Breast cancer
awareness
October 22, 2018
A SPECIAL SUPPLEMENT TO THE
Press-Republican
“A tiny little calcification. There were a ton of them. Only one looked cancerous.” Kelly Timmons
Also Inside: ‘Everybody’s story is different’ Self-exam was key to revealing breast cancer. Page 9
‘It’s a long journey, a life-changing journey’ Plattsburgh woman has new outlook after cancer battle. Page 11
Kelly Timmons poses with her sister, Tracy Burnham, while wearing their breast-cancer awareness t-shirts. Read Kelly’s story on page 5. PHOTO PROVIDED
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Press-Republican • Breast cancer awareness
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We would like to encourage all women to seek regular mammograms ~ Clinton County, Essex County and Franklin County employees of
Press-Republican • Breast cancer awareness
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Press-Republican • Breast cancer awareness
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monday, October 22, 2018
Breast cancer
awareness A publication of the Press-Republican
Inside the 2018 edition: 5
Tiny calcification leads to double mastectomy for Peru woman
9
Self-exam was key to revealing cancer
11 Plattsburgh woman has new outlook after cancer battle 15 Experts take on eight common breast-cancer myths 19 Chemotherapy ‘personalized’ through targeted treatments 21 A glossary of terms to help decipher the terminology Contact Information
specialpubs@pressrepublican.com
Publisher
Brad Bailey Produced by
Features Editor Nathan Ovalle Edited by
Lois Clermont Editor Suzanne Moore Features Editor Nathan Ovalle Contributing Writers
Editor Suzanne Moore Josh Miner Toni Smith
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To read the online edition, go to wwww.pressrepublican.com and scroll down to the Special Publications section of the site.
monday, October 22, 2018
Press-Republican • Breast cancer awareness
‘A tiny little calcification’
5
Mammogram leads to double mastectomy for Peru woman
T
BY SUZANNE MOORE Editor
he cancer was tiny, so minute, that Kelly Timmons never felt a lump. A mammogram caught it in a duct in her left breast; she’d had no suspicion it was there. “A tiny little calcification,” Kelly said. “There were a ton of them. Only one looked cancerous.” As she underwent a needle biopsy at University of Vermont Health Network, Champlain Valley Physicians Medical Center Women’s Imaging Center in Plattsburgh, a dot of titanium was placed at the spot to signal the exact location of the suspicious cells. The Peru woman, 53, got her diagnosis Aug. 24, 2017. The cancer was so minuscule that, before undergoing a lumpectomy on Aug. 31 at CVPH, Kelly was first sent to Women’s Imaging to have a tiny “needle” of titanium inserted to show the surgeon where to go. “They did it under magnification so he knew exactly where that titanium piece was,” she said. “I wasn’t even worried at all,” she said of those early days with a cancer diagnosis. SECOND OPINION But tests of the tissue surrounding the area excised by the lumpectomy didn’t signify “all clear.” “They want a certain margin around the cancer area showing no cancer,” Kelly said.
A sample sent to the Mayo Clinic came back positive. By then, her casual acceptance of that tiny bit of cancer had evolved into growing nervousness. She underwent a second lumpectomy. The surgeon removed as much of the breast as he could without performing a full mastectomy. “There was no clear emergence” in these results, either, Kelly said. Her oncologist in Plattsburgh recommended radiation. TEAM EVALUATION But she opted to get a second opinion at the UVM Breast Care Center in Burlington. With her daughter, Kaitlyn Timmons; her sister, Tracy Burnham of Gansevoort; and mother, Diane Donivan of Morrisonville, Kelly saw an entire team that day. “The team was phenomenal,” she said. “There were social workers, counselors, financial planners — they were there for any questions I had.” In the end, oncologist Dr. Seth Harlow recommended a full mastectomy. Or, if Kelly didn’t want to go to that extreme, he offered a third lumpectomy, along with radiation. OUT OF WHACK While a sonogram showed no cancer in her right breast, Kelly opted to err on the side of caution and Continued on page 6
Kelly Timmons with her son, Brandon, and daughter, Kaitlyn, who have supported her throughout her breast cancer journey. They also tested positive for the abnormal PALB2 that increases risk for breast and pancreatic cancer but are now better armed against possible diagnoses.
PHOTO PROVIDED
Press-Republican • Breast cancer awareness
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chose to have a double mastectomy; surgery was set for November. But complications came from an entirely unexpected source: a tick bite. Symptoms that included high fever, body aches and severe migraines sent her to the CVPH Emergency Department. But it was too soon after the bite for Lyme disease to show itself, she was told. Then, when she went to Vermont for bloodwork in advance of the double mastectomy, scheduled for November, something wasn’t right. “My bloodwork was all out of whack,” Kelly said. INTERRUPTION While she had decided on the surgery in Burlington, Kelly had remained under care, too, at Fitzpatrick Cancer Center, where the support she received bolstered her health and her emotional strength. The day she got her diagnosis, she was intro-
duced to Patti Johnson, who handed her a thick book packed with information. “She explained everything to me,” Kelly said. “She was phenomenal as well.” In the midst now of a strange illness that landed her in bed for a couple of days, left her feeling better then sick again, she relied on the staff there for help. In fact, Kelly was seeing nutritionist Charlotte Gosrich there one day when her fever spiked. “I just felt myself fading,” Kelly said. “My mother said I turned white as a ghost.” Johnson got her to the ER, where her temperature topped 104 degrees and, after X-rays, a spinal tap and other tests, infectious-disease specialist Dr. Keith Collins diagnosed her with anaplasma phagocytophilum, another tick-borne disease. “I was the fourth person in Clinton County to get it,” she said. She was hospitalized for five days; her mastectomy surgery was canceled. “I was very depressed,” she said. “It was a
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rough time in my life — I wanted to get surgery over with so I could go back to work.” PINK TIARAS But Kelly embraced the recommendations and offerings of the Fitzpatrick Cancer Center, joining the Treasure Chests support group and finding fellowship and support from other women with breast cancer or who have had the experience. Kelly, who worked at Pfizer in Rouses Point for 19 years, was between jobs when she was diagnosed. And school taxes were coming due. Cancer Center social worker Stacey LaFave helped her find financial assistance. There are many programs out there for that kind of need, Kelly noted, including the American Cancer Society. Last October, she and her mother were among the ladies treated to the Women’s Health and Cancer Conference in Burlington by Fitzpatrick. “They bought us all pink tiaras, pink beads;
Continued on page 7
monday, October 22, 2018
Press-Republican • Breast cancer awareness
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Continued from page 6 there were survivor or caregiver buttons.” And she left a day’s worth of seminars with a whole notebook of valuable information. RECONSTRUCTION CHOICES Then there was the decision on what type of breast reconstruction to choose. Kelly wanted flap surgery, which involves using tissue from the patient’s own body, usually the abdomen, to create a new breast mound. But a CT scan in Burlington showed her blood vessels weren’t strong enough. Again, Kelly sought a second opinion. On Jan. 2, friend Dee Davis drove her and her mom to DanaFarber Cancer Institute in Boston, where physicians said the procedure could be performed. But her health insurance wouldn’t pay for it. It was really too far away anyhow, Kelly decided. FAMILY AND FRIENDS Kelly’s double mastectomy was now set for late March, and her family stepped up its support. Her son, Brandon, moved in with her ahead of the surgery; her friend Kim Pisall came from Virginia and was there two weeks, including the day Kelly was wheeled into the operating theater at the Vermont hospital. So were Kelly’s mom; sister; ex-husband, Tim Timmons; Kaitlyn and her fiancé, Kolby Keysor; and friends Molly Lamora and Lisa Smith. “I had a lot of support,” Kelly said, laughing. That made the Hope Lodge, which
Kelly Timmons and her mother, Diane Donivan, all pinked up for the Women’s Health and Cancer Conference in Burlington.
PHOTO PROVIDED
provides free accommodation to cancer patients and their loved ones, all the more important. Discharged 24 hours after the surgery, Kelly joined her family and Kim there. Then she returned home to an electric recliner, compliments of cousin Tina Howard, and was ensconced there for two months. “I slept there, I ate there — that’s where I lived,” she said. “That chair was a godsend to me. It really saved my body.”
DON’T MOVE YOUR ARMS The pain was intense. “It took my mom and Kim — both of them — to get me out of bed because I was in so much pain,” Kelly remembered her post-op time in Vermont. And for six weeks, she had to keep her arms in the T-rex position (elbows at sides) to promote proper healing. “I had everybody yelling at me, ‘Don’t move your arms!’ They did everything for me,” she said.
“My daughter and my mother and my friend Kim even had to bathe me — you appreciate your family and friends when they have to go through something like that.” IMPLANTS TO COME After Dr. Seth Harlow removed Kelly’s breasts, plastic surgeon Dr. Robert Nesbit performed the reconstructive surgery, including
Continued on page 8
Press-Republican • Breast cancer awareness
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the addition of temporary tissue expanders. So every two weeks for three months it was back to Vermont; each time, saline was pumped in to gradually expand muscle and skin to make room for the silicone implants Kelly will receive in December. Meanwhile, she has worked to support her own recovery, continuing to attend Treasure Chest meetings. And in July, she joined a Next Steps fitness program at the CVPH Wellness and Fitness Center at PARC, working with weights to strengthen her abdomen in anticipation of her next surgery. She helped plan the Making Strides Against Breast Cancer walk, held yesterday. And as a first step toward returning to work, she is selling It Works health and beauty products from home. “I’m still discombobulated,” Kelly said. “I feel like I need to be going back to work.” But there’s something else she needs to do, too. GENE TESTING Testing showed Kelly has an abnormal PALB2 gene, which according to a study referenced on breastcancer.org, increases the risk
breast exams yearly starting at age 25 and begin having mammograms at 30, rather than the recommended age of 40 to 45. While Brandon, 28, has a chance of developing breast cancer, his risk is less, Kelly said. Thinking of her own experience, she wishes Kaitlyn could begin mammograms sooner. “Breast exams are always important,” she said. “But I had it in my ducts — I would not have known if I hadn’t had a mammogram.”
Kim Pisall (right) used a two-week vacation to be with her friend, Kelly Timmons, coming from her home in Virginia to support her.
PHOTO PROVIDED
of breast cancer in women, overall, 9.47 times more than average. “Women with an abnormal PALB2 gene had a 14 percent risk of developing breast cancer by age 50 and a 35 percent risk of developing breast cancer by age 70,” the site said, citing research published in the Aug. 7, 2014, issue of the New England Journal of Medicine. “It’s a pretty unknown gene they’re doing a lot of research on,” Kelly said. After the gene showed up in her DNA, her sister, Brandon and Kaitlyn were tested, too. Burnham proved negative for the abnormal PALB2 gene, but both her son and daughter inherited it.
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Kelly and her kids met with Dr. Marie Wood, who heads the Breast Care Center, and genetics counselor Wendy McKinnon soon after the results came back, to make a plan. Kaitlyn, 23, will undergo two
PROACTIVE APPROACH PALB2 can also trigger pancreatic cancer, Kelly added. In January, she has an appointment to see gastroenterologist Dr. Richard Zubarik in Burlington to learn more about that. “I hope to be part of a study,” she said, “as he’s doing research on it.”
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Monday, October 22, 2018
Press-Republican • Breast cancer awareness
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Self-exam was key to revealing cancer T
BY TONI SMITH Press-Republican
here’s something to be said for the bond between twins. For Janice Loveless, that bond is what helped her detect breast cancer early enough for treatment. Her twin sister, Janet Calipari, had called one day back in early spring complaining about pain in her own breast, prompting her to ask Loveless when she had had her last mammogram. Loveless, who had been performing breast self-exams throughout her life but hadn’t had a mammogram in four years, did a self-exam. Instinctively, her hand went right to the spot where there was a lump. She called to schedule the test. After that, the process was quick — from mammogram, to sonogram, to biopsy, to surgery took perhaps a few weeks. The lump was removed cleanly, but to be safe, Loveless has been doing chemotherapy and radiation since April, when the West Chazy woman was diagnosed with Stage 1 breast cancer. Doctors told her she had caught it very early. She completed her treatment in mid October. “It’s kind of a unique story. My sister likes that I tell it. If my sister hadn’t said anything, I don’t know when I would have found it (the lump),” Loveless said. “That’s why I tell everyone, ‘Be sure you do your self-exams.’” Calipari’s own mammogram, for that pain she’d been having, turned out clear. DIFFICULT TO DISCUSS In the beginning, Loveless kept the
Janice Loveless (center) takes a minute to talk with staff at Fitzpatrick Cancer Center in Plattsburgh after a recent radiation treatment. The West Chazy woman’s breast cancer might have been detected much later had her twin sister not felt breast pain then urged her to have a mammogram. With her here are radiation therapist Haleigh Weiner (clockwise from left), licensed practical nurse Sonia LeClair, radiation therapist Emily Vanderveeken and registered nurse Lynn Trombly.
SUZANNE MOORE/STAFF PHOTO
diagnosis to herself. She didn’t want everyone on Facebook, or even her close friends, to know what she was going through. She had feelings of shock and denial and couldn’t believe this was happening to her. During the process, she and her twin juggled being a caregiver for their mother, Elizabeth Clark, of Potsdam, who had developed lung cancer. Fortunately, her mother is cancer free now. The family is waiting to get the all clear on Loveless. SUPPORT GROUP Now that she is at the point where
can share her diagnosis without getting choked up, Loveless said, she is able to attend Treasure Chest support-group meetings that are held at University of Vermont Health Network, Champlain Valley Physicians Hospital in Plattsburgh. She has found a new group of friends who can empathize with her struggles as she finishes her chemotherapy and radiation treatments and as she enters the next step: survivorship. She is grateful for the experiences and people she has met. Loveless said there are survivors of all different levels in the group, some with only a few cancer-free years and some with
many years of living and thriving postcancer. “Everybody’s story is different, but it is nice to know somebody that has gone through it, (that they) can help with any issues you have,” Loveless said. Loveless has attended group meetings that focus on nutrition, which for someone with hormone-related breast cancer can be crucial in maintaining a cancer-free diagnosis. She also found a yoga and mindfulness workshop to be very helpful in dealing with the process of
Continued on page 10
Press-Republican • Breast cancer awareness
10 Continued from page 9 chemotherapy and radiation. “It was wonderful,” she said of the workshop. “It is geared toward cancer patients.” BACK ON TRACK Loveless is getting back to her routine, returning to her job in mid October.
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In the future, she hopes to become more involved with the support group so she can share her experiences with others who are newly diagnosed. Her ability to have a positive outlook throughout treatment and recovery, combined with skills learned from being a customer-service representative, could help those who felt as she did when she first
received the news. “I really want to make a difference. I’ve been through it; I know what it’s like, and I just want to help others,” Loveless said. NEW HOBBY As a result of her diagnosis, she recently has taken up painting, something she always wanted to do but was
Monday, October 22, 2018
too afraid to try, joking that her twin is the “craftier” one of the pair. It is an activity that she really enjoys, and she hopes that something comes out of it for the future. Loveless is taking a new approach to Purch everything. g “Life is too short to worry about what Purch other people are thinking; just go do it. g That’s what my new philosophy is.” Give you
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Press-Republican • Breast cancer awareness
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‘It’s a long journey, a life-changing journey’ Plattsburgh woman has new outlook after cancer battle
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BY JOSH MINER Press-Republican
ee Sorensen never wanted breast cancer, but she wouldn’t change what happened even if she could. In 2013, the Plattsburgh woman was doing everything she could to lead an active, healthy life. That December, only two weeks after a routine breast exam was negative for cancer, she had a mammogram that would change her life. While the doctor conducting the physical exam was unable to feel the cancer weeks earlier, Sorensen could see the calcification in her breast during the mammogram. Sorensen, who was 43 years old, knew instantly that something wasn’t right. “You could see the image as they’re doing it, and I looked,” she said. While she couldn’t detect a mass or a tumor, her intuition told her something was off. She had a feeling the extra images taken meant something wasn’t right. Those fears would be confirmed in January. “When they called me back, I think they assumed that I knew I had a mass, and I didn’t. Then they did an ultrasound, and they biopsied right then and there. Which is good, because you don’t want to have to come back,” she said. “I told him he could call me at work, and he did. And so then he told me. I said, ‘Whoa, what did you just say? Did you just say I have cancer?’”
Lee Sorensen credits her fight against breast cancer with a life lesson learned; she no longer gets upset at the little things.
JOSH MINER/STAFF PHOTO
That’s when Sorensen’s life changed forever, beginning the most difficult journey she had even known. While the cancer was only in her left breast, she opted for a double mastec-
tomy, performed at the same time as her reconstruction surgery. STRONG SUPPORT Sorensen was soon overwhelmed by an outpouring of love, including from
her employer, Pfizer. She’d worked at the pharmaceutical plant in Rouses Point for nearly 19 years. In addition to the emotional support Continued on page 12
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during her six months off of work, Pfizer sponsored a fundraiser to help her with the costs. “People that you don’t think would step up, they do,” she said. DIFFICULT TO EAT That March, she started her chemotherapy. While she expected to make weekly trips to Vermont for treatment, she was thankful to find an open slot here in Plattsburgh at the Fitzpatrick Cancer Center. Her boss and one of her closest coworkers were a constant support for her during this time, bringing her to and from her treatment sessions. Afterward, they would take her to restaurants to try to get her to eat, although for several days after the treatment she would have a hard time eating or drinking anything. There were times, Sorensen said, where she couldn’t even finish a single saltine cracker over the course of an entire day. Still, the encouragement and strength her Pfizer
family gave her helped her through some of her darkest days. “You realize there is a lot of support,” she said. “They were willing to do anything.” With Stage 1 breast cancer, she wasn’t required to go through radiation treatment. However, the chemotherapy caused her to lose her hair and drop from 120 pounds to 108. TOUGH TIMES Her family was also there every step of the way. Her ex-husband, with whom she shared a home, and her college-age daughter were a further source of strength, bringing her to appointments and supporting her emotionally. “She probably saw me at my lowest point,” she said of her daughter. “It was hard not to break down, but it was kind of good because she could see that I am just a person; I’m not just a mother.” Sorensen said she became open about her conversations about breast cancer and didn’t shy away from most aspects of it.
Monday, October 22, 2018
With her two youngest children, who were about 10 and 6 years old at the time, she was a little more careful with her words. “At first, I didn’t say much; I didn’t want to put the word cancer out there,” she said. “But eventually I had to say it.”
MOVIE HELPED After they became aware of what their mother was going through, it wasn’t long before a an unlikely source put her mind at ease. Something about “Guardians of the Galaxy” caught her eye, even though Sorensen admits she doesn’t normally watch those types of movies. While on a family visit to her mother, she offered to rent it. “I didn’t know the movie opens up with the mother dying of cancer.” Sorensen remembers her younger kids both turning to look at her with worried faces, asking if this meant she was dying.
Continued on page 14
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Press-Republican • Breast cancer awareness
14 Continued from page 12 “I was like ‘Oh no, no, no, no, you guys, I’m good!’” Thinking she was about to have a heavy conversation, she was surprised at their reaction. “They looked and me and go, ‘Oh, OK,’ and I’m, like, ‘Well, that was easy! Wow, really? OK,” she laughed. TURNING POINTS While the conversation was easy at the time, it becomes more difficult now that her youngest daughter is becoming a teen. With her own breast cancer becoming an increasingly distant memory, her daughter is seeing the prospect of a breast-cancer diagnosis of her own as a real possibility. “I’m having to realize that it’s not really over. I feel like life is back to
normal and it’s all good, but I didn’t realize that I still need to have that conversation with them as they have turning points in their life.” EDUCATING OTHERS She encouraged friends and family members to feel the mass before it was removed, in order to educate others about what a tumor really feels like. Her open approach eventually encouraged other people in her life to open up about their own experiences. Sorensen became a certified tumor registrar at CVPH after completing her treatment, allowing her to see breast cancer from the other side. Now that she is helping others find and deal with their own cancer, she’s in a position to help those in situations much like her own. Still, she said, no two patients will have the same experience.
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CHANGED While her friends and family went all out to take care of her, it was also the hardest part of the experience. Sorensen admits she used to be very tightly wound. With a Type A personality, she was used to always being the one in control.
“It’s hard to sit back,” she said. Being forced to take a step back for once and let others take care of her was frustratingly difficult. However, she said it allowed her to gain a new perspective. “It’s a long journey, a life-changing journey. For me, it was worth it,” she said. “I think I’ve relaxed. I’m just going to go with the flow.” With an entirely new outlook on life, she no longer gets upset at the little things. “I needed to learn that life lesson. I don’t think I would have learned it if I hadn’t gone through (this). “It’s sad to say that I was that stubborn. But I hope I learned what I was supposed to learn, and I know I continue to learn. “That’s why I think that I wouldn’t undo it, for me, because I feel like it put me in a better spot.”
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“Be aware. Don’t be afraid to ask questions. Always make the best decisions for yourself,” Sorensen says to those going through cancer treatment. “Everybody’s journey is so different.” Before her diagnosis, she never performed self-exams. She now encourages those in her life to listen to what their body is telling them and believes that men should be the first line of defense for their partners. “For me, it’s like: ‘OK, men, if you’re going to be touching your woman, you might as well do that at the same time.’”
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Press-Republican • Breast cancer awareness
Monday, October 22, 2018
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Experts take on eight common breast-cancer myths BY JOHN ZAKTANSKY The Daily Item (Sunbury, Pa.)
A
breast cancer diagnosis can be a scary experience for a variety of reasons — but Cheryl Donlan suggests not letting certain myths and misconceptions add to the anxiety. “A breast cancer diagnosis does not mean impending doom. It does not mean you have to put your life on hold,” she said less than a year after a 2-centimeter malignant tumor was found in her left breast. “A diagnosis can put your life into perspective and can make you realize everything you have for which to be grateful.” Donlan, the program director for ARC Susquehanna Valley, emphasized that each person experiences the process differently. For her, one of the main misconceptions during her 10-month process of treatments — which included a lumpectomy, chemotherapy, radiation and a mastectomy — was just how bad the chemo treatments would be.
“I had some preconceived notions about the effects of chemo. I thought I would be incredibly nauseous and tired. To my surprise, I wasn’t fatigued and never vomited,” she said. “I learned that you should think of chemo not as poison, but as tiny butt-kicking ninjas being set loose in your blood to attack and kill cancer cells.” Dr. Rosemary Leeming, of Geisinger Medical Center, Dr. Susan Branton, medical director of the Kathryn Candor Lundy Breast Health Center through UPMC Susquehanna, and Dr. John Turner, of the Thyra M. Humphrey Breast Center at Evangelical Community Hospital, all agreed that there are a variety of misconceptions that infuse unnecessary fear into breast cancer patients.
1. Breast cancer is not a death sentence. “A vast number of cases — especially those who are diagnosed via a screening — are treatable and even curable if caught early,” Leeming said. Even for those who have dealt with breast can-
cer and eventually have a recurrence — which is statistically small — that recurrence isn’t a death sentence, according to Turner. “People don’t die from tumors in breast, they die from cancer that’s in the breast and goes elsewhere,” he said. “A recurrence does not have to be deadly. If we find it early — in Stage 1 or Stage 2 — survival rate is upwards of 90 percent. It is about as good a survival rate as a primary cancer diagnosis.” 2. By the time you get to five years of being breast cancer-free, you can not assume you are cured forever. “The highest chance of recurrence is three to five years, but you need to stay vigilant forever,” said Leeming. I have seen a new breast cancer develop or a recurrence 30 to 40 years later. This isn’t to scare anyone and not the norm, but something to keep in the back of your mind. Keep up with those
Continued on page 16
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Press-Republican • Breast cancer awareness
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checks and screenings.” Branton agreed that patients need to maintain vigilance. “Many cancers are curable, but long-term monitoring is still recommended,” she said. “In most cases, being ‘cured’ of cancer takes time, and the longer someone is cancer-free, the better the chance it will not come back.” Women who have been diagnosed with breast cancer are more likely to have a breast cancer recurrence than those who have not had breast cancer before, Branton added. “Sometimes, a patient’s cancer can be ‘cured,’ but just by having that type of cancer raises their risk of other types of cancer — for example, those with a family history of breast cancer may also have a high risk of ovarian cancer as the two cancers can be related,” she said. 3. Mammograms are not foolproof. “Mammograms are the most effective screen-
ing tool for breast cancer in patients of average risk and they are an excellent screening tool, but they are not ‘foolproof.’ No study is,” Turner said. “Screening mammography does lower the death rate from breast cancer significantly.” Leeming agreed. “Mammograms don’t pick up all breast cancers. These days, we are required by law to tell women about their breast density. We can miss cancers in dense breasts without additional screenings,” she said. “Personally, I recommend that everyone gets comfortable with self-breast exams and if there is anything on the exam you are uncomfortable with, make sure to tell your doctor so additional imaging can be done as needed.” That isn’t to say that mammograms aren’t important, Branton added. “They serve to aid in the process of early cancer detection when a cure is much more possible. Screening mammograms can detect or at least start the process of detecting 80 percent of breast cancers,” she said. “A negative mammogram should never encourage women to forego sub-
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sequent mammograms or not report changes or symptoms in her breasts. False negatives may be higher in women with dense breasts, which is why 3-D mammograms or tomosynthesis is now the recommended screening mammogram modality.” 4. There is not an epidemic of young people getting breast cancer. “Every time you see a young woman in the news getting diagnosed, it can cause a stir, but breast cancer is definitely much more common as you get older,” said Leeming. “About 6-7 percent of breast cancers are diagnosed below the age of 40,” said Turner. “Breast cancer in young patients is sometimes more advanced at the time it is found due to the limitations of assessment in dense breast tissue in this age group and because younger patients may ignore warning signs because they do not think young women can get breast cancer.” Women who have a family history of breast
Continued on page 17
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Press-Republican • Breast cancer awareness
Continued from page 16 cancer or some other predisposed risk may be recommended to start screening earlier, although that may change the screening process in some cases. “Younger women tend to have denser breasts, so traditional 2-D mammograms may not be recommended,” said Branton. “They may be directed to have a 3-D mammogram or ultrasound.” 5. While breast cancer is far more frequent in women, men can be diagnosed. “Incidence of breast cancer in men is at about 1 percent,” said Turner. “Most breast cancer in men occurs between the ages of 60 and 70,” added Branton. “We don’t recommend men get screened as women do, even those who have the RCA mutation, we don’t typically recommend mammograms,” said Leeming. “However, if men are aware of something in a breast, they should get it checked out.” 6. Even if you have a double-mastectomy, you still need to be aware that breast cancer can occur. “It depends on what the diagnosis was on the initial cancer, and while removing a breast may reduce the chance of getting a cancer in the future, it doesn’t do anything to protect you from the cancer you’ve already gotten,” Leeming said. “If it is aggressive and moving to your lymph nodes, the prognosis won’t be helped by removing the second breast. As surgeons, we can do a second mastectomy, but we owe it to our patients
to educate them on how it benefits them — or won’t require chemo, but sometimes small tudoesn’t.” mors can be aggressive. It really depends on the “Undergoing a bilateral mastectomy drastically type of cancer, where it is and how it is developreduces your chances of breast cancer recurrence ing,” said Leeming. since almost all of your breast tissue has been Turner agreed. removed,” said Branton. “There is a very small “Every case is managed individually,” he said. chance that residual breast tissue or cancer cells “Today, more than 80 percent of breast cancer could recur on the chest wall. That is why it is patients do not require chemotherapy and the important to continue with self-breast exams, majority (78 percent at Evangelical) choose see your doctor on a regular basis for partial mastectomy/ lumpectomy over examinations and report any breast mastectomy.” “We try to treat changes to your doctor.” “Mastectomy lowers the 8. There is debate within every cancer personally. Some future risk of breast cancer the medical community people think that because a cancer by 90 percent. This is a about the frequency of is small, it won’t require chemo, but viable option in patients mammograms. sometimes small tumors can be with a harmful ge“Here at Geisinger, aggressive. It really depends on the netic mutation, but in we follow guidelines type of cancer, where it is and how it patients with a breast by larger institutions is developing.” cancer on one side do such as the American not gain an improved Society of Breast Sursurvival by removing the geons that recommends - Dr. Rosemary Leeming, opposite breast along with starting mammograms Geisinger Medical Center the breast with cancer,” said at age 40 and getting them Turner. “Given that there is done annually,” Leeming said. a low risk of breast cancer in the “There is debate about that, some opposite breast compared to patients based on scientific research on how fast with high risk from family history, genetic mucertain cancers develop and some suggest it is OK tation, etc., contralateral mastectomy conveys to get a mammogram every other year, but there minimal if any risk reduction when done along are exceptions for that so we stick with the recomwith a mastectomy for the breast with cancer.” mendation of doing them annually after age 40. “The real question comes on when to stop 7. Every breast cancer will not require chemo- screenings, and I usually say to stop when you likely wouldn’t do anything about a diagnosis of therapy, radiation and surgery. breast cancer if it is found. Some people develop “We try to treat every cancer personally. Some people think that because a cancer is small, it it in their 90s.”
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Press-Republican • Breast cancer awareness
Monday, October 22, 2018
19
Chemotherapy ‘personalized’ through targeted treatments BY RANDY GRIFFITH The Tribune-Democrat (Johnstown, Pa.) JOHNSTOWN, Pa. – It’s not just chemotherapy anymore. Advances in medical oncology have individualized treatments based on molecular makeup of cancer cells. “The way we treat patients is quite different compared to when I was a medical student,” medical oncologist Dr. Ibrahim Sbeitan said at Conemaugh Memorial Medical Center. “It is much less toxic, with much better survival.” Improvements in both the cancer drugs and those used to treat side effects have made traditional chemotherapy more tolerable, but doctors see the future in targeted treatment and
immunotherapy. “We are doing a lot more with immunotherapy in breast cancer,” oncologist Dr. Sheetal Higbee said. “It is activating the body’s own immune system to fight the cancer. We are turning away from (traditional) chemotherapy.” “There is nothing like our own immune system to fight the cancer,” Sbeitan added. Everyone’s body produces cancer cells, Sbeitan explained. Normally the body’s immune system fights the cancer much as it fights viruses. Tumors develop because the immune system no longer recognizes the cancer, he said. “Cancer fools the immune system,” Sbeitan said. “Immunotherapy removes a shield from the cancer cells so
the cancer cells are recognized as bad cells.” Targeted treatments are based on research identifying how proteins or genetic components of cancer cells function. Targeted therapy agents seek to interrupt the function and respond, Sbeitan said. “Most people who have advanced cancer, we send the specimen for testing,” he said. “Cancer happens because there is a mutation. The goal is to find the mutation.” Much of the targeted treatment research is in the early stages. “It is still an ongoing process,” Sbeitan said. “Often, you find multiple mutations. You don’t know what is the driver mutation and you don’t know what is the passenger mutation.” Researchers are continuing to look
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Press-Republican • Breast cancer awareness
Continued from page 19 Pa. “It can really change who will benefit from chemotherapy. “It used to be the same treatment for everybody. Now it’s so personalized.” The advances have been gamechanging, Johnstown breast surgeon Dr. Patti Ann Stefanick said. “When I started, there were three or four (chemotherapy) drugs,” Stefanick said. “If you failed them, you failed drug therapy. Now there are more than 40 – so many different drugs and different ways they can act upon the tumor. They are so much more effective with much fewer side effects.” The proof is in the results, breast surgeon Dr. Dan Clark said at Indiana (Pa.) Regional Medical Center. “We now have very targeted treatment for breast cancer,” Clark said. “We are doing the same operations I did 20 years ago, but survival has been
dramatically improved.” Sbeitan said most of the chemotherapy agents of the 1990s are no longer used. “The actual changes have been dramatic,” he said. “We are trying to make cancer a chronic disease. Some patients do very well. Two-thirds can be cured and one-third, we can significantly prolong their lives.” The next generation of genetic sequencing of cancer cells is expected
Monday, October 22, 2018
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patients through the Joyce Murtha center, breaks down the entire cancer genome of more than 20,000 genes. The information is compared to healthy cells to identify targets and develop the next generation of cancer drugs. “Life is very good for cancer patients,” Sbeitan said. “Progress is steady and positive. Cancer is no longer a death sentence. This TUESDAY &is the bottom line.” THURSDAY
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Press-Republican • Breast cancer awareness
21
A glossary of terms to help decipher the terminology • Breast Density – A measure used to describe the relative amounts of fat and tissue in the breasts as seen on a mammogram. • Axillary nodes – The lymph • Calcifications – Deposits of nodes under the arm. calcium in the breast that appear • Benign – Not cancer. • Bilateral – Affecting or about as bright, white spots on a mammogram. both the right and left sides of • Cell – The basic unit of any body. For example, a bilateral living organism. mastectomy is removal of both • Chemotherapy – A drug or breasts. • Biobank (Tissue Repository) combination of drugs that kills cancer cells in various ways. – A large collection of tissue • Clinical Breast Examinasamples and medical data that is tion – A physical exam done by used for research studies. a health care provider to check • Bioinformatics –The field the look and feel of the breasts of endeavor that relates to the and underarm for any changes collection, organization and or abnormalities, such as lumps. analysis of large amounts of • Clinical Trials – Research biological data using networks studies that test the benefits of of computers and databases. possible new ways to detect, di• Biopsy – Removal of tissue agnose, treat or prevent disease. to be looked at under a microPeople volunteer to take part in scope. these studies. • BRCA1/BRCA2 • Core Needle Biopsy – A Genes (BReast CAncer genes) needle biopsy that uses a hollow – Genes that help limit cell needle to remove samples of growth. A mutation in one of these genes increases a person’s tissue from an abnormal area in the breast. risk of breast, ovarian and cer• CT Scan (Computerized tain other cancers. Tomography Scan) – A series of • Breast Cancer – An unconpictures created by a computer trolled growth of abnormal linked to an X-ray machine. The breast cells. BY RANDY GRIFFITH The Tribune-Democrat (Johnstown, Pa.)
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scan gives detailed internal images of the body. • Cyst – A fluid-filled sac. • Data Mining – The ability to query very large databases in order to satisfy a hypothesis (“top-down” data mining); or to interrogate a database in order to generate new hypotheses based on rigorous statistical correlations (“bottom-up” data mining). • Diagnosis – Identification of a disease from its signs and symptoms. • DNA (deoxyribonucleic acid) – The information contained in a gene. • DNA sequencing – The technique in which the specific sequence of bases forming a particular DNA region is deci-
phered. • Expression (gene or protein) – A measure of the presence, amount, and time-course of one or more gene products in a particular cell or tissue. Expression studies are typically performed at the RNA (mRNA) or protein level in order to determine the number, type and level of genes that may be up-regulated or down-regulated during a cellular process, in response to an external stimulus, or in sickness or disease. • Family History – A record of the current and past health conditions of a person’s blood-related family members that may help show a pattern of certain
Continued on page 22
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Press-Republican • Breast cancer awareness
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diseases within a family. • Genes – The part of a cell that contains DNA. The DNA information in a person’s genes is inherited from both sides of a person’s family. • Gene Expression – Process in which a gene gets turned on in a cell to make RNA and proteins. • Genetic Testing – Analyzing DNA to look for a gene mutation that may show an increased risk for developing a specific disease. • Genome – The total genetic information of an organism. • Genomic testing – Analyzing DNA to check for gene mutations of a cancer tumor. • Genomics – The study of genes and their functions. • Hormones – Chemicals made by certain glands and tissues in the body, often in response to signals from the pituitary gland or the adrenal gland. • Immunotherapy – Therapies that use the immune system to fight cancer. These therapies target something specific to the biology of the cancer cell, as opposed to chemotherapy, which attacks all rapidly divid-
ing cells. • Implant – An “envelope” containing silicone, saline or both, that is used to restore the breast form after a mastectomy. • Informatics – The science of information; the collection, classification, storage, retrieval, and dissemination of recorded knowledge treated both as a pure and as an applied science. • Invasive Breast Cancer – Cancer that has spread from the original location into the surrounding breast tissue and possibly into the lymph nodes and other parts of the body. • Lesion – Area of abnormal tissue. • Linear Accelerator – The device used during radiation therapy to direct X-rays into the body. • Lumpectomy (Breast Conserving Surgery) – Surgery that removes only part of the breast – the area containing and closely surrounding the tumor. • Lymph Nodes – Small groups of immune cells that act as filters for the lymphatic system. Clusters of lymph nodes are found in the underarms, groin, neck, chest and abdomen. • Lymphedema – Swelling due to poor draining of lymph fluid
that can occur after surgery to remove lymph nodes or after radiation therapy to the area. • Malignant – Cancerous. • Mammogram – An X-ray image of the breast. • Mastectomy – Surgical removal of the breast. The exact procedure depends on the diagnosis. • Medical Oncologist – A physician specializing in the treatment of cancer using chemotherapy, hormone therapy and targeted therapy. • Metastasize – When cancer cells spread to other organs through the lymphatic and/or circulatory system. • MRI (Magnetic Resonance Imaging) – An imaging technique that uses a magnet linked to a computer to make detailed pictures of organs or soft tissues in the body. • Mutation – Any change in the DNA of a cell. Gene mutations can be harmful, beneficial or have no effect. • Nipple-Sparing Mastectomy – A breast reconstruction procedure that removes the tumor and margins as well as the fat and other tissue in the breast, but leaves the nipple and areola intact.
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• PET (Positron Emission Tomography) – A procedure where a short-term radioactive sugar is given through an IV so that a scanner can show which parts of the body are consuming more sugar. Cancer cells tend to consume more sugar than normal cells do. PET is sometimes used as part of breast cancer diagnosis or treatment, but is not used for breast cancer screening. • Prognosis – The expected or probable outcome or course of a disease. • Protein – Any of various naturally occurring extremely complex substances that consist of amino-acid residues joined by peptide bonds, contain the elements carbon, hydrogen, nitrogen, oxygen, usually sulfur and occasionally other elements. • Proteomics – The cataloging of all the expressed proteins in a particular cell or tissue type, obtained by identifying the proteins from cell extracts. • Prophylactic Mastectomy – Preventive surgery where one or both breasts are removed in order to prevent breast cancer. • Radiation Oncologist – A physician specializing in the
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Monday, October 22, 2018 Continued from page 22 treatment of cancer using targeted, high energy X-rays. • Radiation Therapy – Treatment given by a radiation oncologist that uses targeted, high energy X-rays to kill cancer cells. • Radiologist – A physician who reads and interprets X-rays, mammograms and other scans related to diagnosis or followup. Radiologists also perform needle biopsies and wire localization procedures. • RNA (Ribonucleic Acid) – A molecule made by cells containing genetic information that has been copied from DNA. RNA performs functions related to making proteins. • Sentinel Node Biopsy – The
Press-Republican • Breast cancer awareness surgical removal and testing of the sentinel nodes – the first axillary nodes in the underarm area filtering lymph fluid from the tumor site – to see if the node contains cancer cells. • Stage of Cancer – A way to indicate the extent of the cancer within the body. The most widely used staging method for breast cancer is the TNM system, which uses Tumor size, lymph Node status and the absence or presence of Metastases to classify breast cancers. • Targeted Therapy – Drug therapies designed to attack specific molecular agents or pathways involved in the development of cancer. Herceptin is an example of a targeted therapy used to treat breast cancer • Tomosynthesis (3D Mam-
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benign (not cancerous) or malignant (cancerous). • Ultrasound – Diagnostic test that uses sound waves to make images of tissues and organs. Tissues of different densities reflect sound waves differently. Sources: Susan G. Komen; Federal University of Rio Grande do Sul, Brazil.
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PRICES SLASHED 2018 CADILLAC XT5
6CYL, POWER MOON ROOF, POWER HEATED LEATHER SEATS, REMOTE STARTER, REAR CAMERA, ALLOYS, ONLY 12K, #3129A
2015 CHEVY 1500 LT DBL Z71 5.3L, POWER SEAT, REMOTE STARTER, REAR CAMERA, ALL STAR EDITION, ONLY 36K, #3111A
PRICES SLASHED PARKER PRICE
$28,990 $2788*
*
PARKER PRICE
$42,990* $41,990*
2011 CHEVY CRUZE LS
2016 CHEVY SUBURBAN LT
PARKER CHEVROLET
DVD, MOON ROOF, ALLOYS, NAVIGATION, 46,000 MILES, #41189A
4 CYL., AUTO, CRUISE, GREAT FUEL ECONOMY, #41351A
PARKER PRICE
$8,490* $7,990*
PRICES SLASHED 2016 GMC 2500 CREW
DIESEL, POWER HEATED SEAT, REMOTE STARTER, REAR CAMERA, ALLOYS #41189A
PARKER PRICE
$48,995* $46,880*
PRICES SLASHED
PRICES SLASHED PARKER PRICE
$44,995 $43,990* *
2015 CHRYSLER TOWN AND COUNTRY 3.6L, 7 PASSENGER, REAR ENTERTAINMENT, POWER LEATHER SEATS, #3197A
PARKER PRICE
$19,040* $18,440*
622 State Rte. 11, Exit 42 | Champlain, NY (518) 298-8272 | www.Parkercountry.com *Tax, title and registration extra ** Must be a current GM Lease Customer Or up to $1500 for Owner/Lease of a qualifying Non GM Vehicle. *** Must be employed by any school, college or university; be Active, Reserve or Retired Military Personnel or First Responder or a Verified GM Supplier **** GM DPA Must finance with GM Financial for well qualified buyers