Better Health - October 2022

Better Health

MERCY MEDICAL CENTER:

BAYSTATE HEALTH:

Rays of Hope 2022

By C ORI U RBAN

Special To The Republican

As a breast cancer survivor, Lindsey S. Bubar, of East Longmeadow, knows first hand the impact such a diag nosis can have on not only the patient but the family too.

That’s why she supports the Rays of Hope Walk & Run Toward the Cure of Breast Cancer. “It has done so much to support the ‘whole’ patient and the community, provid ing opportunities for other nonprofits to support cancer survivorship,” she said.

Rays of Hope has raised more than $16.1 million; funds raised remain in West ern Massachusetts.

The in-person walk and run will take place Oct. 23, beginning at Temple Beth El in Springfield and continuing through Forest Park and the surrounding communities.

Expect to see all of the tradi tional and well-loved features including the iconic pink arch, the Survivors’ Photo, the Rays of Hope store selling new merchandise, the beautifully decorated Pink Hope Survi vors Lounge and the won derful entertainers along the 2- and 5-mile routes.

“We are asking everyone

to ‘Embrace the Power of Pink’ and help raise money in support of the women and men faced with breast cancer in our communities,” said Kathy Tobin, director of annual giving and events for Baystate Health Foundation. “The pandemic has halted many things, but our research has not stopped, nor has the support we offer survivors and their families throughout their journey. Hundreds of local families are affected each year with a cancer diagnosis, and they need our support now more than ever.”

Understanding that these are hard times for many individuals, Tobin reported that despite everyone’s best efforts, last year’s virtual event raised $341,000, which is half the fundraising during pre-pandemic years. “The re sult is less money for research and services. This year, Rays of Hope really needs a pow erful pink effort to fulfill our mission and exceed last year.”

Michelle Graci, manager of events for Baystate Health Foundation, expressed thanks for the corporate sponsors, participants and donors who support the event every year. With their help, funds support

and

CANCER: Potential Warning Signs, S8

the Rays of Hope Center for Breast Cancer Research, programs, services and equip ment through the Baystate Regional Cancer Program and Baystate Breast and Wellness Center, and local community programs and services such as Cancer House of Hope and the Livestrong programs at the YMCA of Greater Spring field and the YMCA of Greater Westfield.

Breast cancer is a difficult topic to address, “but Rays of Hope helps make breast cancer something we can talk about and help solve togeth er,” Tobin said. “With Rays of Hope, no one has to face this disease alone and the research gives us hope.”

Since the walk began in 1993 much progress has been made in breast cancer treatment nationally and in the local community. “The chances of an individual surviving breast cancer have increased significantly since 1993. This is partly due to screening mammography and partly due to better surgery, better radiation and better medica tions,” explained Dr. Grace Makari-Judson, interim vice president and medical direc tor, Cancer Services, Baystate

Health; and chair of Baystate Health Breast Network, Bay state Health; and co-director of Rays of Hope Center for Breast Cancer Research. “In 1993, we had chemotherapy and hormone treatments. Now, our treatment options have expanded to include tar geted treatments, for exam ple, for those with HER-posi tive cancers. Immunotherapy is used in triple negative breast cancer. We also have a new category of drugs called antibody-drug conjugates that treat specific subsets of breast cancer with less toxicity than chemotherapy.”

She noted that one in eight women will develop breast cancer in their lifetime; one in 800 men will be diagnosed with breast cancer during their lifetime.

Mammography is recom mended for women age 40 and older.

Makari-Judson recommends people know their risk and their family history, and pointed out that there are medications that can reduce breast cancer risk for higher risk individuals. Personalized strategies for screening may also be recommended. “For

Detection,

Left: Runners leave the starting line of the 2019 Rays of Hope Walk & Run Toward the Cure of Breast Cancer. (PHOTO COURTESY OF FREDERICK GORE PHOTO)

Center: Members of Springfield Central High School Air Force Junior ROTC at the 2021 Parade of Hope event. Right: Donna Valletti, left, and Gale Kirkwood, members of the Rays of Hope Steer ing Committee, show off T-Shirts at the 2021 Parade of Hope event. (PHOTOS COURTESY OF STEVEN E. NANTON PHOTO)

Above: Lindsey Bubar, 2022/2023 Chair of the Rays of Hope Walk & Run Toward the Cure of Breast Cancer.

COURTESY OF

Rays of Hope

everyone, no matter what your risk, don’t smoke, limit alcohol, maintain a healthy weight and exercise regular ly,” she emphasized.

Annual screening mam mography detects cancers when they are smaller, “and this may lead to less extensive treatment and more favorable prognosis,” she said.

According to Bubar, who was diagnosed with breast

those who need it the most,” Makari-Judson said. “Because we work as a multidisciplinary team, we can coordinate, personalize and recommend the best options for long term cure, while at the same time avoiding overtreatment.

Treatments are better and we have gotten better at select ing the treatments a patient needs.”

Tobin hopes that this year all long-time Rays of Hope sup porters along with many new ones will demonstrate the “power of pink” against this

years,” Tobin said. “However, there is a direct correlation on how much Rays of Hope raises and what we can offer the community, so it’s very important that everyone steps up and out to restore all that Rays of Hope represents.”

There is no established fee to participate, but to receive the collectible Rays of Hope T-shirt, individuals must raise $50 or more.

“Even though we haven’t found a cure we’ve seen progress in understanding the disease, new treatments and

cancer in 2017 and is the 2022-2023 chair for Rays of Hope, many people don’t know that even after it’s “all done,” cancer survivors continue to deal with phys ical challenges, mental and emotional struggles and even financial strain. “Rays of Hope continues to serve and support the survivor beyond diagnosis and treatment and remains a beacon of hope for those looking to be part of something truly special for years to come,” she comment ed.

The goal today is not only to provide the most effec tive treatments, but to limit toxicities. “Surgery is focused on conserving the breast and limiting surgery in the axilla. Radiation is targeted. Che motherapy is reserved for

disease and come out in force for the event: “Our hybrid events over the last two years have helped some people participate virtually, and that is still an option however, we believe that we have created a safe atmosphere for anyone who can join in person. Your presence and your fundraising make a difference!”

The Rays of Hope website provides ideas for creative fundraising as well as sup port. In addition to individual fundraising, many form teams to magnify their impact. Some choose to organize events whether it’s a bake sale, tag sale or sports outing to meet their personal fundraising goal.

“We are thankful for all the money raised especially over these last two challenging

improved outcomes. The Rays of Hope community wraps survivors and their support system in a big pink hug and it’s contagious,” Graci said. “Their stories give us all hope.’

To register and fundraise online go to baystatehealth. org/raysofhope. Traditional walk papers are available also online and can be printed from the Rays of Hope web site.

For more information about this year’s Rays of Hope event, visit baystatehealth.org/ raysofhope or call 413-794-8001.

FAMILY

Rays

BaystateHealth.org/RaysofHope

“We believe that we have created a safe atmosphere for anyone who can join in person. Your presence and your fundraising make a difference!”

KATHY TOBIN - DIRECTOR OF EVENTS AND ANNUAL GIVING FOR BAYSTATE HEALTH

time with

YOUR SUPPORT CAN PROVIDE

Above: Lucy Giuggio Carvalho, founder of Rays of Hope speaks at the 2019 Rays of Hope Walk & Run Toward the Cure of Breast Cancer. (PHOTO COURTESY OF BAYSTATE HEALTH)

Above: Coleen Holtan, left, and Tammy Schmidt, both of Holyoke, ride in the back of a pickup truck at the 2021 Parade of Hope event. (PHOTO COURTESY OF STEVEN E. NANTON PHOTO)

Above: Lexi Anamsis of West Springfield sings the National Anthem at the 2019 Rays of Hope Walk & Run Toward the Cure of Breast Cancer in Springfield.

CONTINUED FROM PAGE S1 Above: Nate Costa, president of the Springfield Thunderbirds, addresses the crowd at the 2019 Rays of Hope Walk & Run Toward the Cure of Breast Cancer. (PHOTO COURTESY OF FREDERICK GORE PHOTO)

Importance of Early

of

Cancer

By C ORI U RBAN Special To The Republican

Breast cancer, when found at an early stage, has a higher likelihood of being curable. That’s why regular screening mammograms allow doctors to detect very small changes in the breast well before these changes would be noticeable on exam by a woman or her doctor.

A screening mammogram is an X-ray-based test that examines the breast tissue in patients who do not have symptoms. Its goal is to identify changes in the breasts at the earliest stages, well before a lump could be felt in the breast. “When diag nosed at an early size/stage, patients are less likely to need extensive treatment such as mastectomy, removal of all lymph nodes under the arm or chemotherapy,” explained Dr. Sarah J. McPartland, medical director of the Center for Breast Health and Gynecolog ic Oncology at Mercy Medical Center.

According to the American Cancer Society, breast cancer is the most common cancer in women in the United States,

55, have their first pregnancy after age 30 and who use certain types of birth control or hormone replacement therapy.

Lifestyle risk factors that increase breast cancer risk include being overweight or obese, consuming alcohol and being physically inactive.

Family history is also im portant. “Women can inherit genes that increase their risk of breast cancer,” the doc tor said. “Breast cancer in a first-degree relative or multi ple family members increases risk of breast cancer.”

Of the nearly 300,000 new cases of breast cancer diag nosed each year, the majority are early-stage cancers, she noted that the 5-year survival rates for a stage I and II breast cancer are 98-100 percent and 90-99 percent, respec tively.

More than 200 patients are treated at Mercy Medical Center each year for breast cancer; a small percentage of them are men.

“In general, male breast cancer accounts for less than 1 percent of all breast cancer di agnoses,” McPartland noted.

exam, in part because large studies have failed to show a significant benefit of these exams when looking at large populations of women, par ticularly if women are also having screening mammo grams, McPartland pointed out. “With that being said, I routinely recommend breast awareness to my patients.

This is simply developing a familiarity with your breasts so that you can recognize when something is new or has changed. It is not uncommon that I treat patients who have found their breast cancer be cause of this awareness.”

In general, screening mam mograms are performed once

a year. “However, we now take an individualized ap proach to recommendations for when to start (and when to stop) screening exams based on personal and family histo ry,” she said. It is important that women discuss screening recommendations with their doctor. Women at higher risk for breast cancer may benefit from more frequent breast exams by a physician or other breast-imaging tests.

Mercy Medical Center’s breast surgeons have exper tise in the evaluation and care of women with all types of breast disease, including benign conditions (such as breast pain and nipple

discharge), management of hereditary breast cancer syn dromes and breast cancers.

They employ contemporary surgical techniques such as breast conserving surgery (lumpectomy), MagSeed localization—a wirefree and radiation-free method of localizing tumors for sur gery, skin and nipple sparing mastectomy, reverse axillary mapping and oncoplastic procedures.

“Breast cancer treatments continue to evolve and improve. Women and men facing this diagnosis should feel empowered to know there are many treatment options as they face this battle,” McPart

land said.

The breast care program at Mercy Medical Center is accredited by the National Accreditation Program for Breast Centers and the Ameri can College of Surgeons Com mission on Cancer, assuring that it meets the highest standards of care for patients with diseases of the breast.

For more information or to schedule an appointment, call the Mercy Center for Breast Health and Gynecologic On cology at 413-452-6600. To make a routine mammogram appointment, call 413-7489729.

Visit TrinityHealthOfNE. org/Mercy-Breast-Gyno.

except for skin cancers. It is about 30 percent of all new female cancers each year.

The American Cancer Society estimates that in the United States in 2022 about 287,850 new cases of invasive breast cancer will be diag nosed in women, and about 43,250 women will die from breast cancer.

“Breast cancer is more likely to occur in older patients. Having dense breasts, prior radiation treatments to the chest or breasts or increased exposure to estrogen over their lifetime increases risk of breast cancer,” McPartland explained, adding that this includes women who start their period before age 12, go through menopause after age

Most breast cancers are de tected by screening mammo gram and are often too small to produce symptoms. “As they grow, breast cancers may be felt as a lump or swelling in the breast. Some women may develop a rash or dimpling of the breast skin or areola.

Inversion of the nipple or discharge can sometimes be a sign of breast cancer under the nipple,” she explained. “Swelling or lumps in the armpit or around the collar bone can also occur. Benign conditions can also cause these symptoms, so follow up with a doctor is important if any of these occur.”

The American Cancer Society no longer recom mends monthly self breast

Above: Sarah McPartland, M.D., MS, FACS, Medical Director of the Center for Breast Health and Gynecologic Oncology at Mercy Medical Center, stands in the lobby of the hospital’s Sister Caritas Cancer Center. (PHOTO COURTESY OF MERCY MEDICAL CENTER)

The link between diet and breast cancer

Cancer is an insidious disease that affects just about every part of the body, including the breasts. The World Cancer Research Fund International indicates there were more than 2.26 million new cases of breast cancer in women in 2020.

Women understandably want to learn what they can do to reduce their risk of de veloping breast cancer. One of the first considerations may be analyzing diet and determining if it is affecting breast cancer risk.

A variety of factors affect a woman’s risk for developing breast cancer, and certain lifestyle choices, including diet, can play a role. Howev er, according to Healthline, the risk factors with the big gest impact include sex, age and genetics. Lifestyle can influence breast cancer risk but not at the same levels as genetic markers, family histo ry, gender, or age. However, women interested in doing all they can to stay healthy may want to take a closer look at the foods and beverages that can adversely affect breast cancer risk.

Healthy diet

Healthy food choices are linked to lower incidences of

cancer and other conditions.

Susan G. Komen states that eating plenty of fruits and vegetables may be linked to a lower risk of developing breast cancer. A pooled anal ysis of data from 20 studies found women who ate the most vegetables had a lower risk of estrogen receptor-neg ative breast cancer (but not estrogen receptor-positive breast cancer) compared to women who ate the least vegetables, according to a 2013 report published in the Journal of the National Can cer Institute. And it doesn’t really matter if produce is or ganic or not. According to the American Cancer Society, the benefits of eating fresh fruits and vegetables outweigh any health risks linked to pesti cide residue.

The complex relationship between fat, sugar and cancer

Though a single food will not lead to higher breast cancer risk, overeating and putting on excess weight can increase risk. That is why it is essential to get plenty of exercise each week and monitor calorie consumption. While women who are in their reproductive years may not see as much breast cancer risk from being overweight or obese, after menopause, that risk increases, says Susan G. Komen. The risk is not direct

ly related to fatty foods, how ever. The American Cancer Society says an examination of the amount of fat eaten by women in the United States found no link between fat and breast cancer risk.

In addition, while consum ing too much sugar may not be healthy in the long run, it’s a myth that sugar feeds cancer. Eating sugar may lead to weight gain, which may increase the risk of breast cancer, says the ACS.

Alcohol consumption

One component of diet that has been studied extensive ly is the effects of alcoholic beverages on breast cancer risk. Susan G. Komen reports that a pooled analysis of data from 53 studies found women who had two to three alco holic drinks per day had a 20 percent higher risk of breast cancer compared to those who didn’t drink alcohol. Alcohol should be limited to one drink per day for the average woman, or none at all, if possible.

Diet is only one factor in the risk for developing breast cancer. While important, there are other components that increase risk by a more significant margin.

What to know about prophylactic mastectomy

Breast cancer is the most common cancer diagnosed in American women, and is the leading cause of cancer death in less developed countries, says the Breast Cancer Research Foundation. According to Susan G Komen, more than 680,000 breast cancer deaths occurred worldwide in 2020.

Breast cancer affects the anatomy of the breasts and can often spread to the lymph nodes. While breast cancer can affect just about any woman (as well as men), cer tain women are at higher risk for developing breast cancer than others. Such women include those with a family history of breast cancer and/ or the presence of genetic markers called BRCA1 or BRCA2 gene mutations, ac cording to the Bedford Breast Institute. Those women have a lifetime risk of up to 87 per cent for getting breast cancer and 53 percent for developing ovarian cancer. Other risk factors include the presence of dense breast tissue, expo sure to radiation at an early age and having already had cancer in one breast.

What is prophylactic mastectomy?

In instances when breast cancer risk is particularly high, women may opt to un dergo prophylactic mastecto my, also called preventative mastectomy. This is the surgi cal removal of one or both breasts with the intent to dramatically reduce the risk of developing breast cancer.

Rate of risk reduction

The Mayo Clinic says prophylactic mastectomy reduces the risk of develop ing breast cancer by 90 to 95 percent among women with BRCA gene mutations. It is roughly the same risk reduc tion for women who already have had breast cancer or have a strong family history of the disease and then have a breast removed.

Studies indicate that preventative mastectomy of the unaffected breast (called contralateral prophylactic mastectomy) in cases when breast cancer occurred in the other breast, when no genetic mutations or hereditary risk factors are present, has little to no effect on overall survival rate. This is a surgery only for those with very high risk.

Why isn’t risk reduced completely?

Not all breast tissue can be removed during a pro phylactic mastectomy. That is because breast tissue can sometimes be found in the chest, armpit, skin, above the collarbone, or on the upper part of the abdominal wall, states the Mayo Clinic. It is impossible to remove all breast tissue cells during sur gery. Although risk reduction is significant after mastec tomy, that risk cannot be eliminated entirely.

Risks associated with prophylactic mastectomy

There are some risks as sociated with prophylactic

Obstetrics

mastectomy, both during the procedure and afterwards.

BreastCancer.org says bleed ing or infection, fluid collect ing under the scar, delayed wound healing, scar tissue formation, loss of sensation in the chest, and complica tions while being put under anesthesia are all possible. Women are urged to carefully consider the pros and cons before opting for the surgery.

Alternatives

Prophylactic mastectomy is only one option for women at high risk for developing breast cancer. Some alterna tives include:

z Ultrasounds, physical exams, and mammograms every three to six months for the rest of the patient’s life.

z Medication that can reduce risk of developing breast cancer.

z MRIs in addition to mam mograms.

z Surgery to remove the ova ries, which can decrease both the risk of breast and ovar ian cancers. It may reduce breast cancer risk by up to 50 percent if performed before age 50.

z Breast cancer risk is higher in some individuals, which may prompt discussions about prophylactic mastec tomies.

Charles W. Cahill, MD

Hani Haddad, MD

Yelena Mikich, MD

Devon Foulks, MD

Peilan E. Tang, MD

Nicole Thompson, MD

By K eith J O ’C onnor, Sr. Special To The Republican

How many times have you gone to the doctor then returned home only to realize you forgot to ask several im portant questions?

Do you known the right questions to ask after getting a diagnosis of breast cancer, so that you can better under stand your diagnosis, treat ment plan and overall care?

A Baystate Health breast surgeon and breast medical oncologist offer their insight on questions to ask your doctor to prepare you for your breast cancer journey.

“Patients come to us under standably very nervous, some may be angry, but I think most are generally overwhelmed by their diagnosis. Some are upset and have not done any research beforehand, and others have done some read ing. For those who have done research, it is important for me to understand what they have read,” said Dr. Holly Ma son, Section Chief for Breast Surgery at Baystate Health.

“For any patient, it is important that I help them to understand the diagnosis and the various parts of breast cancer treatment. It is also important for me to learn the patient’s preferences and how they view the options that I present so that, in the end, they feel comfortable with the surgical plan,” she added.

Dr. Mason noted there is a lot of information for breast cancer patients to consume.

“We help our patients to get through it all, explaining everything so it hopefully makes sense to them, and

understanding your diagnosis, treatment plan and overall care

talking to them about how different treatments accom plish different goals. We also discuss the support systems we have available from social workers to nurse navigators to help them through what may be the most challenging time in their lives,” she said.

According to the Baystate breast surgeon, before under going any type of surgery it is important to feel comfortable with and have the utmost con fidence in both your surgeon and your treatment plan.

It is reasonable to ask your surgeon their level of exper tise in taking care of breast cancer patients or what per cent of their practice is breast surgery.

Dr. Mason noted the ques tion she is most often asked by her patients is: “Am I going to survive?”

“Today, the 5-year relative survival rate for localized breast cancer in the United States is excellent,” said Dr. Mason, noting there are more than 3.8 million breast cancer survivors in the United States, including those currently being treated.

Here are just some of the many important questions to ask your surgeon beforehand:

• What type of breast cancer do I have, how large is the tumor, how aggressive is the cancer, and does it use hormones as a fuel source and does it have the HER2 growth factor?

• Has all my imaging been done or will I need other tests before surgery?

• Will I be able to have a lumpectomy or will I need a mastectomy?

• Is there any difference in the cancer coming back in the breast or chest and in my overall survival in choosing between a lumpectomy or mastectomy?

• Is breast reconstruction a possibility?

• Will the lymph nodes in my underarm need to be removed?

• What about lymphedema and other possible side effects?

• Will I need radiation therapy after surgeryand will that affect reconstruction options?

• Will I need radiation even after a mastectomy?

• What are the risks and possible complications of the surgery?

• Should I consider genetic testing?

“Many patients want to know if they will need chemo therapy. For some patients, we know the answer at the very beginning based upon the type of cancer they have. For other patients, the answer may not be known until after surgery is completed and they have seen the medical oncolo gist,” said Dr. Mason.

According to Dr. Prarthna Bhardwaj, Senior Medical

Oncology Fellow with special interest in breast oncology at the Baystate Regional Cancer Program, they normally see breast cancer patients after their surgery to discuss fur ther treatment options such as chemotherapy or hormonal therapy.

“Other times, we may see them prior to surgery when it is determined that upfront chemotherapy may be ben eficial to shrink the tumor, thus making the surgery less extensive. This is dependent on the stage of the cancer and type of receptors your breast cancer cells have including hormone receptors and HER2 receptors that are responsible for the growth of the cancer,” she said.

Asking and knowing the stage of your cancer and if it is invasive or not (ductal car cinoma in situ DCIS) is very important because that will determine treatment.

Nearly 85% of breast can cers are hormone receptor positive and can be treated with hormonal therapy to de crease the recurrence of these cancers after curative surgery, Dr. Bhardwaj noted.

“Early-stage breast cancers are usually curable with a combination of surgery with or without chemotherapy, with or without radiation, and with or without hormonal therapy. What combination of treatments we use, and the sequence is dependent upon the type of cancer you have that is determined upfront at the time of your biopsy. We have a high functioning mul tidisciplinary team of radiol ogists, pathologists, medical

oncologists, breast surgeons and radiation oncologists who discuss the appropriate sequence of care for sever al of our patients,” said Dr. Bhardwaj.

The Baystate medical oncologist also noted that if your surgeon hasn’t already discussed genetic testing with you, to ask about the possi bility.

“The National Compre hensive Cancer Network has specific guidelines for genetic testing for which you may qualify, information which can be used to determine what kind of surgery or ther apy you will get especially if you have a hereditary cancer syndrome, for example, the BRCA gene,” said Dr. Bhard waj.

Additional questions to ask your breast medical oncologist include:

• What will the side effects of all my treatments be, and how can they be addressed?

• What is the additional benefit of the treatment I am undergoing?

• What is my overall prognosis?

• Will treatment affect my sexual health and fertility?

• Are there any clinical trials available to me?

• Should I undergo any scans to determine if there is cancer elsewhere in my body?

• What lifestyle changes should I be making to decrease the risk of breast cancer recurrence?

• Are there any supplements I should be taking?

For a more comprehensive list of breast cancer questions to ask the health care team, visit the American Society of Clinical Oncology webpage https://www.cancer.net/ cancer-types/breast-cancer/ questions-ask-health-careteam.

And so you don’t forget to ask anything, make a list of questions you want to discuss at your appointment and bring them with you wheth er on a piece of paper, your phone or tablet.

For more information on the Baystate Breast and Wellness Center, visit baystatehealth. org/services/breast-care or to make an appointment with a breast specialist, call 413-794-8899

Ann-Kristin Friedrich, MD

Alexandra Richards

Jesse Casaubon, MD

Dr. Holly Mason, Section Chief for Breast Surgery at Baystate Health. (PHOTO COURTESY OF BAYSTATE HEALTH)

Family History

age in women with family histories of the disease.

than the general population.

7 Ways to Reduce breast cancer risk

In fact, only certain skin cancers affect more women than breast cancer within the United States and Canada.

The World Cancer Re search Fund International says breast cancer is the most commonly diagnosed cancer in women across the globe.

Belgium, The Netherlands and Luxembourg had the highest number of breast cancer cases in 2020, while Barbados and Fiji had the greatest number of deaths at tributed to the disease. Some of these high case numbers may be attributed to women with family histories of breast cancer - something that in creases risk significantly.

BreastCancer.org indi cates that women with close relatives who have had breast cancer, such as sisters, mothers or grandmothers, are at considerably higher risk of developing breast cancer themselves. Also, breast can cer may occur at a younger

Understanding breast cancer risk is vital for wom en’s health. The following breakdown, courtesy of the Centers for Disease Control and Prevention, can help women from all backgrounds understand their risk for breast cancer.

Average risk:

No first- or second-degree rel atives with breast or ovarian cancer, or one second-degree female relative with breast cancer (in one breast only) diagnosed after age 50.

Moderate risk:

This is a somewhat higher risk that may not turn into breast cancer. It occurs when there is one or two first-de gree or two second-degree female relatives with breast cancer (in one breast only), with both relatives diagnosed after age 50; otherwise, one or two first- or second-degree relatives with high grade prostate cancer.

Strong risk:

Women with strong risks have much higher chances of developing breast cancer

Conditions like having one or more first- or second-de gree relatives with breast cancer diagnosed at age 45 or younger, triple negative breast cancer, primary cancer of both breasts, and both breast and ovarian cancer in the same relative are warning signs of increased risk.

It’s important for women with increased risk for breast cancer due to family history to discuss options with their doctors. More frequent mam mograms and other screening tests may be recommended, and screening at younger ages than the standard age also may be considered. Women who are at high risk may be urged to undergo genetic counseling and testing for hereditary breast and ovarian cancer markers.

Breast cancer can be an especially scary prospect for women with family histories of the disease. By familiar izing themselves with their risks for breast cancer, wom en can take the necessary steps to protect their longterm health.

Many women are concerned about the potential for developing breast cancer in their lifetimes. Breast cancer is the second-most common cancer among women in the United States and Canada.

Despite that prevalence, there are ways for women to reduce their risk for breast cancer.

While it is impossible to change family history or genetic markers like gene mu tations that increase breast cancer risk, the following are seven ways women can lower their risk.

1. Exercise regularly and maintain a healthy weight.

Physical activity and moni toring calories can keep weight in check.

The Mayo Clinic

recommends at least 150 minutes per week of mod erate aerobic activity or 75 minutes per week of vigorous aerobic activity. Strength training at least twice a week also is recommended. Being overweight or obese increas es a woman’s risk for breast cancer.

2. Consume a healthy diet.

The link between diet and breast cancer risk is still being studied. However, research suggests that a diet high in vegetables and fruit, and calcium-rich dairy products, but low in red and processed meats may lower breast can cer risk.

3 Avoid or limit alcohol consumptions.

Alcohol increases risk of breast cancer, even in small amounts.

For those who drink, no more than one alcoholic drink a day should be the limit.

The more a woman

drinks, the greater her risk of developing breast cancer, states the Mayo Clinic.

4. Undergo genetic counseling and testing.

Women concerned about a genetic connection or family history of breast cancer can speak to their doctor about testing and counseling that could help them reduce their risk. Preventive medicines and surgeries might help those at elevated risk for breast cancer.

5. Limit hormone therapy.

Combination hormone replacement therapy for post-menopausal women may increase risk of breast cancer, indicates the Centers for Disease Control and Pre vention. Similarly, taking oral contraceptives during repro ductive years may increase risk. Women can speak with their physicians to weigh the pros and cons of taking such hormones.

6. Breastfeed children, if possible.

Breastfeeding has been linked to reducing a woman’s risk of developing breast cancer.

7. Learn to detect breast cancer.

Women should get to know their bodies so they can deter mine if something is awry as early as possible. Early detec tion of breast cancer increas es the chances that treatment will prove successful.

Women can embrace various strategies to reduce their risk of developing breast cancer.

Millions of people across the globe will be diagnosed with breast cancer this year.

Breast Cancer Drug Trial results in

survival rates

ed with the protein, turning HER2-positive breast cancers from those with some of the worst prognoses into ones where patients fare very well.

received standard chemother apy.

By G ina Kolata The New York Times

But a treatment with a drug that targeted cancer cells with laserlike precision was stun ningly successful, slowing tumor growth and extending life to an extent rarely seen with advanced cancers.

The new study, presented at the annual meeting of the American Society of Clinical Oncology and published on Sunday in the New England Journal of Medicine, would change how medicine was practiced, cancer specialists said.

“This is a new standard of care,” said Dr. Eric Winer, a breast cancer specialist, director of the Yale Cancer Center and head of the ASCO. Winer was not involved with the study. He added that “it affects a huge number of patients.”

The trial focused on a par ticular mutant protein, HER2, which is a common villain in breast and other cancers. Drugs that block HER2 have been stunningly effective in treating breast cancers that are almost entirely populat

But HER2-positive cases constitute only about 15% to 20% of breast cancer patients, said Dr. Halle Moore, director of breast medical oncology at the Cleveland Clinic. Pa tients with only a few HER2 cells — a condition known as HER2-low — were not helped by those drugs. Only a small proportion of their cancer cells had HER2, while other mutations primarily drove the cancer’s growth. And that posed a problem because the cancer cells evaded chemo therapy treatments.

The clinical trial, spon sored by the pharmaceutical companies Daiichi Sankyo and AstraZeneca and led by Dr. Shanu Modi of Memorial Sloan Kettering Cancer Cen ter, involved 557 patients with metastatic breast cancer who were HER2-low. Two-thirds took the experimental drug, trastuzumab deruxtecan, sold as Enhertu; the rest under went standard chemotherapy.

In patients who took tras tuzumab deruxtecan, tumors stopped growing for about 10 months, as compared with five months for those who with standard chemotherapy.

The patients with the experi mental drug survived for 23.9 months, as compared with 16.8 months for those who

“It is unheard-of for chemo therapy trials in metastatic breast cancer to improve survival in patients by six months,” said Moore, who enrolled some patients in the study. Usually, she says, success in a clinical trial is an extra few weeks of life or no survival benefit at all but an improved quality of life.

The results were so im pressive that the researchers received a standing ovation when they presented their data at the oncology confer ence in Chicago on Sunday.

Trastuzumab deruxtecan was already approved for patients with HER2-positive breast cancer, but few expect ed it to work because other drugs for such cancers had failed in HER2-low patients.

The drug consists of an anti body that seeks out the HER2 protein on the surface of cells. The antibody is attached to a chemotherapy drug. When trastuzumab deruxtecan finds a cell with HER2 on its sur face, it enters the cell, and the chemotherapy drug separates from the antibody and kills the cell.

But “what is unique and distinct” about trastuzumab deruxtecan, Modi adds, is that the chemotherapy drug seeps through the cell’s membrane. From there, it can move into nearby cancer cells and kill them as well.

Like all chemotherapy, trastuzumab deruxtecan has side effects, including nausea, vomiting, blood disorders and, notably, lung injuries that led to the deaths of three patients in the trials.

But, Winer said, “if I were a patient with metastatic breast cancer, and if I were to get a drug with chemotherapy’s side effects, I’d prefer this drug.”

Doctors have said they are planning to try the treatment in their breast cancer patients who have metastatic HER2low cancers.

“We are all going back and looking at our patients right now,” said Dr. Susan Domchek, a breast cancer specialist at the University of Pennsylvania’s Abramson Cancer Center. She says that even before the Food and Drug Administration ap proves trastuzumab deruxtec an for HER2-low patients, she will see if the data from the new study will be enough to convince insurers to approve

the drug, which has a whole sale price of about $14,000 every three weeks.

Winer emphasized that tras tuzumab deruxtecan is not a drug for earlier stage breast cancer; it still must be tested in that group of patients. But that is a likely next step, as is testing the drug in other can cers and extending its strategy beyond HER2.

“This strategy is the real breakthrough,” he said, ex plaining that it would enable researchers to zoom in on molecular targets on tumor cells that were only sparsely present.

“This is about more than just this drug or even breast cancer,” Winer said. “Its real advantage is that it enables us to take potent therapies directly to cancer cells.”

One patient in the current

study, Mary Smrekar, 55, of Medina, Ohio, said she felt she got a temporary reprieve from certain death.

She was diagnosed with breast cancer in 2010 and has undergone surgery, chemo therapy and radiation. Her cancer went into remission.

“I thought I was free and clear,” she said.

But in 2019, the cancer came back. It had spread to her pelvis. She had chemotherapy, but this time, there was little improvement.

Two years ago, she entered the trial at its Cleveland Clinic site. Her cancer has not gone away, but the tumors stopped growing.

“I’m so happy I got another two years,” Smrekar said. “My daughter is getting married next month. I didn’t think I’d make it to the wedding.”

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The patients had metastatic breast cancer that had been progressing despite rounds of harsh chemotherapy.

Suzanne Williams

According to the World Cancer Research Fund International, there were more than 2.26 million new cases of breast cancer in women in 2020. Such figures are sobering, but it’s important to recognize that breast cancer survival rates have improved dramatically in recent de cades, providing hope to the millions of women who may be diagnosed with the disease in the years to come.

Various factors have helped to improve breast cancer survival rates, and education about the disease is certainly among them. Women are their own greatest allies against

breast cancer, and learning to spot its signs and symptoms is a great first step in the fight against this poten tially deadly, yet treatable disease.

Knowing your body

The American Cancer Society urg es women to take note of how their breasts normally look and feel. That knowledge is vital because it helps women recognize when something does not look or feel good to the touch with their breasts. Screening alone may not be sufficient, as the ACS notes that mammograms do not find every breast cancer.

Signs and symptoms

When women are well acquainted with how their breasts look and feel, they’re in a better position to recog nize any abnormalities, which may or may not be indicative of breast cancer. The ACS reports that the fol lowing are some potential warning signs of breast cancer.

A new lump or mass:

The ACS indicates that this is the most common symptom of breast cancer. A lump or mass that is cancerous is often painless, but hard and has irregular edges. However, lumps caused by breast cancer also can be soft, round and tender. Some even cause pain.

Swelling:

Some women experience swelling of all or part of a breast even if they don’t detect a lump.

Dimpling:

The skin on the breast may dimple. When this occurs, the skin on the breast sometimes mimics the look of an orange peel.

Pain:

Pain on the breast or nipple could indicate breast cancer.

Retraction:

Some women with breast cancer experience retraction, which occurs when the nipple turns inward.

Skin abnormalities:

Breast cancer may cause the skin on the breast to redden, dry out, flake, or thicken.

Swollen lymph nodes:

Some women with breast cancer experience swelling of the lymph nodes under the arm or near the collarbone.

The presence of any of these symptoms merits a trip to the doc tor. Women with these symptoms should not immediately assume they have breast cancer, as the ACS notes that various symptoms of breast cancer also are indicative of non-cancerous conditions that affect the breasts. Only a physician can di

agnose breast cancer, which under scores the importance of reporting symptoms to a doctor immediately.

Breast cancer is the most commonly occurring cancer in women across the globe.