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PINK Knowledge and technology join the fight against breast cancer Presented by
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Education key at
diagnosis The sun is one source of vitamin D. Vitamin D may help the body fight cancer, according to a recent report in the journal Anticancer Research. Micolo J/Flickr By Melissa Erickson More Content Now
More than half of women newly diagnosed with breast cancer are more likely to remove a second, unaffected breast to prevent cancer spread, according to a new study. “There is so much information about breast cancer that it’s easy for patients to get overwhelmed. Interventions that address patient anxiety and lack of knowledge are needed to facilitate more informed decision making for patients,” said Dr. Katharine Yao, director of the breast surgical program at NorthShore University HealthSystem in Evanston, Illinois.
Danger of overdiagnosis A third of women who are given information about the chance of overdiagnosis through breast screening programs may not fully understand the risks involved, according to research reported in Science Daily. Overdiagnosis happens because some breast cancers grow so slowly that it would take more than a lifetime for them to threaten a woman’s health. For every life that is saved through screening, researchers estimate that around three women will be overdiagnosed with breast cancer.
Vitamin D increases survival Breast cancer patients with high levels of vitamin D in their blood are twice as likely to survive the disease as women with low levels of this nutrient, according to research recently reported the journal Anticancer Research. “Vitamin D metabolites increase communication between cells by switching on a protein that blocks aggressive cell division,” said Cedric Garland, professor, University of California, San Diego School of Medicine. “As long as vitamin D receptors are present, tumor growth is prevented and kept from expanding its blood supply. Vitamin D receptors are not lost until a tumor is very advanced. This is the reason for better survival in patients whose vitamin D blood levels are high.”
Age at diagnosis A recent study that appeared in the journal Cancer found that women diagnosed with breast cancer at younger ages are more likely to experience difficulties with symptoms and side effects than those diagnosed when older. Younger women with breast cancer had more depression, fatigue, attention problems, problems with sexual function, body image concerns, anxiety, sleep difficulties, problems with marital satisfaction and fear of recurrence than their older peers and young, undiagnosed women. These women face greater quality-of-life issues over time, researchers concluded.
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myths and
facts By Melissa Erickson
Myth: Most breast lumps are cancerous.
A disease like breast cancer can be a mortal battle fraught with overwhelming stress and devastating physical and emotional impact. Confronting breast cancer is made even more difficult when fictions get caught up with the facts. Here’s a myth-busting look at breast cancer risks:
Fact: Eight out of 10 lumps that women may feel in their breasts are not cancerous, according to BreastCancer.org. “A benign lump can be a collection of normal or hyperactive breast gland cells, or it may be a water-filled sac (cyst),” according to its website.
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Myth: Breast cancer only affects older women. Fact: Breast cancer doesn’t discriminate. Although it most often strikes women between ages 55 and 65, women of all ages should be diligent about screenings and be aware of their risk factors. “Diagnosing breast cancer in its earliest, most treatable stage is difficult in young women whose breast tissue is generally denser than that of older women, making mammogram and physical exam unreliable. There is also the common belief among young women that they’re simply too young to develop the disease,” says Dr. Gale England, an Advocate Medical Group breast surgeon, Downers Grove, Illinois.
Myth: Men don’t get breast cancer. Fact: Yes, men do get breast cancer, but it is not common. The chance of a man getting breast cancer is 100 times less than women, England said.
Misinterpretation: 1 in 8 women will develop invasive breast cancer. Fact: Your risk increases as you get older. It’s more accurate to say 1 in 8 women who reach the age of 80 can expect to develop breast cancer. “In each decade of life, the risk of getting breast cancer is actually lower than 12 percent for most women,” according to BreastCancer.org.
Q: Do breast self-exams save lives? A: “The use of breast self-exams is controversial; technically they do not save lives, as a self-exam-detected cancer is going to be bigger than one detected mammographically,” England said. “That being said, I always encourage my patients to perform self breast exams. They may detect subtle changes, especially in younger women, where mammograms are less sensitive.”
Mammograms are important tools in recognizing existing cancer, but don’t help prevent it.themozhi’s pixel displays/flickr
SEE MYTHS AND FACTS, PAGE 5
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Myths and facts
Myth: Wearing an underwire bra increases your risk of getting breast cancer.
There is no targeted treatment for this subtype,” the Breast Cancer Deadline 2020 website reads. This type of cancer lacks certain receptors and cannot be controlled Fact: There is no scientific evidence that by drugs like tamoxifen that target those wearing an underwire bra causes “breast receptors. The website continues, “There From Page 4 cancer by blocking the drainage lymph are fewer effective treatment options for fluid cause breast cancer by blocking the these patients; however it appears that Myth: Mammograms prevent drainage of lymph fluid from the bottom chemotherapy may be more effective in breast cancer. of the breast so it can’t get back into your this type of breast cancer.” Fact: Mammograms do not prevent body,” according to BreastCancer.org. breast cancer, but they are a screening tool that will detect cancer that is already in the True or false: Fewer people are breast. “They are tools for early detection, Myth: The mortality rate from dying from breast cancer now which improves survival,” England said. breast cancer is the same for
Myth: Only people with a family history of breast cancer are at risk.
African-American women as it is for Caucasian women.
Fact: White women are more likely to be diagnosed with breast cancer, but AfricanFact: “Most women who get breast American women are more likely to die cancer do not have a family history. Only from it, according to the National Breast 20 percent of new breast cancer cases are Cancer Coalition. About 118 of 100,000 African-American women are diagnosed, related to heredity,” England said. compared to 128 white women and 88 Hispanic women. The mortality rate Myth: A family history of for breast cancer for African-American breast cancer matters only on women is about 33 per 100,000 women, compared to 24 for white women and 16 the mother’s side. Fact: It’s now know that a history of breast for Hispanic women. “One reason for the difference in cancer in the women on a father’s side is just mortality among African-American as relevant as a woman’s family history on women may be that young Africanthe mother’s side. Hereditary breast cancer American women are disproportionately can be passed down from the father’s side, affected by triple-negative breast cancer. according to BreastCancer.org.
than in the past.
True: Breast cancer mortality rates are declining, which is good news, but 40,000 women will die of breast cancer this year, according to the National Breast Cancer Coalition. Between 1930 and 1990, breast cancer death rates changed little, but they decreased 27 percent from 1990 to 2005. Between 1994 and 2003, the mortality rate for women of all races combined declined by 2.4 percent annually. In white women, breast cancer mortality declined by 2.5 percent annually. In black women, mortality declined by 1.4 percent annually during the same period.
Myth: Breast cancer is preventable, or if you’re at risk, there’s little you can do to prevent breast cancer. Fact: While breast cancer is not preventable, there are things a woman can do to lower her risk such as losing weight if she’s obese, getting regular exercise and limiting alcohol consumption. Some factors that increase the risk of breast cancer are mostly uncontrollable such as age, personal and family breast cancer history, genetic factors, first menstrual period before age 12, menopause after 55, breast density and race, according to the National Breast Cancer Coalition.
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Tips The Cancer Support Community’s newest Spotlight Series offering “Frankly Speaking About Cancer: What Do I Tell the Kids” is available as a free download on its website, orders.cancersupportcommunity.org.
Here are tips from Goldberger and the Cancer Support Community:
An important conversation Randen Pederson/Flickr
How to talk to children about a cancer diagnosis By Melissa Erickson More Content Now
Sara Goldberger knows how tough it is to talk to children about a family member’s breast cancer diagnosis, but it’s not simply because she’s a licensed clinical social worker and senior director at Cancer Support Community. It’s because she’s a cancer survivor whose son was 13 when she was diagnosed. Cancer affects families in many ways, and children of all ages feel the impact of the illness whether you talk to them about it or not. Parents often fear “they’ll open Pandora’s box” if they bring up the subject of cancer, Goldberger said. They’re scared they’ll make it worse. “It’s challenging and it’s difficult, but that’s OK. It’s a tough conversation, but it needs to be had,” Goldberger said. “I believe having these conversations with your child are life-learning experiences.”
Be age-appropriate While 2-year-olds have no idea what cancer is, “even the youngest, infants and
toddlers, can recognize changes in the day-to-day routine or notice something’s different and know something’s going on,” Goldberger said. Whispered discussions or phone conversations that end abruptly when a child walks into a room will alarm children at any age. “The anxiety of knowing something bad is going on is worse than knowing the reality,” Goldberger said. So talk to your kids, but be sure the message is appropriate for your child and his or her maturity level. Tailor your message and language to your child’s level of understanding. Not all 8-year-olds will understand or be able to accept the same conversations, Goldberger said. Oversharing details and medical terms that kids don’t understand isn’t helpful. “Some people are so proud that they told their daughter that ‘Mommy’s hair is falling out because she’s undergoing chemotherapy,’ but young children won’t understand what that is,” Goldberger said.
• Use a calm voice. • Time the conversation for when you won’t be interrupted and your child is receptive and not hungry or tired. • Keep it straightforward with short answers and simple words that state the facts. • Do less talking and more listening. • Prepare yourself for questions and feelings that children may have. • Let them know that any question is OK. • Assure children that cancer is not their fault and that it’s not contagious. • Try and be comfortable. If parents are not comfortable talking, children will not feel safe to ask questions. • Remember it’s not one conversation. It will be ongoing. • Leave every conversation with words like “I know I’ve given you a lot to think about. Come back to me if you have questions later.” • Keep the lines of communication open even when not a lot is going on (for example, in between chemotherapy appointments). • Be a physical presence for your child. Sit together and read a book or watch a TV show to show that you’re there for them. Keep the lines of communication open, Goldberger said. It shows you’re not hiding anything and that you will include them when important things happen. Most children will find it comforting when you check in briefly every now and then.
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The Bald
truth
Ballerina, 23, fights stage 4 cancer and misconceptions about who can get it By Melissa Erickson More Content Now
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till dancing every chance she gets, Maggie Kudirka is the self-proclaimed Bald Ballerina, and she’s sharing her devastating yet inspirational story on social media to raise awareness and funds for her fight against breast cancer. “Cancer can strike anyone: no one is too young or too fit,” said Kudirka, a 23-yearold dancer at New York’s Joffrey Ballet School who was recently diagnosed with stage 4 breast cancer. “I am young, thin and physically active. I followed a healthy diet consisting of primarily fruits and vegetables; I do not smoke or drink. I have never taken hormones. “A lesson I learned while studying ballet was that even the most difficult movement can be mastered with hard work and consistent practice. I have taken this approach to fighting cancer,” she said. “I have changed my diet, added supplements
and begun practicing breathing and visualization. I imagine the cancer cells leaving my body while reciting my mantra: ‘Another one bites the dust’ from the Queen song.”
—Her journey— In June, Kudirka discovered a large lump on the top of her left breast. “Other than that, I had no other symptoms: no pain, no discharge, no discomfort,” she said. “I had trouble getting in to see a doctor because their gatekeepers did not think a lump in a 23-year-old woman was serious. They had openings several months later. The gatekeepers invariably said, ‘Don’t worry. It’s probably nothing. Most lumps in young women are benign. Not an emergency. You’re too young for breast cancer.’ How I wish they had been right.” A second opinion showed a much more
advanced cancer that had spread. “In my case, the cancer chose the absolute worst possible part for a dancer: the bones. I wondered if I could ever return to dancing again, and had visions of bones breaking as I danced,” she said. Kudirka has undergone four chemotherapy treatments out of six, with the last treatment scheduled for October, and she plans to have a double mastectomy afterward. At the time of her diagnosis Kudirka was on full scholarship in the Joffrey’s pre-professional Concert Group and her future looked very bright, said Davis Robertson, artistic director of the Concert Group. “She’s a fighter. She came to me and asked, ‘Will I have a place (back in the Concert Group)’ when I’m ready to return?” Robertson said. “Not only is she an amazing dancer, she’s an inspiration to
everyone around her.”
—Her mission— To share her journey with friends and family, Kudirka started the Bald Ballerina Facebook page with the goal of not only raising awareness but also “to let people know that it is their right to demand good medical care, to challenge and question their doctors, and to seek second, third or even fourth opinions if uncomfortable with their current care,” she said. She hopes to grow Bald Ballerina into a nonprofit foundation to provide grants for medical and living expenses for dancers with cancer. “Fighting cancer is expensive, even with health insurance. There are deductibles, co-pays, and treatments not covered by insurance. Sadly, most dancers do not earn a lot of money and they cannot work during treatment. It is hard to concentrate
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on healing when you are worried about paying your bills,” Kudirka said. She also has advice for women out there who may be facing a breast cancer diagnosis. “Listen to your body and follow your intuition. If you think something is wrong, seek out a medical professional. Be persistent and determined. Do not let wishful thinking lead you to accept a medical opinion that is based on statistics and not supported by test evidence. You may be one of those rare cases like me,” Kudirka said. Take control of your own body and medical care. “It may have saved my life,” Kudirka said. “Learn as much as you can about your condition and don’t be afraid to question your doctor about your treatment plan. If you are uncomfortable with the answers, get a second or even a third opinion. Trust your instincts and stay positive,” she said.
Kudirka’s body has “responded very well to the treatments, and the cancer is retreating,” she said. “Presently, there is no cure for stage 4 cancer, so I will need to remain on various drugs until a cure is found. Fortunately, much research is being conducted on my type of breast cancer (Her-2-Neu positive) and I am hopeful that I can get into a clinical trial testing a potential cure.” Because the Concert Group is a student company, Kudirka has had no income in the past year. Her parents are selfemployed and own an auto repair shop. If you would like to contribute to Kudirka’s medical care, you can make a donation on YouCaring.com at http:// www.youcaring.com/medical-fundraiser/ bald-ballerina-fighting-breastcancer/206980 or through the mail at: Bald Ballerina, 1801 Gwynn Oak Ave., Baltimore, MD 21207.
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A plan for
you
Cancer fight gets customized By Melissa Erickson More Content Now
The future of breast cancer is understanding biology. In other words, don’t expect your doctor to treat your breast cancer the same way he would treat your girlfriend’s breast cancer, said Dr. Anne Wallace, director at UC San Diego Comprehensive Breast Center. Hear the words “breast cancer,” and most women are terrified, but treatment is a complex issue, Wallace said. In the past, breast cancer treatment was categorized. “If you had stage 1, you do this; stage 2, do that. That’s no longer the case. Now
women are receiving more personalized therapy” based on the genetic details of the tumor, said Dr. Marleen Meyers, assistant professor in the division of medical oncology at the NYU Perlmutter Cancer Center. The field of breast cancer research is changing rapidly as scientists seek to understand the genes, molecules and lifestyle factors that cause breast cancer. Researchers are now figuring out new ways to treat breast cancer more precisely by looking at the specific biological signatures of a tumor.
Phil and Pam Gradwell/Flickr
“All cancer is very heterogeneous,” meaning each case of breast cancer is unique “based on biology or how it looks under a microscope,” Wallace said. “In the future everyone’s cancer will look different (under the microscope). It will be like looking at snowflakes.” Unfortunately, some women and their doctors are seeking “overtreatment,” said Wallace, who suggested a comparison to prostate cancer and its treatment. When men are diagnosed with prostate cancer, they look at their level of PSA (prostate specific antigen) with their doctors. If it’s low, they often seek a wait-and-watch course of treatment rather than take drastic action, Wallace said. On the other hand, a woman may feel a lump or get a mammogram with signs of a tumor and instantly think the right course of action is a mastectomy, Wallace said. “They hear those words ‘breast cancer’ and want to die,” she said. “The topic of breast cancer is so politically motivated.” Wallace agrees. “Some women will walk into their doctor’s office and say, ‘I want to do everything possible to fight this.’ The doctor’s response should be, ‘Yes, we want to do everything possible, but the key is does the benefit outweigh the risk?’” Wallace said. Doctors identify cancers into different subgroups in order to plan a course of
treatment. For example, some tumors are estrogen receptor-positive and are treated well with the drug tamoxifen. Another woman’s breast cancer may test positive for HER2 receptors and be treated with the drug Herceptin. Other breast cancers don’t respond well to any drugs and a more drastic course of action (surgery, radiotherapy and chemotherapy) is called for. By establishing different subgroups of breast cancer with a detailed system of tumor categories, the correct treatment can be determined, which will lead to less overtreatment, Wallace said. “The key is to understand the biology,” she added. “Every cancer is unique, and each day we’re getting more tools to pinpoint treatment so that it is patient-specific,” Meyers said.
Haukeland universitetssjukehus/flickr
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FINDING AN
OUTLET
Survivors find comfort through breast cancer-related art By Melissa Erickson More Content Now
Meant to inspire, empower, educate and motivate, breast cancer-related art runs the gamut from pink-ribboned messages of strength and cheeky bedazzled bras to thought-provoking pieces that personalize a woman’s struggle with the disease that steals about 40,000 lives a year. For Los Angeles artist Bettina Hubby, creating art helped her endure after being diagnosed with stage 1 breast cancer last January. While friends and family reacted with fear and panic, Hubby decided she needed to face cancer differently. She created a Facebook page titled “Thanks for the Mammaries,” and later curated a similarly named exhibition of boobthemed art. “I think this is the best example of the somewhat cringe-worthy phrase: art can change your life. I am a witness that it can bring relief, joy and/or a lightness of being to the darkest of times,” Hubby said. One of the “best things” she has ever done, Hubby said the experience “helped me during the hardest time of my life by getting these images flooding in daily from friends and strangers. It cheered me, and it enabled others to deal with a tragic situation in a lighthearted way whilst still showing care. I then turned it into a fullblown art show benefiting cancer research and care with 125 artists involved.” Serious, positive and humorous is how you could describe the Art Bra project at Process Art House in Amarillo, Texas. “Since everyone deals with traumatic events differently, each piece created relays a different message,” said Rhoda Breeden, chief operating officer of the gallery. The artistic style of the decorated bras varied from solemn to sassy, humble to bold. “The array of emotions from dealing with breast cancer is wide, and how each person expresses those emotions is unique,” she said. “Art can be used as a coping mechanism that a lot of people may not consider. It
gives the person coping a new voice to express their feelings and their journey, and it allows them to relay their message to others in a unique way.” The inspiration for artist Pam Sims’ breast cancer artwork came to her in the middle of the night. Her resined plaques – she calls them Save the Ta Tas – shine with a positive hope of survival. “Breast cancer has hit my family three times so far – my mother, my motherin-law and my sister-in-law. The older women did very well, but my sister-in-law had a very, very difficult time and is now clear,” said Sims, owner of Resinique, who sells her artwork at Resinique.etsy.com. “What these women have gone through is much like a soldier goes through who is deployed. Both are undergoing a life-changing event, with an unknown outcome. They are battling an enemy, seen and unseen. How they will come out of this battle is anyone’s guess and hopefully they will still be in one piece at the end. Their battle changes the lives of not only themselves, but everyone around them. “At the end of the battle, they are heroes for having gone through hell. Artwork that depicts these battles are not only for the one who has gone through the battle, but for the families to express how proud they are of the survivors, as well as those who have lost their lives, and how much they love them and think of them,” said Sims, who plans to donate a portion of her proceeds to Susan G. Komen breast cancer organization. Breast cancer-related artwork is just a click away on sites like Zazzle.com. “I think the wall art can be very inspiring for survivors or loved ones to show your support as a gift,” said Diana Adair, Zazzle’s director of communications. “Perhaps it can provide positive healing or perspective to remind yourself of your own strength on a daily basis.”
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New treatments
By Melissa Erickson More Content Now
What’s making headlines in breast cancer research
Breakthrough drugs and new, advanced treatments give breast cancer patients and their families hope for a longer and better life. Here’s a look at some recent advancements:
Gene mutations It’s an exciting time in breast cancer research, especially with what’s happening with genetic research and testing, said Dr. Marleen Meyers, assistant professor in the Division of Medical Oncology at the NYU Perlmutter Cancer Center. The PALB2 gene is something doctors have known about for years, but recently they’ve uncovered that it holds a newfound importance. The new research shows that women with mutations in the PALB2 gene have on average a 1 in 3 chance of developing breast cancer by age 70, making it potentially one of the most relevant genes associated with breast cancer after BRCA1 and 2. “It’s not new, but it’s important,” Meyers said. “Women who were tested 10 years ago, but came up negative for BRAC1 and BRCA2, should go back and get tested again for the PALB2. It’s especially
important if you have a strong family history of breast cancer,” she said.
Pre-surgery drug Also exciting is the first drug approved to shrink breast tumors cancer before surgery, said Dr. Chau Dang, chief of medical oncology at MSK West Harrison, an outpatient treatment center of Memorial Sloan Kettering Cancer Center, which will open in October. Oncologists sometimes use chemotherapy to treat breast cancer before surgery, but this is a drug. Pertuzumab was approved last year to treat metastatic HER-2 positive breast cancer along with a combination of other drugs, and is now approved to treat patients with early stage breast cancers that respond to the HER-2 protein, said Dang. The medical oncologist specializes in the treatment of women with breast cancer, and her research focuses on developing more-effective and less-toxic treatment strategies.
Screening New screening technologies like
tomosynthesis are also benefitting breast cancer patients. In this digital process, rather than one photo, a series of small, photographic “slices” at different depths and thicknesses is taken, which saves both time and reduces radiation exposure. While mammography and MRI have their downsides (false positives and unneeded biopsies), tomosynthesis or digital breast imaging is more precise and can pick up smaller, hidden tumors, Meyers said. A new three-dimensional breast imaging device, General Electric’s SenoClaire, was approved by the FDA in September. Developed in collaboration with Massachusetts General Hospital, SenoClaire uses a step-and-shoot procedure and a low-dose short X-ray sweep to create a 3-D image with no increase in radiation from a standard 2-D mammography.
Hormone, radiation therapy Another recent change in treatment is the duration of the therapy for women with hormone-receptor positive breast cancer – the most common form of breast cancer, Dang said. “While five years used to be the
standard, now a decade of follow-up care is being shown to lead to a longer survival rate and lower risk of breast cancer recurrence,” Dang said. The American Society of Clinical Oncology now recommends 10 years of tamoxifen for both pre- and perimenopausal women. Post-menopausal women who have completed a five-year regiment of tamoxifen have the option of five more years of AI (aromatase inhibitor) treatment. “Hormonal therapy is effective and women have options. The choice of drugs depends on their tolerance, but for most people longer therapy is better,” Dang said. Radiation therapy is also “shorter and more safe now,” said Dang. “The classic regiment was five or six weeks, now it’s three weeks or even one week,” she said “And it’s given on the stomach to protect the heart and lungs.”
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