Monday, June 23, 2014

Please, Don't Let Your Teen Go To a Tanning Salon

New test predicts if breast cancer will spread

"Tests assessing metastatic risk can help doctors identify which patients should receive aggressive therapy and which patients should be spared," said lead and corresponding author Thomas Rohan, MD, PhD, professor and chair of Epidemiology & Population Health at Einstein and Montefiore. The study was led by researchers at the National Cancer Institute (NCI)─designated Albert Einstein Cancer Center of Albert Einstein College of Medicine of Yeshiva University and Montefiore Einstein Center for Cancer Care, in Bronx, New York. It was published in the Journal of the National Cancer Institute (2014; doi:10.1093/jnci/dju136).A test of tumor microenvironment of metastasis (TMEM) predicted risk of distant metastasis in estrogen receptor–positive and HER2-negative breast cancer, according to a new study. The test may help in guiding treatment decisions and in preventing overtreatment.

To measure the effectiveness of the test, the researchers used it on about 500 breast tumor specimens that had been collected over a 20-year period. The test proved more accurate in predicting the risk of distant tumor spread than a test closely resembling the leading breast cancer prognostic indicator on the market.

According to the NCI, 232,340 American women developed breast cancer last year and 39,620 women died from the disease. Death from breast cancer is mainly due to distant metastasis, when cancer cells in the primary tumor invade blood vessels and travel via the bloodstream to form tumors elsewhere in the body.

Primary breast cancers metastasize when a specific trio of cells is present together in the same microanatomic site: an endothelial cell (a type of cell that lines the blood vessels), a perivascular macrophage (a type of immune cell found near blood vessels), and a tumor cell that produces high levels of Mena, a protein that enhances a cancer cell's ability to spread. A site where these three cells touch is where tumor cells can enter blood vessels. That site is called a tumor microenvironment of metastasis, or TMEM.

A team of pathologists applied intravital imaging observations in living rodents to identify TMEMs in human breast biopsy specimens. The scientists developed a test that uses a triple immunostain containing antibodies to the three cell types that make up a TMEM. Several different imaging technologies were combined to reveal in great detail how cancer and other complex diseases get started and progress in the body, permitting the translation of basic-science observations into relevant clinical applications.

When the TMEM test was applied to samples from 259 women who later developed a distant metastasis, and was then compared to control samples from women who did not develop metastasis, the risk of distant metastasis was 2.7 times higher for women with tumors in the high-score TMEM group compared with women with tumors in the low-score TMEM group.

http://www.oncologynurseadvisor.com/new-test-predicts-if-breast-cancer-will-spread/article/356770/

The Path To Your Door

MINDFUL MONDAY

June 23, 2014 by Editor

The path to your door

Is the path within:
Is made by animals,
Is lined by flowers,
Is lined by thorns,
Is stained with wine,
Is lit by the lamp of sorrowful dreams,
Is washed with joy,
Is swept by grief,
Is blessed by the lonely traffic of art,
Is known by heart,
Is known by prayer,
Is lost and found,
Is always strange,
The path to your door.

Michael Leunig

http://journeyingbeyondbreastcancer.com/2014/06/23/mindful-monday-50/

Cancer survivors: Reconnecting with loved ones after treatment

Friends and family provide an important circle of support for cancer survivors. Learn how to nurture relationships so that you can avoid common problems.By Mayo Clinic Staff

Your friends and family love you and are worried about you — but they sometimes have strange ways of showing it. Some people withdraw and avoid talking to you. Others smother you and treat you like a child.

Many cancer survivors find that one barrier to a smooth transition out of cancer treatment is the reaction they get from friends and family. One way for cancer survivors to prepare for relationship difficulties is to expect these problems and plan accordingly.

Common relationship issues for cancer survivors

Chances are you've noticed that some of your relationships have felt strained since you ended your cancer treatment. You've probably felt alone and sad as you've seen people turn away from you or otherwise treat you differently from how they had before. Navigating relationships is a challenge for cancer survivors transitioning to life after treatment.

You may recognize some of these common scenarios:

Changing responsibilities. During treatment, you might not have been able to handle all the household duties you had performed before your cancer diagnosis. For instance, maybe you were in charge of grocery shopping and cooking dinner. If cancer treatment tired you out and you were unable to continue those tasks, your partner or another family member might have filled in for you. Now that your cancer treatment is over, that person might be expecting you to resume those responsibilities — but you might not feel up to it yet. This can be frustrating for your family member, and you might feel pressured to do more than you can handle.
Changing roles. If you were a take-charge kind of person before cancer, you may find that during treatment your partner had to take over that role. Deciding when and how to switch back can be confusing and awkward.
Withdrawing from you. You may find that some friends and family members are avoiding you. It could be subtle or overt, such as when someone stops returning your phone calls. Either way, it hurts. People withdraw for a number of reasons. The person might not know what to say or is worried about saying the wrong thing. He or she might not know how to offer you support. Others don't know how to react.
Giving you too much attention. Rather than feeling lonely, you might find yourself being smothered with good intentions. Friends or family might baby you and insist on doing things for you when no assistance is needed. They love you and want to help, but in fact they're too helpful.
Being nosy. Some people ask a lot of questions — perhaps more than you're comfortable answering.
Confusing expectations. If your recovery isn't going as well as you'd hoped, you might be frustrated. You might expect everything to go back to normal right away, but that isn't happening. Try not to take your frustrations out on the people around you. If you do, you could push them away.

Whether you encounter problems with your relationships often depends on the strength of the relationships beforehand. Relationships that were already strained tend to continue that way after cancer, sometimes completely falling apart. Strong relationships can become even stronger through the cancer experience.

http://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer-survivor/art-20045378?linkId=8532355

Breast cancer's difficulties leads woman to open shop for other patients

http://www.freep.com/article/20140622/FEATURES08/306220014/1025

We are honored to be a part of the Detroit Free Press Cancer Survivors project. Susan

Susan Thomas opened Susan's Special Needs, a Pleasant Ridge boutique born from her own experiences in 2000. The store carries wigs, prosthetic breasts, bras, hats, headscarves, seat belt pads, everything a woman undergoing breast cancer treatment might need — including emotional support.

Wig helps breast cancer survivor grow confidence: Susan Thomas talks about her experience with wigs. Georgea Kovanis/Detroit Free Press

By Georgea Kovanis

Detroit Free Press Staff Writer

FILED UNDER

Purchase Image ZOOM

Susan Thomas opened Susan's Special Needs, a Pleasant Ridge boutique born from her own experiences in 2000. The store carries wigs, prosthetic breasts, bras, hats, headscarves, seat belt pads, everything a woman undergoing breast cancer treatment might need — including emotional support. / Kathleen Galligan/Detroit Free Press

Susan’s Special Needs

24052 Woodward, Pleasant Ridge
www.susansspecialneeds.com or 248-544-4287

Warning signs of breast cancer

■ New lump in the breast or underarm.
■ Thickening or swelling of part of the breast.
■ Irritation or dimpling of breast skin.
■ Redness or flaky skin in the nipple area or the breast.
■ Pulling in of the nipple or pain in the nipple area.
■ Nipple discharge other than breast milk, including blood.
■ Any change in the size or the shape of the breast.
■ Pain in any area of the breast.
Source: Centers for Disease Control and Prevention, www.cdc.gov

Factors that decrease the risk of breast cancer

■ Being older when you first had your menstrual period.
■ Starting menopause at an earlier age.
■ Giving birth to more children, being younger at the birth of your first child, and breastfeeding your children.
■ Getting regular exercise.
■ Maintaining a healthy weight.
Source: Centers for Disease Control and Prevention, www.cdc.gov

Factors that increase the risk of breast cancer

■ Long-term use of hormone replacement therapy.
■ Personal history of breast cancer or noncancerous breast diseases.
■ Family history of breast cancer.
■ Treatment with radiation therapy to the breast/chest.
■ Exposure to diethylstilbestrol (DES).
■ Dense breasts.
■ Drinking alcohol.
■ Night-shift work (which throws off circadian rhythms).
Source: Centers for Disease Control and Prevention, www.cdc.gov.

Susan Thomas wasn’t sure what was worse — that her wig looked like dog fur or that it kept sliding off her head.

But this she did know: The wig, the best she could find in 1992 when she lost her hair from the chemotherapy that was part of her treatment for breast cancer, made her look like a cancer patient.

■ Related Special Section: Surviving Cancer

And people treated her differently once they knew she was sick. Instead of seeing Susan walking toward them, they saw cancer coming their way. “I had a neighbor who had a new baby,” said Thomas, who was 39 when she was diagnosed. “She wouldn’t let me hold the baby because she thought I was contagious.”

That sort of reaction, that sort of thinking can be devastating to a cancer patient.

“It makes us feel like we’re not worthy,” said Thomas, a former oncology nurse. Believing you look bad — or unlike yourself — can make you feel like you’re losing everything. That instead of getting the best of cancer, cancer is getting the best of you. That instead of beating cancer to its core, cancer is beating you — and taking away your identity with it.”

So she decided to try to change that.

A new path

At 63, Thomas, who lives in Birmingham, is cancer-free. She and her husband, 68-year-old David Thomas, own Susan’s Special Needs, a Pleasant Ridge boutique born from Susan Thomas’ experiences.

The store carries wigs, prosthetic breasts, bras, hats, headscarves, seat belt pads, everything a woman undergoing breast cancer treatment might need — including emotional support.

“As soon as I walked in the shop, I knew I was in the place for me,” said Natasha Robinette, a 42-year-old radiologist who lives on Grosse Ile and showed up at Susan’s when she first needed wigs to cover bald spots on her scalp, the result of cancer surgery.

Upon receiving her first great wig, Robinette rolled down the car windows on the drivehome

so her hair could blow in the breeze. “That, to me, was the feeling of feeling like a woman again,” Robinette said.

“With Susan’s efforts, work and support, I feel complete, whole and beautiful again,” Robinette said.

The store is set up more like a salon — with individual consultation rooms and beauty parlor chairs — than a place that sells medical supplies.

It doesn’t smell like sick. It doesn’t smell like despair.

Wigs in the store range from $250-$3,000. The wig fitters at Susan’s Special Needs are meticulous; they and Thomas won’t let a woman out of the door unless they think she looks fantastic — no matter how many times a wig or prosthesis needs to be adjusted.

Thomas tells the women what they can expect from treatments, what soaps might irritate their skin, what camisoles can disguise postsurgical drainage tubes. She is at once fashion consultant

, cheerleader, nurse and educator.

Thomas has been known to ask clients who are nervous about what is ahead of them: “Will it help you if I show you my scar?”

And when they say yes, she unbuttons her blouse and shows them.

“I share with them who I am and what we can do to make their journey easier. We can guide them through the process of talking about hair loss and what we can do to make that journey easier,” she said.

Carol Schroeder, who had a double mastectomy in September found Susan’s Special Needs after trying other stores that sell prostheses. “The thing is, people have to remember, I’ve never done it before. Otherwise, sometimes you talk to people who’ve been in the business

for a long time they don’t take time to tell you or be patient enough with you.”

But Thomas, said Schroeder, who is 66 and lives in Sterling Heights, “was very reassuring. She talks about making sure you get the right fit for what you need. ... I would I describe her as a patient, gentle perfectionist. She just answers all your questions.”

A shocking biopsy

Susan Thomas was in the shower, doing her routine self-exam when she felt a lump in her left breast.

As a nurse who worked with cancer patients, she knew she needed to see a doctor.

As a woman, a wife, a mother of two young girls facing the potential

of a life-altering diagnosis, Thomas chose to believe the doctor when he said the lump was probably just a cyst and she should simply monitor it.

Within six months, the lump had gotten larger. In May 1992, a biopsy came back: cancer.

“We were all shocked,” said Thomas, who was 39 at the time. “I do not have a family history of breast cancer. I was young. I didn’t know anybody else who was diagnosed with breast cancer.”

Thomas had surgery, followed by chemotherapy.

When her hair began falling out in clumps, she and her husband checked into the Townsend Hotel in Birmingham, ran a bath, got in the tub and pulled out the rest of her hair. They went to dinner.

“He poured me a glass of champagne and said ‘Here’s to the future.’ He took me down to the Rugby Grill and I put on my wig for the first time. It looked awful. It wasn’t fitted to my head. It moved. I was sitting here, I got a new outfit. I sat there and thought, ‘Oh my God, this is awful! I can’t walk around looking like this!’ ”

The more she thought about the situation, about what was available for women undergoing breast cancer treatment, the more disgusted she became.

“This is ridiculous,” David Thomas said, finally. “We’re changing this!” They started a wholesale business in 1993, transitioned into retail in 2000.

Along the way, Susan Thomas has made many friends and lost many of those friends to cancer.

“The emotional purge and support I receive at Susan’s explains the smile on my face as I’m leaving,” said Robinette, who visited the shop last weekend for a wig fitting. “These things have no price tag. They are not on Susan’s website or product inventory list.”

Said Thomas: “I love what I do. It’s just not a business. It’s more my ministry. This is more to me than selling a wig. This is hoping to change the journey.

http://www.freep.com/article/20140622/FEATURES08/306220014/1025

Saturday, June 21, 2014

Virtual Community, Real Support for Breast Cancer

Member News

19 Jun 2014 1:50 PM

Deanna J. Attai, MD, on the rewards of co-moderating a popular chat group on Twitter

	Deanna J. Attai, MD Institution: Center for Breast Cancer, Inc. Specialty: Breast Cancer Member since: 2013 ASCO Activities: Breast Cancer Symposium News Planning Team

#bcsm is not a typical cancer support group. It has no physical office, no dedicated funding, and no full-time staff. However, it does have regular meetings; every Monday at 9:00 PM EST, hundreds of people affected by breast cancer share their stories, ask questions, and discuss the disease with experts, and it all happens on Twitter. #bcsm stands for "breast cancer social media," and from this pithy hashtag has grown an enormous online community devoted to evidence-based medicine, open discourse, and compassionate support for everyone touched by breast cancer.

ASCO member and breast surgeon Deanna J. Attai, MD, of the Center for Breast Care, Inc., in Burbank, CA, and President-Elect of the American Society of Breast Surgeons, serves as co-moderator of the weekly #bcsm chats, with writer/cancer advocate Jody Schoger and cancer survivor Alicia Staley. Together, the three volunteers plan discussion topics, recruit expert guest tweeters, and keep chats on track. Their innovative approach to cancer advocacy and community-building earned them a coveted presentation slot at the tech conference South by Southwest in March 2014.

#BCSM Chat

Apr 6

Check out the growing list of #BCSMresource links.bcsmcommunity.org/resources/

AC: How did you get started with Twitter?

Dr. Attai: When I first joined Twitter in 2010, I wasn't really sure where I belonged, but I saw right away that women were talking on Twitter about things that they should be discussing with their doctors, and clearly they weren't getting the information they needed. So I found myself doing online what physicians do every day, offering advice to people who aren't our own patients but want our guidance— friends, neighbors, people you run into in the grocery store—suggesting questions the person should be asking their doctor, or reinforcing the need for a second opinion. I also disseminate information about new studies and dispel myths, especially when there's a blockbuster headline about a new drug in the news but the reality for patients is very different.

I'm always very aware that I'm on Twitter representing not just myself, but also the leadership roles that I hold, so I keep it professional. I might occasionally tweet a picture of my garden or talk about sports—topics I would discuss casually with a patient are fair game, but I don't share private things that I would talk to my friends about. It's good to draw some boundaries.

AC: What was your first experience with the #bcsm community?

Dr. Attai: I missed the first chat. Jody and Alicia won't let me forget it, although they purposefully launched it with very little fanfare. The first chat was on July 4, 2011, which was the Monday of a holiday weekend, and I try not to spend too much time online during weekends. On Tuesday, a few people I knew on Twitter asked why I wasn't on the #bcsm chat, and it was because I didn't know about it! I started participating in the chats the following week.

Initially the chats were focused almost exclusively on survivorship issues. I learned so much from listening to these women talk. As the chats branched out to include information from medical meetings and focused on specific medical aspects of breast cancer, I played a larger role in the discussions. In October 2011, I was asked to come on as a co-moderator.

AC: Aside from its home on Twitter, what distinguishes #bcsm from other breast-cancer support groups?

Dr. Attai: There are a lot of breast surgeons, medical oncologists, radiation oncologists, and psychologists who have made themselves available to the group, even when the chats aren't taking place. They're an incredible resource for patients. Jody and Alicia were very passionate from the start that this space would not perpetuate myths or bad science, and we focus on making sure that any medical information we discuss is evidence based and accurate. It's not okay for someone in the chat to make snake-oil claims about breast cancer treatment. This is why we've been so successful in getting other doctors involved in the chats—they see we're having constructive discussions and that patients are clamoring for legitimate medical guidance.

AC: What did it mean for #bcsm to be featured at such a high-profile event as South by Southwest, which highlights the latest innovations and most creative ideas in technology?

Dr. Attai: It was incredible. We never expected this kind of attention. Our goal is to help educate and empower the breast cancer community, which is a huge community, so it was an amazing opportunity to get our message out.

Jody, Alicia, and I gave the presentation, with [journalist and activist] Xeni Jardin as the moderator. We talked about how #bcsm started, what we're doing now, and how we're a different type of community that can engage, support, and be medically accurate all at the same time. It was very well received, and we got great questions and great feedback.

AC: What's next for #bcsm?

Dr. Attai: We're only reaching a small number of patients on Twitter. Branching out to a website (bcsmcommunity.org) has helped widen our audience, and we have some ideas for taking it even further. For example, we'd like to help create opportunities for patients and patient advocates to attend medical meetings, like the American Society of Breast Surgeons Annual Meeting and the Breast Cancer Symposium.

The organization is just the three of us, working on our own time. #bcsm evolved very organically from the beginning, really from the ground up, so now we're starting to sit down and plan what's next. It can be hard to find the time and resources to make it work, but we're extremely committed to this community and we're moving forward.

http://connection.asco.org/Magazine/Article/ID/3910/Virtual-Community-Real-Support-for-Breast-Cancer.aspx

What's The Deal With Soy And Breast Cancer?

The Huffington Post | By Meredith Melnick

Posted: 06/20/2014 8:33 am EDT Updated: 06/20/2014 8:59 am EDT

Print Article

Welcome to Ask Healthy Living -- in which you submit your most burning health questions and we do our best to ask the experts and get back to you. Have a question? Get in touch here and you could appear on Healthy Living!

"Ask Healthy Living" is for informational purposes only and is not a substitute for medical advice. Please consult a qualified health care professional for personalized medical advice.

I avoid soy like the plague because of a family history of breast cancer. What is the real story on soy and breast cancer? -- Adrienne

About 75 percent of breast cancer tumors have estrogen receptors, meaning they grow in response to estrogen. And so, if breast cancer runs in your family, it stands to reason that you'd want to closely regulate exposure to a hormone that promotes tumor growth. For many people, doing so includes avoiding soy -- but luckily for those who love their edamame or veggie burgers, this isn't necessary at all. Yes, soy mimics estrogen and estrogen is linked to some hormonally active cancers, but that does not mean that soy itself is linked to cancer.

"There has been concern over the years regarding soy consumption and development or recurrence of breast cancer, and the basis for this concern is isoflavones, a compound in soy with a similar chemical structure to estrogen," Dr. Erica Mayer, M.D., M.P.H., a medical oncologist at the Susan F. Smith Center for Women's Cancers at Dana-Farber, explains to HuffPost. "The idea is that this could potentially fuel growth of breast cancer, but that doesn't bear out in the data."

Breast cancer and soy studies typically fall into two categories -- lab studies in rodents, or large-scale, observational studies of human behavior over time. Some rodent studies have shown that if you give rats or mice a very high dose of pure isoflavones, it can promote tumor growth. But, as Mayer points out, this result cannot be extrapolated to how humans process soy, both because of physiological differences between humans and rodents and because of the major differences between isoflavone supplements and dietary soy.

And then there's the other side of the research spectrum: the observational, population-level studies. These studies have generally followed large Asian populations, where soy is most commonly consumed. And, not only does this high soy diet not contribute to increased rates of cancer, it actually seems to lower them in many cases.

"Even though animal studies have shown mixed effects on breast cancer with soy supplements, studies in humans have not shown harm from eating soy foods," echoes Marji McCullough, strategic director of nutritional epidemiology for the American Cancer Society in a blog post for the organization. "Moderate consumption of soy foods appears safe for both breast cancer survivors and the general population, and may even lower breast cancer risk. Avoid soy supplementsuntil more research is done."

While there is no definitive explanation for why soy may be able to lower breast cancer risk, there are a few factors that are likely involved. On a micro-level, though isoflavones mimic estrogen, there is also some evidence that they have anti-estrogen properties, including a role in blocking estrogen from binding to receptors (and helping them to bind in the blood instead) and inhibiting the formation of estrogen in fat tissue, according to the American Cancer Society. More globally, for overweight or obese women, a plant-based diet can lead to weight loss and weight loss is associated with a decreased risk of breast cancer.

"The message that [the] oncology community is trying to get out is that instead of following concerns about soy in the diet, women should be focusing on exercise and weight loss as preventive measures for breast cancer," explains Mayer. "We really do have very good evidence and a growing accumulation of data on the link between obesity and breast cancer risk and the beneficial effect of exercise. That's not the case for soy."

http://www.huffingtonpost.com/2014/06/20/how-much-soy-should-you-eat-breast-cancer_n_5249925.html?&ncid=tweetlnkushpmg00000033

Monday, June 23, 2014

Please, Don't Let Your Teen Go To a Tanning Salon