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surviving
breast cancer 2014 | The Spokesman-Review
livewell spokesman.com/health
Words of Wisdom 8 survivors share the one thing they wish they had known before undergoing treatments
A Pound of Prevention Chef Rocco DiSpirito, proponent of the breast cancer-friendly Mediterranean diet, reveals how he learned to love food and lose weight
PLUS: Use Exercise to Combat Fatigue Is Vitamin D a Super Fighter?
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Prevention is key, and knowing how to talk to your doctor could set you on the road to a healthier year – here are the top tips to ace your exam
Rules for Effective Physicals
By Bev Bennett CTW Features
I
f you’re scheduling your first routine physical, or first in years, you may anticipate a conversation similar to speed dating.You want your doctor to know as much as possible about you, but you have
a limited amount of time to share it. In addition, you may wonder if, as in speed dating, you should omit a few less appealing facts until the patient-doctor relationship progresses.
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Although physicians each have their own preferences about how much they want to address in one session, they do have general areas of agreement. Here are five things physicians want to hear from you during that first visit.
1. Why you made the appointment “You may say you’re here for a physical but you probably have an issue,” says Dr. Richard Sadovsky, associate professor of family medicine, SUNY-Downstate Medical Center, Brooklyn, N.Y. “Be clear to say why you’re here.The doctor will explore that,” Dr. Sadovsky says. Have ready your list of concerns. Some physicians want your top three; others don’t mind all 30. “We take an ‘everything’s on the table approach,’ but not everything might be addressed on the first visit. It may take more than one visit to address all the concerns,” says Scott Massey, professor of physician assistant studies and program director, Misericordia University, Dallas, Pa. Prioritize – introduce the most urgent health matters first. If you’re unsure, think about any symptoms you experience. Ask yourself whether these are continuous and whether they’re getting worse, says Dr. Christopher Fitzgerald, internal medicine-pediatrics, Cedars-Sinai Health Systems, Cedars-Sinai Medical Group, Beverly Hills, Calif. “If symptoms are getting worse we have to address them,” Dr. Fitzgerald says. Physicians will also encourage you to mention symptoms you consider trivial, especially if recurring and bothersome, such as intermittent heartburn. “There may be a disease lurking under trivial symptoms,” Massey says.
2. Your health history Include your medical records, medications, family history going back to your grandparents and your lifestyle habits, Massey says. Smoking, drinking and lack of sleep can affect your health. Don’t hold back because you think you’ll be judged.
“Most doctors aren’t judgmental, even with things that might be embarrassing. If you feel you can’t be honest, get another doctor,” Dr. Fitzgerald says.
3. Your expectations If you have a tendency to be deferential – to not ask for what you need because you don’t want to be perceived as a “bad” patient – you may not be getting appropriate care. Don’t be afraid to speak up. “You want the physician to know what concerns you,” Dr. Sadovsky says. Being forthright helps physicians as well, he says.
4. Your follow-through plans Ask your physician what your next steps should be.These may include treatment for any conditions, screening tests according to your age and risk factors and a review of the test results.
5. Your doorknob question This is what you bring up when you or the physician are halfway out the door. Ideally this wouldn’t come up because you came prepared and are feeling comfortable with the physician. But, speak up if something is still on your mind. “In my practice I would rather have a patient ask and take an extra minute than not,” Dr. Fitzgerald says. It’s easy to play Internet MD, looking up symptoms for various conditions you’ve self-diagnosed. There are advantages and disadvantages to this, Dr. Fitzgerald says. You could use the information to take better care of yourself. But if you visit a site that’s not from a credible source, you could be misinformed. Your health professional is likely to commend you on your desire to be up to date, but then recommend you not get too far ahead or read too much into the symptoms, Massey says. For guidelines on the frequency of a physical exam and screening tests for your age and gender, visit the National Institutes of Health website at: www.nih.gov
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Sharing her story to help others survive By Theresa Carpine Spokesman-Review Marketing Writer
S
helley Barton has been an educator for many years. Even before earning her teaching certificate, she worked as a drug and alcohol specialist and behavior interventionist with students at Quilcene High School on the Olympic Peninsula, and helped found Crossroads Community, an alternative high school program, in 2004. While she still loves teaching children, she’s now a passionate educator about breast cancer to her peers in Eastern Washington. Barton, who returned to her hometown of Spokane in 2007, was diagnosed with breast cancer in May 2011. During an annual visit with
her general practitioner, her doctor asked if she’d had a mammogram recently. “I said,‘No, not in a while.’ And the doctor said,‘Well, I didn’t feel anything, but check that one off, ASAP,” Barton said. Her physician strongly recommended adding this to her to-do list.“God bless her for that. She was a piece of the puzzle that has helped make me the woman that I am today.” The radiologist noticed some concerning asymmetrical calcifications in Barton’s imaging and ordered a biopsy. Barton doubted that anything would be found in her results because she did not have a history of the disease in her family. “I later found out that 85 percent of women or men diagnosed now do not have a family history of breast cancer” she said.
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A close friend accompanied Barton to get the results. When the doctor said it was cancer, it left Barton speechless. Her surgeon spent the next two hours explaining “in plain English” about cancer percentages and stages, and discussed Barton’s options. She chose to have a double mastectomy. “It was the answer for me, it’s not the answer for everyone else,” she said. Initially Barton felt private about her diagnosis, choosing not to share it with her family until her cancer was staged. She also recalled being fearful and uncertain about approaching the disease as a single woman. Feeling isolated, “You’re reaching out to different people, and you don’t know who’s going to show up and who’s not going to show up,” Barton said. “What I found is that the people that you least expect come alongside you and hold you up.” A friend from high school heard about Barton’s diagnosis through word of mouth and reached out to her. As a woman who had also faced breast cancer, she shared her story with Barton and helped her understand what to expect from surgery and recovery. “She was my saving grace,” Barton said. As she recovered, Barton’s friends rallied around her, bringing meals and offering to do the simplest, most mundane tasks that post-surgery would be extremely difficult. Shelly felt that her strength came from her very strong faith,
her family and her friends.“When you’re diagnosed, you feel that everyone around you is also diagnosed.There are all these lives, whether they are your sons or daughters, mom or dad or good friends — you really are not alone. They are so closely connected that we call them co-survivors. They hurt and ache as much as you.There’s something that grabs their heart,” Barton said “and they feel as though they are living it as well.” The following year, Barton participated in the 2012 Komen Race for the Cure with the Eastern Washington Affiliate of Susan G. Komen. After meeting with Executive Director Claudia Bell, Barton resolved to make a difference in the lives of those facing cancer. “If I could just touch one life and be a part of the solution to help save that life or give it longer than normal, then that was good enough for me,” she said. That same year, Barton organized Pitch for the Cure with Komen and the Spokane Indians.The event to raise money and build awareness about breast cancer was especially significant to Barton, whose late father William played for the baseball club in 1949.“It was a way to honor him. When I saw the crowds show up, I was thrilled,” Barton said. She threw the ceremonial first pitch, dedicating it to her dad and sending him a quick prayer to help her get the ball to the catcher.“Just to stand in that field where he did was an honor.” Barton continued to participate in Komen programs and events as other organizations contacted the nonprofit with requests for speakers.
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is the most fun I’ve ever had, it’s a spectacular precious time,” Barton said. To reduce her risk of recurrence, Barton has eliminated alcohol, sugar, and meat from her diet. She also prioritizes exercise,“And I’m not talking about going to the gym. I’m talking about taking a walk every day, and if it’s really awful outside, going to the YWCA or to the mall to walk. “I’m doing everything possible to fulfill the dreams that I have, and to keep giving back,” Barton said.“I strongly believe that because of all of this—the tough times, the rough times, the painful times and the suffering, that the joys of seeing my grandchildren and enjoying the small things such as the flowers, the wind, the sun on my face, that all have enriched my life more than I could ever have imagined. There is something bigger than all of us that connect us to one another in a wonderful and mysterious way. And it’s up to me to find meaning in this experience.” To learn more about Susan G. Komen, Eastern Washington Affiliate, visit komeneasternwashington.org.
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“My education gift took a U-turn towards breast cancer awareness,” Barton said.“I’m helping people understand it better, and hopefully I’m getting one or two people to go ahead and get their mammogram. My cancer was found only on the mammogram, as it was not palpable.This mammogram saved my life. I make that very clear to people when I tell my story.” Now the Education Chair for the Eastern Washington Affiliate of Susan G. Komen, Barton continues sharing her story throughout 14 counties. Her goal is to ensure that individuals living in areas lacking the community resources to educate about breast health and cancer, will get the information that could save their lives. “It seems as though these days breast cancer is hitting younger woman and more people who do not have a family history of it. People are always surprised about those facts,” Barton said. Barton has two grandchildren, ages eight and five, and she is excited to be involved with them. “I want to be able to experiences their lives like my grandparents did with me.This
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Happier on the Mediterranean Diet?
F
ollowing a healthy Mediterranean diet has long been linked to decreased risk of developing cancer, but it may improve your emotional state as well as your physical one. Eating whole grains, vegetables, fruits and olive oil, with a moderate intake of fish, may lessen the likelihood of developing clinical depression, a side effect often experienced by breast cancer patients and survivors. Researchers looking at the dietary patterns of seniors for more than a decade discovered that adhering to the Mediterranean diet was inversely related to developing depressive symptoms over time, according to a study published in The Journal of Nutrition, Health & Aging. As with other studies, researchers looked at food groups not specifically ingredients grown in Mediterranean countries. “It was a Midwestern version of the diet,” writes Kimberly A. Skarupski, Ph.D., lead author on the study, in an email interview. Her research suggests that the Mediterranean diet may be beneficial to mental health because it supplies B vitamins that play an important role in the synthesis of neurotransmitters that affect mood. In addition, the antioxidant-rich diet may protect cells from oxidative damage. Is it possible that the Mediterranean diet, which is as delicious as it is wholesome, provides pleasure as an antidote to depression? “We did not measure the ‘pleasure factor.’ I would think that taking the time to enjoy anything [food] would be good for depression,” says Skarupski, assistant dean for faculty development, Johns Hopkins University School of Medicine, Baltimore, Md. –Bev Bennett
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Celebrity Heath:
Eat, Exercise, Survive
Chef Rocco DiSpirito, proponent of the breast cancer-friendly Mediterranean diet, reveals how he learned to love food and lose weight
By Lisa Iannucci CTW Features
A few years ago, Chef Rocco DiSpirito fell into bad habits. “If you are a chef, you live in an environment full of indulgences,” says the Food Network star and author of 10 cookbooks.“There is a lot of foie gras and other food and you taste everything you make. It’s a late night lifestyle that comes with an above average amount of drinking and eating. As we get older, most chefs find that they are putting on the pounds.You know what they say, never trust a skinny chef.” All kidding aside, the 47-year-old DiSpirito, who had been working in kitchens since he was a mere 11 years old and traveling around the world living in Paris and Israel, began to pack on the pounds.“It wasn’t until I was in my 30s when
things changed and I started to take note,” he says. When he couldn’t see his feet anymore, he began to follow a Mediterranean diet, choosing whole fruits, vegetables and grains over fatty foods. DiSpirito also cycles and spins to keep in shape and dropped his extra 30 pounds, and has since written multiple weight loss books, including his “Now Eat This” (Ballantine, 2010) and his latest,“The Pound a Day Diet: Lose Up to 5 Pounds in 5 Days by Eating the Foods You Love” (Grand Central Life & Style, 2014). DiSpirito knows something about eating foods you love, especially growing up in a household with a mom who cooked traditional Italian feasts. “Funny thing about Italian food though is that it’s not that unhealthy at all,” DiSpirito says.“The Mediterranean diet is also not a fad in Spain, Italy and Greece. Even though there’s mozzarella and parmesan, Italians in Italy use local fresh foods.
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healthy and delicious solutions out there.This book shows you how to get a lot of food out of a calorie.”
They don’t eat tons of chocolate; it’s treasured red for a very special moment. Soda is a rare thing. ing. Most of the time they are drinking water and nd wine they make themselves.”
DiSpirito understands that others have struggled with w diet programs.“Think about the reasons for making the change,” he says.“Use your overall fitness m level le as motivation. Deciding to make the change is the hardest part for some people. Make healthy changes and give up sugar immediately. Use monk ch fruit fru and stevia. Sugar is a dangerous addiction.”
DiSpirito stresses that the Mediterranean diet is just as much about socializing as it is about eating.“When you eat you commune with people and you’re laughing and talking,” g,” DiSpirito says.“It’s not just about indulging and sugar craving. It’s a much richer social experience when you’re making better choices.You also eat less and slower.”
DiSpirito says that artificial sweetener is OK to use D here her and there, especially if you’re transitioning off of sugar, but using substitutes like monk fruit is all s natural natu and safe.
In the book, he explains how by following the plan, you will obtain most of your calories from fruits, vegetables and grains. His book includes 50 quick, 5-ingredient recipes, as well as ready-made suggestions for those who simply cannot find the time to cook; a primer on healthy and fast cooking techniques; caloriecalibrated menus and shopping lists.
Preparing for your new healthy routine is also vital Pr to your yo success.“You can’t leave home unprepared,” he says.“Bring food with you constantly. I bring a box of food and ask the hotels for an extra refrigerator to keep my food. I don’t want to eat other food.” fo For more information on Rocco DiSpirito and “The Pound A Day Diet,” visit www.poundadaydiet.com.
“It’s a collection of everything I’ve learned,” DiSpirito says.“There are
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SUPER
VITAMIN!
By Bev Bennett CTW Features
W
omen with breast cancer who have high levels of vitamin D in their blood have significantly higher survival rates than women with low levels, according to researchers who analyzed five studies with thousands of patients. This recent study from the University of California San Diego is one of several showing an association between breast cancer protection and vitamin D, which is found in fatty fish and made by the body when the skin is exposed to sun. What’s the connection between cancer and vitamin D? “Vitamin D helps prevent tumors from growing,” says Dr. Cedric F. Garland, fellow, American College of Endocrinology (F.A.C.E.), professor, Department of Family and Preventive Medicine and Moores UCSD Cancer Center, University of California San Diego, La Jolla, Calif. Even so, any recommendation to consume more vitamin D for an anti-cancer benefit is controversial. There’s still a question of whether vitamin D is an active cancer fighter or an indication of some aspect of a healthy lifestyle. “In looking at observational and population studies we don’t know whether vitamin D is the preventive or a marker,” says Alice Bender, registered dietitian nutritionist, Associate Director for Nutrition Programs, American Institute for Cancer Research, Washington, D.C. It’s possible that the women who fare better eat more fish, which is high in vitamin D, according to Bender. Given the uncertainty, many experts are cautious in interpreting the research. “We’re not saying that treating [women] with vitamin D will cure breast cancer.That’s not the implication,” says Dr. Heather Hofflich, F.A.C.E., University of California San Diego Health System, Department of Medicine, Associate Clinical Professor, La Jolla. Instead, vitamin D may be useful as an adjuvant treatment (a treatment given after primary cancer therapy to increase the chance of long-term survival), according to Dr. Hofflich, who, with Garland, is one of the authors of the breast cancer vitamin D study. “But I think we still have a lot to learn,” Dr. Hofflich says. Based on current knowledge, should you become more informed about whether you’re getting adequate vitamin D?
A vitamin most associated with bone health also may provide another essential benefit for women fighting breast cancer
Yes, says Garland, who has done extensive vitamin D research. “If you’re a woman you should talk to your physician about getting your vitamin D levels checked. It should be the center of a wellwoman visit,” he says, suggesting the end of winter, when you’ve been sun-deprived, as the best time for testing. Your physician can advise you about raising your vitamin D levels if appropriate.
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Get Your Vitamin D Here!
A
lthough vitamin D isn’t naturally available in many foods, you can meet the recommendations through a variety of sources. Get out into the sun for 10 minutes, either an hour before or after noon, exposing 40 percent of your skin to sunshine, says Cedric F. Garland, Dr.P.H. Eat foods that are rich in vitamin D. Salmon, tuna and mackerel are high in vitamin D. Fortified milk, soy milk, orange juice and breakfast cereals are also good bets. Dietary supplements are another option. If you’re an adult under age 71 the recommended dietary allowance is 600 International Units (IU) of vitamin D daily. At age 71 or older, increase your intake to 800 IU, according to the Institute of Medicine, an arm of the National Academy of Sciences. (The IOM assumes people are getting a minimal amount of sunshine.) Garland recommends all women get 1,000 IU of vitamin D daily. But don’t overdo it.The safe upper limit for vitamin D is 4,000 IU a day, according to the IOM. Other experts suggest a higher ceiling is safe.
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Cancer Care Northwest focuses on collaboration Local resource offers the latest technology, personalized support Provided by Cancer Care Northwest
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ou’ve been diagnosed with breast cancer, which means you’re beginning a journey that will be challenging physically, mentally and emotionally. What now?
If your doctor has suggested the service of Cancer Care Northwest, you can find all your answers here from some of the Spokane area’s most skilled specialists – plus a whole lot of support in many areas of your life. The mission of Cancer Care Northwest is to not only help people fight cancer, but feel as comfortable and as supported as possible through their treatment while receiving the best care available. Cancer Care Northwest has been a part of the area’s medical community for more than 30 years, and over that time has developed strong partnerships and firm relationships throughout Eastern Washington and North Idaho. Patients receive access to state-of-theart technology and expert services plus emphasis on making the center a helpful resource not just for patients but their whole families.
Q. Can they keep their doctor? Yes. But we also put together an integrated care model that can include radiologists, pathologists, plastic surgeons and other doctors to determine the optimal therapy for that individual. We evaluate the individual’s disease and prognosis and make recommendations for further testing or therapy such as chemotherapy or endocrine therapy. When working with breast cancer patients, we often put together a Breast Cancer Tumor Board where our providers come together to discuss those specifics and coordinate a personal plans for each patient. Q. What else is special about Cancer Care Northwest? Our new Valley office at 1204 N. Vercler Road has been designed to offer a wide range of oncology treatments and d related care and support. But it was also designed to be a r relaxing, tranquil environment where you can focus on healing. r We also have three other comprehensive clinics including W Downtown Spokane, North Spokane and South Hill. D
Dr. Joni Nichols
Dr. Joni Nichols, Cancer Care Northwest’s practice president and a breast cancer specialist, likes pointing patients in the right direction and describing the personalized services available. She’s part of a multi-disciplinary breast cancer team and is on a variety of community advisory board including Susan G. Komen and the American Cancer Society. Q. What do you say to someone who has just found out that they have cancer? We provide education about their situation, explain the comprehensive care resources available and standard treatment options which apply to their diagnosis, which could include surgical, medical, gynecological, and endocrine oncology. For breast cancer, part of the education process includes a consultation with a breast surgeon. Our teams can also offer nutritional and emotional support.
Q. Anything else you want the community to know? I’ve seen Cancer Care Northwest grow from only six medical oncologists when I joined here in 1995 to the talented multion disciplinary teams we have today that also maintain strong di relationships with other community providers. Patients are re our ou inspiration and I am regularly amazed by their courage and strength as they approach these significant challenges. str Part of the success of Cancer Care Northwest comes from the talented medical staff, which collectively brings backgrounds in everything from radiation therapy to yoga.This offers patients a depth of expertise that will benefit them every step of their cancer journey.
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ne physician who works with breast cancer patients is Dr. Christopher Lee, a board-certified radiation oncologist. Along with his role helping patients, he’s involves in clinical research and has presented several papers about radiotherapy, which is using targeted radiation for patients with cancer in sensitive organs such as the brain, neck, breast, gynecologic areas and prostate. Q. What’s your role with Cancer Care Northwest? I specialize in precisely targeting the breast area and surrounding lymph nodes, and at the same time optimally protecting the nearby vital organs.
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Q. What tools do you and your teams have available? Cancer treatment today is significantly different than it was even 6 or 7 years ago.There are new cutting-edge technologies available that improve cure rates, reduce side effects, improve quality of life and make it easier to continue a normal life. Patients have more treatment options than just a one-size-fits-all strategy. In fact, almost all treatments are now customized to each person’s exact anatomy with detail of the tumor shape and size as well as the surrounding critical organs.
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instructors. Our services include counseling, imaging, nutrition counseling and stem cell therapy. n Q. How else can people get information? Our website, www.cancercarenorthwest.com, is an excellent resource for what we do and how we can e help. You’ll find a “New Patient” section that includes h a lot of definitions and advice for those just beginning their th journey.There’s info about our team, services and community partners.You’ll find tips for healthy living and co even ev a “Mythbuster” section that debunks some of the incomplete information or rumors going around about in what can supposedly cause or cure cancer. w
In this area, we are doing some great things Q. Q What warnings may indicate cancer? with stereotactic body radiation therapy and We W encourage women to have mammograms, which can brachytherapy (internal radiation). We’re help he diagnose cancer in the early stages, even before they Dr. Christopher Lee considered pioneers in this region for some of start sta to show symptoms. Other signs could include breast these advanced techniques and have experience swelling, tenderness, changes in skin color or texture or optimizing these therapies for thousands of patients. When we meet abnormal nipple drainage. We encourage people to contact one of our with patients, we can conveniently perform lab tests, CT scans or clinics for a consultation. PET scans in our facilities for patient convenience, which provide the Q. Anything else you want people to know? ability to further customize therapies. Cancer therapy today is very different than your mother’s or Q. Beyond radiation oncology, what other services are grandmother’s treatment. Many tools are available to optimize quality available? of life and overall health and well-being during therapy. I am fascinated We have a variety of health professionals, including licensed by the current ongoing research and we regularly try to integrate them therapists, registered dietitians, cancer support coordinators, even yoga into our practice.
Breast cancer or general health-related events The following are some of the upcoming events and fundraisers in the area this fall. For a full list or to submit your free listing, visit www.spokesman.com/health. Oct. 2 — Komen Laugh for the Cure, 6 p.m., Lincoln Center. Enjoy yourself while raising money for local cancer research and advocacy. Comedians include Gabriel Rutledge and Heath Harmison. Reduced ticket prices for cancer survivors. komeneasternwashington.org/get-involved/komen-activities/laugh-for-the-cure-event.html Oct. 5 — Party in Pink Zumbathon, Northern Quest Casino and Resort, 10 a.m. The fourth-annual fitness event raises money for breast cancer efforts. SpokanePartyinPink.com Oct. 6 — Free exercise classes for recent breast cancer survivors, Washington State University Spokane. Eligible participants can receive 12 weeks of classes plus nutrition education as part of a research study. New classes start the first Monday of November and December and take place Monday, Wednesday and Thursdays. Call (509) 389-5844 or email j.larsen@email.wsu.edu. Oct. 9 — Spokane Public Radio presents Dr. Zorba Paster, 7 p.m., Bing Crosby Theatre. The family doctor and host of “Zorba Paster On Your Health” will answer questions and discuss his book “The Longevity Code.” ticketswest.com/events/dr-zorba-paster/37799/ Oct. 10 — Beyond Pink Designer Bra Fashion Show, Spokane Convention Center. Come enjoy this display of fancy undergarments while supporting breast cancer research.The event also includes a silent auction. All proceeds assist women who can’t afford thermography. https://beyndpnk.ejoinme.org/MyEvents/BeyondPinkSpokane2014/ tabid/546037/Default.aspx Oct. 26 — Purple Light National Vigil, Central Valley High School, 7 p.m. Prepare for National Pancreatic Cancer Awareness Month in November and join members of the Pancreatic Cancer Action Inland NW Affiliate by remembering those who have fought pancreatic cancer and honor survivors. pancan.org
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Cancer Care Northwest is in the
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We all know someone a friend, a sister, a mother, a loved one. That’s the reality of cancer. At Cancer Care Northwest, our team is dedicated to providing the best comprehensive care, the latest technology, and the most experienced cancer specialists in the region. We’re here for you, every step of the way, so that your someone gets the best care possible.
call 509-228-1000 toll free 800-866-9809 cancercarenorthwest.com
e fight against breast cancer.
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Anxious Aftermath After cancer treatments end, many patients experience a range of emotions – and not all of them are happy By Matthew M. F. Miller CTW Features
coming in every day,” she says.“Then you transition from regular contact and a lot of patients are left out on their own.” Further, ancer treatment is a full-time job, an there’s a follow-up appointment looming all-encompassing experience that in the future; between treatment and that changes lives forever. And, since it is appointment there might be a sense of such a challenging event both emotionally and helplessness because patients are no longer physically, it’s easy to assume that when cancer “actively” fighting cancer. Fear of the unknown treatment ends for those who have had to results of all this treatment also compounds endure it, the reaction immediately following these other emotions. the last treatment would be immense relief. Both Rigg and Dr. Wagner stress to their After all, to those of us who have watched patients that feeling any of this and more is someone we love experience cancer, it’s a big completely normal. Just as each cancer and relief when it’s “over.” treatment plan is individual, so is the range
C
The reality, however, is different. For cancer patients, it’s not over and, according to Dr. Lynne Wagner, director of the supportive oncology program at the Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Chicago, Ill. finishing treatment can be a relief tempered with anxiety but it can also cause depression in some patients.“It’s somewhat individual, from a research perspective,” Dr. Wagner says.
of emotions one may feel about finishing and attempting to resume “normal” life. Rigg finds that women who share their stories in groups realize quickly they are not alone in these feelings.
Reconnecting with social networks, exercise and taking stock of priorities going forward can all help patients during this transition. Making healthy lifestyle choices can also empower patients to feel more “in control” of Christie Rigg, El Cerrito, Calif., a breast cancer their situations during this time. Dr. Wagner says therapist and survivor herself, notes that advocacy work can also be helpful, whether when someone is diagnosed with cancer,“Life fundraising, counseling or volunteering with a becomes incredibly busy. It’s like your job is cancer organization. dealing with the cancer,” she says.“I said cancer It’s important to realize that cancer is a lifeshould come with a secretary—you’ve got changing event and patients are “really going appointments, surgeries, chemo, biopsies, bills – through a grieving process,” Dr. Wagner says. and everything else needs to keep going.” “Part of that loss is that the view of themselves As a result, she says, a lot of the women she has changed—their view of a vibrant healthy works with don’t begin to process their person and they’re reminded of mortality.That’s emotions until treatment ends and those quite a loss.” feelings bubble up. The National Cancer Institute has a Additionally, with all those appointments comprehensive booklet online on this topic, comes a built-in support system that cuts off which can be found at www.cancer.gov/ cold turkey, Dr. Wagner says.“You’re getting cancertopics/life-after-treatment. good support from the medical team and
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From the Mouths of Survivors: Eight breast cancer survivors each share the one thing they wish they had known before undergoing cancer treatments
By Dawn Klingensmith CTW Features
N
ot every breast cancer patient goes through a “Why me?” period, but most reflect back at some point and identify knowledge gaps – things they wish they’d known at various stages, from pre-diagnosis through treatment and recovery. Here, survivors share those things in hopes of helping others facing similar health challenges.
Men get breast cancer, too I had experienced a little pain and noticed a little lump in my chest. I thought,“It’s just an ingrown hair. Ignore it and it’ll go away.” I didn’t know men could get breast cancer and didn’t have it looked at until I noticed blood. After the mastectomy, I started chemotherapy, not expecting it to be a big deal. I even kept plans to entertain customers
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Help Is a Click – or a Call – Away Breast cancer survivors want to spread the word about organizations and resources they find particularly helpful. Our featured survivors were especially vocal about the organizations listed here. By no means is this list comprehensive or intended to replace a doctor’s care or advice. ❦ Adelphi NY Statewide Breast Cancer Hotline & Support Program (800-877- 8077) ❦ Breastcancer.org ❦ CancerNutritionConsortium. org for recipes based on chemo aversions and cravings
in Breckenridge. Well, I missed my ski trip and ended up in intensive care due to an aggravated cecum (intestinal pouch) as a result of the chemo. Eventually I was told about this test (Oncatype DX Breast Cancer Assay) to determine my recurrence likelihood with or without chemo. My insurance didn’t cover it, but we did it anyway and that’s how I found out I had only a 3 percent chance of recurrence without chemo. I wish I’d known about the test earlier because I could have skipped chemotherapy in the first place. Mike Nelsen, 54, sales director, Barrington, Ill.
Recovery means work – and relaxation As soon as you get the diagnosis, that means a change needs to happen. It’s a wakeup call.You can’t get sick and keep doing the same thing. We like to take a pill and not do the work.You have to do the work. For me, that involves diet, exercise and “me time” – meditating, journaling or just sitting still with a cup of green tea.“Me time” is part of the work because it’s a productive and worthwhile investment. I wish I’d put this knowledge into practice sooner because stress is so harmful to health. Bershan Shaw, 40, OWN “Love in the City” docudrama star, New York City
❦ Cancer Treatment Centers of America (800-931-9299)
Food need not be dull or agonizing
❦ URAWarrior.com online support forums
I wish I had known more about the impact of chemo on my ability to eat during treatment. My mouth had severe sores and my energy level dropped drastically which meant that proper nutrition was even more important, but I was unable to eat many foods. Anything acidic or salty burned my mouth. I had a constant metallic taste and a sore throat so it was difficult to swallow. I was limited to mashedup, liquefied, bland foods. I have since learned there are other options through my involvement with the Cancer Nutrition Consortium, which offers resources and recipes for people in treatment.
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Mammograms save lives … I wish I’d known how important it is to get annual mammograms. I missed two because I was “too busy” with work to take time off. By the time my cancer was diagnosed, I required surgery, chemo and radiation to treat it, and missed a lot more work than the couple of hours the exam would have taken. I’ve always wondered how different things might have been if I had gone for those two exams. Myra Taylor, 69, retired IT professional, Freeport, N.Y.
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However, mammograms aren’t fail proof I wish I’d known that a lump in my breast would not scrub away in the shower.That “We can see you in two weeks” was not an appointment I had to accept.That “Nothing shows on the mammography” is not necessarily an indication of breast health. Bonnie Hirschhorn, 68, teacher and guidance counselor, Bayside, N.Y.
Support comes from unlikely places I was so concerned about telling my kids, but it turns out my 19-year-old daughter knew more about cancer in general than I did and was able to help me explain it to my son. In fact, it was my daughter who said, when we went in for shots,“Hey, Ma, you might as well say something about that little lump you found.” So she was a huge help from the very beginning. After my diagnosis, she helped me research my options and write down questions for my doctor. She even made it seem like losing my hair was the coolest thing in the world.
have gotten tested and known we were BRCA positive. We wish we knew sooner that there are labs that can take a biopsy and indicate the most effective chemotherapies for a patient’s individual cancer. The tests (called Chemo-Sensitivity Testing or assays) aren’t widely used and you generally have to ask for them.
There are holistic treatment providers Before I went to Cancer Treatment Centers of America, my only option seemed to be traditional medicine – just the drugs. At CTCA, they round it out with naturopathic care, nutrition, acupuncture, massage and emotional and spiritual support – a mind-bodyspirit approach, with different modes of treatment and everyone working together as a team. I know I needed the chemotherapy to rid my body of the cancer, but the natural remedies really helped with the side effects, and massage with the after effects. RuPearl Sharpe, 57, account billing specialist, Sharpsburg, Ga.
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Dana Manciagli, 54, left, career coach and speaker, New York City
My identical twin,Tracy Frank, and I both survived breast cancer twice. The third time took Tracy’s life on May 18, 2014. I’ll speak for Tracy on the things we wished we knew. Since we had no known family history of cancer, we wished we had known that the BRCA gene (breast-ovarian cancer susceptibility gene) was highest in Ashkenazi Jewish heritages. We would
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Moving On Up Statistics show that many women begin to exercise less following a breast cancer diagnosis, a worrisome and dangerous trend say doctors and health advocates By Bev Bennett CTW Features
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hen asked how she sticks with her exercise plan Bridgette Hempstead says,“my motivation comes from ‘I’ve got to do something for me’.” It wasn’t always that way. Hempstead was first diagnosed with breast cancer on her 35th birthday, 18 years ago.Then, in November 2013,
she had a cancer recurrence. Prior to the most recent diagnosis, exercise was “more of a hit or miss,” says Hempstead, president and founder of Cierra Sisters, Inc., an African-American breast cancer support organization, in the Seattle area. Now that she’s “at normal range,” Hempstead is doing all she can to keep it that way. Exercise is part of her wellness routine.
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Unfortunately, not enough women are as dedicated as she is. Instead, a diagnosis of breast cancer is often followed by a decline in physical activity, according to a recent study from the University of North Carolina. Researchers looked at the physical activity of more than 1,700 women aged 20 to 74 comparing their activity levels before and six months after their diagnosis of invasive breast cancer. “Before their diagnosis approximately 61 percent of our study participants met the physical activity guidelines,” writes Brionna Hair, doctoral candidate in epidemiology, University of Carolina at Chapel Hill, in an email interview. Six months after the diagnosis, 35 percent of all study participants met the exercise guidelines. Among AfricanAmerican women, 24 percent met the guidelines, according to Hair, who led the study. These figures are worrisome because exercise is valuable for women with breast cancer. Physical activity may reduce fatigue, boost energy and improve body image. Exercise may also reduce the risk of breast cancer recurrence, although health experts are cautious in making any claims. To push yourself to get more physical activity, focus on the benefits while eliminating the barriers, say health experts. Fatigue is a common complaint for women who are battling breast cancer. But surprisingly,“the best treatment for fatigue is exercise,” says Dr. Jennifer A. Ligibel, medical oncologist, Susan F. Smith Center for Women’s Cancers at Dana-Farber Cancer Institute, Boston. Mass.
In fact, several randomized controlled trials have shown that aerobic exercise “improves quality of life and reduce fatigue in breast cancer survivors,” writes Dr. Anne McTiernan, Fred Hutchinson Cancer Research Center, Seattle, Wash., in an email interview. Strength training is good for muscle tone and may help with everyday activities. It may also reduce the severity of lymphedema (swelling caused by a blockage in the lymphatic system) according to a report from the American Cancer Society. However, because lymphedema is a concern, do strength training in a safe manner. You may want to find an expert who specializes in strengthtraining techniques for women recovering from breast cancer. The kinds of physical activities you want to pursue and how you want to go about it are up to you. You may prefer joining a gym, working with a support group or maybe you want to work out alone. “It’s not the same fit for everyone,” Dr. Ligibel says. Having someone getting you up off the sofa is sometimes all you need to get moving, according to Hempstead, whose organization offers group activities (www.cierrasisters.org). “If you don’t have someone walking with you or encouraging you, it may be easier for the individual to say,‘Hey, I’ll catch it on another day.’ Make it today,” Hempstead says. But don’t beat yourself up for not exercising as much as you should. Lack of exercise isn’t just a problem for women who are recovering from breast cancer. “It’s across the board,” says Keith M. Bellizzi, Ph.D., associate
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professor, human development and family studies, Center for Public Health and Health Policy, University of Connecticut, Storrs, Conn. “If we look at national health data behaviors, cancer survivor behaviors are similar to those of the general public,” Bellizzi says. Exercise habits begin early in life and may be more challenging to sustain later. However, it’s not impossible, according to Bellizzi. “I found out that when we make it fun or mix it up or find a partner or survivor group to make exercise social, it seems to motivate patients, he says. Rewarding yourself for exercising is very important, according to Bellizzi. “Focus on short-term goals and set up some kind of reward system,” he says, suggesting a gift of a high-tech exercise tracker or a new pair of running shoes. Although Bellizzi thinks more exercise may be better than less, he also says some activity is better than none.
The CancerExercise
B
eing physically active after a breast cancer diagnosis is associated with a reduced risk of breast cancer recurrence and breast cancer-specific mortality, according to a report from the American Cancer Society based on research from health experts. What effect might exercise have on cancer? Randomized controlled studies of exercise suggest answers. “Exercise may result in beneficial changes in the circulating level of insulin, insulin-related pathways, inflammation and possibly immunity,” writes Dr. Anne McTiernan, Ph.D., Fred Hutchinson Cancer Research Center. But she adds:“the evidence is still preliminary.”
Some studies showing positive results that come from walking. That may come as good news because if you didn’t follow the national guidelines to get 150 minutes of moderate-intensity physical activity a week (plus resistance training twice a week) before breast cancer, being told to do so now can stop you in your tracks. Start with baby steps. Hempstead walks her long driveway and walks in a pool as physical activities. She’s doing what she can with plans to “ramp it up” when she’s able and offers the similar advice to others. “The numbers – 150 minutes a week – are overwhelming,“ Hempstead says. “Isn’t it easier to hear ‘just walk around the house?’ Once you walk around the house, you might feel like walking around the block and once you walk around the block you might feel like going to the gym,” Hempstead says.
Link
In part the caution comes because for now the association between exercise and reduced cancer recurrence is based on observational studies of women after their diagnosis, according to Dr. Jennifer A. Ligibel, medical oncologist, Dana-Farber Cancer Institute. “There may also be other factors such as getting a better diet, or taking medications,” Dr. Ligibel says. Medical experts can’t say exercise is a miracle cure. Have an exercise conversation with your healthcare provider, Dr. Ligibel says. Ask how to start an exercise program. Ask about convenient facilities and appropriate support groups in your community. For more information on exercise and your breast cancer recovery, visit the following sites: The American Council on Exercise: www.acefitness.org/acefit/ fitness-fact-article/3320/exercise-for-breast-cancer/ The Centers for Disease Control and Prevention: www.cdc.gov/physicalactivity/everyone/guidelines/adults.html
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Breast Cancer and the Working Woman
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By Matthew M. F. Miller CTW Features
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reast cancer statistics paint a staggering picture of a disease that will impact the lives of everyone. According to the American Cancer Society, 235,030 Americans will be diagnosed with breast cancer in 2014, and 40,430 will die from the disease. What gets lost in these raw numbers, however, are the issues that extend far beyond overcoming the disease itself. A new study out of the University of Michigan, Ann Arbor, found that nearly one-third of breast cancer survivors who were employed when they began cancer treatment were unemployed four years later. Women who received chemotherapy were the most likely not to be working. The study surveyed 746 working women at the time of early-stage breast cancer diagnosis and then followed up four years later.Thirty percent of those women were no longer working at the time of the follow-up, 55 percent of the women said it was important for them to work and 39 percent were actively seeking employment. “Many doctors believe that even though patients may miss work during treatment, they will ‘bounce back’ in the longer term.The results of this study suggest otherwise,” says lead study author Dr. Reshma Jagsi, associate professor of radiation oncology at the University of Michigan Medical School.“Loss of employment is a possible longterm negative consequence of chemotherapy that may not have been fully appreciated to date.”
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With higher numbers of chemotherapy patients reporting unemployment, researchers say it is possible that the need to take time off from work during the treatment could lead to long-term employment issues. Aside from employment issues, many breast cancer survivors reported overall financial hardships, with 25 percent of women saying they are worse off financially than the were pre-diagnosis. “As oncologists, we are proud of the advances in our ability to cure an increasing proportion of patients diagnosed with breast cancer. But as treatments improve, we must ensure that we do not leave these patients in financial ruin because of our efforts,” Jagsi says. Race had a major impact on the findings, as Spanish-speaking Latinas were the most likely to be impacted, with debt more likely to be reported by English-speaking Latinas and Blacks than by Whites. According to the study, other important factors that made a woman more likely to experience these hardships include: age less than 65, household income less than $50,000, part-time work at diagnosis, reduced work hours after diagnosis, lack of substantial prescription drug coverage, breast cancer recurrence and undergoing chemotherapy. “These patients are particularly vulnerable to financial distress,” Jagsi says.“We need to ensure appropriate communication between patients and their doctors regarding the financial implications of a cancer diagnosis and treatment decisions to help reduce this long-term burden.”
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Early detection with annual mammograms can save lives
By Theresa Carpine Spokesman-Review Marketing Writer
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etting a mammogram can be intimidating or even scary, especially the first time, but an annual screening for breast cancer can also save lives. Brenda Klohe, an elementary physical education teacher, began getting annual mammograms at age 40. Following her visit at age 52, an Inland Imaging radiologist noticed something suspicious. “My 2008 exam was clean, but my 2009 exam showed something of concern. In the time frame of just one year, things had changed,” Klohe said. “We caught my cancer when it was small and early—it hadn’t gotten to my lymph nodes.” Although Klohe regularly scheduled her annual screening, she didn’t really consider that she would be diagnosed. “In spite of having several friends go through the breast cancer experience and one of those friends dying from her breast cancer, I still had the attitude of ‘Oh, it won’t happen to me,’” Klohe said.“I know differently now. I find that I don’t take things for granted as much, especially my own personal health.” Another breast cancer survivor, Kellie Durgan, a recovery nurse, also benefited from early detection when diagnosed with breast cancer at age 43. “My grandmother died of breast cancer and so I’ve always been vigilant about my screening mammograms. Because of my early diagnosis, I am cancer-free today,” Durgan said. While women like Durgan with a history of breast cancer in their family should be especially pro-active about screening and detection, 75 percent of diagnosed women have no known family history. A study in 2008 investigating mammogram trends in the Spokane area revealed that only half of local women over the age of 40 have an annual screening mammogram. Women cited lack of time and access, concerns of cost, and underestimating potential risk as factors that prevented them from scheduling an annual exam. “I was shocked to hear only half of Spokane women have an annual screening exam. If it were not for my annual screening, my breast cancer at age 43 would not have been found. Who knows where I would be without it? Women must take control of their health,” Durgan said. Muriel McBride, a legal coordinator, requested a mammogram in her early
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40s because her mother was diagnosed with breast cancer in her early 60s. At the time, she did not meet her insurance’s eligibility guidelines to cover the exam, and was informed she was too young for the procedure. “I had it and paid for it myself. I think some women might hear ‘too young’ and decided the insurance company must know what they are talking about, especially if they are afraid,” McBride said. When she was diagnosed at age 58, the cancer was detected early.“My treatment was less difficult and shorter than it might have been,” she said. To combat deterring factors, Inland Imaging created the Every Woman Can Foundation in 2010, which provides community resources for breast cancer awareness education and access to mammogram screenings. Since then, EVC has provided 1,326 free mammograms to area women. Throughout the year, EVC schedules “mamm parties” at various Inland Imaging Centers. Held during more convenient after work hours, refreshments and massages are provided for eligible women (over 40 with no current breast symptoms) before and after their mammogram exams. Women can attend an open party, or host a mamm party for 20 or more for comfortable experience with friends and family. EVC also provides grants to organizations that increase
mammography access for uninsured women and build public awareness about breast cancer screenings, health, and education. Recipients of grants include Community Health Association of Spokane and the NATIVE Project. A statement from the EVC Community Report declares,“We live in a great community that has served as a platform to spread the message regarding the importance of an annual screening mammogram. We strive to participate in local events and support other organizations that are fighting against breast cancer.” With survivors like Klohe, Durgan, and McBride willing to share their stories, the opportunity to save more women’s lives through education and resources from the Every Woman Can Foundation of Inland Imaging continues to grow throughout the Inland Northwest. For more information about Every Woman Can, visit everywomancan.org.
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diagnosis when it is detected and treated early. According to the American Cancer Society, mammograms
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remain one of the most effective methods for early detection. If you are 40 or older, or are considered to be at risk, Rockwood Health System encourages you to have a mammogram once a year – starting now.
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