In association with
SUMMER 2016
FREE A magazine for women's health
SEVEN SPOONS Recipes that reach and reflect
CONTENTS 2 7 8 11 14 17 20 23
Summer 2016
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Seven Spoons Share your story in PiNK! RFTC News Lymphedema and Exercise Cancer Survivorship: Fatigue Precision Medicine Dense Breast Breast Cancer Updates
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From the Foundation (Follows English section) 1. Resources 2. PiNK Readership Offer 3. What I Can Do ... 4. RFTC Products 5. Monthly Self-Examination 6. What Do You Really Know About Breast Cancer? 7. Lemon Project Progress Report 8. Dear Survivor
Run for the Cure ® Foundation is a registered NPO with the Tokyo Metropolitan Government since 2004. Our mission is to eradicate breast cancer in Japan as a life-threatening disease through education, timely screening, and treatment. Through our activities, the Foundation funds education initiatives, clinical examinations and mammography machines; donates funds to organizations that promote activities specific to the mission of the Foundation; and develops and executes community outreach programs. We have donated six mammography machines to six clinics in areas where women are underserved, more than 14,000 women have benefited from mammograms, with over 3,600 funded screenings. The Foundation holds three annual events open to the general public to raise funds in support of our cause. PiNK is Japan's one and only magazine dedicated to breast cancer. Some 18,000 copies of this quarterly magazine are distributed free-of-charge nationwide through medical institutions, cooking studios, sports shops, libraries and sponsoring companies. Please contact inquiries@runforthecure.org for subscriptions. ®
For more information about how to donate, become a sponsor, and/or volunteer for Run for the Cure Foundation, please visit www.runforthecure.org
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SEVEN SPOONS An inventive cookbook by Tara OâBrady offers recipes that reach and reflect.
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t is easy to get stuck in a dinner rut. At our house the weekly rotation can become a repetitive cycle of nightly riffs on burritos, pasta, and salad, which, while basically acceptable and nutritious, gets old. Really old. So when I saw the gorgeous photos and imaginative recipes that fill Tara OâBradyâs cookbook, Seven Spoons: My Favorite Recipes for Any and Every Day (Ten Speed Press, 2015; $27.50), it seemed just the thing to stretch my culinary ambitions and help me deliver something a bit more tasty to the table. OâBrady originally began sharing recipes via her blog, Seven Spoons, which she started in 2005 about a year into culinary exploration in the first apartment she shared with her now husband, Sean. In the 10 years since, the couple has moved twice and had two sons, but cooking has stayed at the center of life. In fact, cookingâand the next mealâ were often the focus of family life as she grew up in Canada, the daughter of parents who loved to cook and entertain and influenced by her Indian heritage, her Italian neighbors, and a host of other delicious factors. When she met Sean, his English and Irish roots were added to the mix. The recipes in Seven Spoons reflect all of these influences: the pages are filled with everything from whole-wheat peanut butter cookies to fresh green chutney to a description of a traditional English ploughmanâs lunch. Throughout the reader is offered stories of the role of various dishes in OâBradyâs personal history and also a clear, thorough explanation of ingredients and techniques. The photos, which are OâBradyâs own, are beautiful and inspiring. It can be intimidating for home cooks to venture into new culinary waters; OâBrady offers up recipes rich with wide-ranging, inventive flavors and ingredients in a soulful, accessible way that places these dishes firmly in the realm of the family kitchen. â Diana Price
Five-Spice Steak Serves 4 to 6 This might smoke up the kitchen, but it is worth it. The fivespice powder is fused to the steak with the blistering heat of the pan, making for a raspy, sizzling crust. It is finished with a quick, flavorsome sauce of herbs, chiles, and rice vinegar, rounded out by toasted sesame oil. The anointing works like a late-addition marinade, not only dressing the meat but also seeming to keep it incredibly soft and tender. 1 bone-in rib steak, 2 inches (5 centimeter [cm]) thick, weighing approximately 1œ pounds (680 grams [g]) 1œ teaspoons Chinese five-spice powder 1 teaspoon medium-grain kosher salt œ teaspoon freshly cracked black pepper 2 teaspoons toasted sesame oil 1 clove garlic, minced 1-inch (2.5 cm) piece of fresh ginger, peeled and minced 1 small red chile, stemmed, seeded, and minced 1 tablespoon unseasoned rice vinegar 2 teaspoons tamari 1 teaspoon natural cane or light brown sugar 3 green onions, white and light green parts only, minced 2 large handfuls of cilantro, leaves and tender stems, chopped
Season the steak all over with the five-spice powder, salt, and pepper. Dab on the sesame oil with a brush. Place a large cast-iron pan over medium-high heat. Once the pan is good and hot, lay in the steak. Let it cook, undisturbed, for 2 to 3 minutes, then check for even color and move it around if necessary. Keep shuffling until well browned, 2 to 3 minutes more. Flip the steak and continue to cook until the second side is equally charred and cooked to your liking. (An instant-read thermometer inserted in the thickest part, without touching bone, should read 120°F [50°C] for medium-rare and will take approximately 3 to 5 minutes after flipping to the second side.) Set the steak aside and reduce the heat to medium-low. Add the garlic, ginger, and chile to the skillet and cook, stirring, for 1 minute. Stir together the rice vinegar, tamari, and sugar, then pour it into the pan, scraping up any browned bits and allowing the liquids to reduce, about 1 minute. Scrape the sauce into a small bowl with half the green onions and half the cilantro. Present the steak whole at the table, or slice across the grain and arrange on a platter. With either presentation, pour some of the sauce over the meat and shower with the reserved green onion and cilantro. Offer the rest of the sauce alongside.
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Roasted Carrots with Harissa Aïoli and Dukkah Serves 4 The harissa-twirled aïoli that accompanies the carrots has heat and complexity, but with a blend of milder oils it is not a bodacious personality on the plate. In fact, it plays quite nicely with the mellow sweetness of honey-roasted carrots, especially when those carrots are finished with the mix of nuts and earthy spices that make up the Egyptian spice blend called dukkah. Mayonnaise, which aïoli basically is, can be prepared in a blender or food processor; however, with those methods the resulting texture is denser than when done by hand. This recipe uses a whisk, but if youâd like the challenge, feel free to use a mortar and pestle. Aïoli is best the day it is made, and I like to keep it out of the refrigerator, so it is advisable to make the mayonnaise while the carrots roast and not much earlier. A good-quality store-bought mayonnaise can always be used as the base for the aïoli, especially if there is a concern over using raw egg yolks. Simply stir the garlic, lemon juice, and harissa into Ÿ cup (180 g) of the prepared stuff. Dukkah 3 tablespoons whole hazelnuts, skin on 1 tablespoon sesame seeds, white or black, or a mix 2 teaspoons coriander seeds 1 teaspoon cumin seeds Fine-grain sea salt and freshly cracked black pepper 12 skinny carrots, trimmed of their tops and scrubbed clean Extravirgin olive oil 2 teaspoons honey Ÿ cup (180 g) Harissa Aïoli (recipe follows)
It can be intimidating for home cooks to venture into new culinary waters; OâBrady offers up recipes rich with wide-ranging, inventive flavors and ingredients 4
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To make the dukkah, preheat an oven to 400°F (200°C) with a rack in the upper third of the oven. In a small skillet over medium heat, toast the hazelnuts until lightly golden and aromatic, shaking the pan often, about 2 minutes. Transfer the nuts to a small bowl and set aside. Repeat the process with the sesame seeds, coriander seeds, and cumin seeds, toasting each separately, then adding to the bowl with the hazelnuts. Let cool completely. In a mortar with pestle or in a small food processor, process the spices and nuts into an unevenly textured mix. Season generously with salt and pepper. On a sheet pan, toss the carrots with a light coating of the olive oil and honey, then season with salt and pepper. Roast the carrots, turning once, until browned and tender, 15 to 20 minutes. Arrange the carrots on a serving platter and sprinkle with as much dukkah as youâd like. Pass the aïoli at the table. Note: The dukkah can be made ahead and stored in an airtight container at room temperature for 3 days. Harissa Aïoli Makes about Ÿ cup (180 g) 2 cloves garlic, peeled, halved, and any green germ removed Fine-grain sea salt 1 fresh egg yolk ÂŒ cup (60 milliliters [ml]) mild extravirgin olive oil or neutral-tasting oil ÂŒ cup (60 ml) peppery extravirgin olive oil Juice of one-half lemon Freshly cracked black pepper 2 teaspoons harissa (recipe above)
Twist a damp kitchen towel into a rope and shape it into a ring on a work surface. Place a stainless-steel bowl into the center so that the towel can anchor the bowl as you whisk. In the bowl, sprinkle the garlic with a pinch of salt, then crush the two into a paste with a pestle or fork. Remove half the garlic and set aside. Stir the egg yolk into the remaining garlic, then add a few drops of the mild olive oil, whisking constantly. Continue to whisk, slowly dripping in oil, until the mayonnaise begins to thicken. At this stage you can start to incorporate the oil in a thin, steady stream, still whisking all the while. You may need to stop adding the oil every so often, then whisk vigorously to thicken the emulsion, then resume with the oil. Once the mild olive oil is fully blended in, whisk in the more rugged one. Stir in the lemon juice and thin the mayonnaise with water, if necessary, to achieve the desired consistency. Check for seasoning, adding salt and pepper and the reserved garlic as needed. Then fold in the harissa paste. Cover and leave at cool room temperature for 30 minutes before using, or refrigerate for up to 2 days.
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Chia Pudding with Fruit and Golden Honey Elixir
Chia Pudding Œ cup (60 ml) Greek-style plain or vanilla yogurt 2 to 3 tablespoons chia seeds, depending on desired firmness Ÿ cup (180 ml) unsweetened milk (dairy or nondairy both work) 1 tablespoon agave nectar or honey Generous œ teaspoon vanilla extract or vanilla bean paste Fine-grain sea salt
Serves 2 Serving Options This pudding takes advantage of how chia seeds can gel a liquid because of their soluble fiber; it is a bit creamy, with an understated vanilla note. I put up a batch in the evening, and it is ready for me come breakfast. I serve it with fruit, seeds and nuts, and sometimes toasted oats, but truly the star of this recipe is the turmeric-infused honey I pour over the topâ somewhat cheekily christened Golden Honey Elixir. Turmeric root, unmistakably ochre and persuasively astringent, is often used in Ayurvedic medicine for its antibacterial, anti-inflammatory, antioxidant, and antiseptic properties. It is believed to help with brain function, digestion, and heart disease. For the elixir it is combined with honey, apple cider vinegar, and gingerâall healing and preventive powerhouses on their own. The idea behind this potent slurry comes from two sources: the turmeric paste prescribed for myriad ailments in alternative medicines, and Golden Milk, a traditional restorative sip made with milk, ginger, and turmeric. Even if you donât go to the trouble of making the chia pudding, do try the elixir, which works perfectly well as a topping for yogurt, as a drink (stirred into hot, not boiling, water, or gently heated and stirred into milk), as the base for salad dressings (especially ones with root vegetables), in smoothies, and even on vanilla ice cream.
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1 cup (240 ml) Greek-style plain or vanilla yogurt 2 to 4 tablespoons Golden Honey Elixir (recipe follows) Pinch of fine-grain sea salt Fresh fruit, such as sliced peaches, sliced strawberries, or red currants ⢠Chopped nuts, such as pistachios or almonds To make the pudding, in a bowl whisk together the yogurt and chia seeds until smooth. Slowly add the milk, followed by the sweetener, vanilla, and a pinch of salt, stirring all the while. Cover and refrigerate overnight. Stir again before serving. When ready to serve, stir the pudding, then fold in the 1 cup (240 ml) yogurt once or twice. Drizzle the Golden Honey Elixir and salt on top, then fold once more. Divide between plates, along with your toppings of choice. Eat straight away. Note: Chia pudding made with whole seeds has a texture similar to that of tapioca puddingâthat is to say, gelatinous spheres suspended in weighty liquid. Use ground chia for a smoother consistency, if desired. If you happen to have frozen raspberries, they are a pretty spectacular addition. Bash them in a sealed storage bag with the bottom of a sturdy glass so that theyâre in bits but not pulverized. The icy nubs burst like pomegranate seeds when eaten and streak the yogurt with fuchsia ripples. Golden Honey Elixir Makes about 1 cup (240 ml) Ÿ cup (180 ml) honey, preferably raw 3 tablespoons grated fresh ginger 2 tablespoons apple cider vinegar, preferably raw and unfiltered Zest of 1 lemon 1 tablespoon plus 1 teaspoon ground turmeric About â teaspoon freshly cracked black pepper
Stir all the ingredients together in a jar until smooth. Let stand for at least 30 minutes before using, or cover and refrigerate. Use within 1 week. Reprinted with permission from Seven Spoons: My Favorite Recipes for Any and Every Day by Tara OâBrady, copyright © 2015. Published by Ten Speed Press, a division of Penguin Random House, Inc. Photography © 2015 by Tara OâBrady.
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Share your story in PiNK! Healing Power We have been publishing a âSurvivor Storyâ in the Japanese section of PiNK ever since the quarterly magazineâs launch in 2007. We continue to receive a lot of very positive feedback from both writers and readers. There is the special healing power of writing that allows survivors to open up, reflect back and share their personal journey â sorting
their thoughts and embracing their feelings. Readers have commented on how the stories are reassuring, helping them to move forward and providing timely support. Run for the Cure® Foundationâs founder and chairman, Vickie Paradise Green, shared her personal journey as a breast cancer survivor in PiNK fall 2013.
Please keep in mind some basic requirements. In Word format (or similar) and at 800 â1,100 words, please include how you found out you had breast cancer; whether you had annual mammography screenings and if so from what age; whether you regularly self-examined; at which stage you were when diagnosed; whether you had a mastectomy or lumpectomy; what sort of treatment you underwent; and the types of drugs you used if any. Be sure to include your name, age, address, phone number and email. We reserve the right to edit your story for consistency in style regarding PiNK magazine, and crop or resize the photography you submit to fit our layout. The photography should be high resolution, at 300 dpi or more, as you will be on the English cover! You must confirm there is no copyright infringement for photography submitted and/or direct quotes you include from other sources. Please be reassured that we will not use your personal information for any other purpose without your prior consent. There is no compensation for the story you submit. We look forward to hearing from you! For any queries and submissions, email pink@runforthecure.org
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RUN FOR THE CURE® NEWS @RFTCtokyo
Run for the Cure Foundation
PiNK Beauty Party Vol. 5
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n May 22nd, 40 breast cancer patients and survivors met at the PiNK Beauty Party, Vol. 5, held at Fujishin FASTA in Shibuya, for an afternoon of beauty treatments and camaraderie. Participants engaged in a medical Q&A session and chose between receiving nail care from manicurists, or learning cosmetics techniques from a makeup artist. Other events included experiencing aromatherapy or acquainting themselves with wig-and scalp-care. The threeâandâaâhalf hour event, which also included afternoon tea, was created by Run for the Cure® Foundation to increase the quality of life for breast cancer âfightersâ by arming them with the tools to improve both their physiological and psychological well-being. The event opened with remarks from sponsors and by Ms. Kiei Ogata, the Foundationâs awareness program manager. Participants then listened attentively to a discussion about breast reconstruction by a panel featuring Ms. Ayako Mizoguchi, a breast cancer survivor, and Dr. Toshiharu Minabe, a professor and head of the Department
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of Plastic Surgery of Saitama Medical Center, Saitama Medical University. Prof. Minabe explained about the different options that cancer patients and survivors have when considering this reconstructive surgery and described what patients can expect in the preand post-operative stages. Throughout the session, Ms. Mizoguchi would raise questions from the perspective of a potential patient. Feeling inspired at the conclusion of the presentation, the participants felt such booming exhilaration as they made their way to their first sessions.
In the makeup corner, over the course of 50 minutes, participants learned several techniques on how to use makeup as the means to create their desired appearance. Women were shown how to make their skin appear brighter, for example, how to cover up the side effects created by anti-cancer agents, and how to look better rested. Guided by a professional, the women became makeup artists in their own right by using their own palette, which was donated by the cosmetics company Say. With contentment and amazement filling the room, it was difficult to tell
whether the participants were flushed from the blush or from the excitement they felt over their newfound skills. Health and appearance were emphasized in the nail session, where participants were paired with nail technicians from Future Nail Co. Each technician shared information and addressed individual concerns for improving both the function and appearance of nails. Concerns such as nail discoloration and deformation from chemotherapy were addressed as well. Every woman was then given a manicure that aimed to show off
eachâs personality: nails were painted different shades of reds and pinks, with playful designs ranging from stripes to polka dots. Mannequins adorned with wigs of different haircuts, textures and colors filled the room hosted by Svenson, a medical wig company. Participants were able to try on new hairstyles while learning about the proper ways to wear, cut, and style the wigs. Smiles and surprised looks covered their faces as participants witnessed their appearance transform before their very eyes. After familiarizing themselves with wig management, the women were taught about scalp care for the different stages of their cancer prognosis. They learned about the best types of shampoos to use to soothe their skin as their hair grows back, how to prevent balding, and methods to stimulate hair growth. Building on its popularity and success at last yearâs party, Natural
Beauty TULA returned with Ms. Hattori leading the aromatherapy seminar, and was joined by Ms. Iida from Ruban Rose. Under their careful guidance, participants gained greater awareness of the benefits to aromatherapy. Ms. Iida began with a lecture about how such a complementary therapy does not interfere with the effects on the hormones during cancer treatment and the recovery process. Fresh floral and fruity scents drifted in the air as participants tried out scented oils with assistance from Ms. Hattori. These bottles could be taken home by the participants to use at their own leisure. Following his panel session, Prof. Minabe provided his expertise throughout the afternoon by leading intimate Q&A sessions consisting of 10 people. These small groups gave participants the opportunity to directly ask the doctor about their own possible breast reconstructive surgery. Women left the panel with their anxieties appeased and feeling better informed to make a decision. After an afternoon of pampering and learning, the women enjoyed the brisk aroma of coffee and tea wafting through the room as beverages and biscuits were served. Delighted voices and delightful laughter could be heard as participants excitedly exchanged stories about their day, sharing memories from their sessions and marveling at everybodyâs lovely refreshed appearance. A volunteer professional photographer was on hand to capture the dayâs events. Filled with warmth, participants left the party with a souvenir bag full of items donated by our generous sponsorsâand the message that while they are physically beautiful, their inner strength is what truly makes them shine.
Co-organizers: Fujishin, Future Nail, Natural Beauty TULA, Ruban Rose, Say, and Svenson Special thanks: Prof. Toshiharu Minabe and Ms. Ayako Mizoguchi Sponsors: Herbalife of Japan K.K., le cadeau du soleil, and OPI Japan
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Run for the Cure® News
Casino Night 2016 Fundraiser Date: September 2 (Fri.) Doors open at 6:30PM Venue: The Ritz-Carlton, Tokyo Participations fees: 17,500yen/person (including dinner and drinks) runforthecure.org/en/casino-night/
CUISINE for the Cureâ¢
Date: October 13th (Thur.) 6:30 â 9:00p.m. Place: Australian Embassy Tokyo Participation fees: 15,000yen/person (including dinner and drinks) Only 72 available â book now at runforthecure.org/en/cuisine-for-the-cure/
Tokyo Run for the Cure®/ Walk for Life 2016 Date: Place: Types:
November 26, 2016 (Sat) Hibiya Park / around the Imperial Palace 5K/10K Run and 5K Walk
Participation fees: 5,000yen (adults), 2,500yen (children 6-12 year-old), Free for children 5 and below
Run for the Cure® Partners (Alphabetical order)
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An evening of exceptional dining prepared by Salt Tokyo featuring the cuisine of world-famous Luke Mangan, at the Australian Embassy
BY CAROL MICHAELS
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xercise and fitness training provide valuable benefits for patients during and after cancer treatment. Many survivors can experience persistent fatigue, deficits in strength and range of motion, decreased ability to manage work and home tasks, and lymphedema. Studies are increasingly indicating that exercise can help combat many of these side effects of treatment. During chemotherapy, exercise may increase fitness and energy levels, improve mood, and help patients better tolerate cancer treatments. After treatment is concluded, exercise can increase strength and aerobic capacity, improve joint flexibility, elevate mood, and help patients resume regular activities and work demands. In addition, exercise has been shown to decrease the risk of onset or recurrence of many types of cancer.
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It is also helpful to incorporate Pilates into your exercise routine because of the deep breathing used with each movement. It is essential that cancer survivors communicate with their healthcare team and engage in exercise that is appropriate for their unique needs and stage of treatment or recovery. In Exercises for Cancer Survivors (FriesenPress, 2014), coauthor Maria Drozda and I provide valuable information about the role of exercise during and after cancer treatment to help patients and caregivers understand how to exercise safely and effectively. One of the goals of Exercises for Cancer Survivors is to encourage fitness without incurring pain or injury that could trigger or exacerbate lymphedema, a possible side effect of cancer treatment. Recent studies have demonstrated that regular exercise, including strength training, may decrease the risk of lymphedema or diminish symptoms of the condition if it is already present. We hope that by providing information about how to perform exercises safely and use good technique to im-
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prove flexibility, strength, and function, we can help survivors who are experiencing lymphedema enjoy the many physical and psychological benefits of exercise. The following excerpt offers valuable insight into safe and effective strategies for managing lymphedema and exercise.
Lymphedema [excerpt from Exercises for Cancer Survivors] Lymphedema is a swelling produced by an accumulation of lymph fluid in tissue. Too much lymph fluid can accumulate in an area of the body that has been damaged because of the removal of lymph nodes or radiation to the area. Fibrosis of the axilla due to surgery or radiation can also cause lymphatic obstruction. Symptoms include a feeling of tightness, leathery skin texture, and heaviness. Lymphedema can be
debilitating and painful and can affect emotional health. The circulatory system is made up of arteries, veins, and the lymphatic system. The lymphatic system relies on the movement of muscles to circulate the lymph fluid throughout the body. You can think of the lymphatic system as a road system. When one or more roads are blocked due to lymph node removal, the system does not flow smoothly. The âtraffic congestionâ can cause swelling known as lymphedema. Even if you have only had a few lymph nodes removed, you should still understand the lymphedema precautions. Lymphedema can occur right after surgery or years later.
Decreasing the Risk of Lymphedema One of the most important things you can do to decrease your risk of lymph-
edema is to maintain a healthy weight. It is also important to learn proper nutrition and the appropriate exercise routines for your specific needs. The following are additional steps one should take to decrease the chance of developing lymphedema: ⢠Try to avoid extreme temperatures, and avoid sunburns. ⢠Avoid restricting your lymph circulation. Examples of this would be taking blood samples from or blood pressure on the affected arm, carrying a heavy bag on your arm, or wearing tight clothing and jewelry.
signs of swelling, pitting, redness, or heaviness, lymphedema can be kept under control. The specialist will also make sure that your exercise plan is compatible with the treatment and will clear you to exercise if your lymphedema is under control. Additionally, if baseline measurements have not already been taken at the hospital, it is recommended that you obtain a baseline girth measurement by a lymphedema specialist. The limbs that are at risk for lymphedema should be periodically measured to make sure they have not changed in size. Symptoms can be managed more easily if dealt with as soon as they appear. A compression garment or sleeve, which supports the muscles and helps bring the lymphatic fluid to the heart, can be worn while exercising and at other times. These garments need to be professionally fitted and monitored by a lymphedema specialist.
Exercise and Lymphedema ⢠Check regularly for infection, and call your doctor immediately if an infection occurs. Insect bites, scratches, skin punctures, and bites can cause infections. ⢠Wash the affected area frequently and apply moisturizer to avoid cracks in the skin. The National Lymphedema Networkâs website (lymphnet.org) is a terrific resource. You should also speak with your therapist for a complete list of lymphedema precautions.
Lymphedema Therapist Learn the first signs of lymphedema; it is easier to manage if treated early. Your lymphedema specialist will teach you complex decongestive therapy, consisting of skin care, manual lymph drainage, and exercise. If you meet with your lymphedema specialist at the first
Your body will work better if you are engaged in regular physical activity. Moreover, exercise is very helpful for lymphedema control, but it must be done in a safe manner if lymph nodes have been removed or radiated. If you have lymphedema, you should begin to exercise under professional guidance after receiving medical clearance. It is important to learn the right exercises for your particular situation and how to perform them properly and with good form. Exercise needs to progress slowly, using a properly fitted garment. Our goal is to promote physical activity without incurring pain or injury, which can make lymphedema worse. All the exercises should incorporate abdominal breathing and relaxation breathing. These breathing techniques are beneficial because they do the following:
⢠Stimulate lymph flow and lymphatic drainage ⢠Act as a lymphatic system pump, moving the sluggish lymph fluid ⢠Enable oxygen to get to the tissues ⢠Reduce stress, a common cancer side effect It is also helpful to incorporate Pilates into your exercise routine because of the deep breathing used with each movement. When you begin Pilates exercises, perform just a few repetitions and use no weights or use the lightest machine tension. After you are able to exercise for several sessions without flare-ups, you can use resistance bands, light weights, and modified body-weight exercises. You can develop a good fitness level without triggering lymphedema. Swimming is a very good exercise for those with lymphedema. The water creates compression. Because repetitive motions are risky, try to vary your swimming strokes. The water should not be hot, and the pool area should be clean to help you to avoid infection. When you leave the water, follow proper skin care precautions. Moisturize to prevent dry skin, which can lead to cracks in the skin and infection. Yoga poses can cause flare-ups. Do not perform the following poses: downward-facing dog, upward-facing dog, plank, and side plank. Avoid hot yoga. Exercise helps the lymphatic fluid move throughout the body. Muscles pump and push the lymph fluid and can help move the lymph away from the affected area. Strength training may help pump the lymph fluid away from the affected limb, but it does not necessarily prevent lymphedema. Slow progression of exercise will allow you to monitor fullness or aching, which can indicate stress to the lymphatic system. You should stop if you feel tired or if your limb aches or feels heavy.
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Cancer Survivorship:
Fatigue BY BARRIE C ASSILETH, PHD
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Fatigue is a common issue for many cancer patients. It is a persistent sensation of tiredness that is brought on or exacerbated by chemotherapy, radiation treatment, medications, or stress, among other factors. In a survey of cancer patients, 60 percent reported that they experienced fatigue at least once a week during their most recent chemotherapy cycle. Although most patients̢۪ energy levels rebound within a few months of finishing treatment, others continue to feel fatigued for an extended period. Moreover, cancer treatment is not the only cause; you
may find that you have less energy even before you begin treatment. Being diagnosed with cancer is a difficult and stressful experience in and of itself, as you know only too well, and fatigue can be a product of that. But donât despair. Fatigue, like many other cancer-related symptoms, can be improved. Exercise, yoga, acupuncture, and massage are among the complementary therapies that can help you to regain your energy. Make sure to discuss your symptoms with your doctor, so he or she can make sure there is no underlying cause that should
be corrected medically. For instance, fatigue may be caused by anemia, thyroid problems, or sleep disruption, among other issues, in which case those should be addressed first.
Managing Fatigue with Exercise Itâs understandable if you feel too tired to move about or work out, but you may want to reconsider. Although exercise seems tiring, it can actually help combat your fatigue. By putting a little energy in, you can get a lot more out in return. It can be as simple as a period of brisk walking each day, working out in a gym (ideally with the guidance of a trained professional), swimming, or any other activity that is safe for your condition. In a recent analysis, University of Connecticut researchers pooled the results of 44 separate randomized controlled trials covering more than 3,000 fatigued patients with various types of cancer. Those who exercised experienced higher energy levels and reported significant reductions in their cancer-related fatigue compared to control subjects who did not exercise. This was particularly true for older patients who engaged in moderateintensity resistance training (strengthbuilding exercises such as lifting weights). Older patients in fact experienced greater reductions in fatigue than younger ones. Furthermore, the more intense the exercise program, the greater the improvements in energy levels. Similarly, a 2008 review article produced by the well-regarded Cochrane Collaboration examined 28 trials and concluded that cancerrelated fatigue was improved significantly more in patients who exercised than in those who did not. This was true for patients both during and after active cancer treatment. Although most of the trials included breast cancer patients, there is no reason to believe that the finding
wouldnât apply to those with other cancer diagnoses as well. Generally, studies suggest that exercise can be safe and effectively reduce fatigue even during chemotherapy and radiation, and for many different cancer types. It appears that even lowintensity exerciseâaerobic and/or resistanceâcan be helpful. Because cancer treatment can lead to muscle wasting, exercise may help to diminish fatigue by building muscle and restoring its function. There are other theories as well, as the exact cause of cancer-related fatigue is not well understood. Remember that reduced fatigue is only one of the many physical and psychological benefits of exercise, from improved stamina, agility, and muscle tone to heightened self-confidence, self-esteem, and happiness. As discussed earlier, it also may reduce the risk of recurrence and lengthen survival time. All things considered, an exercise program is a great place to start for tackling cancer symptoms such as fatigue and for generally enhancing your health. Its importance cannot be overstressed.
Managing Fatigue with Yoga By combining physical exercise with meditation, yoga practice promotes relaxation and may help to reduce fatigue (as well as stress, anxiety, and depression). In yoga, the practitioner maintains various physical postures while focusing on the body and breathing. Most patients find it to be enjoyable, and perhaps more peaceful than ordinary exercise. It is sometimes practiced as part of a broader meditation program called mindfulness-based stress reduction. To date, very few trials of yoga or other lifestyle changes have specifically targeted cancer patients with persistent fatigue. The studies that do exist are small but encouraging. In a recent randomized controlled trial conducted at the University of
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CaliforniaâLos Angeles, researchers sought to determine the effectiveness of yoga for breast cancer patients with persistent fatigue. The study included 31 women who had completed cancer treatments at least 6 months before and who had no other medical conditions that would explain their fatigue. Half of the women completed a 12week yoga program (specially designed
Managing Fatigue with Acupuncture Although acupunctureâs benefits are most well documented for pain and nausea, many studies suggest that acupuncture may also help to alleviate cancer-related fatigue. One notable trial compared the effects of acupuncture, self-acupressure, and sham (fake) acupressure on fatigued cancer patients who had previously completed chemotherapy and found that both acupuncture and acupressure significantly improved fatigue. Acupressure is like acupuncture except that points on the body are stimulated by physical pressure rather than with needles. As such, you can perform acupressure at home on yourself, without the need for an acupuncturist. In this study, sham acupressure involved pressure at the wrong points and thus should not work, serving as a control. Patients receiving acupuncture received six 20-minute sessions over 2 weeks, and patients receiving acupressure were taught which points on their body to press/massage and then did so daily for 2 weeks. Although the study was small, with only 47 participants, the results were remarkable: patients in the acupuncture group experienced a 36 percent improvement in fatigue, compared to 19 percent for the acupressure group, and 0.6 percent for the control, sham acupressure group. Another small study, conducted by UCLA researchers, assessed the value of acupuncture in women who had completed treatment for breast cancer but suffered from ongoing fatigue. One group of patients received once-weekly acupuncture treatments for 8 weeks combined with a wellness education
The suggestion that yoga may help cancer patients to overcome persistent fatigue is quite promising, although there hasnât been enough research yet to prove these effects. for fatigued patients) and the other half a 12-week health education program. The patients who practiced yoga saw a significant decline in their fatigue and a significant increase in vigor compared to others in the health education class. Moreover, the benefits lasted for at least 3 months after the program ended. Despite their fatigue, 80 percent of the patients attended at least 20 of the 24 yoga classes offered, suggesting that they found the experience to be worthwhile, rewarding, and pleasant. The suggestion that yoga may help cancer patients to overcome persistent fatigue is quite promising, although there hasnât been enough research yet to prove these effects. There is, however, a body of evidence that shows that yoga can significantly decrease stress, anxiety, and depression. And decreasing those debilitating problems can indirectly reduce fatigue. Most importantly, yoga is very safe when practiced with the guidance of a professional trained to work with cancer patients. If other methods have not successfully reduced your fatigue or if you are interested in yoga for other reasons, it is worth a try.
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class. A second group received usual care from their physicians (no acupuncture). Patients in the acupuncture group ultimately experienced a 66 percent reduction in fatigue. Researchers are still probing the effects of acupuncture on fatigue and further study is ongoing. Given that existing evidence has been largely favorable, however, and that acupuncture is extremely safe, it may be worth considering for your fatigue symptoms. Acupuncture also has many other well-documented benefits such as easing pain. If you choose to get this type of treatment, make sure to seek out an acupuncturist who is trained to work with cancer patients, and tell the acupuncturist about all symptoms you may be experiencing, such as pain and depression as well as fatigue. The acupuncturist should be able to treat all of those problems at the same time.
Other Things That May Help Manage Fatigue Very limited studies suggest that massage or music therapy also can be beneficial for relieving fatigue, at least in some cases. Similarly, some herbs and dietary supplements, such as ginseng, vitamin B12, and folic acid, may be helpful for increasing energy, but they have not been well studied and results are mixed. Cancer patients should be particularly cautiousâitâs a good idea to discuss them with your doctor before using any herbs or supplements. Memorial Sloan-Kettering Cancer Center (MSKCC) has developed a website and a free app containing everything you need to know about herbs and other dietary supplements. Visit MSKCC.org/AboutHerbs for more information or to download the free app. Healthcare providers can also obtain additional information under the âProfessionalsâ tab.
Excerpted with permission from Survivorship: Living Well during and After Cancer by Barrie Cassileth, PhD. Copyright Spry Publishing 2014.
Precision Medicine Patients see benefits as cancer care continues to evolve BY SUSAN KREIMER
D
onna Lawson, 67, a retired payroll administrator in Glen Rose, Texas, was diagnosed with triple-negative breast cancerâa particularly aggressive malignancyâin 2006. She underwent multiple surgeries, but the disease persisted. In 2011 precision medicine offered a ray of hope. Donnaâs oncologist sent a tissue sample for gene sequencing at the
Translational Genomics Research Institute (TGen) in Phoenix, Arizona. The results revealed mutations in her genome that could respond to a new oral medication being evaluated in a clinical trial. The drug, BEZ-235, which Donna received at Baylor Research Institute (BRI) in Dallas, is an inhibitor targeting the PI3K pathway, which has a major impact on the growth of malignant
cells and is often abnormally hyperactive in tumors. In the study BEZ235 was administered in combination with chemotherapy. In Donnaâs case it turned the cancer from chemotherapy resistant to chemotherapy sensitive. âIâve had a year and a half of clear scans. In October it will be two years,â says Donna. âEven if the next scan doesnât come up good, Iâve still had all this time for which Iâm very, very thankful.â
âIâve had a year and a half of clear scans. In October it will be two years,â says Donna. âEven if the next scan doesnât come up good, Iâve still had all this time for which Iâm very, very thankful.â P iNK ⢠S U MMER 2016
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Unprecedented Progress For patients who once had dim prospects of long-term survival, precision medicine is taking the oncology world by storm. Conquering cancer is no easy task, but research into genomics and genetics has led to unprecedented progress. Tailored treatments have emerged to match a personâs genetic makeup or a tumorâs genetic profile. As a result, patients with cancers of the breast, lung, or colon or with melanoma or leukemia now typically receive molecular testing that guides their physicians in determining which therapies are more likely to boost the chances of survival while limiting the potential for adverse effects. Collaborations between healthcare systems and biomedical research companies, such as the partnership between TGen and BRI, are helping identify specific gene defects in various disease processes that could lead to the discovery of targeted therapies for patients. In addition to cancer, research plans call for extending the positive outcomes to diabetes, infectious diseases, and afflictions of the cardiovascular, neurological, and metabolic systems.
âPrecision medicine holds great promise for treatment, diagnosis of disease, and prediction of risk of developing disease,â says Robert Mennel, MD, medical director of the Baylor Precision Medicine Institute and a professor of medicine and oncology at Texas A&M Health Science Center College of Medicine in Bryan, Texas. âHowever,â Dr. Mennel adds, âwhile thereâs a definite clinical application thatâs occurring every day, much is yet to be discovered, and research is ongoing in many areas.â Still in its infancy, precision medicine needs to make many more strides before it can benefit the majority of cancer patients. Nonetheless, âit cannot be overstated how big of an advance it is,â says David Jablons, MD, chief of general thoracic surgery and program leader of thoracic oncology at the University of California, San Francisco. Customizing cancer treatment based on specific molecular arrangements of an individual tumor offers a much better chance of delivering effective and long-lasting therapies that hopefully lead to a cure. âThatâs a change in our
thinking in general about cancer and cancer treatment,â Dr. Jablons says. âItâs been a long time coming.â To further stimulate progress in precision oncology, President Barack Obama has unveiled the Precision Medicine Initiative. A $215 million investment in the presidentâs 2016 budget will provide funding for the National Institutes of Health (NIH), along with the US Food and Drug Administration (FDA), and the Office of the National Coordinator for Health Information Technology (ONC). The initial announcement came during the State of the Union address in January 2015, with specific details disclosed 10 days later. Of this sum NIH will obtain $130 million to develop a national cohort of 1 million or more Americans to voluntarily participate in research. The National Cancer Institute (NCI), part of NIH, will receive $70 million to accelerate efforts in identifying genomic drivers in cancer and applying that information to better therapies. A $10 million allotment to the FDA will pay for modernized databases that protect participantsâ privacy, as well as new strategies for assessing the accu-
âit cannot be overstated how big of an advance [precision medicine] isâ
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racy and reliability of gene-sequencing technology tests. ONC will use the remaining $5 million to support the development of interoperability standards and requirements that address privacy and enable secure exchange of data across systems. âOncology is the clear choice for enhancing the near-term impact of precision medicine,â wrote Francis S. Collins, MD, PhD, current NIH director, and Harold Varmus, MD, who held directing posts at NIH and NCI, in the February 2015 issue of the New England Journal of Medicine. âCancers are common diseases; in the aggregate, they are among the leading causes of death nationally and worldwide, and their incidence is increasing as the population ages. They are also especially feared, because of their lethality, their symptoms, and the often toxic or disfiguring therapies used to treat them,â the co-authors continued. âResearch has already revealed many of the molecular lesions that drive cancers, showing that each cancer has its own genomic signature, with some tumor-specific features and some features common to multiple types.â
The Personal Impact of Precision Jeanine Pucci, now 44, a first-grade teacher from Howard Beach, New York, was scheduled to receive chemotherapy for Stage IV lung cancer in December 2013, when lab results revealed she had the ALK gene alteration, which is present in 3 to 5 percent of people with nonâsmall cell lung cancer (NSCLC). Unlike the hereditary BRCA1 and BRCA2 mutations that may be present in patients with breast cancer, this is an acquired alteration that occurs in some malignant cells as cancer develops. The discovery of her ALK gene alteration has offered Jeanine two new, productive treatments since that initial result. From December 2013 to March
2015, she took the oral medication Xalkori® (crizotinib; targeted therapy)â granted accelerated approval by the FDA in August 2011 for patients whose metastatic NSCLC expresses the ALK gene alteration. When she became resistant to Xalkori, she turned to the oral drug Zykadia® (ceritinib; targeted therapy), approved in April 2014, also
Conquering cancer is no easy task, but research into genomics and genetics has led to unprecedented progress. for ALK-positive advanced NSCLC, which shrunk the tumor in her liver to less than half its size. Although Jeanine has experienced some side effects, including diarrhea, vomiting, and elevated liver enzymes, the two drugs have afforded her precious time. When she was initially diagnosed, she remembers, âAn oncology nurse said to get my affairs in orderâthat this was going to kill me.â Now, two years later, Jeanine, a lifelong nonsmoker, is grateful for these advances in treatment: âWithout these therapies I donât think that I would be alive right now,â she admits. âI know that.â Jeanine emphasizes the need for continued research to help patients for whom precision medicine is not suitableâfor example, when a tumor lacks a specific genetic abnormality that responds to a matching drug, or who become resistant, as in her case. âI wish they would find something that would work forever,â she says. âThese
targeted therapies work for about eight to 10 months. The cancer learns to kind of trick the pill; it outsmarts the medication. Thatâs why I had the progression.â
Benefits of Precision Medicineâs Targeted Therapies For those who respond to precision medicine, the treatments can greatly extend survival and improve quality of life. Patients tend to tolerate the therapies well, avoiding the common side effects such as hair loss and lower blood counts that arise with chemotherapy, says Saiama Waqar, MD, a thoracic oncologist and an assistant professor at Washington University School of Medicine in St. Louis, Missouri. âHair loss can be pretty emotionally devastating,â Dr. Waqar says, âand decreased blood counts may lead to severe infections and even increase the risk of death.â In contrast, diarrhea and rash are the main side effects of Tarceva® (erlotinib), the most common targeted therapy for lung cancer, and can often be well-managed with medications. Tumor shrinkage from drugs targeting the EGFR and ALK gene alterations can help alleviate shortness of breath and reduce reliance on supplemental oxygen, Dr. Waqar says. Taking a pill at home is also more convenient for patients than receiving chemotherapy infusions in a hospital or outpatient facility, resulting in fewer medical appointments. The convenience and reduced hospital time, Dr. Waqar says, have another benefit: âPatients often can continue to work and have as close to a normal life as possible.â In Dr. Waqarâs assessment, many benefits of the treatments that fall under the umbrella of precision medicine combine to offer patients something intangibleâand invaluableâon their journey with cancer: control. âThatâs a pretty empowering feeling for patients,â she says.
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The key term that may save your breasts and your life:
Dense Breast
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ancy Cappello in the United States had always received a negative result from her annual mammogram, and that was the case in 2004 as well. Six weeks later, however, her doctor called to say: âI had felt a lump in your breast, and now advise you to have an additional mammogram and ultrasound.â So Nancy went back to the hospital for follow-up screenings as recommended. The result of the additional mammogram was again negative; however, a 2.5-centimeter lump was found through the ultrasound. To Nancy, her life was turned upside down as her fight against breast cancer began. At the same time, she was left bewildered, and kept wondering why the mammograms hadn't detected her breast cancer? There are various methods to check for breast cancer, but most people initially think of mammography. However, it is not a well-known that mammograms alone may not be sufficient in detecting breast cancer. Breast tissue can be divided into two broad categories: fatty tissue and the lacteal gland. On a mammogram image, fatty tissue is shown in black while the lacteal gland appears in white (see Fig. 1). But what about any cancerous lumps? They also appear in white on
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the image, which makes it very difficult to detect lumps in breasts with highdensity lacteal glands, since the lumps can be blurred or hidden. This type of breast is called a âdense breastâ; and it is much more common in Japanese women than Western women. Lacteal Gland
Fat
Cancer
Another question that may arise, then, is âHow do you know if you have dense breasts?â There is actually an international standard. The breasts' lacteal gland density is categorized into four types; the two at the top usually define dense breast (see Fig. 3). Until recently, the categorization was performed based on what doctors saw in the image, which means that the same breast could be categorized differently, depending on the doctor
(Fig. 1) How dense breast is shown on a mammogram
An ultrasound is helpful in resolving this problem, as the images show cancerous lumps in black. If you learn that you have dense breasts, you can increase the chance of detection by requesting an ultrasound (see Fig. 2). Mammography Fat
Ecography Fat
Lacteal Gland Cancer
Best for detection of calcification
Lacteal Gland Cancer
Best for screening of dense breast
(Fig. 2) Each of the screening methods
This does not mean that mammograms are not beneficial. One of the factors that helps doctors suspect breast cancer is in calcification, which mammography screenings show, while ultrasound screenings do not.
Dense breast The breasts are almost entirely fatty
There are scattered areas of fibroglandular density
The breasts are heterogeneously dense, which may obscure small masses
The breasts are extremely dense, which lowers the sensitivity of mammography
(Fig. 3) Categories of lacteal gland density
who was interpreting the screening image. This was considered an issue that needed to be resolved. In order to tackle any inconsistency in evaluation of the lacteal gland density, imaging software can now facilitate analysis and categorization of the density. Physical data acquired through a mammogram is input into the computer and analyzed. The lacteal gland density is calculated based on the
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tissues that the mammogram captures and then categorizes into one of the levels. Research about dense breast has advanced dramatically following the invention of these kinds of software, such as VolparaDensity⢠(Volpara), and the current research shows a correlation between women with dense breasts and the higher risk in developing breast cancer (see Fig. 4). Nancy beat breast cancer. During her research into dense breast, she found out that there were many women in this category, which accounts for 47% of American women over the age of 40. It was quite shocking for her to learn that most of them do not know about dense breast. This lack of awareness became a great motivation, and force, to start a grassroots activity called âAre You Dense?â to better inform women about issues related to dense breast. Her efforts and activities finally got the attention of US local governments; and, today, 26 states have legislated the Density Notification Law that mandates doctors to inform patients whether they have dense breast (see Fig. 5). Dense breast has gradually become a topic of discussion among the Japanese medical community. Hokuto Hos-
pital in Obihiro City, Hokkaido, is one of the first hospitals in Japan to introduce Volpara. The lacteal gland density of Lacteal Gland Category
Lacteal Gland Density (%)
(Fig. 5) Permeation of the Density Notification Law
a patient who comes in for a breast cancer screening is analyzed and evaluated, based on the mammogram. The
patient is informed of the results right after the first screening, and receives a recommendation to have an ultrasound screening if needed (see Fig. 6). Since they are able to take the additional screening on the same day, more than 90% of those advised to have an ultrasound screening take advantage of this. Furthermore, women who do not have dense breast will know that the necessity for an ultrasound screening is low, which will help reduce medical costs and other burdens. As each person possesses unique characteristics, so a breast also has its own defining characteristics. Dense breast is one of them. Knowing such characteristics about your body may help save your breasts and your life.
(Fig. 6) Efforts at Hokuto Hospital
Contribution: Volpara Solutions Incorporated. (New Zealand) Are You Dense Incorporated. (The United States of America)
(Fig. 4) Volpara result
PROFILE
Hirofumi Namba President, Breast Healthcare Inc.
PINK: Enacted Law RED: Introduced Bill BLUE: Working on Bill WHITE: No Action BLACK â : Insurance Coverage Law
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Born in Miyazaki in 1985, Hirofumi Namba started Breast Healthcare Inc. in 2013, with the objective to realize a society where all women feel secure by providing the means to healthcare and programs related to breast cancer. He has been an active advocate of dense breast issues in Japan since the establishment of the company.
Breast Cancer UPDATES Two recent advances in breast cancer treatment offer patients guidance and additional therapy options.
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Expert Consensus Offers Welcome Guidance on Surgical Margins B Y S H I C H A K U M A R , M D, FA C S B R E A S T/ E N D O C R I N E S U R G EO N R O S W E L L PA R K C A N C E R I N S T I T U T E
W
hen removing a breast tumor, a surgeonâs goal is to eliminate the cancer completely. To accomplish this we remove both the tumor and a narrow rim of healthy cells around itâan area called the surgical margin. But how much healthy tissue must be removed to effectively limit the likelihood that the tumor will return? Until now the answer has not always been clear. In February 2015 the Society of Surgical Oncology (SSO) and American Society for Radiation Oncology (ASTRO) issued a joint statement describing how wide surgical margins should be to have the best chances of reducing
It is especially important for oncologists to have evidencebased guidelines for reducing the chances of recurrence while avoiding overtreatment. 24
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recurrence in patients with early-stage breast cancers. The statement detailed the conclusions of a multidisciplinary panel that reviewed the results of 33 different studies involving more than 28,000 patients who received both breast-conserving surgery and wholebreast radiation to treat Stage I or Stage II breast cancer. The joint statement provided the first clear guidance for surgeons, radiation medicine specialists, and patients on a few key points. First, it confirmed that cancer was more likely to recur in patients with âpositive marginsââthat is, cancer cells on the edge of the tissue specimen that had been surgically removed. This held true even if patients received additional radiation therapy or other treatment after surgery. Second, although negative marginsâno evidence of cancer on the edge of the surgically removed tissueâ were strongly linked with a decrease in cancer recurrence, the panel found that a narrow margin was sufficient; there was no benefit in removing a wider rim of healthy cells around a breast tumor. Because the majority of women with early-stage breast cancer opt for breast-conserving therapy, it is especially important for oncologists to have evidence-based guidelines for reducing the chances of recurrence while avoiding overtreatment. Among those women as many as 40 percent have
been found to have positive margins and may have required additional surgery, which can be emotionally and physically challenging, worsen cosmetic outcome, delay other planned therapies, and increase healthcare costs. Although these guidelines do not replace surgical judgmentâand each patientâs case should be considered carefully and individuallyâthis important, evidence-based guidance from two influential medical societies will help standardize one of the most common surgical procedures for breast cancer, giving patients their best protection against recurrence while reducing the consequences of additional treatments they do not need. In the past no consensus existed on what constitutes a negative margin, and decisions about the width of the area removed around the tumor and what additional treatment might be needed could be very different from center to center and from surgeon to surgeon. The consensus statement from SSO and ASTRO means that more patients can choose breast conservation if medically appropriate for them and that fewer patients will need additional surgery after an initial lumpectomy. The panelâs strong and clear definitions can reassure breast cancer surgeons, radiation oncologists, and patients that we can reduce the number of operations a patient may need without compromising outcomes.
New Oral Medications Offer Additional Options BY SAR AH SCHWEBER, MD MEDIC AL ONCOLOGIST MEMORIAL SLOAN KET TERING COMMACK
P
ositive results from two key clinical trials have generated excitement about a new class of oral medications to treat breast cancer: cyclin-dependent kinase (CDK) 4/6 inhibitors. These agents work by blocking signals that tell breast cancer cells to divide. Two recently reported trials showed that combining the CDK 4/6 inhibitor Ibrance® (palbociclib) with standard anti-estrogen therapies improved outcomes in patients with Stage IV hormone-positive, HER2negative breast cancer. The PALOMA-1 trial enrolled patients who had not received any prior treatment for Stage IV breast cancer. Ibrance plus Femara® (letrozole) doubled the duration of cancer control when compared with Femara plus an inactive placebo. Based on these encouraging results, a larger, confirmatory study of this combination is ongoing. In the PALOMA-3 trial, Ibrance plus Faslodex® (fulvestrant) more than doubled the duration of cancer control compared with Faslodex plus an inactive placebo. All patients on PALOMA-3 had progressed on a previous antiestrogen therapy. A third had also received prior chemotherapy. Ibrance was generally well tolerated in both studies. The most commonly reported side effect was low white blood cell count. Most patients were
These results suggest that we will soon have more non-chemotherapy options for patients with advanced hormone-positive breast cancer.
able to complete their prescribed treatment. These results suggest that we will soon have more non-chemotherapy options for patients with advanced hormone-positive breast cancer. Most patients with hormone-positive breast cancer initially respond to antiestrogen therapies but eventually develop resistance. The combination of the oral mTOR inhibitor everolimus with Aromasin® (exemestane) was the first regimen proven to overcome resistance in some patients and is now one option available in the clinic. CDK 4/6 inhibitors are on track to become a second option. Two clinical trials with the CDK 4/6 inhibitor abemaciclib in combination with standard anti-estrogen therapies are open at many Memorial Sloan Kettering locations. In addition to demonstrating the efficacy of this treatment strategy, researchers hope to identify tumor characteristics that will predict which patients will be most likely to respond. Memorial Sloan Kettering researchers are also investigating other novel agents for the treatment of advanced hormone-positive breast cancer. PI3K inhibitors and new antiestrogen therapies will be studied in current and upcoming clinical trials. These studies represent a very exciting time in breast cancer research. We have learned so much about the cellular signaling pathways that promote tumor growth and the techniques for developing drugs to target particular signaling molecules. These results are an example of how we put this knowledge together to bring new treatments to patients. I would encourage patients to consider participating in clinical trials to help us move forward in this work.
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ãã§ãã å¯èŽãã6å°ã®ãã³ã¢ã°ã©ãã£ãŒæ©åšã¯2014幎12æçŸåšãåèšã ãã18,720人ã®å¥³æ§ã«å©çšããŠé ããŠããŸããæ€èšºãå蚺ããçŽ 60%ã®å¥³æ§ããåããŠãã³ã¢ã°ã©ãã£ãŒæ€èšºãå蚺ããããšã¢ã³ã±ãŒ ãã«åçããŠããããã³ã¢ã°ã©ãã£ãŒæ€èšºãæ®åããŠããªãããšãç© èªã£ãŠããŸãã Below is a list of hospitals where Run for the Cure® Foundation has donated a mammography machine. 18,720 women have received screenings on these machines and 60% indicated it was their first-ever screening.
Foundation.
æ± äº¬ éœ / To k y o èè·¯å åœéç é¢ / St. Luke's International Hospital ã 104-8560 æ±äº¬éœäžå€®åºæç³çº 9-1 (9-1 Akashi-cho, Chuo-ku, Tokyo 104-8560) tel. 03-3541-5151 www.luke.or.jp æå倧åŠç é¢ ä¹³è ºå€ç§ ⢠ãã¬ã¹ãã»ã³ã¿ãŒ / Shouwa University Hospital Breast Center ã 142-8666 æ±äº¬éœåå·åº æã®å° 1-5-8 (1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666) tel. 03-3784-8000 showa-breast.com
å è ç / Chiba åèå¥çç é¢ / Chiba Kensei Hospital ã 262-0032 åèåžè±èŠå·åºå¹åŒµçº 4-524-2 (4-524-2 Makuhari-cho, Hanamigawa-ku, Chiba-shi 262-0032) tel. 043-276-1851 www.chibakensei-hp.jp åèæ°éœåžã©ãŒãã³ã¯ãªãã㯠/ Chiba Shintoshin Rurban Clinic ã 270-1337 åèçå°è¥¿åžèæ·± 138 (138 Soufuke, Inzai-shi, 270-1337) tel. 0476-40-7711 www.chibashintoshi.or.jp
èš å ç / Ibaraki ãŸã€ã°ããŠã£ã¡ã³ãºã¯ãªãã㯠/ Matsubara Women's Clinic ã 300-1152 èšåççš²æ·é¡é¿èŠçºèå·æ¬é· 2018-7 (2018-7 Arakawahongo, Ami-cho, Inashiki-gun, Ibaraki 300-1152) tel. 029-830-5151 www.happy-mw.com
å² é ç / Gifu
Medical Institutions that support Run for the Cure®
æ±äº¬å ±æžç é¢ / Tokyo Kyosai Hospital ã 153-8934 æ±äº¬éœç®é»åºäžç®é» 2-3-8 (2-3-8 Nakameguro, Meguro-ku, Tokyo 153-8934) tel. 03-3712-3151 www.tkh.meguro.tokyo.jp
ä¹ å· / Ky u s h u 瀟äŒå»çæ³äººåæäŒ çžè¯ç é¢ / Sagara Hospital ã 892-0833 鹿å 島ç鹿å 島åžæŸåçº 3-31 (3-31 Matsubaracho, Kagoshima-shi, Kagoshima 892-0833) tel. 099-224-1811 ãã¬ã¹ããã¢ãªãã°ç é¢ / Breastopia Namba Hospital ã 880-0000 å®®åŽåžäžžå±± 2-112-1 (2-112-1 Maruyama, Miyazaki-shi, Miyazaki 880-0000) tel. 0985-32-7170 www.breastopia.or.jp
å æµ· é / Hokkaido
å»çæ³äººéŠšä»äŒ è€æç é¢ / Fujikake Hospital ã 509-0214 å²éçå¯å åžåºèŠ 876 (876 Hiromi, Kani-shi, Gifu 509-0214) tel. 0574-62-0030 www.okbnet.ne.jp/~fuj598
瀟äŒå»çæ³äººåæ åæã¯ãªãã㯠/ Hokuto Clinic ã 080-0833 垯åºåžçš²ç°çºåºç· 7-5 (7-5 Kisen, Inadamachi, Obihiroshi, Hokkaido) tel. 0155-48-8000 www.hokuto7.or.jp
倧 éª åº / Osaka 糞æ°ã¯ãªãã㯠/ Itouji Hospital ã 559-0016 倧éªåžäœä¹æ±åºè¥¿å è³å± 1-1-6 (1-1-6 Nishikagaya, Suminoe-ku, Osaka 559-0016) tel. 06-6681-2772 www.myclinic.ne.jp/itoujiclinic/pc/index.html å»çæ³äºº çŽå¹žäŒ è±äžæž¡èŸºç é¢ / Toyonaka Watanabe Hospital ã 561-0858 倧éªåºè±äžåžæéšè¥¿çº 3-1-8 (3-1-8 Toyonaka-shi, Osaka 561-0858) tel. 06-6864-2301 www.watanabe-hp.or.jp/hospital
NPOæ³äºº Run for the Cure® Foundation
ã141-0032 æ±äº¬éœåå·åºå€§åŽ3-6-28 Daiwa倧åŽ3äžç®ãã«6é
(Daiwa Osaki 3-chome Bldg. 6F, 3-6-28 Osaki, Shinagawa-ku, Tokyo 141-0032) Tel: 03â-â6420â-â0860
Email: inquiries@runforthecure.org
www.runforthecure.org
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A three-night stay at PIC Saipan, plus a pair of economy class Delta Air Lines tickets for two!
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Offer details
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The Pacific Islands Club, Saipan is an American resort, located just 3.5 hours south of Japan. A unique range of sports & recreational activities, staff interaction and exceptional personalized service is promised for maximum enjoyment and relaxation. Also enjoy the comfortable trip with Delta Air Lines, the one-and-only airline that offers direct flights from Tokyo to Saipan.
Run for the Cure® Foundation Logo Brooch with Swarovski elements
1. Three-night stay in a Superior Room with 3 meals a day for two 2. A pair of roundtrip Delta Air Lines economy class tickets. Validity through: For one year from the campaign winner annoucement
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Pink Ribbon Charms set
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RFTC ã¯ãªã¹ã¿ã«ãã¢ãŒ 1åæ§ RFTC Crystal Bear
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How to enter Please email the below information: 1. Full name: 2. Age; 3. Postal address; 4. Telephone number; 5. Email; 6. Do you arrange for an annual Mammogram?; 7. Please let us know what types of articles (e.g., Q&A, Beauty tips, Survivor stories, Recipes, Exercise regimens, Caregivers, Prevention, Coping, etc.) you'd like to see (more of) in PiNK; 8. Do you know of a breast cancer survivor? If yes, what did you learn from that person? If no, what are the two most important points you know about breast cancer in Japan? Entries will be accepted until 11th November 2016. Winners will be announced in the Winter 2017 issue published in December 2016. Please title your email "PiNK Readership Offer entry" and send to pink@runforthecure.org
P I NK ⢠S U MME R 2016
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What I Can Do ... ⶠBecome a Distribution Point
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®
Run for the Cure Foundation is seeking companies, organizations,
Run for the Cure Foundation ã§ã¯ãPiNK èª ãé åžã»èš 眮ããŠãåœ
cafés, salons, libraries, or individuals that will be partnering with us
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to distribute PiNK and deliver its important contents to raise greater
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awareness about breast cancer and health. The magazines and
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delivery costs are free-of-charge! Please help us make PiNK more accessible and easier to pick up all across Japan.
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The PiNK magazine is âŠ
PiNK èªã¯âŠ
⢠published 4 times a year in March, June, September & December.
⢠ïŒæãïŒæãïŒæããã³ 12 æã®å¹Žã« 4 åçºè¡ãããŠããŸãã
⢠distributed all free-of-charge to individuals and companies.
⢠å人ãªãã³ã«äŒæ¥ã«ãç¡æã§é åžã»çºéãããŠããŸãã
⢠available from 1 copy up to 10,000 copies per location.
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â· Donate Time and Expertise
â· æéãšçµéšã§ãµããŒããã
Do you have experience working as a professional translator, editor and/or proofreader? Please contact us if you are interested in
ããã®ç¿»èš³è ãæ ¡ æ£è ãç·š é è ãšããŠåããçµ éšããããŸããïŒ PiNK
helping us create PiNK!
èªã®å¶äœã«ãååé ããæ¹ã¯ããã²ãé£çµ¡ãã ããïŒ
âž Donate for the Production/ Printing/Delivery Costs
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PiNK magazine has been produced, printed and delivered to its
PiNK èªãèªè ã®çæ§ã«ç¡æã§ãå±ãã§ããŠããã®ã¯ãå人ãäŒæ¥ã®ã¹
readers and beneficiaries free-of-charge because of our generous
ãã³ãµãŒã®çæ§ããã®å¯å€§ãªãæ¯æŽã®ãããã§ããçæ§ã®ãå¯ä»ã¯ã倧
individual and corporate sponsors. Your contribution will educate,
åãªç¥èãæããèªè ãå±ãŸããç·å¥³åæ¹ã®ãšã³ãã¯ã¡ã³ããå³ããåœ
encourage and empower both men and women in Japan for better-
ãå®ãããè¯ãéžæãããŠããããšãå©ããŸãã
informed and potentially life-saving decisions.
äžè±æ±äº¬ UFJ éè¡ æžè°·æ¯åº
Mitsubishi Tokyo UFJ Bank
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Shibuya Branch Futsuu 3609116
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Tokuhi) Run for the Cure Foundation
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For more information or to become a distribution point, please contact PiNK@runforthecure.org
詳现æ å ±ãçºéåžæã¯ãPiNK@runforthecure.org ãŸã§ã
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EASY YOGA FOR EVERY DAY
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A magazine for women's health
2015 幎㻠å€
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Five easy ways to achieve mind-body wellness.
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PiNK 2016 å¬
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Volume 9 / Issue 2 å£ å èª
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Volume 8 / Issue 3 å£å èª
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2015 幎㻠ç§
ãµ ã 〠ã I ã» ã¹ ã I 㪠I
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In association with
Happy Mind, Healthy Body
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Appearance ç Matters
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Power of Love
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RFTC Products ONLINE SHOP www.runforthecure.org/shop/ ã¹ã¯ããã¹ããŒã»ã¯ãªã¹ã¿ã«ã䜿çšãã ããŽã»ãããŒã Logo Brooch with Swarovski elements
RFTC ãšã³ããã° Eco-bag Â¥ 300
Special edition
Â¥ ïŒ,500
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RFTC ãã£ãã RFTC cap Â¥ 500
RFTC T-shirt 2015 S/M/L/XL
Â¥ 1,000
2005 L/XL/XXL
UNTIL THERE'S A CURE ãã³ã¯ãã³ã Pink Band
NEW!
MïŒL
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2012 L/XL
Â¥ 300
RFTC ããã¯åŒé»ããŒã«ãã³
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RFTCã¯ãRun for the Cure®/Walk for Lifeã€ãã³ãã®ãªãªãžãã«T-ã·ã£ãã«ããã¥ãŒ ãã©ã³ã¹ãžã£ãã³ã®åè³ããããŠããŸããOur Run for the Cure®/Walk for Life event t-shirt is sponsored by New Balance Japan.
RFTC Ballpoint pen (Self examination method in Japanese)
Â¥ 300 ãã¥ãŒããã¯ãžã«ã³ãã¢ä» ããã¯ããŒã¯ Bookmark with a cubic zirconia ï¿¥3,360 ã¯ãªã¹ã¿ã« ããŒã ã ã¢ã¹ (ã·ã«ããŒ) çŽ 0.8cm Crystal heart earrings (silver) approx 0.8cm ï¿¥3,675
ãã¥ãŒããã¯ãžã«ã³ãã¢ä»ã ããã°ãã³ã¬ãŒ Bag hanger with cubic zirconia ï¿¥3,780
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www.runforthecure.org/shop/ 代éã¯ãäžèšéè¡å£åº§ã«æ¯ã蟌ã¿ãã é¡ãèŽããŸãã ïŒæãå ¥ããŸããæ¯èŸŒææ°æã¯åèªãè² æ äžããã Shop online at www.runforthecure.org/shop or email/fax us your order. After we get back to you with shipping fees and
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stock availabilities, please make payment to below account with your full name - bank fees should be incurred by purchaser.
ãæ¯æãéè¡å£åº§:
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E-mail: inquiries@runforthecure.org
ãã¯ãïŒ ã©ã³ãã©ãŒã¶ãã¥ã¢ãã¡ã³ããŒã·ã§ã³
Tokuhi) Run for the Cure Foundation
www.runforthecure.org
äžè±æ±äº¬UFJéè¡ æžè°·æ¯åº æ®é 3609116
Shibuya Branch Futsuu 3609116
Tel: 03-6420-0860 Fax: 03-3492-1202
P I NK ⢠S U MME R 2016
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Monthly Self-Examination èª å·± æ€ èšº 㧠ã 〠ã ã® æ 觊 ã èŠ ã ãŠã
You know your body better than anyone
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else. Know your normal, so you can detect
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the slightest abnormality immediately.
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When to examine It's best to self-examine after your
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menstruation cycle, when breasts are less
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tender or swollen. If your cycle is irregular
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or you have reached menopause, pick a
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date you can easily remember and check
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every month.
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Self-Exam Procedure 1.
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Raise arms in front of a mirror and examine for irritation, swelling or discharge.
ããªãããä¹³ é ããåæ³ ç©ããªãããèŠ ãŠç¢ºãããŸãã
2.
and ring finger; to check your right breast, use your
ã¯ããŠã¿ãŸãããã人差ãæãäžæãè¬æ ã®ïŒæ¬ã®æè ¹ãå³èžããã§ãã¯ããéã¯å·Š æã䜿ããŸããÂ次ã®ããã«åãããŠèã®äžã
left hand. Gently explore your breast area within the
2
boundaries connecting armpit, rib, collarbone and shoulder for lumps following the patterns below, and
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repeat with the other side.
ã èž å š äœ ããŸã ã¹ ããªã調 ã¹ ãŸãããã çµãã£ãããå³æã§å·Šèžã調ã¹ãŸãããã
a) Draw three coin-sized circles in one spot, applying different pressure each time: light, medium and deep.
a) ïŒç® æã«ã€ãã³ã€ã³ãµã€ãºã®åãïŒåæãã軜ãã»å° ã匷ãã»æ·±ããŸã§è§Šããããã«ãå§åãå€ããŠãã§ãã¯ã
b) Vertical or "up and down" (or "squares") pattern
ãŸãã b) èã®äžããå§ããèžå šäœã«ããã£ãŠäžäžæ¹åã«ãäž
You can self-examine while taking a bath or shower. Use the pads of your pointing finger, middle finger
2. ã颚åãã·ã£ã¯ãŒã§èº«äœãæŽãæã«ãã§ã
covering the entire breast. When moving downwards, move your ring finger one space over and have your
3
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other fingers follow. Move horizontally by moving
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your middle finger one joint over. When moving
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upwards, move your pointing finger one space over
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and have your other fingers follow.
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c) Draw two strips using the same methods from
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shoulder to the center of the collarbone.
3. ãŸããä»° åãã« å¯ãŠãè ãé äžã«ãã㊠調ã¹ãããšãã§ããŸãã ãããããæ¹æ³ã§ æ¯æè¡ããŸãããã
3.
There is another method where you lie down with one arm tucked behind your head. Check your breast every month with whichever method you find easiest.
å€åãç°åžžãæãããšãã¯ãããã«å°éå»ïŒå€ç§ãä¹³è ºå€ç§ãä¹³è ºç§ïŒã«çžè«ããŸãããã幎ã«äžåºŠã¯ããã³ã¢ã°ã©ãã£æ€èšºã åããäºãæšå¥šãããŠããŸãã觊ã£ãŠãããããªããããªå°ããªãããèŠã€ããããšãã§ããŸãã If you find any changes or abnormalities, contact your doctor immediately. Some abnormalities cannot be detected by touch alone; therefore, it is recommended that women receive a mammography once a year. ç£ä¿®ïŒé岡ããã»ã³ã¿ãŒ ä¹³è ºå€ç§ é«æ©ãããå»åž«ãMammaCare Corporation
5
PiN K ⢠SUMMER 2 0 1 6
What do you really know about breast cancer? What do you know about breast cancer? How can you tell if you have any abnormalities relating to breast cancer? What does it look like? What does it feel like? How can you detect it?
ä¹³æ¿ã®ããŒã¿ indentation
ç®èã®ãã ã skin erosion
ä¹³ããã®ããš æ¬åœã« ç¥ã£ãŠããŸããïŒ ä¹³ããã«ã€ããŠãã¿ãªãããåç¥ã§ããã ã©ã®ãããªæ¹æ³ã§èŠã€ããããšã
ã§ããã§ãããïŒ
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èµ€ã¿ã»ã»ãŠã redness or heat
ä¹³é ããã®åæ³ new fluid
ç®èã®ç¡¬å hardening
è¡šé¢ã®å¹åž dimpling
çªåºããããã bump
ä¹³æ¿å ã®ããã inside lump
éèã®æ匵 growing vein
ä¹³é ã®çœåŒ nipple retraction
å·Šå³ãµã€ãºã®å€å ç®èã®å€å new asymmetry âorange peelâskin
For more information, please visit our website at
ãããžã§ã¯ãã®è©³çŽ°ã¯ããŠã§ããµã€ã
http://runforthecure.org/feature/lemon-project/
http://runforthecure.org/feature/lemon-project/
or contact us at PiNK@runforthecure.org
Looking for an English-speaking support group?
www.runforthecure.org
ãŸã㯠PiNK@runforthecure.org ãŸã§ãåãåãããã ããã
Tokyo Bosom Buddies, Survivor group in Tokyo for foreigners and English-speaking Japanese. Gatherings at Franciscan Chapel Center in Roppongi once a month. For details, please email PiNK@runforthecure.org
P I NK ⢠S U MME R 2016
6
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or women, 1 in 12 have a chance of being diagnosed with breast cancer in her lifetime. Therefore early detection, through methods such as annual screening and self-examination, is critical for treatment of breast cancer. Self-examinations are completely free and can be performed in the comfort and privacy of a personâs home. With this in mind, The Lemon Project was established in 2013 to explain why early detection is important and how to carry out self-examinations. This past spring, we were invited to the Hilton Grand Vaca-
7
PiN K ⢠SUMMER 2 0 1 6
tions to run two sessions. Each seminar began with a lecture by Kiei Ogata, Run for the Cure® Foundationâs Awareness Program Manager, who shared information about different screening methods, the timing of when to start screening, and treatment options. Participants were then taught how to perform a selfexamination. After learning about the different steps and watching a demonstration video, seminar participants were given silicon breast models containing abnormalities to practice what they had learned. Cries
Campaign designed by worldwidebreastcancer.com
of âOh! I found it!â and âDo I have to push this deep?â could be heard as participants began palpating the models. Many attendees expressed their surprise at how real the models felt. During this time, Kiei also went to each participant and showed them how different irregularities manifest themselves. After the presentation, the women agreed that early detection and self-examinations are important.
SURVIVOR ãµ ãã€ã ãŒ ã® æ¹ ãž ã®ã¡ãã» ãŒãžã³ãŒããŒ
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ããŒã®æ¹ãžã¡ãã»ãŒãžãæžããŠé ããDear Survivorãã¡ãã»ãŒ ãžã³ãŒããŒãèšããŸãããã²ã¹ãã®çããŸã¯ãS.T. Dupont ã® çŸããäžå¹Žçã䜿ã£ãŠããããã®ãæ°æã¡ãæžããŠäžãããŸã ããåœå€ãäŒå Žã«ãããã 2 åã®ãµãã€ããŒã®æ¹ã«ãã¹ãã¡ã ã»ãŒãžãéžãã§é ããäœè ã®æ¹ã«ã¯ S.T. Dupont ã®ããã£ã㌠ã«ãã³ïŒå®äŸ¡ 3 äžåã»ã©ïŒãèŽãããŸããããã®æ¥ã«å¯ããã ãçŽ æŽãããã¡ãã»ãŒãžãå°ãã玹ä»ããŸãããã
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t our 12th annual Pink Ball held on Friday, March 20th, 2015, we collaborated once again with one of our sponsors this year, S.T. Dupont, to host a "Dear Survivor" corner. All guests had the opportunity to write a personal message to a survivor using the elegant pens created by S.T. Dupont. Toward the end of the evening, two survivors chose their favorite message, and the authors were awarded a Defi Blue, Red or White Ballpen worth around 30,000 yen each. We thought it timely to share some of these inspiring messages with our readers.
ããªããæŠã姿ã«åæ°ãããã£ãŠããŸãã ãããããªããèªä¿¡ã倱ããããã èœã¡èŸŒããããªæã¯ã ç§ãåŽã«ããããŠãã ããã ãªã«ãã§ããªããããããªããã©ã å¯ãæ·»ãããšã¯ã§ããŸãããâŠ
Your bravery in the fight inspires me. But when you have lost your confidence, Or in times of disappointment, Please let me stand by your side. I may not be able to do anything, But I am there for you.
ãããšãã®æ²»çãé害ãä¹ãè¶ããããªãã®ã ã®åæ°ã¯ã家æãå人ããããŠã³ãã¥ããã£ãŒ ã®ã¿ããªãžã®èŒãæš¡ç¯ã§ãïŒïŒ
Your courage in overcoming cancer, and the many necessary treatments and obstacles is a shining example of the power of life for your family, friends and community!!
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