Breast Cancer Awareness 2015

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F2 | THURSDAY, OCTOBER 1, 2015 | THE HERALD-TIMES | BREAST CANCER AWARENESS

Now what? Life after cancer treatment

By Lauren Slavin 812-331-4376 | lslavin@heraldt.com

A breast cancer patient’s radiation therapy is complete. They’ve rung the bell at the Indiana University Health Cancer Radiation Center that signifies to their doctors, nurses and fellow patients that their treatment is over. After weeks of intense treatment following a terrifying diagnosis, the patient is left with one final question.

Now what?

“They’ve had time to decompress after their treatment, to take everything in. Their skin is getting better,” said Melissa Baltzegar, director of the IU Health Cancer Radiation Center. “Now they’re trying to figure out what’s next.”

At the Radiation Center, a patient who has received treatment with a curative intent — meaning that the patient has a high likelihood of remaining cancer-free — returns for a follow-up

“They’ve come here every day for treatment for six to eight weeks; they’ve built a community with us; and then, they’re gone. ... You’re better, but we want to make sure you stay better, too.”

LAURA HUNSUCKER, registered health information technician for IU Health appointment three months after therapy ends. After ending the routine of regular doctors’ appointments and seeing the familiar faces of nurses and other patients, a newly cancerfree person might start to feel isolated and uncertain of their future, said Laura Hunsucker, a registered health information technician at the IU Health Can-

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cer Radiation Center.

“They’ve come here every day for treatment for six to eight weeks; they’ve built a community with us; and then, they’re gone,” Hunsucker said.

A cancer diagnosis on its own is overwhelming, Hunsucker said. But what can be equally emotionally and mentally difficult is what comes after the fight against the disease is over.

Continued education on post-treatment care, future health management and available supportive resources are necessary to ensure a successful transition to life after treatment, Hunsucker said. That’s where IU Health’s recently implemented survivorship care plan can help.

“You’re better, but we want to make sure you stay better, too.” Hunsucker said.

At their three-month follow-up appointments, Radiation Center patients receive packets of information about everything they have experienced over the past few months, and how to continue care in the years to come.

The survivorship plan, titled a “Roadmap to Your Future,” includes a summary of the patient’s diagnosis, and their individualized treatments based on that diagnosis.

They are provided lists of potential treatment side effects, how to identify health problems that require early intervention and how often to return to health care professionals for additional examinations such as physicals and mammograms.

Education is one of the best ways to ease a patient’s health concerns,

Baltzegar said. The survivorship plan also tries to explain a patient’s medical care in non-clinical terms, and provides definitions and detailed explanations of possible complications after radiation, such as lymphedema, a collection of fluid in the arms and legs that causes swelling and should be addressed with therapy.

“It’s a place you can keep track of all the information,” said Gwen Osborne, a certified medical dosimetrist at the IU Health Cancer Radiation Center. “It’s a good source of information to not feel so lost.”

The survivorship plans can also be passed along from one relative to another to provide background information for different doctors. Risk of breast cancer increases if a first-degree relative — such as a parent or sibling — has been diagnosed with breast cancer, and a patient’s relative can use the plan to determine risk factors to their own health.

After the patient goes through the survivorship plan, IU Health’s Olcott Center, which is primarily funded by donations to the annual Hoosiers Outrun Cancer 5K, can fill in the gaps, Hunsucker said. Nurse navigators and on-site social workers can help patients find resources for cancer survivors, direct them to support groups and provide additional education and counseling on what to expect from their bodies now that treatment is finished.

“It takes a village not only to raise a child, but to get people through treatment and beyond,” Hunsucker said.

THINKSTOCK

Apps help patients deal with breast cancer From Thinkstock

Detecting breast cancer early is everything; the National Breast Cancer Foundation says most women can survive the disease if it’s detected in the early, localized stage.

That’s a pretty good incentive to pay attention to risk factors and preventive screening, and that’s why the American Cancer Society works hard to bring to light the importance of early detection during October’s National Breast Cancer Awareness Month.

A couple of apps from the NBCF may be just the tools to help women keep track of their risks and deal with a diagnosis.

The Early Detection Plan: Breast Cancer can be used online at www. nationalbreastcancer.org or downloaded for free as a smartphone app for Apple or Android users.

The EDP helps women keep track of their prevention methods, including

how to identify signs and symptoms, prompts for regular breast self-exams, scheduling reminders for clinical breast exams done by a medical professional, and mammogram reminders for at-risk women.

Breast Cancer: Beyond the Shock is another technological offering from the NBCF that’s available on the Web (www.beyondtheshock.com) or as a free download to smartphones.

It’s a comprehensive guide to dealing with a breast cancer diagnosis that begins with several informative videos about the disease and all its stages.

It also includes a thorough FAQ section that is constantly updated to provide ongoing support and reassurance to newly diagnosed patients and survivors.

Beyond the Shock is also an excellent resource for family members who are dealing with the shocking news of a diagnosis.

BREAST CANCER AWARENESS | THE HERALD-TIMES | THURSDAY, OCTOBER 1, 2015 | F3

IU Health-Morgan among first to offer 3-D mammography St. Francis working to make treatment more accessible

By Emily Tate etate@reporter-times.com

COURTESY PHOTO RONALD HAWKINS | REPORTER-TIMES

IU Health-Morgan in Martinsville.

“The normal 2-D mammogram, it works in conjunction with that,” Bullock said. “The radiologist is able to scroll through that breast tissue in 1-millimeter slices, so to speak, to see if there’s anything hiding underneath that tissue.”

Whereas 2-D imaging is comparable to radiologists examining, for instance, a book from top to bottom, the 3-D screening allows them to look through the book’s pages, Bullock said.

The 3-D technology is among the exams recommended for high-risk patients, such as those who have dense breast tissue or a family history of breast cancer.

“I’ve noticed we’ve had women come from other areas, other hospitals, just strictly for that technology,” she said.

It is available to anyone undergoing a screening or diagnostic mammogram, without the need for a doctor’s orders.

“Just let the technologist know you want 3-D imaging as part of the exam,” Bullock said.

Given that the 3-D screening is an emerging technology, some insurance companies don’t currently cover it.

“It is just so new that

Medicare just started reimbursing at the beginning of the year,” she said.

Insurance companies tend to follow Medicare’s lead in terms of deciding what to cover, Bullock said, and some insurers have already adapted the procedure as part of their coverage. The state of Illinois also requires insurers to cover 3-D imaging.

“If the insurance does not cover it, the patient is given a choice whether she wants the 3-D or not,” Bullock said.

The screening has been approved by the U.S. Food and Drug Administration, so it is no longer considered experimental. IU HealthMorgan offers walk-in mammogram screenings, though appointments are recommended and can be scheduled by calling the central scheduling line at 765-349-6440.

Franciscan St. Francis Health in Mooresville. cer Center, said local access is important for patients.

“We have tried to get the majority of our services located there at our Mooresville location just because it’s more convenient,” she said.

That includes chemotherapy and radiation treatments, as well as surgi-

St. Francis expands services

Further north in Morgan County, Franciscan St. Francis Health has been expanding mammography and breast health treatment and support options at its Mooresville campus.

Lisa Davey, a breast cancer nurse navigator for the Franciscan St. Francis Can-

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Indiana University Health-Morgan now offers a three-dimensional breast imaging screening that detects 41 percent more invasive breast cancers.

Teri deMatas, vice president of marketing and community relations for IU Health, said the 3-D screening also reduces “false positive” results compared with traditional 2-D scans. That alone reduces anxiety and cost for patients, she said — speaking from personal experience. Tissue that overlaps can appear abnormal on a 2-D scan.

“IU Health-Morgan has a really strong commitment to making this a really strong outpatient facility,” she said, and it opted for the most progressive screening option available when it was upgrading its equipment.

The Martinsville facility, at 2209 John R. Wooden Drive, is the only place in south-central Indiana to offer 3-D screening, deMatas said.

“They are finding that it’s even more promising than they had thought,” she said.

Jodi Bullock, lead mammography technologist for the facility, praised the 3-D screening.

“We just acquired the breast 3-D imaging in February,” she said. “It’s probably one of the best technologies available since the digital mammogram came out.”

The 3-D screening builds on what’s available from a traditional 2-D scan.

cal procedures for breast cancer patients. She said many patients who use the 1201 Hadley Road facility in Mooresville don’t have the transportation or financial resources needed to travel to Indianapolis or elsewhere outside their neighborhood for treatment.

“It doesn’t seem like that

far, but as far as the gas, it’s just too much,” Davey said.

“It’s more of a cost than their budget can bear.

“A lot of them only live five to 10 minutes away from that campus, so it helps to keep down that barrier.”

Davey works with patients as they navigate breast cancer treatments, from diagnosis to recovery.

She serves as a resource for those who have questions about administering medication, scheduling appointments and finding assistance to afford medical care.

“They get a little lost in the process and say, ‘I don’t know where to go,’” she said, so she tries to relieve some of their anxiety.

SEE TREATMENT | PAGE F7

F4 | THURSDAY, OCTOBER 1, 2015 | THE HERALD-TIMES | BREAST CANCER AWARENESS

Battling black women’s high death rate from breast cancer The Charlotte Observer

Jeanette Meachem speaks out about breast cancer today because her younger sister, Joye Jordan, did not.

When Jordan, a single mom in her late 20s, found a lump in her breast, she went to a doctor who told her she was too young to have breast cancer and probably just had “lumpy breasts.”

She didn’t see a doctor again until she was 31.

By then she had health insurance, but the lump had grown larger. A biopsy detected cancer that had spread beyond her breast, advanced to Stage IV. Jordan died about a year later, just after she turned 33 in August 2010.

“We have to speak up for ourselves and be our own advocates,” said Meachem, 45. “Being silent can kill you.”

Meachem’s story illus-

trates the disparity in breast cancer deaths between African-American and Caucasian women. The Centers for Disease Control and Prevention put the problem in stark terms in a 2012 report called “Vital Signs”: • Although AfricanAmerican women have a lower incidence of breast cancer overall, they are 40 percent more likely to die from breast cancer than white women.

• Despite advances in screening and treatment over 30 years, many African-American women don’t get diagnosed until their cancers are late-stage and harder to treat.

• Even though African-American women get screening mammograms at the same rate as white women, black women are less likely to get prompt follow-up care after abnormal mammograms, and fewer get the treatment they need after they’re diagnosed.

In North Carolina, Mecklenburg County Health Director Dr. Marcus Plescia, who previously worked at the CDC and co-authored the report, called it an indictment of our “bewildering” health care system.

People “don’t really understand what the options are, and they have a very hard time figuring out how to access what they need,” he said. “We don’t have highly organized follow-up systems that we ought to have.”

Many factors — from socioeconomic conditions to heredity — are blamed for the disparities in treatment and outcomes.

Because there are likely multiple causes, there continues to be uncertainty in the medical community over which factors are more significant.

S o m e re s e a rc h i s focused on genetics, since studies show black women who get breast cancer are often diagnosed with a more aggressive type, known as “triple negative.”

Others place more emphasis on social, environmental and historical factors that affect many African-Americans, such as lack of insurance, lower income, poor health and distrust of the health care system.

Until research clears up the mystery, Dr. Otis Brawley, chief medical officer of the American Cancer Society, pushes for more attention to “socioeconomic things that start adding up and become reasons for the disparity.”

“The one thing we do know is that we have a bunch of people who call themselves black who get less than optimal care,” Brawley said. “That’s a logistical issue we can fix.”

Among those studying the biology of breast tumors is Dr. Lisa Carey, chief of the division of hematology and oncology at the University of North Carolina Chapel Hill’s medical school.

In a 2013 study, Carey and her co-authors said “survival differences persist SEE DEATH RATE | PAGE F6

ROBERT LAHSER, CHARLOTTE OBSERVER | TNS

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By Karen Garloch

Esther Craig, 55, participates in an exercise class on Sept. 29, 2014, at the Dowd YMCA in Charlotte, North Carolina, as part of the Levine Cancer Institute Cancer Wellness Program. Craig had a lump in her breast for several months before she finally sought treatment, due to lack of insurance. By the time she was diagnosed, her cancer had advanced to Stage IV. She has already been through treatment.

BREAST CANCER AWARENESS | THE HERALD-TIMES | THURSDAY, OCTOBER 1, 2015 | F5

HOOSIERS OUTRUN CANCER

SCOTT TENEFRANCIA | HERALD-TIMES

SCOTT TENEFRANCIA | HERALD-TIMES

Hoosiers Outrun Cancer, now in its 16th year, took place Saturday in Bloomington.

Money raised by nearly 5,000 participants in the 5-kilometer and 1-mile runs and walks goes to the Indiana University Health Olcott Center in Bloomington, which provides one-on-one education, weekly support groups and patient navigation for cancer patients and their family members.

See more photos on pages F12-13 and at HeraldTimesOnline.com/media.

ABOVE: Kate O’Rourke catches her breath after being the first female runner to cross the finish line in the Hoosiers Outrun Cancer 5K race Saturday.

The run started and finished at Indiana University’s Memorial Stadium.

ABOVE RIGHT: Runners take off Saturday in the Hoosiers Outrun Cancer 5K (3.1-mile) race.

This year’s event followed a new course.

RIGHT: Torri Koons, 8, hands bottles of water to runners before the race.

SCOTT TENEFRANCIA | HERALD-TIMES

F6 | THURSDAY, OCTOBER 1, 2015 | THE HERALD-TIMES | BREAST CANCER AWARENESS

Two ways to reduce your stress levels after a diagnosis Thinkstock

Being diagnosed with a serious illness such as breast cancer can generate an endless series of emotions like worry, fear, anger or sadness.

Here are two simple ways to facilitate healing by reducing this stress.

Cardiac coherence

The practice of cardiac

DEATH RATE CONTINUED FROM PAGE F4

between blacks and whites (even when) diagnosed at similar stages of illness.”

That suggests factors beyond late-stage diagnosis contribute to worse breast

coherence has become increasingly popular over the last 10 years or so. By controlling the heart beat through breathing exercises, the patient helps the brain recognize the message to lower the production of cortisol, also called the stress hormone.

Anybody can use cardiac coherence exercises; all you need is a quiet place, free of distractions.

cancer survival rates in black women.

Carey was one of the first researchers to point out, in a separate 2006 study, that black women are at “substantially higher risk” of developing the aggressive “triple-negative” breast cancer than white women.

• Sit comfortably facing a timer, clock or watch that counts seconds. Alternatively, you can count off the seconds silently, in your head.

• Inhale through your nose for five seconds while relaxing and expanding your abdomen.

• Exhale through your mouth for five seconds while pulling in your stomach and emptying

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Color therapy

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In triple-negative breast tumors, the three receptors known to fuel most cancer growth — estrogen, progesterone and HER-2/ neu — are not present. That makes the cancer harder to treat because commonly used drugs such as tamoxifen and Herceptin are inef-

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larity around the world.

There is evidence that coloring patterns, such as pre-printed mandalas, is a relaxing way to reduce stress and increase selfesteem.

Artful coloring books and mandala coloring books can be bought at bookstores, department stores or businesses specializing in art materials.

Why not give it a try?

fective.

Once diagnosed with triple-negative breast cancer, blacks and whites have about the same outcomes. “It’s a bad disease for everybody,” Carey said.

The question is why black women have a higher incidence of that cancer type.

Despite the recent attention to triple-negative breast cancer, it is relatively rare.

Carey is now directing her attention to the more common type of breast cancer. These tumors have receptors for estrogen and progesterone but not for HER-2/neu. This type of cancer can be treated with hormonal therapy, usually for five years after initial treatment.

For white women, the prognosis is good. But it’s not as good for black women, Carey said.

“We don’t know why,” she said. That’s one of the questions she’ll be trying to answer as principal investigator of the Carolina Breast Cancer Study. “We’ll know in a year or two.”

That study has enrolled 3,000 North Carolina women, both black and white, who developed breast cancer between 2008 and October 2013.

In the 2013 study, Carey

and her colleagues concluded that differences in breast cancer outcomes can also be due to patient behavior and socioeconomic factors, such as poverty, lack of transportation, lower education levels and lack of insurance.

Although Carey believes biological differences are part of the reason for disparities, she agrees with the cancer society’s Brawley that they could be only a minor part.

“It may have everything to do with black women not (having access) to good health care in general,” she said.

Brawley is outspoken in his view that breast cancer differences should not be blamed on race and genetics.

To make his point, he first describes a study from Scotland, which found that poor women are more likely to have triple-negative breast cancer than other women. Part of the reason, he said, may be that poor women have higher-calorie diets in childhood, weigh more, start menstruating earlier and have different birthing patterns than middle-class women.

“All of these factors … are risk factors for breast cancer,” he said. “Maybe we should look a little beyond

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race.”

Take obesity. Brawley said 50 percent of U.S. adult black women are obese, compared with 30 percent of white women. Obesity is a risk factor for breast cancer, especially in women over 50. It can also complicate treatment because chemotherapy doses have to be adjusted, and doctors may be reluctant to increase them adequately.

Brawley also points to a study based in Atlanta, where teaching hospitals provide a substantial portion of breast cancer care.

It found that 7.5 percent of blacks and 2 percent of whites got no treatment in the first year after being diagnosed with “localized potentially curable breast cancers.” His point is that all women don’t get equal care, but black women are especially vulnerable.

Finally, Brawley cites a portion of the CDC report to support his claim that “race is likely not the reason” for breast cancer disparities: In Delaware, Nebraska and Rhode Island, black and white women have equal breast cancer death rates.

“The bottom line,” he said, “is we need to assure that all women have access to high quality screening and high quality treatment.”

BREAST CANCER AWARENESS | THE HERALD-TIMES | THURSDAY, OCTOBER 1, 2015 | F7

Prioritize exercise to fight fatigue, depression after treatment

By Danielle Braff Chicago Tribune

While going through treatment for breast cancer, many women are nauseated, sore, hormonal and cranky — and exercising is not on the top of their to-do list.

But doctors are recommending that they prioritize it to increase their chances of beating breast cancer, improving their mood and making sure the cancer doesn’t return.

“The largest study to date followed survivors over five years and found that one to two hours of brisk walking per week was associated with 40 percent lower risk of death overall compared with those who were less active,” said Susan Brown, managing director of health and mission program education at Susan G. Komen Breast Cancer Foundation.

A 2011 meta-analysis of studies found that the mortality rate for breast cancer was 34 percent lower for women who were very active when compared with women with breast cancer who weren’t active.

Still, a 2013 study found

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“They just need a lot of support,” Davey said.

“We’ve been trying to get more and more down there.”

As part of National Breast Cancer Awareness Month, St. Francis is offering a “mammathon” — a marathon day of mammogram screenings.

“It’s extended hours, trying to get everyone in to try to encourage them to get

COURTESY PHOTO

Doctors recommend prioritizing exercise to increase a patient’s chances of beating breast cancer. that breast cancer survivors aren’t meeting national exercise recommendations.

“Someone who is in active treatment may not feel like walking nine hours a week, but walking a small amount of time can help,” Brown said.

Even though much of the research has focused on the long-term effects of exercise, many of the results can be felt right away, said Julie Everett, physical therapist at Johns Hopkins Hospital in Baltimore, and a certified lymphedema specialist.

“It can increase your

energy, which sounds a little backward,” Everett said.

“You’re expelling energy to gain more. If you increase your calorie burn, it can decrease the fatigue.”

She said that exercise also combats depression, which is common with cancer patients.

The key is figuring out how to get back into exercising — or even to start a fitness routine from scratch — when a woman is undergoing breast cancer treatment or has had a mastectomy.

Most people who have had a lumpectomy or mini-

their screenings,” Davey said.

For the Mooresville campus, the mammathon is scheduled for Oct. 9. There will be door prizes to help make the experience less nerve-wracking.

“Some things to try to make it a little less scary,” she said.

Screenings are for women with no abnormal symptoms and can be scheduled by calling the central scheduling line at 317-528-8555. Women who want to schedule a mam-

mogram specifically during the mammathon can specify that.

“If they do actually have symptoms — an actual lump they can feel or some type of abnormal discharge of the breast — it needs to be evaluated first,” Davey said.

She advises people who have experienced unusual symptoms to contact their doctor, who can order diagnostic testing beyond what a mammogram can find.

mal surgery should be able to start an exercise regimen within six weeks, after getting approval from their doctor, though those who have undergone a more extensive surgery may have a longer wait, said Lidia Schapira, assistant professor of medicine at Harvard Medical School and staff oncologist at Massachusetts General Hospital.

If the person undergoing treatment is fit and already used to exercising before she was diagnosed, she can continue her routine, simply running a little slower if she was a runner or lifting weights that are a little lighter, Schapira said.

Everett said she recommends beginner yoga and tai chi for breast cancer patients because both

forms of exercise will start to stretch the patient’s arms, targeting the areas that were affected through the treatment.

She said patients would also benefit from simply lying on a bed on their back, arms outstretched with a cane or an umbrella overhead, reaching their arms overhead to get a good stretch.

Those who are sore and are having trouble moving their upper body can simply walk, do steps or ellipticals without arms or use a stationary bicycle where the focus is on the lower body, Schapira said.

However, certain forms of exercise are not recommended to breast cancer patients.

“Stay away from Bikram

yoga,” Everett said, warning that the heat from this style of yoga increases the blood flow, which is especially bad for breast cancer patients who are already at an increased risk for lymphedema, a swelling in the arms or legs caused by a blockage in the lymphatic system.

Regardless of the type of exercise that patients choose, Everett said, the key is to not exercise too ardently, which may be the case if someone wants to take a spin class or to train for a marathon at this point.

“You should still be able to hold a conversation, to talk on the phone,” she said.

“If you’re not able to communicate, you’re working too hard.”

National Breast Cancer Awareness Day

Today, we should all wear pink.

Premier Healthcare and Premier Healthcare Oncology salute the survivors and remember the victims of breast cancer.

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F8 | THURSDAY, OCTOBER 1, 2015 | THE HERALD-TIMES | BREAST CANCER AWARENESS

What to say, and what not to say, to someone facing cancer

By Cheryl Powell

Do’s and Dont’s

DON’T: Give advice. “It’s like being Help organize paperwork.

Heidi Eve-Cahoon at Summa pregnant — everybody has Cancer patients must contend Health System in Akron a story,” Eve-Cahoon said. with piles of insurance forms, offered these other “do’s and “They’re usually horror storeceipts, test results and ries. They don’t need to hear don’ts” for friends and family appointment reminders. those things.” members of cancer patients: Bring meals. But call first Offer platitudes, like “It will DO: to see what the patient is make you stronger” or “It’s Allow patients to be angry interested in eating.

God’s will.” or quiet. “Accept her emoBe a point person. “When tions,” she said.

Tell others about the diagsomebody is ill … everybody nosis, unless the patient says Offer support. Give the FOTOLIA | MCT calls,” she said. “If you have it’s OK to share information. person your phone number one person who is the point October’s Breast Cancer Awareness Month can be a painful “I know one lady who came and offer to do things such person, then they can field all time for women with incurable metastatic breast cancer. to me and she was so upset as go to the grocery store, those calls.” because she didn’t want to drive to appointments, babytell anybody about her breast Do things Help the spouse.

Be willing to accomIt can be as know you care. sit or take children to their cancer until she was ready, to make sure the significant pany the patient to doctor’s simple as, “If you need to talk, activities to make life more and her family member told appointments. “Be a second other has time alone and I’m here for you” or “I’m sorry manageable. set of ears if the person asks understands the emotions are a neighbor and it got all you’re going through this. It around,” Eve-Cahoon said. normal. you to come along,” EveSay things to let the person must be very scary.”

Akron Beacon Journal

AKRON, Ohio — “It will make you stronger.”

“You’re going to lose your hair?”

“My friend had cancer 10 years ago, and they did this treatment and she was a hot mess.”

It seems even people with the best intentions sometimes say the worst things possible when a friend or family member faces a cancer diagnosis.

Or sometimes they simply disappear, unsure what to say or do.

With arrival of October comes plenty of pink on everything everywhere as part of Breast Cancer Awareness Month.

So what better time to raise awareness about what’s helpful — and what’s not — when a friend, family member or acquaintance has cancer?

For many patients, just having someone present in

their lives can be the biggest sign of support, said Heidi Eve-Cahoon, a registered nurse and breast care navigator for Summa Health System in Akron.

“Continue the relation-

Cahoon said. “Take notes.”

ships,” she said. “Too many people back away when somebody has cancer, and it’s either because they’re uncomfortable with it, they don’t know what to say, or they’ve had a bad experi-

ence with cancer in their lives.

“It’s important. That person needs their friendships and their family relationships.”

Akron General Hospital

Tha hank a you too the thhe cance caa cer e spec eci ciaallliists ci i aatt

IU Health Cancer Center at Morgan for tthhe he wonde derfu ful ul ccaare dduuring m myy ccaance cer ttrreeaat atm tme ment!

Left to right: Rhonda Jacobs, RN Manager Cancer Services; Kerstin Dietz, Radiation Therapist; Dr. Danielle Doyle, Medical Oncologist; Sarah Hamilton, Cancer Survivor/Patient; Theresa Taylor, Radiation Therapist; Nancy Johnson, Radiation RN

Sarah Hamilton

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breast care coordinator Kathy Lukity agreed.

“Be present,” she said.

“When you get this diagnosis, there are times you feel like crying. It’s nice to have a friend who has the courage to sit there with you when you feel like crying.

A lot of people don’t.”

Carol Thoman, 73, has relied on the help and comforting words of her neighbors in Cuyahoga Falls, Ohio, since being diagnosed with breast cancer in February.

They brought her meals, offered rides and mowed her grass as she went through treatments.

When they went to the store, neighbors stopped by her home and asked if she needed anything.

Another neighbor who had faced her own breast cancer battle sat with her for hours, sharing thoughts and feelings only a fellow patient could understand.

“Just knowing they were there, whether I used them or didn’t use them, was very

comforting,” Thoman said.

Lukity said it’s often more helpful to patients if friends or relatives offer to help with specific chores, rather than saying, “Let me know if I can do anything for you.”

“You need somebody to say, ‘I’m going to the store.

What can I pick up for you?’ or ‘Let me pick up the kids and take them to the park today,’” she said. “People might not have the nerve to say, ‘Can you go to the store for me?’”

Friends and family members also can help patients by encouraging them to stay active, said Dr. Melanie Lynch, a surgical oncologist at Summa. About 30 minutes of exercise each day can help combat fatigue, a common side effect from cancer treatments.

Offer to go for a walk or take a trip to a mall or museum, she suggested.

“Even if it’s just getting outside, that will help as well,” she said.

BREAST CANCER AWARENESS | THE HERALD-TIMES | THURSDAY, OCTOBER 1, 2015 | F9

Use of breath-holding during breast cancer treatment growing

By Lauren Slavin

Learn more online

812-331-4376 | lslavin@heraldt.com

Breast cancer is the most common form of the disease treated at Indiana University Health Bloomington Hospital. And IU Health oncologists, dosimetrists and medical physicists say they treat this common cancer with a fairly uncommon practice among radiation centers: breath-hold treatment.

Breath-hold treatment has been used in radiation therapy for the past decade, said IU Health Radiation Oncologist Fred Wu, and IU Health has been using the process for about six years. However, the IU Health Cancer Radiation Center is the only facility of its kind in the state that utilizes breath-holding as a harm-reduction technique during radiation therapy.

The two linear accelerators at the IU Health Cancer Radiation Center can rotate 360 degrees to deliver mul-

Read about breast cancer prevention, detection and treatment at iuhealth.org/cancer/ breast-cancer.

JEREMY HOGAN | HERALD-TIMES

IU Health oncologists have used the breath-hold treatment for the past decade. tiple beams of radiation to specific parts of the body to treat a patient’s cancer.

However, treating some body parts also may result in unnecessary radiation to adjacent organs. Treating the left breast, for example, can also expose the heart to radiation, and cause heart

disease even after breast cancer is eradicated.

“Radiation in high doses can cause disease years down the road,” Wu said.

To avoid harming noncancerous sites, patients practice breath holding to make the breasts more prominent and move other

organs out of harm’s way.

A patient first breathes deeply, fully filling their lungs. This pushes the heart out of the way of the radiation. The patient holds their breath for five to 10 seconds, as they are able, and a radiation beam treats the cancer.

“They’re getting the full dose to the breast tissue while avoiding everything else,” Wu said.

When a patient undergoes a computed tomography (CT) scan to identify exactly where they need radiation treatment, doctors measure how deeply a patient can breathe, and how long they can suspend their breath. Not every patient is suited to this treatment, particularly old-

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Doctors and patients also monitor breathing during treatment. A small white box called a marker is placed on the patient’s chest, and the doctor will instruct the patient to look at a small screen that illustrates how the box moves up and down as the patient breathes.

The patient, wearing a pair of special goggles to see the screen, can use the marker and screen as tools to watch and control how much they need to fill their lungs to keep other organs from being exposed to radiation, and how long the lungs must stay filled for a radiation beam to hit only its target.

“They can see how they’re doing; we can see how we’re they’re doing,” said Jeff Mumper, a medical physicist at the IU Health Cancer Radiation Center.

“They have a little control over their treatment and know they’re part of the process.”

Despite the technique’s relative ease and efficacy, the IU Health Cancer Radiation Center is the only radiation center in the Hoosier state to use breathholding in regular practice, Wu said. A typical radiation treatment takes about eight to 10 minutes, and using the breath-holding technique can double that.

For high-volume centers, this means seeing fewer patients, which then affects the center’s profitability, Wu said.

“It takes a little longer, but it’s better in the long run,” said Melissa Baltzegar, director of the IU Health Cancer Radiation Center.

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BREAST CANCER AWARENESS | THE HERALD-TIMES | THURSDAY, OCTOBER 1, 2015 | F11

What about taking breast cancer prevention drugs?

By Judy Peres Chicago Tribune

If oncologist Larry Wickerham ruled the world, every woman would know her chances of getting breast cancer, and those at high risk would be offered a drug to prevent the disease.

This is not a pipe dream, says Wickerham, deputy chair of NRG Oncology, a cooperative research group. The drugs exist; they have been used to treat breast cancer for decades.

But only a fraction of eligible women take them for prevention.

Wickerham would like to see the National Cancer Institute run a sustained campaign to educate doctors and the public about so-called chemoprevention of breast cancer, as the National Heart, Lung, and Blood Institute did to promote reduction of cholesterol and blood pressure as a way to prevent heart disease.

But other experts believe there are many other reasons breast cancer chemoprevention is such a hard sell. Among them: • Women are afraid of the potential side effects, and some doctors are reluctant to prescribe drugs to healthy people.

• Primary care providers are not trained in breast cancer prevention.

• Even if doctors are knowledgeable, they don’t have time in a six-minute office visit to ascertain a patient’s personal preferences, assess her level of risk and discuss the costs and benefits of reducing that risk.

• Manufacturers don’t promote drugs for prevention, especially if they are off-patent.

Medical authorities, including the U.S. Preventive Services Task Force, the American Society of Clinical Oncology and the National Institute for Health and Care Excellence in Britain, recommend that women at high risk of breast cancer consider taking one of several anti-estrogen agents that have been shown to cut the incidence of the disease by one-half or more.

But only about 1 percent of eligible women do so, according to Jack Cuzick, head of the Centre for Cancer Prevention at Cancer Research U.K. Breast cancer chemoprevention remains “an enormously underutilized tool,” said Dr. Paul Goss, director of the Dana-Farber/Harvard Cancer Center breast cancer program.

“Compared with statins (which reduce cholesterol) or antihypertensive agents (used to treat high blood pressure), the use of breast cancer chemopreventive

drugs is very low, and, yet, the safety is as good if not better.”

Fran Visco, president of the National Breast Cancer Coalition, warns that “we have to be certain that the risks are exceedingly small” before offering drugs to a healthy population.

But advocates of prevention believe the side effects, including bone-thinning, hot flashes and a slightly increased risk of blood clots and uterine cancer, have been exaggerated.

“Patients have unbelievably been oversold on the side effects,” said Dr. Marc Lippman, professor of medicine at the University of Miami. “There is a simple retort: Most women in the randomized trials of chemoprevention drugs could not correctly identify whether they were on the drug or a placebo.”

“The Holy Grail is efficacy with no toxicity,” said Dr. Nancy Davidson, director of the University of Pitts-

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burgh Cancer Institute, “but we don’t have too many drugs that achieve that goal.

Statins have their own side effects, but we’ve been able to articulate the benefit.”

“On the whole,” Davidson said, “breast cancer (risk-reduction) drugs have pretty limited toxicity.”

But if a patient does have unwanted symptoms, she said, switching to another agent is always an option.

Lippman pointed out that millions of people take medications to reduce their risk of heart disease even though there is a “significant risk of harm” in taking a statin or a baby aspirin.

“The correct question is, ‘Is the benefit outweighed by the harm?’” he said. “I don’t think people appreciate that 125,000 cases (of

breast cancer in the U.S.) could be prevented every year. Think of the health savings and the misery prevention!”

Lippman noted that the two drugs approved by the Food and Drug Administration for breast cancer chemoprevention, tamoxifen and raloxifene, have also shown dramatic ability to prevent osteoporosis. “And as many women will die of osteoporosis as of breast cancer,” he said.

Despite the hurdles, there are signs of progress.

Wickerham believes Cuzick’s 1 percent figure may be outdated. NRG has been evaluating the decision-making process of women thinking about chemoprevention. “We’re finding that 20-25 percent

accept it,” he said.

Lippman, too, says he’s “pretty successful” at getting high-risk women to try chemoprevention. “I explain everything,” he said, “and the women are smart. They understand they’re not doing it for life, only as long as it’s not bothering them.”

To the extent that cost is a disincentive, the Affordable Care Act will require new health insurance plans starting next year to cover chemoprevention with no co-payment or deductible in high-risk women. Meanwhile, European investigators are looking into whether reduced doses of tamoxifen, the oldest of the prevention drugs, can achieve the same benefit with fewer side effects.

F12 | THURSDAY, OCTOBER 1, 2015 | THE HERALD-TIMES | BREAST CANCER AWARENESS

Making it to the finish line RIGHT: Some Hoosiers Outrun Cancer participants were running the 5-kilometer course Saturday morning with a focus on their finishing time and placement, while for others, just completing the course was an accomplishment.

At right, Chatham Anderson talks with an event volunteer at Indiana University’s Memorial Stadium after sprinting through the finish line. Nearly 5,000 people signed up for one of the running or walking events, raising more than $225,500 for the IU Health Olcott Center, which aids cancer patients. See more HOC photos on pages F5 and F13, and at HeraldTimesOnline. com/media.

BELOW: Runners grab fruit and water from a tent at Hoosiers Outrun Cancer Saturday.

SCOTT TENEFRANCIA | HERALD-TIMES

SCOTT TENEFRANCIA | HERALD-TIMES

SCOTT TENEFRANCIA | HERALD-TIMES

Don Keele nears the finish line during the Hoosiers Outrun Cancer 5-kilometer race at Memorial Stadium. Overcast skies and pleasant temperatures Saturday morning helped the event’s run and walk participants endure the 5K and 1-mile courses.

BREAST CANCER AWARENESS | THE HERALD-TIMES | THURSDAY, OCTOBER 1, 2015 | F13

PHOTOS BY SCOTT TENEFRANCIA | HERALD-TIMES

Cancer survivor Dennis Leimer, above, approaches the finish line, seen at left, during the 16th annual Hoosiers Outrun Cancer Saturday morning at Indiana University’s Memorial Stadium. He finished the 5-kilometer course in about 44 minutes.

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F14 | THURSDAY, OCTOBER 1, 2015 | THE HERALD-TIMES | BREAST CANCER AWARENESS

Factors to consider in assessing breast cancer risk From Thinkstock

Research into breast cancer has shown that its origins include a variety of potential causes and risk factors. Although many of them are biological and non-preventable, some can be eliminated, prevented or controlled by changing certain lifestyle habits.

Non-preventable factors

The potential physical causes of breast cancer that have been identified are as follows: • Age (increased risk after the age of 50).

• High breast density.

• A personal or family history of breast or ovarian cancer.

• Genetic mutations associated with the BRCA1 and BRCA2 genes.

• Taking the postmenopausal hormones estrogen and progesterone.

• A history of benign breast disease (cysts, hyperplasia).

• The early onset of menstruation or late onset of menopause.

Preventable factors

On the other hand, some potential causes of breast cancer are closely related to personal lifestyle choices.

Here is a partial list: • Alcohol consumption.

• The use of oral contraceptives for several years.

• Physical inactivity (a sedentary lifestyle).

• Excess weight and obesity in adulthood.

• Smoking and prolonged exposure to second-hand smoke.

• Late pregnancy (after the age of 30).

Please note that these risk factors are not all equally weighted. Get all the information you need about your particular circumstances before changing your lifestyle. It’s always a good idea to consult a health professional as well.

You can reduce the risk of developing breast cancer by changing some of your lifestyle habits.

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BREAST CANCER AWARENESS | THE HERALD-TIMES | THURSDAY, OCTOBER 1, 2015 | F15

How to talk to your children about your diagnosis From Thinkstock

“How on earth am I going to tell my children?” This question haunts all mothers who have just received a breast cancer diagnosis.

Fortunately, psychologists, cancer survivors and social workers have established some ground rules to facilitate this step.

Choose a good time

When you’re ready to break the news, wait until all your children are gathered together in a familiar place. This approach has two advantages. First, it allows all of them to hear the same information simultaneously. It also prevents any one child from feeling excluded or hurt by hearing the news after his or her siblings.

After announcing your diagnosis, take the time to ensure that your children have understood the information you just gave them.

Even though the subject is a difficult one to deal with, silence and denial won’t help them understand or accept the situation.

Be candid and explain to your children all the steps you’ll have to go through in the coming months (treatments, side effects, operation, etc.) Encourage them to ask any questions that are worrying them.

Read to them

Breast cancer is a pretty abstract concept for young children. To help them better understand, read stories to them that deal with this delicate subject in simple terms. You can find several beautifully illusTell the truth trated books in bookstores, When the time comes, through breast cancer supavoid long preambles and port groups or at your local get straight to the point. library.

It’s best to get straight to the point when telling your children about your breast cancer diagnosis.

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