other hormone therapies. Hormone replacement therapy can alleviate menopausal symptoms, but also it can elevate breast cancer risk. Other options are available, and women can speak with their doctors about alternatives to HRT.
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