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Bringing Breast Cancer Awareness to the “Hoods”

Social media is filled with comments about the coming of October’s rush of pink items for sale on the web and in stores. Some of those who shared their comments feel we have reached the saturation point on breast cancer awareness. 

Really? I am here to say we will be a long time reaching saturation point in the “hoods” across the USA.

These days, I spend part of my time speaking to women living and working in socio-economically disadvantaged communities. Their lack of knowledge about breast cancer and their need to be vigilant about early detection can only be described as limited, at best.

Through an interpreter, I speak to women who do not speak English. There awareness is all but non-existent.

breast cancerMost of the women attending technical, trade and other adult learning schools, where I have spoken, are surprised to hear that young women get breast cancer. Many, under 40 years of age, do not get comprehensive breast exams. They assume that breast cancer is a disease of older women. They are shocked to hear the statistics on the incidence of breast cancer in women under 50. They are even more upset to hear of women in their childbearing years getting breast cancer. They don’t know about the BRCA mutations.

Recently I spoke to 400+ students, mostly women returning to the work force. Most live in neighborhoods where there is little breast cancer awareness, where October doesn’t bring a flood of breast cancer awareness activities, where few have the spare cash to purchase the pink products found in department stores outside their “hoods.”

During my talk, women shared about their mothers, grandmothers, sisters, friends who now had breast cancer and those who had died from it. Many of the women never made the connection between early intervention, detection and survival rates. Most didn’t go for annual pap smears, never mind have a comprehensive breast exam. A handful of those women over 40 had ever had a mammogram. Few knew that having a mom, sister, or grandma with breast cancer put them in a risk category.

Many of the women comfort themselves with myths that make them feel safe; the same myths that delay their seeking early detection services. They believe that if breast cancer isn’t in their family, they don’t need to be screened; they believe they are safe.

They don’t know about the different types of breast cancer, or the treatments they will need if they should get breast cancer. They don’t know that, if caught early, the prognosis for survival is excellent. They don’t know that if their cancer is caught in a mammogram, before it can be felt, if it is small and hasn’t spread beyond the breast they may not need chemotherapy.

Most importantly, those who are uninsured, often the working poor, don’t know that can get a free mammogram that could save their lives.

Until there are more breast cancer health educators in our “hoods,” women that know the cultures and speak the languages of the women living in these communities, there will never be enough awareness.

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What is Accomplished in Breast Cancer Awareness Month?

breast cancerIgnore the oft times crass commercialism seen in Breast Cancer Awareness Month,  and look at the good that is accomplished. 

Every October organizations big and small run activities to raise the public’s awareness about  breast cancer as well as raise funds to support research for the long hoped for cure. These events are important because they draw attention to a disease that touches so many lives. The media coverage of these events and TV and radio specials throughout October can reach women and men who need to get checked out for breast cancer and prompt them to get the screenings they need.

While this is the case for many Americans, there is a large segment of our society that continues to remain unaware of the need for a annual mammography and comprehensive breast exam. Immigrants who have English as a second language do not usually listen to American television and radio. To reach them requires a grassroots approach to getting the word out about early intervention screenings for breast cancer. Until there is a way to prevent breast cancer, all we have are early intervention screenings.

As a navigator, I  saw thousands of women come to NYC hospitals seeking treatment for breast cancer that could have been caught much earlier, required less treatment, and had a more promising outlook for survival. These situations exist across the US .

Organizations like the American Cancer Society have culturally sensitive staff that carry the early intervention message to communities that have English as a second language and whose cultures may be resistive to or fearful of seeking medical attention. The numbers of women who fit into these categories  are just too large for agencies to reach them all. We all need to do our part to reach out wherever we can and how ever we can to spread the word that these services exist and can be provided for free, if need be.

Let’s make Breast Cancer Awareness Month a very personal project that lasts year-round. If you know anyone who isn’t going for screenings speak to them about the need to do so and, if you can, offer to go with them.  If you speak a second language, speak to those you know who speak only that language about the importance of early intervention. Offer to make an appointment for them and, if possible, go with them or arrange for someone else to go with them for support.

If each one of us got one woman or man to get screened for breast cancer, think of the lives saved!

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What to Ask About Mastectomy Surgery and Reconstruction

mastectomy

Consider asking your breast surgeon the following questions about mastectomy surgery and reconstruction. It’s a good idea to bring someone with you to your appointment to take notes as your surgeon answers your questions.

If you know someone who has recently been diagnosed with breast cancer, you might want to share these questions with her. The questions come from Medline Plus, the U.S. Library of Medicine, The National Institutes of Health

Questions

What Will my Surgery and Pre and Post Surgical Treatment be like?

  • What types of cancer treatment will I need before or after surgery? Will these treatments be different depending on the type of surgery I have?
  • Will one type of breast surgery work better for my breast cancer?
  • Will I need to have radiation therapy?
  • Will I need to have chemotherapy?
  • What is my risk of getting cancer in the other breast?
  • Should I have my other breast removed?

What are the different types of mastectomy?

  • How is the scar different with these surgeries?
  • Is there a difference in how much pain I will have afterward?
  • Is there a difference in how long it will take to get better?
  • Will any of my chest muscles be removed?
  • Will any lymph nodes under my arm be removed?

What are the risks of the type of mastectomy I will have?

  • Will I have shoulder pain?
  • Will I have swelling in my arm?
  • Will I be able to do the work and sports activities that I want to?
  • For which of my medical problems (such as diabetes, heart disease, or high blood pressure) do I need to see my primary care provider before my surgery?

Can I have surgery to create a new breast after my mastectomy (breast reconstruction)?

  • What are the different choices? Which choice will look more like a natural breast?
  • Can I have breast reconstruction during the same surgery as my mastectomy? If not, how long do I need to wait?
  • Will I have a nipple also?
  • Will I have feeling in my new breast?
  • What are the risks of each type of breast reconstruction?
  • If I do not have reconstruction, what are my options? Can I wear a prosthesis?

How can I get my home ready before I even go to the hospital?

  • How much help will I need when I come home? Will I be able to get out of bed without help?
  • How do I make sure my home will be safe for me?
  • What type of supplies will I need when I get home?
  • Do I need to rearrange my home?

How can I prepare myself emotionally for the surgery? What types of feelings can I expect to have? Can I talk with people who have had a similar surgery?

What medicines should I take the day of the surgery? Are there any medicines I should not take on the day of the surgery?

What will the surgery and my stay in the hospital be like?

  • How long will the surgery last?
  • What type of anesthesia will be used? Are there choices to consider?
  • Will I be in a lot of pain after surgery? If so, what will be done to relieve the pain?
  • How soon will I be getting up and moving around?

What will it be like when I go home?

  • What will my wound be like? How do I take care of it? When can I shower or bathe?
  • Will I have any drains to drain fluid from my surgical site?
  • Will I have much pain? What medicines can I take for the pain?
  • When can I start using my arm? Are there exercises I should do?
  • When will I be able to drive?
  • When will I be able to return to work?

 

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The Soy Story

soy

A few months after completing treatment for my first primary breast cancer 15 years ago, I joined a 10-week breast cancer support group at Memorial Sloan-Kettering. One of the first questions asked by a fellow participant was, “What is the soy story?”

I had no idea what she was talking about.

One of the two oncology social workers running the group explained that since soy had estrogen-like properties; women who had estrogen-fed tumors were advised not to eat soy products.

In the years I worked as a navigator, I often had the opportunity to ask doctors, at the various cancer centers, their opinion about women, who have had breast cancer, eating soy. Answers ran the gamut with some doctors saying to eat soy in moderation, to those who stressed total avoidance of all soy products.

What follows is a press release by HealthDay News on a study published September 4th in the Journal of the National Cancer Institute.

THURSDAY, Sept. 4, 2014 (HealthDay News) – Soy protein may increase activity in genes linked to breast cancer growth — at least in certain women who already have the disease, a new study suggests.

Experts said the findings, reported in the Sept. 4 Journal of the National Cancer Institute, shouldn’t scare women off from eating tofu.

But to be safe, the researchers suggest women with breast cancer eat soy foods only in moderation and avoid supplements.

And for women who don’t have breast cancer? “This study doesn’t tell us anything about whether soy raises the risk of developing breast cancer,” said researcher Dr. Jacqueline Bromberg, a breast cancer specialist at Memorial Sloan Kettering Cancer Center in New York City.

The relationship between soy and breast cancer is complicated. On one hand, in countries where soy is a dietary staple — like Japan — women who eat more of it tend to have a lower breast cancer risk.

On the other hand, soy contains phytoestrogens — plant compounds that have weak estrogen-like properties. And lab research has found that those soy compounds may promote the growth of breast tumors.

In the new study, Bromberg and her colleagues randomly assigned 140 women with newly diagnosed, early-stage breast cancer to one of two groups. In one, women took a soy protein supplement every day for anywhere from one to four weeks; those in the other group were given milk powder as a comparison. The women were premenopausal or just past menopause.

The soy supplement — a powder added to water or juice — was the equivalent of about four cups of soy milk a day, Bromberg said. Women in the study typically used it for two weeks.

Even in that short time, the study found, about 20 percent of the women using soy developed high blood concentrations of genistein, a soy phytoestrogen. Among those women, some showed heightened activity in certain genes that promote breast tumor growth and spread.

But it isn’t clear just what that could mean, Bromberg stressed. “Does that necessarily mean the tumor is growing more rapidly?” she said. “No.”

Bromberg said there was no evidence of “tumor proliferation” in women with revved-up gene activity, but the study may have been too short to detect such an effect.

“All we can say is that two weeks of soy supplementation was enough to increase expression of genes related to tumor proliferation,” Bromberg said.

But to be safe, she said, women with breast cancer should probably not take soy supplements, and should eat soy foods, such as tofu and tempeh, only in moderation.

A breast cancer researcher who wasn’t involved in the study agreed that women should play it safe and avoid soy supplements, particularly within a few years of going through menopause.

But a remaining question is whether using soy later in life could be beneficial when it comes to breast cancer, according to Craig Jordan, scientific director of the Lombardi Comprehensive Cancer Center at Georgetown University in Washington, D.C.

With estrogen replacement, there is evidence from lab research and human studies that “timing is everything,” said Jordan, who wrote an editorial published with the study.

As an example, he pointed to a large U.S. study called the Women’s Health Initiative, which looked at the effects of hormone replacement therapy. In that study, women given estrogen alone (not with progesterone) had a lower risk of developing breast cancer than women given a placebo.

And the women in that study were typically in their 60s.

Based on other research, it seems that estrogen can fuel either the growth or death of breast cancer cells, depending on when it’s given. During and soon after menopause, estrogen — and possibly soy phytoestrogens — may put fuel on the fire, Jordan said.

“But soy might be good when used farther out from menopause,” he said. “If we designed a clinical trial of women in their 60s, we might find more [breast cancer] cell death than survival.”

That trial, however, has yet to be done.

SOURCES: Jacqueline Bromberg, M.D., Ph.D., physician/scientist, Memorial Sloan Kettering Cancer Center, New York City; V. Craig Jordan, Ph.D., D.Sc., scientific director, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C.; Sept. 4, 2014 Journal of the National Cancer Institute

HealthDay

 

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An Alternative to Breast Needle Localization

The most uncomfortable and anxiety producing part of my lumpectomy, for my first breast cancer, occurred hours before my surgery. The breast needle localization, as it is called, is a common practice procedure in which the radiologist inserted a needle with a fine wire into my breast to map the location of the cancer. The wire remained in my breast, poking out of the skin, to guide the surgeon during my surgery.

breastI was pleased to read about a patient friendlier method of pinpointing breast tumors that are visible in a mammogram but not palpable in physical examination. This  procedure proved itself in clinical trials and is being used  in several major cancer treatment centers around the U.S.

The procedure, called radioactive seed localization, begins with a breast radiologist injecting tiny sealed radioactive sources called “seeds” into the patient’s breast to mark the exact location of the cancer. The radiologist can perform this image-guided procedure up to two weeks before a biopsy or lumpectomy.

Once in the operating room, surgeons use a handheld radiation detection device, developed specifically for this procedure, to zero in on the seed and precisely navigate to the location of the cancer, which is removed along with the seed during the operation. After the procedure, there is no radioactivity remaining in the body. A pathologist ultimately takes the seed out of the breast tissue in the laboratory, and radiation safety officers ensure the seed’s safe disposal.

Studies suggest that radioactive seed localization results in more precise removal of small breast cancers as compared to traditional breast needle localization. It also reduces the need to have a second surgery due to incomplete removal of the abnormal tissue.

A  video by Dr. Monica Morrow, Chief of the Breast Surgical Service at Memorial Sloan-Kettering, NYC explains how the procedure is done at Sloan. She speaks to the benefits of this procedure over breast needle localization. “Seed localization has improved our patients’ experience by allowing them to go directly to the operating room on the day of their lumpectomy. It is more convenient because it avoids the need for a wire in the breast for several hours, which many patients find uncomfortable.”

The use of this technique at Memorial Sloan-Kettering was initiated by Chief of the Breast Imaging Service, Elizabeth Morris and Jean St. Germain, an attending physicist and radiation safety officer at Memorial Sloan-Kettering. It is standard practice for the majority of Memorial Sloan-Kettering’s patients with small breast cancers.

“Getting this technique up and running took months of training and coordination among experts in radiology, surgery, medical physics, and pathology to make certain that the procedure would be safe and effective for our patients,” St. Germain said, “This collaboration has ultimately improved our efficiency as well as provided a better surgical experience for our patients.”

Sources: Press releases, Video by Dr.Monica Morrow, Chief of the Breast Surgical Service at Memorial Sloan-Kettering

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