Friday, December 21, 2007

So Long to a Fellow Survivor

Tyler was my age. Ten years ago, he was diagnosed with a rare form of throat cancer with a high mortality rate. (He never smoked.) Tyler went to my friends at M.D. Anderson, where he received radiation treatment, followed by surgery to remove the tumor. He went about the business of surviving.

Three years ago, after an argument, his wife killed herself. He had spent the night at a hotel and came home the next morning to find her sleeping. He noticed that her head was lying at an odd angle on the pillow, but thought nothing of it. Tyler went out to run some errands and came back to find his wife had shot herself. When the autopsy was completed, he was told that she apparently took an overdose of medication and, waking to find that her suicide attempt was unsuccessful, she pulled a gun out of the bedside table and shot herself.

Tyler struggled to regain his equilibrium the past three years. I'm not sure that he ever really did, though. As a suicide survivor, I know that road is long and treacherous. I can't imagine how it's possible to recover when your wife shoots herself, in your bed, after an argument. He went on and tried to find a new life.

Every year since his surgery, Tyler had to go back to M.D. Anderson to have scar tissue from the surgery removed from his throat. He had his last surgery about three months ago. He left a message on our machine a couple of weeks ago, wanting to hear how I've been doing. It was something Tyler did regularly.

His message sounded almost like he was on a respirator. I could hear his labored breathing in between phrases. There's only so much you can do with scars. Ultimately, removal of scar tissue only creates more scar tissue. For Tyler, the scars finally made it impossible for him to breathe and he died in his sleep.

Here's to you, Tyler, to your long struggle to survive. Here's to your will to endure your wife's death. We walked the same paths, but now you've left me far behind. Would you have guessed that I'd be crying for you? I am, just as I'm celebrating your courage and tenacity.

So long, Tyler. We'll all see each other soon.

Wednesday, December 19, 2007

Hark, the Festal Kielbasa Cometh!

"Humor is the instinct for taking pain playfully." ~ Max Eastman

Today, I'm stuffed into what used to be known as "foundation garments." I remember, as a kid, trying to figure out what the hell those were because, in the olden days, you never saw bras or girdles on television commercials. It was too risque even to offer a definition. It seems so quaint now.

I saw my physical therapist yesterday, which is a tantamount to paying someone to abuse me. All of my scar tissue always hurts (and I have a lot of it, everywhere), but after she finishes massaging and pinching, I'm ready to start confessing to things I've never done. I'll say anything, but please don't torture me anymore.

This morning, I woke up feeling more than a little ragged. I'm exhausted and it seems entirely possible that an army of little demons stabbed me with forks all night long. I am not at my best.

PT told me that, if I wore my special compression bra and girdle (the one I wore 24/7 for three months), I'd have a lot less pain. Damn. I was in no shape to be stubborn about it today, so I'm packed into my underwear like a kielbasa. "Less pain" is the operative phrase here; I have a lot left over, despite my discomfort.

I wore one of my festive shirts today, the one with a reindeer who's holding a martini while he has one hoof perched on a beach ball. It's a little loose, but you can still tell there's something weird going on under there. We're having Owner's birthday party today, so I wanted to amp up the merry for the occasion. Not feeling particularly convivial, I knew special effort would be required to get through the Crazy Land lunch. I'm not sure the shirt's going to help much, but I've done all I can. I'm a kielbasa with a reindeer and jingle bell bracelet, earrings and necklace. Hark, the festal sausage cometh!

PT gave me some new exercises to do, specifically aimed at regaining strength and range of motion in my rotator cup and pectoral muscle. The exercises feel just dandy, too. I've added them to my daily 25 (25!) minutes of stationary bike and 20 minutes of yoga. After I finish with those activities, I have self-massage to do. That takes another 30-40 minutes. In a way, my life is still all about breast cancer. Not that I'm whining. All of this is far more bearable than the chemo and recovery from multiple surgeries. Nonetheless, how annoying. How very un-holiday.

When I got home yesterday from physical therapy, after getting stuck in college basketball game traffic, Hubby was hanging around waiting for me to make dinner. I'd gotten some tamales, so all he had to do was cut a couple of holes in the packaging and stick the damn things in the microwave. The brown rice was microwaveable, as was the refried beans. I'd already mixed the salad. Would any of this be hard to do? If your wife was being tortured, wouldn't you want to microwave the damn dinner for her? Yes, you would.

Not my Hubby. My level of pain made it hard to focus on what exactly needed to be done and in what order. While I wandered around the kitchen, getting things together, Hubby was in another room checking his email. Santa will be delivering a lump of coal for Hubby if he doesn't shape up. During dinner, I mentioned several times how exhausting the pain is after physical therapy. Hubby made a sympathetic face, but I assure you that, if it were he who was suffering, there would be no tamale dinner. There would be plenty of whining, though.

That will be about enough from me, too. Here's hoping for a fun, if not jolly, Crazy Land lunch. Owner's been in a funk the past several days, so he may be entertainingly annoying. Mr. Moneybags is weighing in with some serious crotchety, too. The cake has already arrived. Oh God. I just heard the dulcet tones of Loathsome. Looks like we're headed for some choppy waters. The Kielbasa* will keep you posted on the Crazy Land festivities.

*Finally. I think I've found my very own nickname: Kielbasa. Or Sausage. Hey, Mimi, it's the answer to the question you posed so long ago! I've officially earned my own Crazy Land nom de guerre.

Friday, December 14, 2007

Stage 3, Step 3

When the Japanese mend broken objects, they aggrandize the damage by filling the cracks with gold. They believe that when something's suffered damage and has a history it becomes more beautiful. ~Barbara Bloom (I'm not sure this quote goes with this post, but I like it anyway.)

It dawned on me last night that I was diagnosed with Stage 3 breast cancer. Oh shit...how did I not know that? I reviewed what I know about breast cancer staging, just in case I'd jumped to a hasty conclusion. No. Stage 3. Then I called my mom this morning and told her I'd just realized I have Stage 3 cancer.

"Well, they told you that at the time," she said. "I don't think you could handle it then. There were too many things happening too fast to deal with it all."

Well, hell. I wish someone had mentioned it more than once. Seems a little silly to be terrified now. It actually seems kind of funny. Or maybe that's just the hysteria talking. Epiphanies. What a riot!

Today, I have step 3 of the new plan. I thought of it last night in between panic attacks.

What do I know about suffering?

I know that, no matter how good things are, we are never satisfied. We're filled with a restless hunger. Have the perfect job? If only we liked our kitchen more. Have the kitchen redecorated? If only the sun would come out. Sun shining? If only we were having a better hair day.... It's endless, this longing.

We want to push change away, halt time in its tracks, because with change comes loss. We don't like loss; it never feels good.

We yearn so much for feeling good (in all its possible manifestations) that we are unable to accept each changing moment as it comes. That is the solution to my suffering. I have to relearn it every so often. I thought I'd gotten it down during chemo, but no.

I am mourning the loss of my breast. The breast is gone and the new one is scarred and hardened in places. I was diagnosed with Stage 3 breast cancer and now I'm afraid. Things are as they are.

I can let go and experience these truths without judgment, holding close to me in loving embrace the sorrow, anger and fear. I can stop rejecting the breast and love it. I can stop rejecting the body and love it. It is my oldest friend, it will be with me until I die. I can feel some empathy for this skin that carries me around in it.

I can remember that, as much as I don't like this moment, it's perfect, nonetheless.

Thursday, December 13, 2007

One More Thing...

I'm not angry with my beloved Dr. Ross. I still have him penciled in my datebook to elope with whenever he has time enough to think about it. Well, time and...you know...interest.

Jingle jingle.

Steps One and Two

" Man performs and engenders so much more than he can or should have to bear. That's how he finds that he can bear anything." ~William Faulkner

After physical therapy, my day is almost gone, even though I've been at Crazy Land since 6:15 today. (Purely accidental, I assure you.)

Step one of the new plan has already been implemented. I've been listening to Christmas music and wearing my jingle bell bracelet. Okay, I confess. I always wear my jingle bell bracelet from Thanksgiving until Christmas. I make it tinkle whenever I walk around the office. I do what I can to annoy the natives in Crazy Land. Of course, they'd never mention it to me if they found it irritating, but it's bound to get under somebody's skin.

Step two of the new plan is to sit with the sorrow, to maintain some inner silence while I feel the loss. It's hard to write or talk when I'm listening to the sadness, so I've gone missing this week from everyone.

When Dr. Ross told me that I had to have a mastectomy, his physician's assistant told me that a year from treatment, no one would know anything ever happened. I held onto that prediction as if it were a lifeline. I don't think I ever really dealt with the loss of my breast. I didn't have to; I believed her.

It dawned on me last night that Dr. Ross actually talked to me about the problems I would face with reconstruction. He said he would discuss them in conference with his colleagues and try to find the best way to deal with them. I assumed all would be well.

The type of breast cancer I have is not the kind most women have; only 10 percent of diagnosed breast cancers are like mine. There were cancer cells throughout my entire breast, extending very close to the chest wall. After the breast was gone and chemo endured, there was an enormous amount of radiation to the area. My doctors feared the proximity to the chest wall and the neck. We were unable to save any skin, which would have made reconstruction easier.

I'd rather be alive than dead. I'd rather have this breast than none. Nonetheless, I'm angry and frustrated. And sad. So, so sad. I'm present with the heartache; I'm silent as I mourn.

The new plan will continue to unfold and, inevitably, I will be better. As Julian of Norwich said, "...all shall be well, and all shall be well, and all manner of thing shall be well."

Tinkle tinkle.

Tuesday, December 11, 2007

Searching for a New Plan

There will be no more surgeries (aside from nipple reconstruction on the new breast). That means the hard, necrotic tissue will remain where it is, perhaps for years.

Dr. Kronowitz did inject steroids into the chelated areas on the new breast, navel and donor site. That may help with the way the scars look.

I started physical therapy today in hopes of improving strength and range of motion in my left arm.

There's not much else for me to say right now. I'm coming up with a new plan to come to terms with this new, permanent reality.

Thursday, November 29, 2007

Working on Healing

I decided not to move up the time on my stationary bike this week. The twenty minutes of riding and twenty minutes of yoga are still exhausting. Last night I fell asleep several times while sitting on the sofa, watching television. I'm really interested in my Yao Ming book, but I'm so tired I haven't been able to read it.

The next visit to Houston is coming up next week. Yay for the end of the girdle. I'm going to have to ask him about the tissue necrosis under my left arm. I'm afraid to do that, because I'm not going to be happy with the answer, no matter what. If it's going to stay that way, I'll be crushed. On the other hand, the prospect of another surgery is daunting. I'm trying to not think about it much. I'll cross that bridge when I come to it, as always. Breast cancer is like that.

I may ask Dr. Kronowitz to help me get some physical therapy for my left shoulder, back, arm and chest. I've been working hard, trying to rehab with yoga. It's definitely working, but it's slow going. I was thinking that formal physical therapy might help me move along a little faster toward regaining strength and range of motion.

Yoga. I can feel scar tissue being stretched everywhere when I practice. I've also been continuing to work on my lymphatic system.

I'm certain that someday I'll be able to just live, as opposed to working on healing all the time.

Wednesday, November 21, 2007

Getting Back in Shape...Again


This week, twenty minutes on the stationary bike, twenty minutes of yoga. I'm exhausted. I spend part of every evening, sleeping while sitting on the sofa. It reminds me a little of how morphine affected me. One minute, I'm waiting to see Steve Earle on Law and Order, the next thing I know, I've missed 10 minutes of the program.

I'm trying to get back in better condition before my December 6 appointment with Dr. Kronowitz. I want to feel better. I want my doctor to be impressed with my progress. Why? Beats me. He's not even Dr. Ross.

When I do yoga, I can feel all of the scar tissue in my body. There's a lot of it. I can also feel how all of the muscles in my right shoulder, arm, back and chest are shortened and weak. It hurts to stretch them out, but it's nowhere near as painful as the surgeries and radiation that caused it.

Only 15 more days of wearing the girdle 24 hours a day, 7 days a week.

Thursday, November 15, 2007

Progress


I'm now up to 15 minutes on the stationary bike and 20 minutes of yoga every night. I continue to have trouble gaining back the weight I lost after surgery. After counting calories for a couple of days, I figured out that I'm simply not eating enough. Breakfast and lunch combined only added up to about 450 calories. I'm trying to eat more.

My next trip to see Dr. Kronowitz is on December 6. After that, the girdle is gone! Two and a half months of wearing a girdle 24 hours a day, seven days a week has been relentlessly uncomfortable. I guess I'll find out then whether there's any hope for my new girl to look normal. I'm not sure I want to know the answer.

Friday, November 09, 2007

Thank you

This is from my wonderful friend, RubyShooz. Please pass it on to the people who make a difference in your life.

LoveShines

Appreciation

“Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos to order, confusion to clarity. It can turn a meal into a feast, a house into a home, a stranger into a friend. Gratitude makes sense of our past, brings peace for today and creates a vision for tomorrow.”
-Melody Beattie

Wednesday, November 07, 2007

An Apology, Of Sorts

I just received a comment about my most recent post from a very kind man. He is a member of a support group for survivors of a very rare and (at this time) incurable cancer. He could have been stern with me or angry with me. There are a whole range of unpleasant reactions he and others would have a right to express. I thought I should clarify my position on support groups.

I am asocial. That's the bottom line for me. I was a member of a Survivor's of Suicide support group after my father died. I found it amazingly comforting to sit in a room with 12 other people who knew exactly what it felt like to live through that terrible, terrible event. Every week, we'd all stand up and say our names, the names of our departed loved ones, the date they died, and how they chose to leave us. That was as far as I ever got. I listened to everyone talk and I cried for the two hours it lasted every week. The very last week I went, the facilitator actually asked me to talk about my feelings. I talked, but I never went back.

I also participated in fairly long-term group therapy a couple of times in my life. I think my unwillingness to share my heart or my thoughts with groups of people stem from those experiences. They were not positive.

I understand how important it is for people to reach out to others, to have a stable base of supporters who are living through the same difficulties and traumas that you are. Please know that I don't mean to disparage that need or anyone who finds hope and solace through support groups.

This much I know: We all get through it how ever we can. Whatever crises life sends your way, the important thing is to just get through it. No judgments.

Being Upbeat Doesn't Keep You Alive

I'm not a joiner. I don't do support groups. Throughout my breast cancer treatment, my primary care provider and my psychiatrist constantly urged me to get into a support group. "It improves your chances of survival," they told me. I read books that said the same thing. It came to seem almost like a judgment, that if I was unwilling to do the required sitting and sharing, I was inviting death to make a house call. My doctors disapproved of my decision and they disapproved of me. It made me angry and it caused me to question my own intuitive understanding of what I needed to do to get through treatment.

I didn't care what anyone said. The thought of sitting around with a group of women, some of whom definitely would not survive the fight, and talking about having breast cancer made me just want to go ahead and die. I decided that, if that's what was required of me, I'd have to take my chances. No support groups.

If you asked the people who saw me every day, they would tell you that I always maintained a positive attitude throughout my treatment. They're right, but they're also wrong. Mostly I was focused on how much everything hurt. I was primarily aware of how big the pain was. It was as if I'd become a 600 pound lump of agony. I was open to distraction, though. As a matter of fact, I sought out distraction wherever I could find it and whenever I had the energy to use it. When people told jokes, I laughed. When they looked at me and started crying, I comforted them. Then I made a joke, so they could be distracted from my pain. I don't think they knew the diversion was less for them than for me.

I was not upbeat all of the time, not even most of the time. I'm not even sure what "maintaining a positive attitude" really means in that context. I was relatively confident that I wasn't getting ready to die any time soon. I was certain that I was going to be required to endure whatever the treatment regimen dictated. Is that the same as being upbeat? I'm not so sure.

Today, I read an article from WebMD that made me feel better about being asocial and stoic. It turns out that the commandments "Thou shalt be positive or die" and "Thou shalt participate in support groups or die" are wrong. Here's the proof:

Attitude Doesn't Affect Cancer Survival

Study Shows Positive Thinking by Patient Has No Impact on Surviving Cancer
By Salynn Boyles
WebMD Medical News
Reviewed by Louise Chang, MD

Oct. 22, 2007 -- Having a positive attitude may help cancer patients deal with their disease, but it doesn't directly affect survival, according to one of the largest and most rigorously designed investigations ever to examine the issue.

The study included more than 1,000 people treated for head and neck cancer; the emotional state of patients was found to have no influence on survival.

The findings add to the growing evidence showing no scientific basis for the popular notion that an upbeat attitude is critical for "beating" cancer, says University of Pennsylvania School of Medicine behavioral scientist James C. Coyne, PhD, who led the study team.

"I wish it were true that cancer survival was influenced by the patient's emotional state," he tells WebMD. "But given that it is not, I think we should stop blaming the patient."

'The Tyranny of Positive Thinking'

Jimmie Holland, MD, agrees. The Memorial Sloan-Kettering Cancer Center psychiatrist is a longtime critic of the "mind over cancer" proponents who tell patients they must stay positive to survive their disease.

In her book The Human Side of Cancer, Living with Hope, Coping with Uncertainty, Holland coined the term "the tyranny of positive thinking" to describe the belief.

"The idea that we can control illness and death with our minds appeals to our deepest yearnings, but it just isn't so," she tells WebMD. "It is so sad that cancer patients are made to believe that if they aren't doing well it is somehow their own fault because they aren't positive enough."

Holland does acknowledge the benefits of staying positive during cancer treatment, and she is an advocate of techniques like relaxation, meditation, support groups, and prayer to help patients cope with their disease.

But she says there is no credible evidence that positive thinking alone directly influences tumor growth.

"People really want to believe this, so even very good studies like this one probably won't change public thinking," she says. "But the scientific community is getting the message."

Attitude and Cancer Survival

The newly published study included 1,093 patients with head and neck cancer who completed quality-of-life questionnaires during their treatment.

Coyne says the study group was limited to patients with a single cancer who had similar treatments to better assess the impact of state of mind on survival.

A total of 646 patients died during the study follow-up. Even after accounting for other variables that could affect survival, a patient's emotional state was found to have no bearing on whether or not he or she lived or died.

The study appears in the Dec. 1 issue of the American Cancer Society (ACS) journal Cancer.

In a separate review of other studies published earlier this year, Coyne, University of Pennsylvania colleague Steven Palmer, PhD, and ACS researcher Michael Stefanek, PhD, found insufficient evidence that participation in psychotherapy or cancer support groups plays a role in survival.

In that report, the researchers concluded that the hope that emotional state is a driving factor in cancer outcomes "appears to have been misplaced."

"If cancer patients want psychotherapy or to be in a support group, they should be given the opportunity to do so," they wrote in the journal Psychological Bulletin. "There can be lots of emotional and social benefits. But [patients] should not seek such experiences solely on the expectation that they are extending their lives."

Tuesday, November 06, 2007

Making Chemo brain Treatment Decisions with a Chemo brain


I woke at 3:30 this morning and never went back to sleep. Little Andy (my big baby Husky) needed to take an emergency bathroom break, so I got up to let him out of his crate and into the back yard. That was the end of sleep for me.

I read yesterday that M.D. Anderson now has some services to address chemo brain. It all sounds tiring and complex. There will be neurological tests. Heaven only knows what that would entail. Since chemotherapy, I'm noticeably more stupid. My therapist, my husband and my mom can't see it, but I know how much more slowly I think. I notice how frequently I can't think of the right word, can't follow logical progressions in my database development, have difficulty concentrating.

My psychiatrist recently suggested (and I just that same day read) that chemo brain may be trauma-induced. The diagnosis, the chemo, the radiation, the uncertainty of a long-term future are, without a doubt, traumatically stressful. After it's over, we're left to process all of it emotionally and try to cobble together a new life.

I'm mulling over my options. I don't know if I'm willing, at this point, to endure what will be required of me to figure out how (or if) we can fix it. Maybe I simply need to wait a while, continue to work through the past two years and hope things improve.

I'll be in Houston on December 6 and, if I were going to pursue treatment of some kind, it would be great if I could work that in on the same trip. On the other hand, I don't know how likely it would be that I could combine the two. They're busy, you know.

On five hours of sleep, it's hard to come up with the right answer. I think I'm going to allow my intuitive brain to work on this without my intellect getting involved. The right brain is always right. I'm willing to wait while it decides for me.

Wednesday, October 31, 2007

Just Because It's Over, Don't Forget

This is officially the end of Breast Cancer Awareness Month. Just because it's over, don't forget. Specifically, don't forget to take care of yourself. Don't forget self exams. Don't forget mammograms. Don't forget to arm yourself with reliable information.

Today, an article from a British website, one of the few I've found that discusses alternative treatments. Not everyone wishes to undergo chemotherapy and radiation. Visit their website, CancerActive, for more information on breast and other types of cancer.

This article has been compiled by Chris Woollams from worldwide research and expert sources*

The CANCERactive Difference: Intelligent Information. Independent Voice. On this web site you will find more information about more treatment options (Complementary and Alternative, not just Orthodox), and on more 'possible contributory factors' to the development and maintenance of your cancer, than on any other UK cancer web site. Some experts believe that approaching your cancer in this 'total' way can increase an individual's chances of survival by as much as 60 per cent.
The very latest research evidence from all over the world in our news section Cancer Watch supports all this.
We can do this because we are not hide-bound by vested interests, and so we can always put people first. We are not influenced by companies who seek to make financial gains from patients, we have no trustees working for, or sponsored directly or indirectly by such companies, our directors take no remuneration at all. This is our true independence, from which you benefit directly.
But this comes at a price – we rely on you, and people like you to support our work. 47,703 people visited our site in March 2007, viewing 11 pages on average. Every month we add 20 new pages to this site. If you feel an independent voice is essential in cancer, please, please help by making a donation. Every little helps.

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Who gets breast cancer?

Issue 1 coverDespite the high profile cases of Pop stars in their twenties and thirties contracting the disease, the plain fact is that usually 80 per cent of all cancers come in the over 60 age group. Sadly, with ageing comes increased deficiency in cellular replication systems, more chances of genetic mistakes, reduced hormone levels and a build up of toxins.

Breast cancer, however, has seen a gradual lowering of the age of diagnosis with approximately 40 per cent of diagnoses in women below the age of 65, and 60 per cent above that age. So there is more to this cancer than mere ageing.

The breasts are made up of ducts connecting the nipples to glandular tissue containing the lobes. Some of the breast tissue extends into the armpit where lymph nodes are found. All this is surrounded by fat and here in lies some clues to cause. Fat is a wonderful solvent and will dissolve and hold all those chemicals, toxins and hormones (your own and ingested ones) that you really should be excreting. Being overweight will not help as that will increase the percentage of fat, nor will a lack of exercise as this helps stimulate lymph flow and excretion, whilst helping provide more cancer hating oxygen to the tissues. Certain deficiencies in minerals have been found in women with breast cancer, as have vitamin deficiencies.

Although still small numbers, increasingly men are being diagnosed with breast cancer.

But doesn’t breast cancer run in families?

Another concern you often hear is that Breast Cancer ‘runs in families’. Whilst it is true that some people have a genetic ‘weakness’ – genes that weaken the immune system’s ability to spot a cancer cell, or genes that prevent the cell’s ability to repair its own DNA (you may have heard of BRCA1 and BRCA2) - these types of genes are present in less than 7 per cent of women. More genes linked to a higher incidence of breast cancer are still being discovered – for example PALB-2 - but these also seem more to do with the repair and immune systems than the breast tissue itself. Even if you have these genes estimates suggest that the risk of getting breast cancer is less than 70 per cent, although – more clues here – this figure has risen from about 40 per cent 50 years ago, quite probably along with increased levels of toxins around us, poorer diets and less healthy lifestyles.

bbb1By and large prevention (See Breasts, Breasts, Breasts ) is still largely in your own hands with breast cancer and if you have had breast cancer and been given the all clear there is so very much you can do to prevent a recurrence.

Putting together a treatment plan

Fret not – there is so much you can do – mostly to help yourself. When my daughter developed her brain tumour and was given just 6 months to live we found out so many things that could help – but it took at least 6 months hard work and a pair of science degrees. The aim of this site is to short circuit all this for you and to empower you – to pass on all our knowledge, our research findings, the expert studies and the possible causes so that others can benefit immediately. This is also why, when the doctors asked me, I gladly wrote ‘Everything you need to know to help you beat cancer’. The book has been a best seller in the UK for three years – and you cannot even buy it in a shop – only direct from the charity!!
Now, let’s first try to understand what is going on, and what factors might be maintaing this cancer, helping it progress in your body.

The possible contributory factors to breast cancer

Various epidemiology studies have shown that smoking increases risk, as does increasing levels of regular alcohol consumption.

Dietary factors are clearly important. Various global studies show that women with breast cancer have lowered levels of vitamin C, vitamin D, vitamin B-12 and long-chain omega-3. Professor Hollick of Harvard has stated that 25 per cent fewer women would die of breast cancer if they took adequate daily levels of vitamin D. Research shows that tocotrienol vitamin E, fish oils and garlic Garlic appear to be protective. Studies have shown that women with a history of breast cancer have lowered levels of the mammalian lignans enterodiol and enterolactone, which are made from plant lignans in the intestine. These have been shown to be made from plant lignans (e.g. in Flax seed) by the beneficial bacteria in your intestine; both reduce your oestrogen levels.

BB1LadyWomen who exercise regularly (the best is a little every day) have less breast cancer – and those with it have 50 per cent less mortality if they take daily exercise.

However by far the biggest risk factor is a heightened level of the hormone oestrogen. ‘Oestroge-driven’ cancer may well account for over 80 per cent of all breast cancers. Cancer Research UK has stated that Breast Cancer rates are rising at 2 per cent per year, while oestrogen levels are rising in women by 7 per cent.

There are a number of possible reasons for this. For example:

Women are having less children and breast-feeding them for shorter periods. Both factors (more children and breast feeding for 9 months or more) decrease risk. This may well be due to decreases in the lifetime levels of natural progesterone, a known oestrogen balancer

  • Women are starting their periods earlier and ending them later. Modern woman has almost twice the number of periods of her 16th century predecessors.
  • bbb9Women in the Western World consume large amounts of Dairy. Several research studies from the Swedish experts at the Karolinska Institute suggest that the critical factor is the cow’s hormone Insulin Like Growth Factor (IGF-1), which seems to stimulate hormones such as oestrogen and other localised cell factors to make your cells grow rapidly. The more dairy you consume, the greater your breast cancer risk according to Karolinska. Another study, this time by researchers in Denmark, amongst 117,000 girls showed that those who put on a big growth spurt between ages 8 and 14 eventually had a higher risk. Again a finger was pointed at dairy.
  • Women now have more stressful occupations; many of these lead to sleep irregularities and deprivation (e.g. Nurses and Air Hostesses). Research shows that this results in lowered levels of the hormone melatonin, which seems to counter excess oestrogen under normal conditions.
  • The finding that women who had taken more than 25 doses of antibiotics in their lives (Journal of the American Med Assn 2004, Feb 18; 291) started people questioning antibiotics. However the truth is far more likely to be the destruction of Beneficial Bacteria in the intestine which results in decreases in vitamin K, vitamin B-12 and other B vitamins, reduced effectiveness of the immune system plus likely infestations of yeasts (Symptoms like cystitis and thrush may indicate this). Over 100 clinical trials now suggest we ignore the contribution of beneficial bacteria at our peril. You simply must have adequate daily levels of a variety of strains of beneficial bacteria (Probiotics). See below.

Open quotes We ignore the contribution of beneficial bacteria at our peril Close quotes
The US State of Evidence report 2006 summarizes the findings of more than 350 experimental, epidemiology and ecological studies and recommends new directions for the future in disease management. In particular it looks at the growing and vast amount of research on the effects of chemicals and EMF’s on the risks of developing the disease:
  • There is increasing evidence that various Electromagnetic Forces can also reduce these levels of melatonin whilst stimulating levels of IGF-1 and other hormones. This is not a modern myth. Scientists are growing increasingly worried by the electronic smog that surrounds us all – from masts, to mobile phones, to WiFi – even electric blankets!
  • The use of synthetic oestrogens: CRUK has provided data on the increased risks of breast cancer when women take the contraceptive pill – especially if they take it after the age of 30. HRT is also a risk factor. Indeed new research from the USA has shown that breast cancer levels have declined by 7 per cent in 2005 as a direct result of women giving up HRT.
  • Xeno-oestrogens: Increasingly, chemicals that mimic the action of oestrogen in the body are believed to be a significant and modern link to risk. Pesticides like DDT and Lindane, toiletry and personal care chemicals like DEHP and toluene, BPA from white lined cans and even kiddies toys, and Phthalates from plastic bottles and packaging are all thought capable of mimicking the action of oestrogen in the body by experts. Worse Dr Ana Soto of Tufts believes them to be cumulative.

All in all, there may be many factors that contributed to your breast cancer. On this web site we also cover possible links to the thyroid hormone, Thyroxine, plus an article from Eileen O’Connor who is so convinced EMF’s from a local mast gave her breast cancer that she is now a leading campaigner against such EMF’s.

OestrogenbookNow, the important point is that we are not listing the possible contributory factors so that you dwell on things that have happened in the past. We want you to understand what factors might still be present in your life and might be contributing to the maintenance of your cancer. Then you can formulate an action plan. You might try to cut EMF’s out of your life, or you can act to lower the oestrogen (natural and synthetic) in your life – oestrogen that might be fuelling your cancer right now. (We have a book ‘Oestrogen – the killer in our midst’ that tells you the simple steps you can take to cut your natural and synthetic oestrogen levels today). After all that is exactly what your oncologist will try to do with Aromatase Inhibitor drugs like Arimidex. Then there are minerals you can take, like selenium, or complex compounds like chlorella that can help you eliminate heavy metals, or increase levels of Vitamin B-12. And articles on why breast cancer patients should take vitamin D and other natural supplements. You can find out comprehensive information on these topics and more elsewhere on this site.

Diagnosis

About 40,000 - 44,000 cases of Breast cancer will be diagnosed in the UK in the next 12 months. However, if you are pre-menopausal and your diagnosis comes from a mammogram you should read our article on screening mammograms immediately, and understand the high levels of false positive readings occurring. Do not under any circumstances have any treatments until cancer has definitely been confirmed through a means other than screening. (You could use Thermal Imaging, even Iridology as a back up). A biopsy is the most reliable method.

breast cancerYou should check your own breasts regularly. You are looking for lumps, or thickenings especially behind the nipple, sudden inversion of a nipple, dimpling on the skin surface, a rash, or a swelling under the armpit.

Most lumps are not cancer and are benign. Most often they are cysts, which are sacs of liquid randomly appearing in the breast tissue, or they can be benign ‘fibroadenomas’. Either way they are easily treated and no cause for concern.

If a cancer is suspected, the normal procedure is to have a biopsy. This may take tissue from under your armpit as well as from your breast. Only after tissue has been taken can anyone correctly tell you the spread (the Stage) and aggressivity (the Grade) of the cancer. After analyzing the biopsy tissue, the experts should be able to tell you clearly

A Whether the tumour is oestrogen and/or progesterone sensitive
B Whether you are HER-2 positive

Other

There have been articles in the Lancet about biopsies possibly spreading the disease, but it is a small risk.

There have been research studies covered in icon on abortion and whether it increases risk of breast cancer. Absolutely no evidence of increased risk has been reported by expert studies.

US research on Swedish women with silicone breast implants (Yes, seriously!) showed that while they had no higher risk of breast cancer, cases of lung cancer were higher than expected (Journal of the Nat. Cancer Inst. 2006; 98; 557).


DCIS and LCIS

Mam2About 50 per cent of the anomalies shown up by mammograms are Ductal (DCIS) irregularities. There seems total disagreement around the world on this. The team at Christie Manchester sent us a press release stating that they were going to test various drugs on women with DCIS to try to halt this very aggressive form of cancer. Meanwhile US experts were claiming that DCIS is neither cancer nor pre-cancer but calciferous particles blocking the ducts. The lead Professor at the 2004 US Breast Cancer Symposium told everybody that only 20 per cent of cases go on to be full breast cancer. If these are calcium deposits, it might explain some of the issues with dairy and the benefits of fish oils and vitamin D.

Treatment

Surgery: If you are pre-menopausal, you must try to have your operation in the second part of your cycle not the first, for then progesterone, not oestrogen dominates. Two studies from Guys have shown significant long-term survival benefits.

You may have a lumpectomy, or a full breast mastectomy. (You may be advised to have chemotherapy prior to surgery to reduce the size of the tumour and increase your chances of a lumpectomy rather than full-blown breast removal). If you have lymph node removal you should find out about lymphatic drainage, which may help you in the longer term.

Reconstructive surgery may then be proposed and effected at the same time, although US research suggests waiting.

Radiotherapy

Radiotherapy is most commonly used after surgery to kill off any localised and remaining cancer cells. It may also be used on the lymph glands under the armpit if they were infected. We have a good article on how to maximise the effectiveness of your radiotherapy. (Look under ‘Treatments’ – radiotherapy.) You should continue to take all anti-oxidants and supplements during this time. We also have reports from MD Anderson and UCLA that they increase the effectiveness of Radiotherapy.

Although dosage is much more targeted, you should be clear that radiotherapy to the chest region could cause problems with the lung and heart tissue. In the past these were quite common and could be pronounced with up to 20 per cent of lung tissue damaged. Modern techniques have reduced this.

Chemotherapy: The actual programme of chemotherapy depends totally upon the individual (age, health etc) and the state of the cancer. Several drugs may be suggested at the very outset, before a very specific plan is drawn up. You can find a full review of the most common drugs on this site (Click here) and a clear analysis of what diet you should be on to maximise its effectiveness.

Be clear. The purpose of the drugs is to try to kill any remaining cancer cells and especially to try to PREVENT a recurrence in the other breast or spread to secondary organs like the liver (Vitamin K has been shown in Japanese and US research to reduce the dangers to the liver).

The two standard therapies that are most commonly talked about are:

1 Tamoxifen (for five years) followed by three years of an Aromatase Inhibitor (e.g. Arimidex).

CRUK has opined that by the end of the 8 years your cancer will have gone away. (We think it may, but only if you have altered the factors that gave it to you in the first place). Tamoxifen aims to sit on, and therefore block, cellular receptor sites that in breast cancers are attacked by oestradiol. ‘Blocked sites means no attack’ is the theory.

Since over 20,000 women in the UK are currently taking Tamoxifen, we thought it wise to say a few words here about this drug:

Tamoxifen: When told the possible side effects less than 1 in 5 US women want to take the drug

Open quotes When told the side effects less than 20% of women want to take Tamoxifen Close quotes
(Cancer 2005: 103; 1996-2005). For example: Recent research by CRUK on cancer of the womb, which has risen by 30 per cent in a decade and is now twice as common as cervical cancer, implicates a number of factors like being overweight, not having had children and Tamoxifen usage. Dr Bushnell of Dukes, USA reviewed 9 studies on Tamoxifen and concluded that it more than doubles a woman’s risk of ischemic stroke.

Research results carried in icon (Vol 3 Issue 4) from the University of North Carolina showed that it had a minor effect (6-8 per cent) in breast cancer prevention in women with no cancer but at higher risk; however the conclusion was that side-effect risks outweighed the benefits..

US research has shown clearly that the use of natural vitamin E in its total 8 forms reduces the need for Tamoxifen doseage by 25 per cent – as it increases its effectiveness.

It is however the first line drug, the Gold Standard, in oestrogen-driven Breast cancer and blocks sites on cells that oestradiol would normally bind to, and then cause havoc inside the cell. Recent US research shows that its effects continue for 5 years after the last dose. Normally prescribed for 5 years, followed by an Aromatase Inhibitor for three years, many of the makers of these latter drugs are questioning why the patient is not moved more quickly from Tamoxifen to their drug. But then they would, wouldn’t they? There has already been a study (American Soc. Clin. Onc) which suggests better long-term survival results if women come off Tamoxifen and go onto the Aromatase Inhibitor Exemestane earlier.

2. Herceptin. Let’s be clear – about 20 per cent of women are HER-2 positive and this drug will work well for about half of them. Yes, and it does cost 20,000 pounds per year. A recent trial (Lancet 2006) confirms that Herceptin offers benefit with early stage breast cancer patients too.

Open quotes Ask whether the combination of drugs proposed for your chemotherapy have been through clinical trials Close quotes

The side effects of any chemotherapy are very individual, not insignificant and depend upon your condition and the drug. You should also ask whether the combination you are on has actually been through clinical trials. Sometimes only the individual drugs have been.

Treatment for anaemia: Managing and counteracting anaemia can reduce death from anaemia by 50 per cent. Research published by the Cochrane Collaboration showed that epoetins (alfa and beta epoetin) show significant survival benefits. Particularly striking were the results for patients with solid tumours (Breast, lung, colon) where risk of death decreased by 51 per cent). In a second study (European Soc. For Medical Oncology- 31st Oct 2005) epotin beta was shown to reduce risk of tumour progression in patients with anaemia.

bbb10Treatment for fatigue: icon has run several pieces on fatigue. A qualified naturopath will be able to suggest dietary changes to boost energy levels. Qualified homeopaths may be able to suggest ways to counter fatigue. Energy therapists (e.g. acupuncture, cranial osteopaths, Reiki Masters) may well be able to help. Italian research showed a lack of acetyl-carnitine which supplementation could correct. UCLA scientist report that a series of genetic markers become blocked either due to the cancer or due to the chemotherapy treatment. The California team note promising results with Etanercept. Apparently 30 per cent of women who have had chemo for breast cancer have long-term fatigue, even after the cancer has ‘gone’. This may well be true for other cancers.

Other useful tips and therapies.

Professor Howell, of Christie Manchester and one of our Patrons, at our Cancer Prevention Conference told the audience all about the new drugs designed to prevent the return of your breast cancer. Well, good diet, exercise, mental therapies and much more are available for you to start as soon as you wish – all with the very same aim: Preventing this cancer returning. And they can be extremely successful.

Professor Ben Pfeifer has clinical trials on his Diet Therapy. Originally developed from Prostate cancer it has proved so successful they are extending it to Breast cancer treatment. You may be interested in the Gerson Therapy, or the clinical trials of Dr Gonzalez in New York – both are diet based. You can read about Jane Plant who beat her breast cancer by developing her own diet therapy and avoiding dairy completely.

Open quotes Living Proofs - where women who beat breast cancer tell their stories Close quotes
You can also go to our Living Proofs – where women who beat their breast cancer tell their own personal and very individual stories – you might find some useful tips and insights. You might also want to know about Phytoestrogens and their relationship to oestrogen. Try reading Pillar II of our 4 Pillars of cancer (you might find it worth reading them all).

The most aggressive oestrogen is oestradiol, which can increase sodium levels and reduce potassium and oxygen levels inside the cell, causing havoc. Oestrone is its less aggressive sister (about 40 times less potent) and plant oestrogens – called phytoestrogens – are even weaker still. Many people argue that the lowered rates of breast cancers in Asia are due to large levels of circulating plant oestrogens – well which one would you rather have sitting on your breast cancer receptor site? The best sources of plant oestrogens come from ‘greens’ and pulses (like chickpeas, kidney beans and soy) and red clover. The British Journal of Cancer (2006) reports on the benefits of one such phytoestrogen, genistein. Apparently it can increase the repair proteins in a cell – even those in short supply due to the presence of BRCA 1 and BRCA 2. Some people prefer to go this route than take Tamoxifen.

IndoleOther foods can make a difference. For example, polyphenols: Like those in Green tea and olive oil, and Indole 3 carbinol (broccoli, ‘greens’) have been shown in research to turn nasty oestradiol into its safer sister oestrone. The same study above on Genistein, showed that Indole 3 Carbinol can also increase repair protein levels in cells. Sulforaphane, also in broccoli and brussel sprouts, can inhibit the development of breast cancer cells. US Dr Keith Singletary and his team claim it works as well as the chemotherapy drugs, by causing the release of certain cancer killing enzymes. Our book, ‘The Tree of Life – the Anti-cancer Diet’, will tell you much more, and even give you a shopping list and recipes.

Recently there has been an enormous flury of research on the role of beneficial bacteria in our bodies. You really shouild read our article on the subject, and the links to cancer. Over 4000 research studies and 100 clinical trials have shown that Beneficial Bacteria in the gut:

  • stimulate and strengthen the immune system
  • help produce certain cancer fighting vitamins like B-12, folic acid and vitamin K
  • help produce short chain fatty acids which reduce harmful fat production (like chlorestrol)
  • can actually chelate to (bind to) heavy metals and help excrete them
  • can actually neutralise and eliminate harmful chemicals like oestrogen and nitrosamines


BB1 There are over 800 strains of bacteria in the gut – about 400 have been identified and a dozen or so seem, according to the research so far, to have the greatest impact on our health. 60 or more years ago we would consume daily supplies of a number of strains – but we no longer live on farms nor drink raw milk and, , instead, we chlorinate our water, fill our chickens with antibiotics, irradiate our food and pasteurise everyuthing. Worse we take drugs, antibiotics and anaesthetics which deplete our stores further.

There is another school of thought that explains that these Beneficial Bacteria at night feed off the yeasts, microbes and non-beneficial bacteria we accidentally consumed during the day. Yeast infection is now endemic. It is estimated that 70 per cent of the population has excess yeasts – signs in men include bloating after meals, yellow toe nails and athletes foot;
in women it’s thrush, cystitis, bad breath and/or bloating and problems trying to lose weight! Try reading Can Candida cause cancer? on this web site.

Consider this quote: “Cancer patients undergoing chemotherapy did not ultimately succumb to cancer, but to an infestation of Candida albicans”. That comes from the 1993 Spring edition of the prestigious US medical journal Contemporary Oncology. Topping up with probiotics (strains of beneficial bacteria shown in clinical trials to deliver a benefit) and following a prebiotic based diet – lots of whole foods and whole grains – with no sugar, dairy or alcohol and certain yeast killers will help defeat the Candida albicans. It’s all in the article. The recent finding that women who take more than 25 lots of antibiotics in their lifetimes have twice the risk of breast cancer, is just one more factor pointing the finger at yeast infection and a lack of enough beneficial bacteria in the body.

Several US studies (Seattle, Integrative Cancer Therapies, Philadelphia Uni.) have all shown the importance of exercise and complementary therapies. Moderate daily exercise can reduce mortality

Open quotes US studies show that exercise and complementary therapies are important Close quotes
rates by 50 per cent according to this research. If you want to know more about complementary therapies start with our ‘kiddies guide’ prepared for us by the London Breast Cancer Haven.

According to the American Medical Association, women who take more than 7 aspirin tablets a week reduce their breast cancer risk by 29 per cent. Many ‘solid’ cancers involve prior inflammation. Aloe Vera would also provide salicylin plus other anti-inflammatories. Since the work by Sir John Vane on localized inflammatory hormones called eicosanoids, we now know garlic, ginger and long-chain omega 3 (fish oils) can reduce inflammation too.

15stepsIf you are not sure where to start try reading our summary ‘Cancer – your first 15 steps’. We even have a helpful book by the same name. Both allow you to start planning your ‘integrated’ or ‘holistic’ therapy programme.

Overall

40,000 women get breast cancer every year in the UK and it’s rising. Eurocare 3 shows that England has a 73 per cent 5-year survival rate but the figure is lower in other areas of Britain. These figures are all below the European Average, and below France and Germany at around 81 per cent. Sweden has the highest 5-year survival rates at 83.3 per cent.

Research by the US magazine Integrative Cancer Therapies has shown the benefit of building an integrated programme of complementary therapies around your orthodox regime. Some experts state that it increases survival by as much as 60 per cent.

PDTOn this site you can find out about alternative options (and all the research) like Ultrasound (HIFU) instead of surgery, Photo Dynamic Therapy, the truth about vitamin B-17 and the Oasis of Hope, and even John of God.

Or go to our Home page to find a list of the ten hottest topics we have covered recently – we promise one or two will definitely be relevant to you.

On this web site you will find more information about more treatment options (Complementary and Alternative, not just Orthodox), and on more 'possible contributory factors' to the development and maintenance of your cancer, than on any other UK cancer web site. Some experts believe that approaching your cancer in this 'total' way can increase an individual's chances of survival by as much as 60 per cent.

This is all supported by the very latest research evidence from all over the world in our news section Cancer Watch.
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IMPORTANT INFORMATION

* Cancer (and its related illnesses) are very serious and very individual diseases. Readers must always consult directly with experts and specialists in the appropriate medical field before taking, or refraining from taking, any specific action.
This web site is intended to provide research-based information on cancer and its possible causes and therapies, so that you can make more informed decisions in consultation with those experts. Although our information comes from expert sources, and is most usually provided by Professors, scientists and Doctors, our easy-to-understand, jargon-free approach necessitates that journalists, not doctors, write the copy. For this reason, whilst the authors, management and staff of CANCERactive,
icon, and Health Issues have made every effort to ensure its accuracy, we assume no responsibility for any error, any omission or any consequences of an error or omission. Readers must consult directly with their personal specialists and advisors, and we cannot be held responsible for any action, or inaction, taken by readers as a result of information contained on this web site, or in any of our publications. Any action taken or refrained from by a reader is taken entirely at the reader’s own instigation and, thus, own risk.

Tuesday, October 30, 2007

Plant Foods May Cut Breast Cancer Risk


More information from breastcancer.org

Plant foods may cut breast cancer risk

What breastcancer.org says about this article

A healthy diet is an excellent way to take care of yourself, whether you're being treated for breast cancer or trying to lower your risk. A diet rich in fruits and vegetables is recommended by cancer experts as well as registered dietitians. Besides fruits and vegetables, a diet rich in plant foods includes whole grain breads and cereals, nuts, seeds, rice, pasta, and beans. Nutrition experts say that variety is key, because different fruits and vegetables have different nutrients and compounds. Lignans are a compound found in plant foods.

The large study reviewed here (almost 60,000 women were in the study) found that women who ate foods high in lignans had a 17 percent lower risk of breast cancer compared to women who didn't eat foods with a lot of lignans.

It's not clear how lignans work to reduce risk. We do know that lignans may have a weak estrogen effect. When a weak estrogen-like substance takes the place of your body's natural strong estrogen in a breast cell's estrogen receptor, then the weak substance can act as a relative anti-estrogen. By acting in this way, lignans might help work against breast cancer that depends on estrogen for its growth.

Visit the breastcancer.org Nutrition Section for more information on how to create a healthy diet and the role of diet in breast cancer treatment and prevention.

Last Updated: 2007-03-21 14:40:18 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Postmenopausal women who eat healthy amounts of plant foods rich in estrogen-like compounds called lignans may reduce their risk of developing breast cancer, according to a new study.

"Following the general dietary guidelines for a healthy and prudent diet, that is, consuming large amounts and varieties of fruits, vegetables and whole-grain cereal products daily (all foods rich in lignans) may also help prevent breast cancer in postmenopausal women," Dr. Francoise Clavel-Chapelon told Reuters Health.

Clavel-Chapelon, from the National Institute of Health and Medical Research, Villejuif, France, and associates evaluated the relationship between the amount of four types of plant ligands in the diet and breast cancer risk in 58,049 postmenopausal French women.

Over an average follow-up period of 7.7 years, 1469 women were diagnosed with breast cancer, according to the study, published in the Journal of the National Cancer Institute.

Analysis of the data showed that women with the highest total amount of lignans in the diet had a 17-percent lower risk of developing breast cancer compared with women having the lowest dietary lignan levels.

"The reduction in risk was confined to breast cancers positive for hormone receptors, the major type, of which incidence is increasing," Clavel-Chapelon noted.

A diet containing lots of plant foods is hypothesized to offer a breast cancer prevention strategy, the researcher added. This hypothesis was recently confirmed by a study that found a reduced risk of invasive breast cancer among postmenopausal women with high lignan levels in their diet, Clavel-Chapelon said.

SOURCE: Journal of the National Cancer Institute, March 21, 2007.

Wednesday, October 24, 2007

Patients and Caregivers Making Treatment Decisions

Please go to National Coalition for Cancer Survivorship for much more information on breast and other types of cancer.

Making Difficult Treatment Decisions

Treatment decisions by you, the caregiver, may be necessary in the event the person with cancer is not able to make them for him- or herself. The patient and caregivers should discuss this situation, and take steps to assure that the person with cancer receives treatment on his or her own terms. One way that is both legal and effective is for the patient to complete an advance directive to express his or her wishes. This approach makes one's wishes clear — and this can be of great importance to caregivers. There are two components to an advance directive, and a person should have both in place when facing any serious illness.

The living will is a message from the person whose will it is to health care providers in regard to the kind of care that is and is not wanted if the patient can no longer make his or her decisions personally. The topics usually covered in a living will include directives about artificial feeding, use of a respirator if a person cannot breathe on his or her own, and whether or not the patient wishes to have cardiopulmonary resuscitation (CPR) if his or her heart stops. No one must respond to every question in a standardized living will format; if a question is not answered, then the health care provider will make those decisions. Also one can add more information detailing what is and is not wanted, directly on the forms. Many living will standard forms are vague, and so it is up to the person involved to add the details that make it appropriate for his or her care, as is wanted.

A more "user-friendly" version of a living will can be found in a document called Five Wishes, created by Aging with Dignity and legal in most states. This document is clearly written and allows a person to make wishes known in understandable language. To obtain a copy, go to www.agingwithdignity.org and follow the instructions there.

The durable power of attorney for health care designates another person to act as the named individual’s representative in making medical decisions for a person if that person cannot make them. It is simpler than a living will, in that it usually just states that if the named person is unable to make his or her own health care decisions, another person, named in the document, is authorized to do so. This document does not have a list of the kinds of care an individual does and does not want. The person chosen to represent the named individual you choose to have your health care power of attorney should be someone who is trusted and who will honor the wishes of the person giving the power of attorney.

For more detailed information on making wishes known, see Thinking Through Your Wishes on this site.

Other sources of help and information include:

Family and Medical Leave Act (FMLA) — Passed in 1993, FMLA requires businesses and organizations with 50 or more employees to grant leave without pay for a variety of reasons including caregiving of family members, including parents. If you have been employed at least 12 months by the employer or at least 1,250 hours during the previous 12 months, you are entitled to a total of 12 workweeks of unpaid leave during any one year to care for a family member (parent, spouse, child only), as well as for other reasons, such as the birth of a child, your own health problems or adoption. FMLA may also be applicable to your loved one, once regular sick leave has been exhausted during the course of cancer treatment. Note that the 12 weeks of leave does not have to be taken all at once, but can be used as needed. For more information, see your employer's human resources office and the Department of Labor's website. Also see the extensive and helpful information on the website of the National Partnership for Women and Families.

• For detailed information about cancer survivors' rights as employees, see Your Employment Rights on this site.

National Family Caregiver Support Program — Enacted in 2001 as part of the Older Americans Act, this program calls for states, working with area agencies on aging, to have basic services such as information services, counseling, and respite care available for family caregivers caring for the elderly and older caregivers caring for young children. Special assistance is provided for people with greatest economic and social needs, and those caring for individuals with mental disabilities. In some instances, these services may be available to caregivers of people with cancer, if other criteria are met. To find out if you may qualify, contact your local Administration on Aging office; look for numbers in the "government" section of the phone book, or ask the hospital social worker for help in contacting these offices.

The Older Americans Act - helps frail and disabled people 60 or older to remain independent. Covers home care aides, escorts, meal delivery, shopping, etc. Contact your local area agency on aging for information and referrals — look under county or city government headings. Or, call the hotline run by the U. S. Administration on Aging at 1-800-677-1116. This helpful referral service is also available online at www.eldercare.gov.

Medicaid: Medicaid, a joint state-federal program for low-income people, is, like Medicare, coordinated by the Centers for Medicare and Medicaid (CMS). Medicaid coverage varies from state to state, but usually includes some amount of coverage for nursing, aides, equipment and supplies. Get information from your community's welfare office, state department of health, and on the Internet at www.cms.hss.gov/Medicaid.

Tuesday, October 23, 2007

Male Breast Cancer

More important information from Breast Cancer.org

"I knew I had a problem for a couple of years—something wasn't quite right—a disfiguration. I had a pre-employment physical and the doctor said, 'You ought to go see your personal physician.' What happened is that the breast cancer had metastasized to my hip, so I had to have a hip replacement. They found out that the cause of that was breast cancer. That's why I say, 'Don't put off what seems to be minor." If you have any suspicion that something is abnormal, don't hesitate—go do something about it.
— Larry, living with metastatic male breast cancer

Male Breast Cancer

Breast cancer in men is a rare disease. Less than 1% of all breast cancers occur in men. In 2005, when 211,400 women were diagnosed with breast cancer in the United States, 1,690 men were diagnosed with the disease.

You may be thinking: Men don't have breasts, so how can they get breast cancer? The truth is that boys and girls, men and women all have breast tissue. The various hormones in girls' and women's bodies stimulate the breast tissue to grow into full breasts. Boys' and men's bodies normally don't make much of the breast-stimulating hormones. As a result, their breast tissue usually stays flat and small. Still, you may have seen boys and men with medium-sized or big breasts. Usually these breasts are just mounds of fat. But sometimes men can develop real breast gland tissue because they take certain medicines or have abnormal hormone levels.

Because breast cancer in men is rare, few cases are available to study. Most studies of men with breast cancer are very small. But when a number of these small studies are grouped together, we can learn more from them.

The Risk Factors for Male Breast Cancer

It's important to understand the risk factors for male breast cancer—particularly because men are not routinely screened for the disease and don't think about the possibility that they'll get it. As a result, breast cancer tends to be more advanced in men than in women when it is first detected.

A number of factors can increase a man's risk of getting breast cancer:

  • Growing older: This is the biggest factor. Just as is the case for women, risk increases as age increases. The median age of men diagnosed with breast cancer is about 67. This means that half the men who are diagnosed are over 67, and half are under.
  • High estrogen levels: Breast cell growth—both normal and abnormal—is stimulated by the presence of estrogen. Men can have high estrogen levels as a result of:
    • Taking hormonal medicines.
    • Being overweight, which increases the production of estrogen.
    • Having been exposed to estrogens in the environment (such as estrogen and other hormones fed to fatten up beef cattle, or the breakdown products of the pesticide DDT, which can mimic the effects of estrogen in the body).
    • Being heavy users of alcohol, which can limit the liver's ability to regulate blood estrogen levels.
    • Having liver disease, which usually leads to lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). This increases the risk of developing gynecomastia (breast tissue growth that is non-cancerous) as well as breast cancer.
  • Klinefelter syndrome: Men with Klinefelter syndrome have lower levels of androgens (male hormones) and higher levels of estrogen (female hormones). Therefore, they have a higher risk of developing gynecomastia (breast tissue growth that is non-cancerous) and breast cancer. Klinefelter syndrome is a condition present at birth that affects about 1 in 1,000 men. Normally men have a single X and single Y chromosome. Men with Klinefelter syndrome have more than one X chromosome (sometimes as many as four). Symptoms of Klinefelter syndrome include having longer legs, a higher voice, and a thinner beard than average men; having smaller than normal testicles; and being infertile (unable to produce sperm).
  • A strong family history of breast cancer or genetic alterations: Family history can increase the risk of breast cancer in men—particularly if other men in the family have had breast cancer. The risk is also higher if there is a proven breast cancer gene abnormality in the family. Men who inherit abnormal BRCA1 or BRCA2 genes (BR stands for BReast, and CA stands for CAncer) have an increased risk for male breast cancer. This risk is approximately 6% over a man's lifetime. That's about 80 times greater than the lifetime risk of men without BRCA1 or BRCA2 abnormalities. Still, the majority of male breast cancers happen in men who have no family history of breast cancer and no inherited gene abnormality.
  • Radiation exposure: Having radiation therapy to the chest before age 30, and particularly during adolescence, may increase the risk of developing breast cancer. This has been seen in young people receiving radiation to treat Hodgkin's disease. (This does NOT include radiation therapy to treat breast cancer.)

    Symptoms of Male Breast Cancer

    One study found that male breast cancer is on the rise, with a 25% increase over the 25 years from 1973 to 1988. But it's still rare. It's unclear whether the reported rise means the disease is slowly becoming more common, or whether men better understand the symptoms and report their symptoms, leading to diagnoses that might have been missed in the past.

    If you notice any persistent changes to your breasts, you should contact your doctor. Here are some signs to watch for:

  • a lump felt in the breast
  • nipple pain
  • an inverted nipple
  • nipple discharge (clear or bloody)
  • sores on the nipple and areola (the small ring of color around the center of the nipple)
  • enlarged lymph nodes under the arm

It's important to note that enlargement of both breasts (not just on one side) is usually NOT cancer. The medical term for this is gynecomastia. Sometimes the breasts can become quite large. Non-cancer-related enlargement of the breasts can be caused by medications, heavy alcohol use, weight gain, or marijuana use.

A small study about male breast cancer found that the average time between first symptom and diagnosis was 19 months, or over a year and a half. That's a very long time! This is probably because people don't expect breast cancer to happen to men, so there is little to no early detection.

Earlier diagnosis could make a life-saving difference. With more research and more public awareness, men will learn that—just like women—they need to go to their doctor right away if they detect any persistent changes to their breasts.