Preparing for Breast Cancer Treatment

Here you are at the Breast Care Center waiting to talk with one of the Breast Surgeons about your recent diagnosis of Breast Cancer.   How OVERWHELMING is this!   Hopefully, once you sit down and discuss the diagnosis and the next steps with the surgeon who will be able to get your thoughts around this diagnosis.
There are many very important things to consider and our surgeons are excellent guides and listeners and will address all your concerns.

Our Nurse Navigator is here for you, too!

So, if all that is not enough to think about, I am going to give you a few more things to think about.
These items are also listed on the Susan G. Komen website and the American Cancer Society website.

Flu shots  

• The Centers for Disease Control (CDC) recommend everyone age 6 months and older, including breast cancer suvivors and their caregivers should receive the seasonal  flu  shot.   People currently undergoing treatment for breast cancer and long-term survivors are at higher risk for complications from the seasonal flu.   You should get the shot when it is available.. NOT the nasal spray vaccine. 

Fertility

• Some breast cancer treatments will affect your fertility or your ability to become pregnant.  If you wish to consider a pregnancy after treatment talk with a fertility specialist before your treatment begins so you know all your options.

GYN exam

• Talk with your gynecologist and make sure you are updated with your pap smears and exam. Chemotherapy may interfere with pap smear results and this test should be done prior to chemotherapy treatments.  Your gynecologist is also an important member of your Survivorship Team. 

Dental Visits

• If you will need chemotherapy treatments it is best to do dental cleanings prior to treatment or after treatment has ended. Your immune system is weakened by chemotherapy and you would be more prone to an infection in your mouth during treatments. 

Travel

• In general, it is safe to travel during  chemotherapy treatments.   Discuss this with your Oncologist (another important member of your Survivorship Team) .  Remember your immune system is weakened so washing of your hands frequently is recommended and using hand sanitizer. 

Massage Therapy

• Many health care professionals recognize that massage can be a useful noninvasive addition to standard medical therapy to help decrease stress , anxiety, depression, pain and fatigue.    Massage therapy should be provided by a Trained Professional with expertise in working safely with people with cancer and cancer survivors.   
• It is important to let your massage therapist know that you have cancer as they may need to refer you to a specialist.  You should also let you Oncologist know that you are receiving massage therapy.
• There is concerns that in theory, tissue manipulation on or near a tumor area should be avoided.  Medications you may be taking may lower your platelet count or thin your blood causing increased risks of bruising.  
• There is no evidence that massage can slow or reverse the growth or spread of cancer, but it is promising at helping to improve quality of life. 

I am sure you may have more questions as you go down this new path and we are here to help and answer your questions!

You are a Survivor!

We are hearing so much about survivorship in cancer.  You have just been diagnosed and can't "get your head around the word cancer"…That has to mean you won’t have a long life, your kids and grand-kids will be here without you!

WAIT!!  One hurdle at a time. You are a Breast Cancer Survivor from the minute of diagnosis through the rest of your life. This word Survivor also includes all those close to you as they are also impacted by this new diagnosis.

This is new and  "uncharted" territory in your life and you do not have to go "it" alone. We are all here to help.

Our goal is that you function at the highest level possible while having cancer treatments and after!

Please check out the PinnacleHealth STAR Program. This is a Training and Rehabilitation Program whose goal is to minimize any side effects of treatment or surgery you are having and to give you the best quality of life possible.

I love the name because you are the STAR and you are beginning a life dedicated to better living and good health.

You are supported by a team of certified STAR Clinicians and Providers that specialize in cancer rehabilitation. Each team member will provide you with the expertise, guidance and training you need.  You will learn how to set new goals for exercise, nutrition and sleep as well as guidance on the best ways to treat or improve any symptoms you are having related to your cancer treatment.

You can call for more information about the program and insurance coverage at 717-214-STAR(7827), or contact your nurse navigator for more information.

Remember you are a STAR and you deserve the best!

Are You Your Aunt Gert???

Have you ever looked in the mirror and tried to decide if you look more like your Father’s side of the family or your Mother’s side of the family?  

If only we could use the mirror to look at our insides, all the way to our individual  cells and our DNA.

The mirror can give us important information, yes, I have green eyes and so did my father and yes, I think I have a great smile and so does my Mother.

What else about your family can you find out and probably more importantly what else do you want to know?

When I started my Nursing career 36 years ago, we were asking family history questions  and doing what we could to help patients decrease risks for certain diseases such as heart disease.

Over the years our knowledge and our ability to test people for genetic diseases has increased by leaps and bounds.

People with a presumed hereditary risk for cancer now have more options than ever when it comes to calculating the reality of that risk.  The possibilities are both empowering and daunting states Suzanne Mahon, RN, DNSc and professor in the School of Nursing at Saint Louis University in Missouri.

This type of personalization of your history does enable you, as the patient, to make difficult choices about care with more solid information.

It is not uncommon in the Breast Care Center for women newly diagnosed with breast cancer and who are trying to make decisions about Lumpectomy versus Mastectomy,  to do genetic testing to help them make a better informed decision about surgery.

Genetic testing has allowed us to become more proactive about our health and our future health care decisions.  We now have options and choices about surveillance schedules, prophylactic surgeries and medications that may help us PREVENT certain types of cancer.

It gives us the opportunity to really look at our lifestyle and change the things we can.  No, I can’t change my DNA , but I can eat a healthier diet, stop smoking, decrease intake of alcoholic beverages and exercise more.

Recent studies noted that woman ages 50-74 that walked about 1 hour daily had a 14% lower risk of breast cancer !!    Even small changes in our lifestyle can make a difference in preventing breast cancer.

Here at the PinnacleHealth Breast Care Center we have started a High Risk Clinic to help our patients and family members understand genetic risks for Breast Cancer and navigate options for care.

We will help “ organize” your Family Tree and discuss testing and surveillance.    There are some  “ Red Flags” that may help you make that phone call to our clinic.

1. Any family member with a known gene mutation such as BRCA.
2. A young age at onset of cancer ( this could be younger than 60, depending on the type of cancer) 
3. Male breast cancer in the family
4. Multiple family members with cancer ( not just breast cancer) 
5. Certain Ethnicities ( such as Ashkenazi Jewish)
6. Two or more types of cancer occurring in the same relative.

A website you may be interested in to help organize your family history is www.hhs.gov/familyhistory.

Genetic science is exploding and understanding what this means for all of us is complicated.   We don’t know how to test for all genetic diseases and having a negative result such as a negative BRCA gene mutation does not mean that that person will never have breast cancer.

It is moving us away from the “One Size fits all Medicine” to a personalized medicine that recognizes how unique we all are.

So next time you look in the mirror think how unique you really are!

Oh No! It is December.. the month of numerous activities, family events and holiday celebrations.

For a  Cancer patient this month can be a time of reflection,  changing  or finding a new "normal".  It can also be very stressful and if you are in active treatment very tiring.  There may also be depression and anxiety about your future health.

It is hard to "let go" of things you have always done in the past and just may not be able to do this year.

Remember: Taking Care of Yourself is the most important item on this year’s  Holiday " to do" list. 

Consider asking family members or friends for help with shopping, food preparation, cleaning or child care. Your family members or friends may be at a loss of how to help you and you may need to sit down and make a list.  And after you make this list ASSIGN Duties! 

Cancer-related fatigue is a common and distressing side effect of having cancer and can be fairly severe in patients going through treatment. It often occurs with  sleep disturbance, emotional distress, such as depression and anxiety, and pain. 

There are many well established studies that support  increased physical activity and exercise as an intervention to help cancer related fatigued.  

Exercise rather than rest to help fatigue??    Really??    

Yes, really. 

An exercise program twice weekly that has a combination of aerobic exercise and resistance training can help improve your fatigue, increase your energy, improve sleep and decrease feelings of depression.  You can also improve your endurance and flexibility.  

Think about it as a New You for the New Year.  

Check out some programs at the YMCA, Gold’s Gym or a program closer to your home.

If you have other health issues that you think need addressed prior to starting an exercise program please consult you Primary Care Provider to discuss a plan.     

You can overcome the fatigue related to cancer!

Great News for Pennsylvania Women!

The PA Breast Cancer Coalition’s Dense Breast Notification Act was passed by our state legislature!

It just needs signed by our Governor, Tom Corbett.   This Act will require Radiologists in PA to notify women of their breast density at the time of their mammogram.

Why is this Important?

Because there are a group of women “falling through the cracks” that are not having their breast cancer diagnosed until a later stage because of the density of their breast tissue.

There is enormous variability in the density of breast tissue from woman to woman.   Some women have very dense fibrous tissue decreasing the ability of a mammogram to “see” through this tissue to diagnose a cancer.  Some women have very fatty and not so dense breast tissue making finding a cancer a little easier with mammogram.  

There are many factors that may increase our risk of breast cancer over time such as our family history, having radiation therapy for cancer as a child, carrying the BRCA gene mutation and others.

It has been known for a long time that breast density can also be an independent risk factor for breast cancer.

Well, if a mammogram doesn't work that well, what will help to make that diagnosis if you have dense breast tissue?

Discuss this with your physician and consider evaluation possibly with Breast Ultrasound, Mammogram with Tomosynthesis, or possibly breast MRI screening.

Be sure you know your Risks and your options for screening!  And Don’t Miss your Mammogram!  You are very Important!

IS BREAST CANCER ONE DISEASE?

One of the most important discoveries concerning breast cancer has been the realization by many scientists that breast cancer is many diseases.

Have you heard of HER-2 and what does that mean if your cancer is HER-2 positive?

HER-2 stands for human epidermal growth factor receptor-2.  This protein can promote the growth of cancer cells.  One in every 5 breast cancers makes too much HER-2 due to a gene mutation.  This causes the cancer to be more aggressive; however treatment that specifically targets HER-2 is very effective.

This discovery was made by a group of researchers lead by Dr. Dennis Slamon, Head of the Revlon/UCLA Women’s Cancer Research Program.   He states that “ there is a molecular diversity of human cancers that has largely gone unappreciated , and it has gone unappreciated because we lump things together.”   Dr. Slamon and his team looked at this HER-2 protein and found that if an antibody was added to the receptor gene that had mutated , tumor growth dropped dramatically.   Hence the “ birth” of the drug Herceptin to treat HER-2 Positive breast cancers.

More and more we are learning about the genetics of breast cancer and how individualized each women’s cancer may be.  As we learn more about the molecular differences we are learning more about treatments for each individual patient.

If you would like to hear more from Dr. Slamon he will be a guest at  this year’s  Breast Cancer Coalition Conference at the Harrisburg Hilton on October 15, 2013.   This conference is open to patient’s and families as well as caregiver’s.   


More information:  PinnacleHealth Breast Care Center

Is DCIS Breast Cancer?

Is DCIS Breast Cancer?

This seems to be a hot topic of late.. Appropriate for August . We know that the use of screening mammograms definitely saves lives.  Its widespread use has led to the increased diagnosis of so called “ high risk lesions “  in the breast as well as Noninvasive carcinoma of the breast called Stage 0 ductal carcinoma  or DCIS.

DCIS cells in the breast are true cancer cells located entirely within the milk ducts of the breast. These cells have not traveled outside the duct and are not invasive.  A woman’s chance of dying from DCIS itself is almost Zero.

BUT.. there is always a but… if left untreated it does have the potential to become Invasive breast cancer.  It is the most common form of non-invasive breast cancer, found in more than 60,000 women in the U.S. each year according to the American Cancer Society. 

Because of the risk that DCIS is a forerunner of invasive disease, treatment is recommended.

Treatment usually includes a lumpectomy, radiation therapy and possibly Tamoxifen for further prevention.   Sometimes mastectomy is advised if the DCIS is extensive throughout the breast.

The problem with DCIS is that there is no current proven way to predict which form of DCIS is more aggressive and will go on to develop invasive cancer.   

There is currently ongoing research that we hope will increase our understanding of DCIS and improve out treatments. 

If you have been diagnosed with DCIS  bring all your questions to your visit with your breast surgeon and make sure you have a full understanding of your diagnosis.