Saturday, December 29, 2012

A Brief History of Breast Cancer


A Brief History of Breast Cancer

This mammogram, showing an abnormality in the breast, is the modern way to diagnose breast cancer.

Is Breast Cancer a Modern Illness?

To the contrary: cancer has probably been around as long as humans.Skeletal remains of a 2,700 year old Russian King and a 2,200 year old Egyptian mummy have both been diagnosed with prostate cancers.
Breast cancer can also be traced right back to ancient Egypt, with the earliest recorded case described on the 1600 BC Edwin Smith Papyrus. Because breast cancer is quite outwardly visible in its most advanced state (seldom reached today thanks to modern medicine) it frequently captured the vision and imagination of our ancestors enough for them to record it.

Is Breast Cancer More Common Today?

You’ve probably heard people remarking how there seem to be many more cases of cancer around these days than there used to be. It is very hard to tell whether breast cancer is actually more common in today’s society, or whether our perception is skewed.
  • We have much better diagnostic capabilities today so more cases are identified.
  • More women are “breast aware.” Nowadays, women are more likely to perform breast self-examinations and get mammograms if they suspect that something is wrong. Women are more likely to receive routine clinical breast examinations at their doctors’ office, inevitably meaning that more cases are identified.
  • Up until the 19th century, people died younger. Breast cancer develops more amongst older women, so this increase in life expectancy could be skewing perceptions.
  • Women used to have more children at a younger age and breastfed for longer, all factors which lower the risk of breast cancer

Beliefs about the Cause of Breast Cancer

Throughout the ages, nobody has really been sure what causes breast cancer. Research still continues today.
Some of the earliest theories have long since fallen by the wayside. The Ancient Greeks, for example, believed that imbalances of bodily humors (fluids, especially black bile) were responsible for breast cancer.
But many other historic theories do still influence modern thought, with remnants of early beliefs left behind to form common breast cancer myths. In the 17th and 18th centuries, lots of possible causes of breast cancer were suggested:
By the 19th century, the hopelessness of not knowing gave rise to a wave of psychological theories such as surgeon John Rodman’s bizarre suggestion thatbreast cancer was simply the fear of cancer.
It wasn’t until the mid 20th century, with the discovery of DNA that scientists could finally begin to understand the role of genetics in breast cancer.

Natural Ancient Remedies for Breast Cancer

Early remedies for breast cancer were aimed at offering temporary relief or prolonging life rather than attempting to cure the disease. The Egyptian Edwin Smith Papyrus echoed a sentiment which lasted many centuries when it pronounced: “There is no treatment.” Surgery was therefore generally avoided as futile and various herbal medicines or ointments preferred.
Common treatments used throughout history when treating breast cancer include:
  • Purging of humors (Ancient Greece)
  • Prayers and rites to the Gods (Greeks and Egyptians)
  • Opium
  • Castor Oil
  • Licorice
  • Sulphur
  • Salves and Balms
  • Cauterization
  • Arsenic

The First Modern Breast Cancer Treatments

Modern breast cancer treatments only became commonplace once
  • Scientists began to establish the relationship between breast cancer and genes
  • Surgeons started viewing breast cancer as a localized disease (in just one area) which could be removed before it spreads
Both of these theories meant shifting away from beliefs about breast cancer relating to bodily fluids, viral contagion or sexual psychology. It now meant that breast cancer could be treated by isolating specific cells or removing affected areas; the beginning of the treatment known today as the mastectomy.
Around the 1750’s a number of surgeons, including Jean Louis Petit, Henri Le Dran, Claude-Nicolas Le Cat and Benjamin Bell, began performing breast cancer surgery removing lymph nodes and underlying muscle along with breast tissue.
These were the forerunners to the radical mastectomy, devised by William Halsted in the mid-nineteenth century. Halsted had the great advantage of developments in biological knowledge about cells and medical advances (anaesthetics, antiseptics and blood transfusions). He agreed with the theory behind removal of the breasts and underlying areas for breast cancer patients but was very concerned about spreading the cancer cells further. His contribution was a mastectomy which removed both breasts, lymph nodes and underlying muscles all in one piece. This became the standard breast cancer treatment until less radical, breast-sparing treatments began to be developed in the 1950s.
[Photo by iStockPhoto]

Why, God?


OP-ED COLUMNIST

Why, God?

  • FACEBOOK
  • TWITTER
  • GOOGLE+
  • SAVE
  • E-MAIL
  • SHARE
  • PRINT
  • REPRINTS
WASHINGTON
Fred R. Conrad/The New York Times
Opinion Twitter Logo.

Connect With Us on Twitter

For Op-Ed, follow@nytopinion and to hear from the editorial page editor, Andrew Rosenthal, follow@andyrNYT.

Readers’ Comments

Readers shared their thoughts on this article.
When my friend Robin was dying, she asked me if I knew a priest she could talk to who would not be, as she put it, “too judgmental.” I knew the perfect man, a friend of our family, a priest conjured up out of an old black-and-white movie, the type who seemed not to exist anymore in a Catholic Church roiled by scandal. Like Father Chuck O’Malley, the New York inner-city priest played by Bing Crosby, Father Kevin O’Neil sings like an angel and plays the piano; he’s handsome, kind and funny. Most important, he has a gift. He can lighten the darkness around the dying and those close to them. When he held my unconscious brother’s hand in the hospital, the doctors were amazed that Michael’s blood pressure would noticeably drop. The only problem was Father Kevin’s reluctance to minister to the dying. It tears at him too much. He did it, though, and he and Robin became quite close. Years later, he still keeps a picture of her in his office. As we’ve seen during this tear-soaked Christmas, death takes no holiday. I asked Father Kevin, who feels the subject so deeply, if he could offer a meditation. This is what he wrote:
How does one celebrate Christmas with the fresh memory of 20 children and 7 adults ruthlessly murdered in Newtown; with the searing image from Webster of firemen rushing to save lives ensnared in a burning house by a maniac who wrote that his favorite activity was “killing people”? How can we celebrate the love of a God become flesh when God doesn’t seem to do the loving thing? If we believe, as we do, that God is all-powerful and all-knowing, why doesn’t He use this knowledge and power for good in the face of the evils that touch our lives?
The killings on the cusp of Christmas in quiet, little East Coast towns stirred a 30-year-old memory from my first months as a priest in parish ministry in Boston. I was awakened during the night and called to Brigham and Women’s Hospital because a girl of 3 had died. The family was from Peru. My Spanish was passable at best. When I arrived, the little girl’s mother was holding her lifeless body and family members encircled her.
They looked to me as I entered. Truth be told, it was the last place I wanted to be. To parents who had just lost their child, I didn’t have any words, in English or Spanish, that wouldn’t seem cheap, empty. But I stayed. I prayed. I sat with them until after sunrise, sometimes in silence, sometimes speaking, to let them know that they were not alone in their suffering and grief. The question in their hearts then, as it is in so many hearts these days, is “Why?”
The truest answer is: I don’t know. I have theological training to help me to offer some way to account for the unexplainable. But the questions linger. I remember visiting a dear friend hours before her death and reminding her that death is not the end, that we believe in the Resurrection. I asked her, “Are you there yet?” She replied, “I go back and forth.” There was nothing I wanted more than to bring out a bag of proof and say, “See? You can be absolutely confident now.” But there is no absolute bag of proof. I just stayed with her. A life of faith is often lived “back and forth” by believers and those who minister to them.
Implicit here is the question of how we look to God to act and to enter our lives. For whatever reason, certainly foreign to most of us, God has chosen to enter the world today through others, through us. We have stories of miraculous interventions, lightning-bolt moments, but far more often the God of unconditional love comes to us in human form, just as God did over 2,000 years ago.
I believe differently now than 30 years ago. First, I do not expect to have all the answers, nor do I believe that people are really looking for them. Second, I don’t look for the hand of God to stop evil. I don’t expect comfort to come from afar. I really do believe that God enters the world through us. And even though I still have the “Why?” questions, they are not so much “Why, God?” questions. We are human and mortal. We will suffer and die. But how we are with one another in that suffering and dying makes all the difference as to whether God’s presence is felt or not and whether we are comforted or not.
One true thing is this: Faith is lived in family and community, and God is experienced in family and community. We need one another to be God’s presence. When my younger brother, Brian, died suddenly at 44 years old, I was asking “Why?” and I experienced family and friends as unconditional love in the flesh. They couldn’t explain why he died. Even if they could, it wouldn’t have brought him back. Yet the many ways that people reached out to me let me know that I was not alone. They really were the presence of God to me. They held me up to preach at Brian’s funeral. They consoled me as I tried to comfort others. Suffering isolates us. Loving presence brings us back, makes us belong.
A contemporary theologian has described mercy as “entering into the chaos of another.” Christmas is really a celebration of the mercy of God who entered the chaos of our world in the person of Jesus, mercy incarnate. I have never found it easy to be with people who suffer, to enter into the chaos of others. Yet, every time I have done so, it has been a gift to me, better than the wrapped and ribboned packages. I am pulled out of myself to be love’s presence to someone else, even as they are love’s presence to me.
I will never satisfactorily answer the question “Why?” because no matter what response I give, it will always fall short. What I do know is that an unconditionally loving presence soothes broken hearts, binds up wounds, and renews us in life. This is a gift that we can all give, particularly to the suffering. When this gift is given, God’s love is present and Christmas happens daily.

Another Side Effect Of Chemotherapy: 'Chemo Brain'


Another Side Effect Of Chemotherapy: 'Chemo Brain'

Dr. Jame Abraham used positron emission tomography, or PET, scans to understand differences in brain metabolism before and after chemotherapy.
Dr. Jame Abraham
It's well-known that chemotherapy often comes with side effects like fatigue, hair loss and extreme nausea. What's less well-known is how the cancer treatment affects crucial brain functions, like speech and cognition.
For Yolanda Hunter, a 41-year-old hospice nurse, mother of three and breast cancer patient, these cognitive side effects of chemotherapy were hard to miss.
"I could think of words I wanted to say," Hunter says. "I knew what I wanted to say. ... There was a disconnect from my brain to my mouth."
Before getting treated for cancer, Hunter led a busy, active lifestyle. But the effects of chemotherapy on her brain made it difficult for her to do even the most basic things.
"I couldn't even formulate a smile. I had no expression," she says. "I might feel things on the inside, but it didn't translate to the outside. ... It literally felt like you were trying to fight your way through fog."
Some cancer patients call this mental fog "chemo brain." And now researchers are trying to quantify exactly what chemo brain really is.
Oncologist Jame Abraham, a professor at West Virginia University, says about a quarter of patients undergoing chemotherapy have trouble processing numbers, using short-term memory and focusing their attention.
Using positron emission tomography, or PET, scans to measure blood flow and brain activity, Abraham looked at the brains of 128 breast cancer patients before they started chemotherapy and then again, six months later.
On the second brain scan, he found significant decreases in brain activity in regions responsible for memory, attention, planning and prioritizing. Those results were recently presented at the Radiological Society of North Americameeting.
Chemotherapy "can cause damage to bone marrow, hair cells, mucosa," Abraham says. "In the same way, it can potentially cause changes in the brain cells, too."
But Max Wintermark, a brain imaging specialist at the University of Virginia, says the findings bring up more questions than answers: Do brain changes occur with all types of chemotherapy or just one type? Do they only happen to breast cancer patients or to all cancer patients?
Wintermark says these are critical questions that warrant further study.
In the meantime, Wintermark says there are some simple ways cancer patients can work around "chemo brain": reminders on sticky notes and detailed grocery lists.
And fortunately, Abraham says chemo brain is almost always temporary. He says patients usually regain their full cognitive abilities within a year or two after chemotherapy treatment ends.

Breast Cancer Study: Patients May Be Too Quick To Have Double Mastectomy


Breast Cancer Study: Patients May Be Too Quick To Have Double Mastectomy


Posted: 
Breast Cancer Study
Many breast cancer patients have their healthy breast removed along with the affected breast despite the relatively low risk of developing cancer in that healthy breast, according to a new study. The findings suggest that fear of the cancer recurring drives many women to have the aggressive surgery. But there is scant evidence that removing both breasts improves most women's long-term survival, some doctors say.
"It is not that that worry is ill-founded. It's perfectly natural for women to worry about their cancer coming back. That is [their] biggest concern," Dr. Sarah Hawley, an associate professor in internal medicine at the University of Michigan and a researcher on the study, told HuffPost. But removing most women's second breast does not improve their rates of survival, she said.
In findings that Hawley and her team will present at the American Society of Clinical Oncology's Quality Care Symposium on Friday, researchers analyzed data on 1,400 women with breast cancer who were registered with the National Cancer Institute's SEER program, which collects cancer statistics across the U.S. Approximately 7 percent of the women opted for a "contralateral prophylactic mastectomy" -- the removal of both the breast affected by breast cancer and the healthy breast.
Women who have tested positive for inherited BRCA gene mutations, which increase their risk for developing a new breast cancer in their other breast, are sometimes advised to consider contralateral mastectomy. (Some women with BRCA gene mutations who do not have cancer nonetheless opt to have one or both breasts removed as a preventive measure, which is a different procedure.)
Women with a strong family history of the disease in multiple, immediate family members may also be encouraged to consider contralateral mastectomy, Hawley said. But according to the new findings, 70 percent of the women who opted to have both their affected and healthy breast removed did not have those risk factors.
While most of the beast cancer patients in the study said that they had been worried about the possibility of their cancer recurring when making decisions about treatment, women who opted to have both breasts removed expressed the most worry -- suggesting fear may be a major reason why many women choose that aggressive option, Hawley said.
"It's not wholly unreasonable to have a bilateral mastectomy even if you don't have a [BRCA] mutation, but you need to understand that, most likely, you're not providing yourself any protection against premature death from breast cancer," said Dr. Stephen Edge, breast center medical director and chief of breast surgery at Roswell Park Cancer Institute. A recent American Cancer Society report states that contralateral mastectomy "nearly eliminates the risk of developing a breast cancer in the second breast," but cautions "there is less evidence that it improves long-term breast cancer survival."
"The risk of recurrence on the breast that had cancer, or [it] coming back elsewhere in the body from that initial cancer, is much higher than the risk of developing a new cancer in the other breast," said Dr. Carla Fisher, a breast surgeon with the Hospital of the University of Pennsylvania. "Treating the primary cancer is the most important thing, rather than treating something that may or may not happen, [which] may or may not have survival benefits down the line."
Nonetheless, recent studies suggest that the number of women in the U.S. opting to have both the affected and healthy breast removed has increased steeply over the past decade. A 2009 study in the Journal of Clinical Oncology found that the rate of contralateral mastectomy among women who had any kind of surgery on their breast increased by nearly 150 percent between 1998 and 2005. Overall, however, the rate of women choosing contralateral mastectomy is still under 10 percent among women with breast cancer.
"Most people would tell you that they've seen a marked upswing in the number of women asking for it, and the number of women undergoing it," said Edge. "Surgery is not a good treatment for fear," he added.
The "right line," Edge said, is subjective.
One concern is that women who opt to undergo contralateral mastectomy may open themselves up to various health risks associated with having a bigger operation. Those risks include infection, longer hospital stays and more difficult recovery.
For now, Hawley said, there is a pressing need to better understand the reasons why women opt for contralateral mastectomy in order to help make sure that they are adequately informed about the possible risks and benefits by their oncologists and their surgeons.
"We are sure there are a lot of other factors, other than just fear, going into this," she said. "We need to understand what those are."

Friday, December 28, 2012

New Meaning and Drive in Life After Cancer



New Meaning and Drive in Life After Cancer


SEIZING THE MOMENT Some of the photos submitted by cancer survivors as part of The Times’s “Picture Your Life After Cancer” project: Clockwise, from top left: Jane C. Bressler, Dr. David Posner, Sandra Elliott and Susan Schwalb.SEIZING THE MOMENT Some of the photos submitted by cancer survivors as part of The Times’s “Picture Your Life After Cancer” project: Clockwise, from top left: Jane C. Bressler, Dr. David Posner, Sandra Elliott and Susan Schwalb.
  • FACEBOOK
  • TWITTER
  • GOOGLE+
  • SAVE
  • E-MAIL
  • SHARE
  • PRINT
The Well Column
THE WELL COLUMN
Tara Parker-Pope on living well.
When people hear the words “You havecancer,” life is suddenly divided into distinct parts. There was their life before cancer, and then there is life after cancer.
The number of people in that second category continues to grow. In June, the National Cancer Institute reported that an estimated 13.7 million living Americans are cancer survivors, and the number will increase to almost 18 million over the next decade. More than half are younger than 70.
A new book, “Picture Your Life After Cancer,” (American Cancer Society) focuses on the living that goes on after a cancer diagnosis. It’s based on a multimedia project by The New York Times that asked readers to submit photos and their personal stories. So far, nearly 1,500 people have shared their experiences — the good, the bad, the challenging and the inspirational — creating a dramatic photo essay of the varied lives people live in the years after diagnosis.
For Susan Schwalb, a 68-year-old artist from Manhattan, a diagnosis of early-stage breast cancer at the age of 62 led to a lumpectomy, followed by a mastectomy and then failed reconstruction surgery. She discovered that cancer was not only a physical challenge but a mental one as well, and she turned to friends and support groups to cope with the emotional strain. When she saw the “Picture Your Life” project, she submitted a photo of herself wearing a paint-splattered artist’s apron.
“What cancer made me do in my own professional life is to pedal faster,” Ms. Schwalb said in an interview. “I’ve encountered some people who decide to enjoy life, retire, work in a garden. I decided I had to have more of what I wanted in life, and I better move fast because maybe I don’t have the long life I imagined I would have.”
Indeed, a common theme of the “Picture Your Life” project is that cancer spurs people to take long-delayed trips, seek out adventure and spend time with their families. Photos of mountain climbs, a ride on a camel, scuba diving excursions and bicycle trips are now part of the online collage.
Dr. David Posner, associate program director of pulmonary medicine at Lenox Hill Hospital in Manhattan, says a diagnosis of metastatic colon cancer at the age of 47 has helped him relate to his own patients with cancer. The past decade has included nine operations, six recurrences and three rounds of chemotherapy, but Dr. Posner said he never missed more than three weeks of work.
“My salvation has been my family and my work,” he said. “When I was at work I wasn’t thinking about myself, and it was very therapeutic. I see my share of cancer patients, and I motivate them and they motivate me.”
Dr. Posner said he decided to be part of “Picture Your Life” because he wants to get the word out that a cancer diagnosis — even a dire one like his — doesn’t have to define your life.
“I think about someone asking me, ‘So how was your last decade — was it wasted or was it a life filled with a lot of happiness and joy?’ ” he said. “The cancer thing was a pain, but for the most part I’ve had a pretty good time.”
The “Picture Your Life” collage includes photo after photo of survivors with their pets. Sandra Elliott, 59, of Claremont, Calif., submitted a picture of herself with her two golden retrievers, Buddy and Molly. They were just puppies when she received a diagnosis of Stage 2 breast cancer in 2003. During her recovery from surgery and chemotherapy treatments, she took the dogs to romp on the Pomona College campus, near her home, and one day a professional photographer snapped the picture.
“No matter how bad I felt that day, no matter how many chemo treatments or doctors appointments, those two little puppies with these big black eyes would look at me with their tails wagging as if to say, ‘It’s time. It’s time. It’s time to go out!’  ” Ms. Elliott recalled.
“I felt so physically horrible, and I’d look at them and the pure joy on their faces and in their bodies for just being out in nature and being able to smell the air, smell the trees, chase a squirrel — that sheer in-the-moment love of life they showed me really lifted my spirit on a daily basis.”
Ms. Elliott still lives with chronic pain as a result of nerve damage from her cancer treatment, and she can relate to others in the “Picture Your Life” project who worry that their cancer will recur or that they’ll never feel completely normal again. But she says a stronger theme runs through all the pictures and stories.
“We have all been forced to find the joy in the smallest things,” she said. “I’m sitting here looking at a geranium about to bloom. These things are out there — we just have to be reminded to look at them. And cancer is a big reminder.”