Press-Republican Breast Cancer Awareness 2016 by Press-Republican

Press-rePublican â&#x20AC;˘ Breast Cancer Awareness 2016 1

awareness Breast Cancer

Getting Healthy, One Step at a Time Catching up with Josephine Hum and the Healthy Steps program

High Science Medical marijuana offers an alternative path to recovery

How to Handle a Cancer Diagnosis Patient education and having a close support group are key things to help you cope

Friday. October 21, 2016 â&#x20AC;˘ A publication of the Press-rePublican

2 Breast Cancer Awareness 2016 • Press-rePublican

awareness Breast Cancer

A publication of the Press-rePublican

Perspective

How to handle a breast cancer diagnosis

Did you know?

Cancer Related Fatalities on the Decline

The stages of breast cancer

Did you know?

A Guide to the Mastectomy Process

Did you know?

Possible Side Effects of Breast Cancer Treatment

10 Types of Radiation Treatments 11 The Risk Factors of Breast Cancer 12 One Step at a Time: Josephine Ham is helping survivors get healthy with CVPH’s Healthy Steps program. By Toni Smith 14 Talk Therapy Can Help Cancer Patients Heal 17 Genetic Testing May Detect Cancer Risk 17 Ways to Improve Quality of Life During Treatment 20 High Science: What Medical Marijuana offers cancer patients in recovery By Susan Acklen 21 Exercising After Breast Cancer

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awareness Breast Cancer

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Phone the Special Publications Desk: (518)565-4183

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Susan Acklen Toni Smith

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PRESS-REPUBLICAN • Breast Cancer Awareness 2016 3

You Go Girl! (Go get a mammogram)

Mammograms save lives. The earlier breast cancer is detected, the easier it is to treat. The Women’s Imaging Center offers patients with all breast types a superior, comfortable and more accurate mammogram using 3D imaging technology. And while this state-of-the art technology is the foundation of the Women’s Imaging Center, it’s our team of board certified mammographers, board certified radiologists and support staff that sets us apart. Call our Women’s Imaging Center today at (518) 562-1055 to make an appointment. We offer convenient hours Monday – Friday from 7 a.m. to 6 p.m. No insurance? Call the Cancer Services Program of Clinton County at (518) 324-7661 for a free screening.

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4 Breast Cancer Awareness 2016 • PRESS-REPUBLICAN

illions of people are diagnosed with cancer every year. One of the leading killers of men, women and children across the globe, cancer affects those diagnosed as well as their families and friends.

How to handle a cancer diagnosis

Cancer treatments continue to evolve, which should come as welcome news to men and women diagnosed with this often treatable disease. That group figures to expand in the coming years, as the World Health Organization estimates the number of new cancer cases will rise by about 70 percent over the next two decades. Regardless of how far cancer research has come, a cancer diagnosis remains a cause for concern. Handling such a diagnosis well can help patients in their fights against the disease and improve their chances of making a full recovery. Learn about your disease. Physicians will make suggestions and recommendations to their patients, but it’s ultimately up to patients to make decisions regarding their treatments. Learning about your disease may help you feel more comfortable about the decisions you will be asked to make during your fight. The Mayo

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PRESS-REPUBLICAN • Breast Cancer Awareness 2016 5 Clinic also advises men and women to determine their comfort levels with regard to their disease. Some may prefer to learn only the basics of their disease, trusting major treatment decisions to their physicians, while others want to know as much as possible so they can be the primary decision-maker regarding their treatments. Don’t be afraid to leave major decisions to your physician if you ﬁnd yourself becoming overwhelmed with information about your disease.

Prepare for change. Cancer treatments have come a long way over the last several decades, but they may still produce unwanted side effects, such as fatigue and hair loss. The Mayo Clinic notes that cancer support groups may be especially helpful as cancer patients prepare and ultimately deal with the changes that accompany their treatments. Ask your physician about the likely side effects of your treatment and if he or she has any suggestions regarding how to handle those side effects.

Embrace your support system. Friends and family members can be wonderful resources during your ﬁght against cancer. The Mayo Clinic advises cancer patients to keep the lines of communication with their loved ones open, sharing updates about your treatments and discussing any decisions you may be facing. Feelings of isolation may grow if you stay tight-lipped about your disease, so embrace your support system, accepting any help your loved ones offer.

Revisit your priorities. Patients will have to devote a lot of time and energy to successfully navigate cancer treatments. Revisiting your priorities to determine what’s truly important can help you clear away personal clutter so you have more energy as you ﬁght your disease. Receiving a cancer diagnosis is a life-changing event. How patients handle their diagnosis can have a dramatic impact on how successfully their bodies take to treatment.

Did you know? Doctors treating patients who have been diagnosed with cancer will eventually present pathology reports as a means of helping patients better understand their disease. Upon confirming the presence of cancer, doctors will conduct tests on their patients to determine the size and appearance of the cancer, how quickly the cancer is growing and if there is anything to suggest that the cancer has spread to healthy tissues near its point of origin. Doctors may also use these tests to determine if hormones, genetic mutations or other things in the body are influencing the cancer’s growth and development. The results of these tests will be included in the patient’s pathology report. Patients who find their reports difficult to understand or those experiencing anxiety after reading their reports should go over any questions they might have with their physicians. Many cancer patients find that learning about their disease helps them effectively keep their emotions in check and capably handle the ups and downs of their treatments.

Cancer-Related Fatalities on the Decline “Cancer” is a word that no person ever wants to hear in his or her lifetime. But millions of people are affected by cancer every year. Although a cancer diagnosis may be met with anger, sadness or denial, there is a light at the end of the tunnel. The American Cancer Society states that the rate of death from cancer in the United States continues to decline among both men and women. Many types of cancer, including cancers of the breast, colon, prostate, and lung, are also in decline among all major racial and ethnic groups. Things look promising across the globe as well. An international consortium of researchers led by the Institute for Health Metrics and Evaluation conducted their own research, which was published in JAMA Oncology in 2013. The findings indicated the death rates from cancer have been falling in many countries. Over a period of 23

years, age-standardized death rates for all cancers fell in 126 out of 188 countries. In the United States, the number cancer-related deaths varies greatly based on geography. According to the National Center for Health Statistics, Utah has the fewest number of cancer fatalities. The southern United States, namely Mississippi, Louisiana, and Alabama, have the highest rates of cancer deaths. Researchers surmise the differences in cancer incidence and deaths rates between states are largely due to behavioral, environmental and socioeconomic factors. While cancer rates may be increasing globally, cancer sufferers and their loved ones should know that more and more people are beating the disease. Prevention education, ongoing research and newly developed treatments are helping in the continued fight against cancer.

6 Breast Cancer Awareness 2016 • PRESS-REPUBLICAN

The stages of breast cancer

pon receiving a breast cancer diagnosis, patients will soon receive a pathology report that informs them about the stage their cancer is in. The stage indicates how advanced the cancer is and whether or not it is limited to one area of the breast or has spread to other tissue or even other parts of the body. Understanding the stages of breast cancer can help patients cope with their diagnoses more effectively. Once the doctor has completed all the necessary testing, patients will then receive their pathology

reports, which will include the stage of the cancer. The following rundown of the various stages of breast cancer can help breast cancer patients better understand their disease. Stage 0 Non-invasive breast cancers are considered to be in stage 0. When doctors have determined the cancer is in stage 0, that means they have not seen any indication that the cancer cells or the abnormal noncancerous cells have spread out of the part of the breast in which they started.

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Breast cancer patients may hear the term “five-year Stage IIB which th survival rate” when discussing their disease with their physicians. The five-year survival rate refers to no large the percentage of people who live at least five years groups o after being diagnosed with cancer. According to the These sm American Cancer Society, the five-year survival rate millimete for women with stage 0 breast cancer is nearly 100 IIB may which th percent. no large spread t Stage I nodes or Stage I refers to invasive breast cancer and is Tumors broken down into two categories: stage IA and stage IB. Stage IA refers to invasive breast cancers have not also be r in which the tumor is up to two centimeters and the cancer has not spread outside the breast. The five-year about 93 lymph nodes are not involved in stage IA breast cancers. In some stage IB breast cancers, there is Stage III no tumor in the breast but there are small groups of cancer cells in the lymph nodes larger than 0.2 Stage III down int millimeter but not larger than two millimeters. But stage IB breast cancers may also refer to instances patients when there is both a tumor in the breast that is no that mea their bre larger than two centimeters and small groups of cancer cells in the lymph nodes that are larger than IIIA, can 0.2 millimeter but no larger than two millimeters. Theaxillary l ACS notes that the five-year survival rate for stage I breastbo are acco breast cancers is roughly 100 percent. cells (lar Stage II Stage II breast cancers are also divided into two subcategories: stage IIA and stage IIB. Both subcategories are invasive, but stage II breast cancers are more complex than stage 0 or stage I breast cancers. Stage IIA describes breast cancers in which no tumor can be found in the breast, but cancer that is larger than two millimeters is found in one to three axillary lymph nodes (the lymph nodes under the arm) or in the lymph nodes near the breast bone. But an invasive breast cancer can still be considered stage IIA if the tumor measures two centimeters or smaller and has spread to the axillary lymph nodes or if the tumor is larger than two centimeters but not larger than five centimeters and has not spread to the axillary lymph nodes.

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PRESS-REPUBLICAN • Breast Cancer Awareness 2016 7 Stage IIB breast cancer describes breast cancers in which the tumor is larger than two centimeters but no larger than five centimeters, and there are small groups of breast cancer cells in the lymph nodes. These small groups of cells are larger than 0.2 millimeters but no larger than two millimeters. Stage IIB may also be used to describe breast cancers in which the tumor is larger than two centimeters but no larger than five centimeters and the cancer has spread to between one and three axillary lymph nodes or to lymph nodes near the breastbone. Tumors that are larger than five centimeters but have not spread to the axillary lymph nodes may also be referred to as stage IIB breast cancers. The five-year survival rate for stage II breast cancers is about 93 percent. Stage III Stage III cancers are invasive breast cancers broken down into three categories: IIIA, IIIB and IIIC. When patients are diagnosed with stage IIIA breast cancer, that means doctors may not have found a tumor in their breast or the tumor may be any size. In stage IIIA, cancer may have been found in four to nine axillary lymph nodes or in the lymph nodes near the breastbone. Tumors larger than five centimeters that are accompanied by small groups of breast cancer cells (larger than 0.2 millimeter but no larger than

two millimeters) in the lymph nodes also indicate a breast cancer has advanced to stage IIIA. But stage IIIA may also be used to describe breasts cancers in which the tumor is larger than ﬁve centimeters and the cancer has spread to one to three axillary lymph nodes or to the lymph nodes near the breastbone. A stage IIIB breast cancer diagnosis indicates the tumor may be any size and has spread to the chest wall and/or the skin of the breast, causing swelling or an ulcer. The cancer may have spread to up to nine axillary lymph nodes or may have spread to the lymph nodes near the breastbone. In stage IIIC breast cancer, doctors may not see any sign of cancer in the breast. If there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast. To be categorized as stage IIIC, the cancer must also have spread to 10 or more axillary lymph nodes or to the lymph nodes above or below the collarbone or to the axillary lymph nodes or lymph nodes near the breastbone. The ACS notes that women diagnosed with stage III breast cancer are often successfully treated and that the ﬁve-year survival rate is 72 percent. Stage IV Invasive breast cancers that have spread beyond the breast and lymph nodes to other areas of the

body are referred to as stage IV. Stage IV breast cancer may be a recurrence of a previous breast cancer, though some women with no prior history of breast cancer receive stage IV diagnoses. The ﬁveyear survival rate for stage IV breast cancers is 22 percent.

Did you know? According to the World Health Organization, breast cancer survival rates vary greatly worldwide. While survival rates range from 80 percent or better in North America and countries such as Sweden and Japan, those figures drop to roughly 60 percent in middleincome countries. Low-income countries fare the worst, with survival rates below 40 percent. The WHO attributes the low survival rates in low-income countries to inadequate diagnosis and treatment facilities and the lack of early detection programs. Early detection is often essential when battling breast cancer, as late-stage survival rates are low regardless of where a person lives. For example, the American Cancer Society notes that, in the United States, the five-year relative survival rate for breast cancers detected in their earliest stages (often referred to as “stage 0” or “stage I”) is 100 percent. The five-year relative survival rate in the United States is considerably lower for stage IV breast cancers, at right around 22 percent.

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Aguide to the mastectomy procedure

breast cancer diagnosis is something no one wants to receive. Dealing with any form of cancer can be overwhelming, but a breast cancer diagnosis can be particularly challenging, especially when physicians recommend mastectomy to their patients. The Mayo Clinic notes that mastectomy is an umbrella term used to describe several different procedures. While it’s largely thought of as removing one or both breasts, mastectomy may also refer to removing lymph nodes under the arms. Lumpectomy is another word that may come up when physicians discuss treatment options with patients who have been diagnosed with breast cancer. Lumpectomies occur when a tumor and surrounding tissue is removed, but most of the breast is left intact. For reasons that are not entirely understood, Susan G. Komen reports that rates of some types of mastectomies are on the rise. A unilateral mastectomy is the removal of one breast, and a bilateral mastectomy is the removal

of both breasts. However, a woman may choose to have a healthy breast removed as a preventative measure called a contralateral prophylactic mastectomy, or CPM. Susan G. Komen says that rates of CPM have been steadily on the rise, and women choosing to undergo the procedure tend to be young and well educated. Any mastectomy has its share of risks that women must weigh against the benefits. Doctors or nurses will explain the procedure before patients enter the operating room. Surgical plans may differ depending on whether a modified radical mastectomy, simple mastectomy, skin-sparing mastectomy, or nipple-sparing mastectomy will be performed. A mastectomy procedure typically lasts up to three hours, but it may take longer if reconstruction of the breast is part of the surgery. Mastectomy is usually performed under general anesthesia, so patients will need to arrange for transportation home from the hospital. Many women find they can go home the same day of the procedure, though women should discuss their options with their

PRESS-REPUBLICAN • Breast Cancer Awareness 2016 9 physicians ahead of the surgery. Incisions will be closed with sutures after the surgery is completed. In some cases, a plastic drainage tube will be inserted where the breast was removed. This tube helps clear away any ﬂuids that accumulate after the surgery. Women may feel some pain, numbness and pinching sensations in the surgical area. There will be a bandage over the site, and instructions will be given on caring for the wound and changing the dressing.

breast tissue eliminates the ducts that produce milk, so breastfeeding will not be possible after surgery. Also, the breast and much of the surrounding area may remain numb due to nerves that are severed when breast tissue is removed. How much sensation returns varies from woman to woman. Women can direct any questions they have regarding wearing bras or breast prosthetics to their surgical teams.

For reasons not entirely understood, mastectomies are on the rise.

It’s important to keep in mind that some of side effects of mastectomy procedures are permanent and irreversible, whether or not a person undergoes reconstruction. Removing

Mastectomy is a common treatment option for women who have been diagnosed with breast cancer. Although mastectomy may seem scary, women can rest assured that many have been there before them and there is a wealth of information available to assuage their fears.

Potential side effects of breast cancer treatments

reatments for breast cancer have evolved considerably in recent years. When breast cancer is detected early enough to be categorized as stage 0 or stage I, the five-year survival rate is 100 percent. That’s a testament to the hard work of cancer researchers who continue to develop effective ways to treat and defeat breast cancer. As effective as cancer treatments can be, breast cancer patients may still experience some side effects during treatment. Side effects may depend on which course of treatment cancer patients and their physicians pursue, but the following are some potential side effects breast cancer patients may encounter during treatment. Armpit discomfort According to Breastcancer.org, a nonprofit organization dedicated to providing up-to-date information about breast cancer, patients may develop armpit discomfort after lumpectomy, mastectomy or lymph node removal surgeries. This discomfort may be characterized by pain, swelling,

Did you know? Men have a small amount of breast tissue, and that means they can be affected by breast cancer. According to the American Cancer Society, men’s breast tissue has ducts, but only few, if any, lobules. That’s because men do not have enough female hormones to promote the growth of breast cells. Breast cancer can be separated into several types based on what the cancer cells look like under the microscope. They can be in-situ, meaning noninvasive or pre-invasive. They also may be invasive types that have spread to the ducts in the breast tissue. Breast cancer is about 100 times less common among men than among women. Only about 2,600 new cases of invasive breast cancer will be diagnosed in men this year. But men who feel lumps or other anomalies in the area around the nipple should consult their physicians.

tenderness, or numbness. The numbness may result when nerves in the armpit are cut during surgery, while tenderness or swelling may occur when surgeons have to remove some of the tissue under the surface of the skin. Patients who receive radiation therapy may develop irritation or soreness in the armpit because the skin of the armpit is so close to the breast. Constipation Some breast cancer patients experience constipation because their eating and exercise habits change during treatment. Constipation is a side effect of pain medications such as ibuprofen, so breast cancer patients relying on medication to alleviate some of the pain associated with their disease and treatment may experience constipation as a result. Chemotherapy and hormonal therapy are two breast cancer treatments known to cause constipation as well. Dry skin During treatment, breast cancer patients may experience dry skin that

is uncomfortable and itchy. This side effect has been linked to chemotherapy, radiation therapy and hormonal therapy. Dry skin tends to last as long as patients are in treatment, gradually subsiding once treatment has been completed. Endometriosis Endometriosis occurs when the cells that make up the endometrium, or the lining of the uterus, grow outside of the uterus. Hormonal therapy may stimulate the growth of endometrial cells, triggering endometriosis, which is most often found on or under the ovaries, behind the uterus or on the bowels or bladder. Endometriosis may cause pain, fertility problems or heavy menstrual periods. Physicians who suspect their patients have developed endometriosis may perform a laparoscopy, a surgical procedure in which a small cut is made over the abdomen. Once that cut is made, the surgeon will insert a thin tube equipped with a viewing instrument so he or she can look inside the uterus to determine if endometriosis has developed. Continued on page 19

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The risk factors for

are growing in developing countries, citing longer life expectancies as one of the primary reasons for that increase.

Breast Cancer C

ancer is a formidable foe. Among women, no cancer poses a greater threat than breast cancer, which the World Health Organization reports is the most often diagnosed cancer both in the developed and developing worlds. Gaining a greater understanding of breast cancer may not prevent the onset of this disease that kills hundreds of thousands of women each year, but it might increase the chances of early detection, which can greatly improve women’s chances of survival. The following are the established risk factors for breast cancer.

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Menstrual history: Women who began menstruating younger than age 12 have a higher risk of developing breast cancer later in life than women who began menstruating after their twelfth birthdays. The earlier a woman’s breasts form, the sooner they are ready to interact with hormones and chemicals in products that are hormone disruptors. Longer interaction with hormones and hormone disruptors increases a woman’s risk for breast cancer.

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Family history: According to the WHO, a family history of breast cancer increases a woman’s risk factor by two or three. Women who have had one first-degree female relative, which includes sisters, mothers and daughters, diagnosed with breast cancer are at double the risk for breast cancer than women without such family histories. The risk of developing breast cancer is five times greater for women who have two first-degree relatives who have been diagnosed with breast cancer.

Lifestyle choices: A 2005 comparative risk assessment of nine behaviors and environmental factors published in the U.K. medical journal The Lancet found that 21 percent of all breast cancer deaths across the globe are attributable to alcohol consumption, overweight and obesity and physical inactivity. Women can do nothing to control breast cancer risk factors like gender, age and family history, but making the right lifestyle choices, including limiting alcohol consumption, maintaining a healthy weight and living an active lifestyle, can reduce the likelihood that they will develop breast cancer.

Gender: Being female is the single biggest risk factor for developing breast cancer. Men can get breast cancer, but the risk for men is substantially smaller than it is for women. According to Breastcancer.org, roughly 190,000 women are diagnosed with invasive breast cancer each year in the United States alone.

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ONE

STEP at a time: Josephine Hum is helping survivors get healthy with CVPH’s Healthy Steps program. Story by Toni Smith

October is National Breast Cancer Awareness Month! Lake Champlain OB/GYN, P.C. would like to remind all women of the North Country to perform self breast exams and to discuss the need for mammograms with your health care provider.

Dr. Barbara Gannon

Dr. Jeffrey Dodge

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Linda Johnston CNM

Caroline Hamel M.D.

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PRESS-REPUBLICAN • Breast Cancer Awareness 2016 13

urviving a breast cancer diagnosis isn’t just about receiving the best medical treatment. The road to survivorship involves physical recovery as well as social and emotional recovery. Enter the Healthy Steps program at CVPH Wellness Center.

Being a class made up of cancer survivors, Hum said, means that these ladies have all been through the same process and can share stories of hope and recovery with each other. Hum also noted that the women who participate are very strong and are still striving to keep up their recovery.

Originally funded through a grant received by the FitzPatrick Cancer Center at CVPH, Healthy Steps is a therapeutic exercise and movement program designed to help breast cancer survivors thrive after surgery or radiation treatment. Josephine Hum, occupational therapist and certiﬁed lymphedema specialist, supervises the exercise class, which runs Wednesdays from 1-2 pm at the CVPH Wellness Center on New York Road in Plattsburgh.

Some women, Hum said, do not have the social support system at home which is integral in recovery. Some are widowed, some are far away from family or do not have the strong family and friend network that other women do. Having this group is a lifeline to aid in the recovery process, Hum said, adding that the class is good for the emotional well-being of participants. It’s a place where women can talk and share opinions.

“Some are widowed, some are far away from family or do not have the strong family and friend network that other women do. Having this group is a lifeline to aid in the recovery process.”

Linda Cumm, a member of the group who had breast cancer in 1989, has been in the program for almost 4 years now. Cumm suffers from lymphedema and ﬁnds that the program is very beneﬁcial to her physical and emotional health.

According to Hum, the goal of an occupational therapist is to get people as independent as possible after an illness or injury. Women who have experience surgery or radiation treatment because of breast cancer can sometimes develop swollen arms and or chest area “I feel fortunate that we are able to be in it (Healthy Steps —Josephine Hum from the trauma of treatment. Lymphedema, which is an program). It’s been good for all of us. I would never give it up. As abnormal collection of ﬂuid just beneath the skin, can also occur long as it’s there I’m going to be there too.” Cumm said of the program. when the lymph nodes are removed. Hum said that women can also According to Cumm, the class is a real workout for seniors. The groups starts develop stiffness in the armor shoulder area after treatments as well. with stretching and works their way into activities like leg lifts and arm circles, which And while the physical part of the class is meant to deal with the physical symptoms that come with recovery, there is the added bonus of helping participants deal with the social and emotional stress that can accompany breast cancer recovery.

are meant to increase mobility and range of motion. Hum said these exercises are done slowly and gently, with low repetitions. The exercises can be done seated or standing, Hum said, and the program is adaptable to the participant. Balance exercises and cognitive exercises are also a part of the workout. Continued on page 19

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Talk therapy can help cancer patients heal

eceiving a cancer diagnosis can be a profound experience that often changes the course of people’s lives. Individuals react to cancer diagnoses in various ways, with some retreating into themselves and others sharing their stories to garner as much strength as they can muster.

Depression is not the only reason a cancer patient may want to speak with a therapist. Cancer also can bring rise to many issues that may be better addressed in a private, judgement-free zone. According to the American Cancer Society, some additional reasons to seek professional support can include:

A strong support system can help men and women navigate the ups and downs of a cancer diagnosis and subsequent treatments. While many people lean on friends and family members for support, therapists also can help patients as they battle cancer.

• trouble adjusting to the illness • feelings of social or familial isolation • family conﬂicts • concerns about quality of life • changes in perceptions of body image • feelings of grief • trouble communicating

Licensed therapists can help treat many of the mental side effects that often accompany a cancer diagnosis. Japanese researchers who reviewed the results of six studies that included 517 patients with incurable cancer and depression found that talk therapy was shown to help treat depression symptoms nearly as well as antidepressant medications.

In addition to addressing these issues, which are commonly referred to as psychosocial problems, therapists can work with individuals and families in other areas. Therapists can help their patients ﬁnd community resources where they can connect with others Continued on page 19

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Press-rePublican • Breast Cancer Awareness 2016 17

Genetic testing may detect cancer risk

ancer affects people from all walks of life. While there is no guaranteed way to prevent cancer, genetic testing can help individuals better understand their risks for certain types of cancer. Genetic testing has been developed for many diseases. Such testing looks for specific markers that can indicate the likelihood that a person will develop a specific disease. Genetic testing has been used to diagnose genetic disorders such as muscular dystrophy and fragile X syndrome. Genetic testing also is used to raise awareness about risk factors for Down’s syndrome. Since cancer sometimes appears to run in families, people with a family history of the disease may benefit from hereditary testing. Some genetic tests examine rare inherited mutations of certain protective genes that may be indicative of cancers of the breast or ovaries. These genes include BRCA1 and BRCA2. The National Cancer Institute says mutations in genes that control cell growth and the repair of damaged DNA are likely to be associated with increased cancer risk. It’s important to note that even if a cancer-predisposing mutation is present in your family, you will not automatically inherit the mutation. And even if you do, it is no guarantee that it will lead to cancer. The NCI says that mutations in hereditary cancer syndromes are inherited in three ways: autosomal dominant, autosomal recessive and X-linked recessive inheritance. Autosomal dominant inheritance occurs when a single altered copy of the gene is enough to increase a person’s chances of developing cancer. Autosomal recessive inheritance occurs when a person has an increased risk of cancer only if he or she inherits an altered copy of the gene from each parent. A female with a recessive cancer-predisposing mutation on one of her X chromosomes and a normal copy of the gene on her other X chromosome is a carrier but will not have an increased risk of cancer. Two mutations makes her more likely to get cancer. Men are less likely to get cancer from this mutation. Researchers continue to develop tests to examine multiple genes that may increase or decrease a person’s risk for cancer. Such tests may facilitate a proactive approach that can detect cancer before it spreads. If you feel you are a candidate for genetic testing, speak with your doctor. Risk is based on things like personal medical history and family history. Testing may be conducted by a trained doctor, nurse or genetic counselor. Patients will go through some sort of genetic counseling and be asked a number of questions about their lineage and the family history of the disease in different branches of their family trees, which will help to determine if further testing is warranted. Testing may be done on a sample of blood, cheek cells, urine, hair, amniotic fluid, or other bodily tissues. Results will be interpreted by experts, and the information will be shared.

Ways to improve quality of life during treatment

ighting cancer is the biggest priority for people when they have been diagnosed with the disease. After the initial shock of diagnosis has worn off, patients can then take their first steps towards recovery. Powerful chemotherapy drugs and radiation treatments can kill cancer cells and prevent them from spreading. Individuals may also need other medications to help mitigate the side effects of these treatments. According to the Mayo Clinic, stress, pain and fatigue can severely diminish quality of life during and after cancer treatment. What’s more, family members caring for cancer patients also may experience diminished quality of life. Incorporating some strategies during and after treatment can help cancer patients and their caregivers maintain a high quality of life. Exercise Exercise pays numerous dividends for cancer patients. Exercise may help keep cancer, particularly breast cancer, in remission. The American Cancer Society says physical activity has been linked to a 24

percent decrease in breast cancer coming back, and a 34 percent decrease in breast cancer deaths. Exercise also can affect the following: · balance · control weight · self-esteem · strength of bones · lessening risk of blood clots · reduction of nausea and fatigue Stress reduction Cancer patients also can benefit from therapies that promote the reduction of stress and anxiety. The Mayo Clinic studied formal sessions that promoted physical therapy, coping strategies or addressing spiritual concerns, and deep breathing or guided imagery to reduce stress. Those who engaged in these therapies showed marked improvement at a critical time in care. Exercise, talking about the cancer and reducing feelings of stress are important to maintaining quality of life during cancer treatment.

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Talk Therapy: Therapists specialize in offering support

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experiencing similar situations. And therapists can help patients learn about the various ways they can educate themselves about their disease. Some therapists may specialize in offering support, while others may focus on cognitive-behavioral therapy in relation to cancer-induced anxieties. Cancer patients have many options when the time comes to choose a counselor. Ask your cancer team to provide references or use the American Psychosocial Oncology Society (www.apos-society.org) or Canadian Association of Psychological Oncology (www.capo.ca) as a resources.

Side Effects: Discuss options with your physician Memory loss Breast cancer treatments such as chemotherapy, radiation therapy and hormonal therapy may contribute to memory loss. Ovarian removal or shutdown may also result in memory loss. Memory loss may also result from medications taken during breast cancer treatment. Breast cancer patients who plan to continue working during treatment should discuss with their physicians how to manage potential memory loss and may benefit from informing their employers about the potential for treatment-related memory loss. More information about potential breast cancer treatment side effects is available at www.breastcancer.org.

Healthy Steps: Tight-kinit group offers each other support “I’m doing better since I’ve been doing these things.” Cumm said of the memory exercises that are designed to help with the brain fog that sometimes comes with recovery. The social connection is evident in the group as well. There is always laughter according to both Cumm and Hum. The group forms a lifelong bond over music and movement. Cumm said that if a member misses a meeting, the group notices and is concerned. The group checks in on each other, making sure that everyone is doing okay. “We all care about each other. We’ve gotten to be kind of close.” Cumm said. Classes are open to anyone who is in recovery from breast cancer. More information can be found at the website www.cvph.org/Departmentsand-Programs/Cancer-Center/Healthy-Steps. You can also visit www. gohealthysteps. com for more information about the Healthy Steps program. Hum ccan be reached directly at (518) 562-4616 at CVPH Rehabilitation Services. Classes are held Wednesdays from 1-2 pm. Call for more information on the next 8-week session.

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High SCIENCE:

Medical Marijuana offers cancer patients a path to recovery that is less harsh on the body than conventional chemotheraphy. Story by Susan Acklen

Pain. Nausea. Anxiety. It’s the unpleasant reality of many cancer patients. There is an unusual type of relief for these symptoms. Relief found in an innovative treatment option. It’s called medical marijuana. Columbia Care, a company with dispensaries in Massachusetts, Illinois, Arizona, and Washington DC, opened four more in New York State within the last year, in Manhattan, Rochester, Riverhead and Plattsburgh. Located at 345 Cornelia Street, the facility provides a variety of products that dispense meticulously formulated chemical derivatives of the marijuana plant. Tinctures, capsules, vaporizers--everything except leaves. “Leaf products are not available in New York State,” says the company’s CEO Nicholas Vita. “Although the products sold are based on the leaf products, they’re botanical extracts.” “New York State‘s regulations are very,very rigorous. We manufacture pharmaceutical grade products that are not only tested by us but by the state and they do that independently to verify stability. Microbial content. Consistency. Presence of heavy metals. Anything that you could think of.” “We strip out and basically extract

chemicals and actually formulate the chemical composition to try to limit the effect of certain chemicals,” he continues. “That’s one of the benefits New York has because its products are actually formulated rather than just stripped off a plant.” So what does medical marijuana do? One of the most frequently prescribed medications issued by oncologists is for treatment of anxiety. Anxiety and sleeplessness are very common among cancer patients due to the stress of the illness. “There are certain chemicals within the marijuana plant that actually are very good at relieving stress,” says Vita. There are certain formulations of the compounds that have antipain applications. “Of our oncology patients, 99% of them say that our products treat their pain better than the standard of care.” says Vita. Nausea is commonly associated with cancer treatment. “It happens to be a very strong anti-emetic and reduces the nausea effect,” he maintains. Loss of appetite often occurs during cancer treatment. “It’s an appetite enhancer, which is obviously very positive when you’re going through chemotherapy. So how does a breast cancer patient go

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about obtaining medical marijuana? Not by prescription. Because it is not FDA approved, it is by recommendation. “Recommendation is provided by the physician,” explains Vita. “You give it to a patient, the patient then registers with the state and the state provides a legal license to access the facility.” The patient then makes an appointment with the dispensary. Upon arrival the patient must present his or her legal license, where it is electronically scanned. They may then enter the building to purchase the particular formulation of medical marijuana recommended by their physician. The cost? It varies depending on the patient’s needs A tincture, for example, which may last for a week or a month, according to the patient’s illness, costs around $50. Insurance does not cover medical marijuana. For more information, visit colcareny.com.

“99% of [our patients] say that our products treat their pain better than the standard of care.”

Exercising after breast cancer

outine exercise is an essential element of a healthy lifestyle. Exercise can help people maintain healthy weights, reduce stress and lower their risk for various diseases. After surviving breast cancer, many survivors wonder if it’s safe to return to the exercise regimens they followed prior to being diagnosed. Breast cancer survivors can benefit from exercise, but it’s important that they prioritize safety when working out. Survivors who have had breast cancer surgery may be at risk of lymphedema, a condition characterized by swelling of the soft tissues of the arm, hand, trunk, or breast. That swelling is sometimes accompanied by discomfort and numbness, and some people dealing with lymphedema also experience infection. Breastcancer.org, a nonprofit organization dedicated to providing up-todate information about breast cancer, notes that some exercise may be especially risky for breast cancer survivors. These exercises include:

• certain yoga poses, including downward-facing dog and Inversions, that put ample weight on the arms • elliptical/cross-training machines • cross-country skiing • tennis While breast cancer survivors might want to avoid certain types of exercise, it’s important to note that the American Cancer Society recommends exercise after breast cancer surgery. But exercise should be approached with safety in mind, and breast cancer survivors should heed the following tips to ensure their exercise regimens do not compromise their recovery. Discuss exercise with your physician and surgeon. Before making exercise a part of your post-recovery routine, speak with your physician and surgeon to determine if there any movements you should avoid. Your doctor and surgeon can tell you how you will be affected by medications you might be taking as part of your continued recovery.

Before you make exercise a part of your post-recovery routine, speak with your physician to dertermine if there are any movements you should avoid.

• swimming laps using strokes with arm movements • activities that involve the usage of resistance bands • pull-ups and push-ups

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breaking through the duct walls and invading fatty breast tissue. IDC, which accounts for 80 percent of invasive cancers, can remain near the site where the tumor originated, but cancerous cells also may enter the bloodstream or lymphatic system and spread anywhere in the body. • Infiltrating lobular carcinoma, or ILC, is considerably less common than IDC, accounting for roughly 10 to 15 percent of invasive breast cancers. ILC begins in the lobules and milk glands before spreading in much the same way as IDC. Some breast cancer cases may be classified as both noninvasive and invasive. Such a classification means that part of the cancer has grown into normal tissue while another part of the cancer has stayed within the milk ducts or lobules. Doctors developing treatment plans for such cases will treat them as invasive cancers. It’s easy for men and women to be overwhelmed when diagnosed with breast cancer. But understanding the disease can make it easier to comprehend treatment plans and beat the disease.

Invasive vs. Non-Invasive Managing your chemotherapy records breast cancer

pon diagnosing a patient with breast cancer, a physician will order a series of tests in order to get a profile of the breast cancer, including how it looks and how it is likely to behave. These tests are typically conducted over the course of several weeks, and each time a test is conducted, the doctor will receive a pathology report that helps the doctor map out a course of treatment. The pathology report also may help breast cancer patients better understand their disease and why their doctor is choosing one course of treatment over another. A pathology report can reveal a host of information about a patient’s breast cancer, including whether that cancer is noninvasive

or invasive. This is an important distinction, as treatment plans for noninvasive and invasive cancers can differ significantly.

Noninvasive breast cancers stay within the milk ducts or lobules in the breast. This is significant, as breast cancer is very treatable when detected early and tests find only localized, noninvasive tumors. Invasive breast cancers are those that spread outside the membrane of the lobule or duct and into the breast tissue. The cancer can then spread into the lymph nodes in the armpits or beyond. Invasive breast cancers are more common and are most often one of two types. • Invasive ductal carcinoma, or IDC, starts in a milk duct before

reastcancer.org, a nonprofit organization dedicated to providing reliable, complete and up-to-date information about breast cancer, recommends breast cancer patients keep separate records for each round of chemotherapy. Make each record as detailed as possible, including the following information so you have an accurate and accessible account of your chemotherapy treatments. • name, address and phone number of institution where chemotherapy was given • dates of chemo • medical record number • name and phone number of doctor who supervised your chemotherapy nurse or nurse

practitioner’s name and phone number • type of central line, if applicable • name of treatment protocol or clinical trial • name of medication • dose received each session • number of doses • cumulative dose • how medicine was given (as a pill, IV through a peripheral vein, IV through a central line, lumbar injection, etc.) • antinausea medicines used • allergic reactions, if any • adverse reactions, if any • change in dose or medicine because of adverse reactions

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