Life after breast cancer

OCTOBER 2015 | A SPECIAL SUPPLEMENT TO
Talking
Treatment
The differences between
chemotherapy and radiation
Life After Diagnosis
Living after beating breast cancer
Identifying
Breast Cancer
Lesser-known symptoms
of breast cancer
2
October, 2015 • The Leader-Herald
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October, 2015 • The Leader-Herald
Lesser-known symptoms
of breast cancer
P
ublic perception that breast cancer is only identified by lumps
detected through self-examination or routine mammography may
prevent thousands of women from receiving an early diagnosis and the
care they need. Although lumps are the most common symptom
associated with the disease, women should recognize that breast cancer
can produce additional symptoms.
Susan G. Komen for the Cure, one of the premier organizations for
breast cancer research, advocacy and treatment, advises that the
warning signs for breast cancer are not the same for all women (or men).
Various changes in the breast and body can occur, including the
following conditions.
• Breast-size changes: Many left and right breasts are not completely
symmetrical, and women familiar with their bodies know that one breast
is often slightly larger than the other. However, breast-size changes that
occur out of the blue may be indicative of a medical problem.
• Skin rash or redness: Women
who are breastfeeding can
experience a rash on the breasts
from an infection of breast tissue. But
those who are not breastfeeding
should be evaluated by a doctor if
redness, irritation or rash appears.
• Nipple changes: Nipple discharge
that starts suddenly and is not
associated with breastfeeding can be
indicative of cancer. Other changes
to the nipples, such as pulling in of
the nipple (inversion) or itchy, scaling
skin on the nipple, should be brought
to the attention of a doctor.
1. Patricia Beck, “Simply put Because mammograms are saving
the lives of grandmothers, mothers,
daughters, sisters, aunts, cousins and
friends. 5. Jean Werle Rust “There
are no good reasons
NOT to get one!”
76. Congressman Paul D. Tonko,
“Get it because your greatest
accomplishments lie ahead of you!”
• Unexplained pain: The Mayo Clinic advises that less than 10 percent
of people diagnosed with breast cancer report pain as a symptom.
But unexplained pain in an area of the breast should not be ignored.
Breast pain that does not go away and seems to involve one area of
the breast should be checked.
• Fatigue: General cancer symptoms can include unusual fatigue and
unexplained weight loss. These symptoms should not be left
unchecked.
One of the best things women and men can do is to familiarize
themselves with their bodies so they will be more capable of pinpointing
any irregularities that may develop. Individuals can routinely look at their
breasts and inspect for subtle changes. But remember that hormonal
breast changes occur during the menstrual cycle, so it’s best to be familiar
with how breasts look and feel both during and after menstruation.
• Changes to the skin: Dimpling of the
skin, peeling, flaking, or scaling skin
can be a cause for concern as well.
Lumps in the breast are not
the only potential indicators
of breast cancer.
• Lumps elsewhere: Cancerous
tumors may not only be felt in the
breasts. Breast cancer can spread to
the lymph nodes around the breasts,
and lumps may be felt under the arms.
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October, 2015 • The Leader-Herald
4
Breast self-exam guidelines
I
n addition to scheduling clinical screenings and
mammograms, women should routinely examine
and massage their breasts to detect any
abnormalities. These breast self-exams can be
an important part of early breast cancer
detection.
Although many women are aware that they
should become familiar with their bodies,
many are unsure about just how frequently
they should conduct breast examinations.
Experts at Johns Hopkins Medical center
advise adult women of all ages to perform
self-examinations at least once a month.
That’s because 40 percent of diagnosed breast
cancers are first detected by women who feel a
lump. Establishing a regular breast self-exam
schedule is very important.
Begin by looking at the breasts in a mirror. Note the size
and appearance of the breasts, and pay attention to any
changes that are normal parts of hormonal changes associated with
menstruation. Breasts should be evenly shaped without distortion or
swelling.
Changes that should cause concern include dimpling, puckering or
bulging of the skin. Inverted nipples or nipples that have changed
position, as well as any rash or redness, should be
noted. In addition, the same examination should
be done with arms raised over the head.
The breasts should be felt while both lying down
and standing up. Use the right hand to
manipulate the left breast and vice versa. Use
a firm touch with the first few fingers of the
hand. Cover the entire breast in circular
motions. The pattern taken doesn’t matter
so long as it covers the entire breast. All
tissue, from the front to the back of the
breast, should be felt.
The same pattern and procedure should be
conducted while standing up. Many women
find this easiest to do while in the shower.
It is important not to panic if something is
detected. Not every lump is breast cancer. And
bumps may actually be normal parts of the breast,
as certain areas can feel different than others. But bring
any concerns to the attention of your doctor.
Breast self-exams are a healthy habit to adopt. When used in
conjunction with regular medical care and mammography, self-exams
can be yet another tool in helping to detect breast abnormalities.
Doctors and nurses will use similar breast examination techniques
during routine examinations.
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Breast cancer can affect both
men and women and is one
of the most common forms of
cancer. Thanks to increased
awareness and screenings, many
cases of breast cancer are
diagnosed early and treated
successfully. BreastCancer.org says
that invasive ductal carcinoma, or
IDC, is the most common form of
breast cancer, accounting for
about 80 percent of all breast
cancers. The American Cancer
Society says that, although IDC
can affect women of any age, it is
most common among women age
55 or older. The good news is that
this type of cancer is highly
curable, provided it has not
spread outside of the ducts to other
breast tissue. Survival rates for any
breast cancers diagnosed in the
early stages are excellent.
October, 2015 • The Leader-Herald
Preparing for your
mammography visit
A
5
23. Patrice McMahon, “Hear more
music, feel more joy.”
29. George Kline, “Get it because there
are road trips to enjoy.” 32. Moshgan
Jones, “My reason is because I love life
and want to live long to see and enjoy my
future grandchildren.” 33. Laurence E.
Kelly, Littauer’s President and CEO:
“Because life is good ... too
700 good to be cut short by cancer.
nnual mammograms are widely recommended for women beginning at age 40.
Some estimates suggest that more than 48 million mammography screenings are
performed in the United States every year.
Whether it is a your first mammography or twentieth, preparing for the appointment can
ease anxiety and make the experience go more smoothly. The following are some guidelines
to consider when preparing for the visit.
• Choose a reputable and certified facility. Select a radiology center that is
certified by the FDA, which means it meets current standards and is safe.
Many women also prefer to select a facility that is covered by their health
insurance. Plans usually allow for one mammogram screening per year.
• Time your visit. Schedule the mammogram to take place one week after
your menstrual period if you have not reached menopause. Breasts are less
likely to be tender at this time. Also, schedule your visit for a time when you
are not likely to feel rushed or stressed. Early in the day works best for many.
• Dress for the occasion. Two-piece ensembles enable you to only remove
your shirt and bra for the examination. A blouse that opens in the front may
be optimal. Some facilities require you to wear a paper gown for the exam.
• Watch your grooming practices. You’ll be advised to abstain from
wearing powder, perfume, deodorant, ointment, and lotions on the chest
or around the area. These substances may look like an abnormalities on
the mammogram image, potentially resulting in false positive diagnoses.
• Take an OTC pain medication. Mammograms are not necessarily
painful, but they can put pressure on the breasts, which creates
discomfort. Breasts are compressed between a plastic plate and the
imaging machine. This spreads out the tissue and helps create a clearer
picture. If your breasts are tender, medications like acetaminophen or
ibuprofen taken an hour before the appointment may ease discomfort.
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• Expect a short visit. Mammogram appointments typically last around
30 minutes. The technician will mark any moles or birthmarks around the
breasts so they can be ignored on the imaging. You’ll be asked to hold
your breath as the images are taken. If the images are acceptable, you
are free to go. But new images may be needed in some instances.
Mammograms are now a routine part of women’s
preventative health care. The procedure is simple and
appointments are quick and relatively painless.
Every two minutes, a woman
in the United States is
diagnosed with breast cancer.
In fact, breast cancer is the
leading cancer among Caucasian and
African American women. Mammography
screenings
are a woman’s best chance for detecting
breast cancer early,
so get yours today.
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October, 2015 • The Leader-Herald
The differences between
chemotherapy
and radiation
7
35. Christian Rohrs, “Get it so that
you won’t miss all of the beautiful fall
colors that the Adirondacks have to
offer!” 36. Barbara Shutts, “No better
way to show your family how much you
love them than by taking care of yourself
which includes your mammogram!!!”
37. Charmaine Miskinis, “Get a
mammogram so you can enjoy your life
with your family and friends!”.
C
ancer can take on many forms and spread throughout the body,
infiltrating healthy cells and causing an uncontrolled division of
abnormal cells that often turn into tumors.
Various cancer-treatment options are available to treat men and women
diagnosed with this potentially deadly disease, but the ones most familiar
to many people are radiation and chemotherapy. Working with their
doctors, patients can explore their treatment options to determine which
therapies may be most effective.
CHEMOTHERAPY
Chemotherapy is a cancer treatment in which a patient is administered
drugs that are designed to kill cancer cells. These drugs work by
attacking the components that allow cells to divide, grow and spread.
Many chemotherapy drugs are given intravenously, in cycles, over a
couple of weeks, but some chemotherapy medications may be taken
orally. Chemotherapy primarily targets cells that divide rapidly, like
cancer cells. But because other healthy cells also divide rapidly, such as
cells in the hair and digestive tract, patients may experience side effects
in these areas when undergoing chemotherapy treatment, according to
the Southeast Radiation Oncology Group.
HORMONE THERAPY
Doctors may suggest hormone therapy to treat breast cancer. The
American Cancer Society says estrogen promotes the growth of cancers
that are hormone receptor-positive (roughly 67 percent of breast cancers
are). Hormone therapy will lower estrogen levels or prevent estrogen
from acting on breast cancer cells. However, it will not work on tumors
that are hormone receptor-negative.
Doctors use a combination of therapies to treat breast cancer and other
forms of cancer. Learn more about various cancer therapies at The National
Institutes of Health’s MedLine Plus website www.nlm.nih.gov/medlineplus/
druginformation.html or speak with an oncologist.
RADIATION
Radiation surrounds us in various forms. Many people are familiar with
ultraviolet radiation from the sun, and radiation can be present in certain
minerals and substances as well. The high-energy particles and waves
contained in radiation can be used in cancer therapy, according to the
American Cancer Society. Radiation therapy can be delivered in various
forms. External radiation uses a machine that precisely directs highenergy rays from outside of the body into a tumor and nearby tissue.
Internal radiation relies on a radioactive implant placed inside the body
near the tumor. Systemic radiation is the delivery of radioactive materials
to a patient orally or through an injection.
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October, 2015 • The Leader-Herald
October, 2015 • The Leader-Herald
What do dense breasts
mean for cancer risk?
9
40. Wally Hart, “Get it so you
don’t have to worry!”
47. Assemblyman Marc Butler,
“Get a mammogram because you
have a bright future waiting just
for you.” 17. Lesa Gray Grosse,
“For yourself and for everyone in
your life who loves you!”
2. Stacy Minkler White, “Early
detection saves lives!”
B
reast cancer risk is influenced by many things, including heredity, age
and gender. Breast density is another factor that may affect cancer risk
and the ability to detect breast cancer in its earliest stages, say some experts.
According to the report, “Mammographic density and the risk and detection
of breast cancer,” published by The New England Journal of Medicine, as
well as data from the National Cancer Institute, women with high breast
density are four to five times more likely to get breast cancer. Only age and
BRCA1 and BRCA2 mutations increase risk more. However, at this time,
health care providers do not routinely use a woman’s breast density to request the information from the radiologist or doctor. Dense breasts show up
assess her breast cancer risk, according to Susan G. Komen for the Cure. with more pockets of white on mammograms than gray fatty tissue in less dense
Density does not refer to the size or shape of the breast, and it may not be breasts. Cancer also appears white, and, therefore, tumors can be hidden.
apparent by just looking at the breasts. Usually women do not learn they In addition to more in-depth screenings, women with dense breasts can
have dense breasts until their first mammograms. Dense breasts have more lower cancer risk by following these guidelines:
glandular and fibrous tissue. Density may be hereditary, meaning mothers
• Maintain a healthy weight.
and daughters can share similar breast characteristics.
• Eat nutritious food.
Dense breasts cannot easily be seen through on a mammogram, which can
• Exercise regularly.
make detecting lumps and other abnormalities more difficult. This can lead
to missed cancers or cancers that are discovered at later stages. Women
• Never smoke or quit immediately.
with dense breasts may require additional screening methods, such as a
• Limit alcohol consumption.
breast ultrasound or an MRI, in addition to yearly mammogram screenings.
• Ask for digital mammography.
Education about breast density is gaining traction in some areas, thanks to
informed women and advocacy groups like AreYouDense.org. Some states Women can consider breast density with other risk factors in the fight
in the United States are part of “inform” lists, in which radiologists include against breast cancer.
information about breast density on mammogram reports so women and
doctors can make decisions about extra testing.
Even if a woman does not live in a state where density is shared, she can
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October, 2015 • The Leader-Herald
10
Life after breast cancer
T
Speaking with others who have survived breast
cancer can help. Join a support group or reach out
to others through social media. Getting a firsthand account of what can be expected the first
year after treatment can assuage anxiety.
he moment a person receives a breast
cancer diagnosis, his or her life changes
immeasurably. The roller coaster of emotions
begins, and suddenly this person is thrust into a
schedule of doctor’s appointments, treatments
and visits from friends and family.
When treatment ends, patients often still have fears
about the cancer, wondering if all of the cancerous
cells have been destroyed and worrying about
recurrence. But focusing on the present and all of
the things you now can do with health on your side
is a great way to put your fears behind you.
The World Cancer Research Fund International
says breast cancer is the second most common
cancer in women and men and is the most
frequently diagnosed cancer among women in
140 of 184 countries worldwide. Despite that
prevalence, the five-year relative survival rate
for women diagnosed with localized breast
cancer (cancer that has not spread to the lymph
nodes or outside the breast) is 98.5 percent,
says the American Cancer Society. Survival
odds increase as more is learned about breast
cancer and more people take preventative
measures, including routine screenings. Today,
there are nearly three million breast cancer
survivors living in the United States.
Many cancer survivors must still visit their doctors after
treatments end. Doctors still want to monitor patients
closely, so be sure to go to all follow-up appointments
and discuss any symptoms or feelings you may be
having. Side effects may continue long after radiation
or chemotherapy has ended. Your doctor may have
suggestions for coping with certain side effects or will
be able to prescribe medications to offset these effects.
Follow-up appointments should gradually decrease
the longer you have been cancer-free.
Breast cancer treatments may last anywhere from
six months to a year. Adjusting after treatment
may not come so easily at first. But adjustments
are easier with time, and many cancer survivors
continue to live life to the fullest in much the same
way they did prior to their diagnosis.
It’s not uncommon to feel differently after cancer
treatment, as your body has been through quite a lot.
Many women still experience fatigue, and sleep or
normal rest doesn’t seem to make it abate. Realize this
is normal, and how long it will last differs from person
to person. It can take months or years for you to
experience your “new normal.” Things do not happen
overnight. While your hair may grow back quickly, it
may take some time for you to feel like yourself again.
Exercise routines or other lifestyle changes may help
you overcome fatigue or make it more manageable.
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October, 2015 • The Leader-Herald
11
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Cancer therapy and
coping with hair loss
A
breast cancer diagnosis can catch a person off-guard and drum up all types
of feelings. Many people diagnosed with cancer become anxious about
treatment and any potential side effects it may produce.
Hair loss is one side effect widely associated with cancer treatment, though not all
cancer patients will lose their hair. For example, Breastcancer.org notes that patients
undergoing radiation therapy for breast cancer will not lose the hair on their heads
because radiation is a localized treatment. Hair loss in the area of treatment, such
as under the arms or on the breast itself, may occur. But hair loss on other areas
of the body is more likely to occur as a result of chemotherapy treatment, as
chemotherapy affects the entire body. Chemotherapy targets rapidly dividing cells.
Hair follicles are some of the fastest-growing cells in the body and chemotherapy
targets fast-growing cancer cells.
Various studies show that many women fear losing their hair more than losing a
breast, as breast loss can be concealed more easily than hair loss. However, there are
ways to cope with hair loss, particularly through the use of wigs and head coverings.
• Ask your doctor to write a prescription for a wig, which may be covered by your
health insurance. If you are covered, that can help to offset the cost of the wig.
• Start shopping for a wig early on — even before hair loss occurs. As you get further
along into treatment, you may feel fatigued and not up to shopping for wigs.
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• Visit a wig store at least once for a proper fitting so you will know what to look
for. Wigs come in different cap sizes. Once you know your size, you can consider
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• Human hair wigs are more expensive, but they can be more durable than
synthetic wigs and offer more styling choices. However, synthetic wigs can usually
be worn out of the box and require less daily styling.
• Head wraps and hats are an alternative when you need a break from wearing
a wig. Choose a variety of options so you can coordinate with your clothing.
LOSING HAIR DUE TO CANCER TREATMENT IS SELDOM EASY.
Being prepared for the transition by having a quality wig
and comfortable head wraps at the ready
can make dealing with hair loss easier.