Friday, October 24, 2008
Thursday, October 23, 2008
Hidden Comments
Tuesday, October 21, 2008
Breast Cancer Information Resources
Detailed Breast Cancer Risk
GE Health Care
Breastcancer.org
Cancer.com
Discovery Health
Revolution Health
National Coalition for Cancer Survivorship
Planet Cancer
ICON Magazine
National Cancer Iinstitute
Susan G. Komen Foundation
National Breast Cancer Foundation
Medline Plus: A Service of the U.S. National Library of Medicine and the National Institutes
of Health
Breastcancer.net
WebMD
MedicineNet.com
Mayo Clinic
M.D. Anderson
National Cancer Institute
American Cancer Society
Healthline
Oncolink: Abramson Cancer Center of the University Pennsylvania
Doctors' Guide to Breast Cancer Information and Resources
Centers for Disease Control and Prevention
I am sorely tempted to (compulsively) alphabetize these, but I've been interrupted by my computer challenged co-worker and now it's time to leave. More tomorrow, perhaps a brief intro to these.
Monday, October 20, 2008
Comcast Pink Ribbon
Watch a wide array of informative, entertaining and inspiration programs from Lifetime Television, Parents TV, Discovery Health, Showtime and Exercise TV with medical direction sand original content provided by Breastcancer.org.
To help raise awareness and provide important information about breast cancer, Comcast partnered with Breastcancer.org and several cable networks to launch The Pink Ribbon Campaign, an original video-on-demand and online initiative bringing together educational and inspirational content for all women and their loved ones.
The Pink Ribbon Campaign presents dozens of programs about prevention, detection, treatment and living with breast cancer as well as discussion forums, health and fitness advice and relevant news clips.
Throughout the entire month of October, Comcast customers with On Demand service will have free access to programs that will encourage and inspire women who are fighting or have survived breast cancer, including episodes of HBO's Sex and the City, Showtime's The L Word, celebrity bios from Bio Channel and Lifetime original movies, such as Living Proof, starring Harry Connick, Jr.
In addition, there are dozens of programs in categories including:
Pink Originals
Original, exclusive programming created specifically for the Pink Ribbon campaign by Lifetime and Parents TV. Topics including how to talk to children about cancer, and what to expect from diagnosis, treatment and recovery are also covered.
Meet the Doctors
New and original content produced by Comcast, in partnership with the University of Pennsylvania Abramson Cancer Center, provides an overview of risk factors, importance of knowing family history and tips on how to detect and defeat cancer.
Prevention-Healing
Programs from Discovery Health and Exercise TV provide in-depth information about prevention, including how to perform a breast self-exam.
TV and Movies
Special segments from TLC, Style Network and Lifetime provide advice for patients and survivors from demonstrations on how to wear a scarf to tips on boosting confidence and self-esteem.
Pink Ribbon Online
Fancast.com will feature most of the programs available On Demand, including episodes of The L Word, Whose Wedding Is It Anyway, One Tree Hill and profiles of celebrities who have battled breast cancer from Bio Channel. Additional content including videos in The Fan, links to relevant news articles and discussion forums is available at http://comcast.net/pinkribbon.
Friday, October 17, 2008
Can Breast Cancer Be Prevented?
From the American Cancer Society
There is no sure way to prevent breast cancer. But there are things all women can do that might reduce their risk and help increase the odds that if cancer does occur, it is found at an early, more treatable stage.
Lowering your risk: You can lower your risk of breast cancer by changing those risk factors that can be changed. If you limit alcohol use, exercise regularly, and keep a healthy weight, you are decreasing your risk of getting breast cancer. Women who choose to breast-feed for at least several months may also reduce their breast cancer risk.
Not using post-menopausal hormone therapy (PHT) if you don't need it can also help you avoid raising your risk.
Finding breast cancer early: It is also important for women to follow the American Cancer Society's guidelines for finding breast cancer early. (See the section, "How is breast cancer found?")
For women who are or may be at increased risk
If you have a higher risk for breast cancer there may be some things you can do to reduce your chances of getting breast cancer. Before deciding which, if any, of these may be right for you, talk with your doctor.
Genetic testing: There are tests that can tell if a woman has certain changed (mutated) genes linked to breast cancer. With this information, women can then take steps to reduce their risk. Recently the U.S. Preventive Services Task Force made recommendations for genetic testing. They suggest that only women with a strong family history be evaluated for genetic testing for BRCA mutations. This group is only about 2% of adult women in the United States.
If you are thinking about genetic testing, you should talk to a genetic counselor, nurse, or doctor qualified to explain the results of these tests. It is very important that you know what genetic testing can and can't tell you, and to carefully weigh the benefits and risks of testing before these tests are done. Testing is expensive and may not be covered by some health insurance plans. For more information, see our document, Genetic Testing: What You Need to Know.
Breast cancer chemoprevention: Chemoprevention is the use of drugs to reduce the risk of cancer. Many drugs have been studied for use in lowering breast cancer risk. The drug tamoxifen has already been used for many years as a treatment for some types of breast cancer. Studies have shown that women at high risk for breast cancer are less likely to get the disease if they take tamoxifen. Another drug, raloxifene, has been approved to help reduce breast cancer risk in women past menopause who are at high risk for breast cancer. Other drugs are also being studied.
Preventive surgery for women with very high breast cancer risk: For the few women who have a very high risk for breast cancer, preventive surgery such as bilateral (double) mastectomy may be an option.
Preventive (prophylactic) double (bilateral) mastectomy: For some who are at very high risk for breast cancer, this surgery (a double mastectomy) may be an option. In this operation both breasts are removed before there is any known breast cancer. While this operation removes nearly all of the breast tissue, a small amount remains. So although this operation greatly reduces the risk of breast cancer, the disease can still start in the breast tissue that remains after surgery. To date, this has been a rare problem.
The reasons for thinking about this type of surgery need to be very strong. There is no way to know ahead of time whether this surgery will benefit a particular woman. A second opinion is strongly recommended before making a decision to have this type of surgery.
Preventive ovary removal (prophylactic oophorectomy): Women with a certain gene change (BRCA mutation) who have their ovaries removed may reduce their risk of breast cancer by half or more. This is because taking out the ovaries removes the main sources of estrogen in the body.
Although this document is not about ovarian cancer, it is important that women with this gene change also know that they also have a high risk of getting ovarian cancer. Most doctors recommend that these women have their ovaries removed after they are done having children.
Thursday, October 16, 2008
Stages of Breast Cancer
From breastcancer.org
Stages of Breast Cancer. Cancer stage is based on the size of the tumor, whether the cancer is invasive or non-invasive, whether lymph nodes are involved, and whether the cancer has spread beyond the breast.
The purpose of the staging system is to help organize the different factors and some of the personality features of the cancer into categories, in order to:
- best understand your prognosis (the most likely outcome of the disease)
- guide treatment decisions (together with other parts of your pathology report), since clinical studies of breast cancer treatments that you and your doctor will consider are partly organized by the staging system
- provide a common way to describe the extent of breast cancer for doctors and nurses all over the world, so that results of your treatment can be compared and understood
Stage 0
Stage 0 is used to describe non-invasive breast cancers, such as DCIS and LCIS. In stage 0, there is no evidence of cancer cells or non-cancerous abnormal cells breaking out of the part of the breast in which they started, or of getting through to or invading neighboring normal tissue.
Stage I
Stage I describes invasive breast cancer (cancer cells are breaking through to or invading neighboring normal tissue) in which:
- the tumor measures up to 2 centimeters, AND
- no lymph nodes are involved
Stage II
Stage II is divided into subcategories known as IIA and IIB.
Stage IIA describes invasive breast cancer in which:
- no tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm), OR
- the tumor measures 2 centimeters or less and has spread to the axillary lymph nodes, OR
- the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes
Stage IIB describes invasive breast cancer in which:
- the tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodes, OR
- the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes
Stage III
Stage III is divided into subcategories known as IIIA, IIIB, and IIIC.
Stage IIIA describes invasive breast cancer in which either:
- no tumor is found in the breast. Cancer is found in axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone, OR
- the tumor is 5 centimeters or smaller and has spread to axillary lymph nodes that are clumped together or sticking to other structures, OR
- the tumor is larger than 5 centimeters and has spread to axillary lymph nodes that are clumped together or sticking to other structures
Stage IIIB describes invasive breast cancer in which:
- the tumor may be any size and has spread to the chest wall and/or skin of the breast AND
- may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone
- Inflammatory breast cancer is considered at least stage IIIB.
Stage IIIC describes invasive breast cancer in which:
- there may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast, AND
- the cancer has spread to lymph nodes above or below the collarbone, AND
- the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone
Stage IV
Stage IV describes invasive breast cancer in which:
- the cancer has spread to other organs of the body -- usually the lungs, liver, bone, or brain
"Metastatic at presentation" means that the breast cancer has spread beyond the breast and nearby lymph nodes, even though this is the first diagnosis of breast cancer. The reason for this is that the primary breast cancer was not found when it was only inside the breast. Metastatic cancer is considered stage IV.
Additional staging information
You may also hear terms such as "early" or "earlier" stage, "later," or "advanced" stage breast cancer. Although these terms are not medically precise (they may be used differently by different doctors), here is a general idea of how they apply to the official staging system:
Early stage
- Stage 0
- Stage I
- Stage II
- Some stage III
Later or advanced stage
- Other stage III
- Stage IV
Doctors use a staging system to determine how far a cancer has spread. The most common system is the TNM staging system. You may hear the cancer described by three characteristics:
- size (T stands for tumor)
- lymph node involvement (N stands for node)
- whether it has metastasized (M stands for metastasis)
The T (size) category describes the original (primary) tumor:
- TX means the tumor can't be measured or found.
- T0 means there isn't any evidence of the primary tumor.
- Tis means the cancer is "in situ" (the tumor has not started growing into the breast tissue).
- The numbers T1-T4 describe the size and/or how much the cancer has grown into the breast tissue. The higher the T number, the larger the tumor and/or the more it may have grown into the breast tissue.
The N (node involvement) category describes whether or not the cancer has reached nearby lymph nodes:
- NX means the nearby lymph nodes can't be measured or found.
- N0 means nearby lymph nodes do not contain cancer.
- The numbers N1-N3 describe the size, location, and/or the number of lymph nodes involved. The higher the N number, the more the lymph nodes are involved.
The M (metastasis) category tells whether there are distant metastases (whether the cancer has spread to other parts of body):
- MX means metastasis can't be measured or found.
- M0 means there are no distant metastases.
- M1 means that distant metastases were found.
Once the pathologist knows your T, N, and M characteristics, they are combined in a process called stage grouping, and an overall stage is assigned.
For example, a T1, N0, M0 breast cancer would mean that the primary breast tumor:
- is less than 2 centimeters across (T1)
- does not have lymph node involvement (N0)
- has not spread to distant parts of the body (M0)
This cancer would be grouped as a stage I cancer.
Wednesday, October 15, 2008
Chemo Brain
“Chemo brain” or “chemo fog” are terms used for thinking and memory difficulty that some associate with chemotherapy treatment. While some research suggests a link between chemotherapy and problems with thinking and memory, findings are not yet consistent and more studies need to be done. What we do know is that for many breast cancer patients, “chemo brain” is a very real issue. You may not remember where you put your keys or why you went to the store, or you may simply not be able to think of the right word. Join us to find out how other aspects of treatment can affect your cognitive abilities, learn ways to improve your mental skills, get the latest research on chemo brain, and more. | |
Join us tomorrow night between 7:00 p.m. and 8:30 p.m (EDT)* for this month's Ask-the-Expert Online Conference: Managing Chemo Brain. Christina Meyers, Ph.D., A.B.P.P. and George Sledge, M.D. will answer your questions about how long memory issues can last, what you can do to keep your brain active including tips to sharpen your memory, and more. | |
Christina Meyers, Ph.D., A.B.P.P. is a board certified neuropsychologist. She created the Neuropsychology Service in the newly formed Department of Neuro-Oncology at M.D. Anderson Cancer Center in 1984. | |
George Sledge, M.D. is the Ballvé-Lantero Professor of Oncology at Indiana University at Indianapolis, where he co-directs Indiana University Simon Cancer Center's Breast Cancer Program. | |
If you'd like to ask a question for our MANAGING CHEMO BRAIN conference, but will not be able to join the conference tomorrow night, you can submit your question now. | |
We'll answer as many questions as we can during the conference. A conference transcript will be posted at Breastcancer.org by October 22, 2008. | |
To join the conference, visit Breastcancer.org any time between 7:00 p.m. and 8:30 p.m. EDT* tomorrow night and click on the "Join Conference" button. It’s easy to participate; no special software is required. The live conference will appear in text on your screen. | |
Visit the Ask-the-Expert Online Conference page for more details. |
Friday, October 10, 2008
Screening
Screening
Screening for breast cancer before there are symptoms can be important. Screening can help doctors find and treat cancer early. Treatment is more likely to work well when cancer is found early.
Your doctor may suggest the following screening tests for breast cancer:
You should ask your doctor about when to start and how often to check for breast cancer.
To find breast cancer early, NCI recommends that:
- Women in their 40s and older should have mammograms every 1 to 2 years. A mammogram is a picture of the breast made with x-rays.
- Women who are younger than 40 and have risk factors for breast cancer should ask their health care provider whether to have mammograms and how often to have them.
Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Further tests are needed to find out if abnormal cells are present.
If an abnormal area shows up on your mammogram, you may need to have more x-rays. You also may need a biopsy. A biopsy is the only way to tell for sure if cancer is present. (The "Diagnosis" section has more information on biopsy.)
Mammograms are the best tool doctors have to find breast cancer early. However, mammograms are not perfect:
- A mammogram may miss some cancers. (The result is called a "false negative.")
- A mammogram may show things that turn out not to be cancer. (The result is called a "false positive.")
- Some fast-growing tumors may grow large or spread to other parts of the body before a mammogram detects them.
Mammograms (as well as dental x-rays, and other routine x-rays) use very small doses of radiation. The risk of any harm is very slight, but repeated x-rays could cause problems. The benefits nearly always outweigh the risk. You should talk with your health care provider about the need for each x-ray. You should also ask for shields to protect parts of your body that are not in the picture.
During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips.
Your health care provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid.
Using the pads of the fingers to feel for lumps, your health care provider checks your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side, then the other. Your health care provider checks the lymph nodes near the breast to see if they are enlarged.
A thorough clinical breast exam may take about 10 minutes.
You may perform monthly breast self-exams to check for any changes in your breasts. It is important to remember that changes can occur because of aging, your menstrual cycle, pregnancy, menopause, or taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for your breasts to be swollen and tender right before or during your menstrual period.
You should contact your health care provider if you notice any unusual changes in your breasts.
Breast self-exams cannot replace regular screening mammograms and clinical breast exams. Studies have not shown that breast self-exams alone reduce the number of deaths from breast cancer.
You may want to ask the doctor the following questions about screening:
|
Wednesday, October 08, 2008
Risk Factors
Risk Factors
No one knows the exact causes of breast cancer. Doctors often cannot explain why one woman develops breast cancer and another does not. They do know that bumping, bruising, or touching the breast does not cause cancer. And breast cancer is not contagious. You cannot "catch" it from another person.
Research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is something that may increase the chance of developing a disease.
Studies have found the following risk factors for breast cancer:
- Age: The chance of getting breast cancer goes up as a woman gets older. Most cases of breast cancer occur in women over 60. This disease is not common before menopause.
- Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
- Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk.
- Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia and lobular carcinoma in situ [LCIS]) increases the risk of breast cancer.
- Gene changes: Changes in certain genes increase the risk of breast cancer. These genes include BRCA1, BRCA2, and others. Tests can sometimes show the presence of specific gene changes in families with many women who have had breast cancer. Health care providers may suggest ways to try to reduce the risk of breast cancer, or to improve the detection of this disease in women who have these changes in their genes. NCI offers publications on gene testing.
- Reproductive and menstrual history:
- The older a woman is when she has her first child, the greater her chance of breast cancer.
- Women who had their first menstrual period before age 12 are at an increased risk of breast cancer.
- Women who went through menopause after age 55 are at an increased risk of breast cancer.
- Women who never had children are at an increased risk of breast cancer.
- Women who take menopausal hormone therapy with estrogen plus progestin after menopause also appear to have an increased risk of breast cancer.
- Large, well-designed studies have shown no link between abortion or miscarriage and breast cancer.
- Race: Breast cancer is diagnosed more often in white women than Latina, Asian, or African American women.
- Radiation therapy to the chest: Women who had radiation therapy to the chest (including breasts) before age 30 are at an increased risk of breast cancer. This includes women treated with radiation for Hodgkin's lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life.
- Breast density: Breast tissue may be dense or fatty. Older women whose mammograms (breast x-rays) show more dense tissue are at increased risk of breast cancer.
- Taking DES (diethylstilbestrol): DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.) Women who took DES during pregnancy may have a slightly increased risk of breast cancer. The possible effects on their daughters are under study.
- Being overweight or obese after menopause: The chance of getting breast cancer after menopause is higher in women who are overweight or obese.
- Lack of physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help reduce risk by preventing weight gain and obesity.
- Drinking alcohol: Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer.
Other possible risk factors are under study. Researchers are studying the effect of diet, physical activity, and genetics on breast cancer risk. They are also studying whether certain substances in the environment can increase the risk of breast cancer.
Many risk factors can be avoided. Others, such as family history, cannot be avoided. Women can help protect themselves by staying away from known risk factors whenever possible.
But it is also important to keep in mind that most women who have known risk factors do not get breast cancer. Also, most women with breast cancer do not have a family history of the disease. In fact, except for growing older, most women with breast cancer have no clear risk factors.
If you think you may be at risk, you should discuss this concern with your doctor. Your doctor may be able to suggest ways to reduce your risk and can plan a schedule for checkups.
Tuesday, October 07, 2008
Understanding Cancer
Understanding Cancer
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.
Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.
Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.
Tumors can be benign or malignant:
When breast cancer cells spread, the cancer cells are often found in lymph nodes near the breast. Also, breast cancer can spread to almost any other part of the body. The most common are the bones, liver, lungs, and brain. The new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer. For that reason, it is treated as breast cancer, not bone cancer. Doctors call the new tumor "distant" or metastatic disease.
Monday, October 06, 2008
The Structure of Breasts
The Breasts
The breasts sit on the chest muscles that cover the ribs. Each breast is made of 15 to 20 lobes. Lobes contain many smaller lobules. Lobules contain groups of tiny glands that can produce milk. Milk flows from the lobules through thin tubes called ducts to the nipple. The nipple is in the center of a dark area of skin called the areola. Fat fills the spaces between the lobules and ducts.
The breasts also contain lymph vessels. These vessels lead to small, round organs called lymph nodes. Groups of lymph nodes are near the breast in the axilla (underarm), above the collarbone, in the chest behind the breastbone, and in many other parts of the body. The lymph nodes trap bacteria, cancer cells, or other harmful substances.
These pictures show the parts of the breast and the lymph nodes and lymph vessels near the breast. |
Wednesday, October 01, 2008
Breast Cancer Awareness Month Begins
From Breastcancer.org
Your Pathology Report
At a Glance
Manage Your Anxiety
Getting tests done and waiting for their results can create a lot of anxiety. Here are some suggestions to help you manage your anxiety:
- Get to know the people on your medical team and make every effort to meet them in person. You'll find out who is the best communicator, who can answer which questions, who is available to help you when you need it most.
- Find a doctor who communicates with you who invites your questions and takes your concerns seriously, who gives you as much or as little information as you feel comfortable with.
- Make plans with your doctor about how to receive test results in a prompt way. Try to schedule important tests early in the beginning of the week, so you don't have to wait over a long weekend, when lab work may slow down or doctors aren't communicating with each other.
In this section you'll find the web version of the breastcancer.org booklet: Your Guide to the Breast Cancer Pathology Report.
Wait for the Whole Picture
Waiting is so hard! But just one test can lead to several different reports. Some tests take longer than others. Not all tests are done by the same lab. Most information comes within one to two weeks after surgery, and you will usually have all the results within a few weeks. Your doctor can let you know when the results come in. If you don't hear from your doctor, give her or him a call.
Get All the Information You Need
Be sure that you have all the test information you need before you make a final decision about your treatment. Also, don't focus too much on any one piece of information by itself. Try to look at the whole picture as you think about your options.
Different labs and hospitals may use different words to describe the same thing. If there are words in your pathology report that are not explained in this booklet, don't be afraid to ask your doctor what they mean.
Breast Cancer Stage
The pathology report will help your doctor decide the stage of your breast cancer. It could be:
- stage 0
- stage I (1)
- stage II (2)
- stage IIIA (3A)
- stage IIIB (3B)
- stage IV (4)
Staging is based on the size of the tumor, whether lymph nodes are involved, and whether the cancer has spread beyond the breast. Your doctors use all parts of the pathology report as well as the breast cancer stage to shape your treatment plan.
How to Start
First, check the top of the report for your name, the date you had your operation, and the type of operation you had. Make sure they are right for you.
Parts of Your Report
- Specimen: This section describes where the tissue samples came from. Tissue samples could be taken from the breast, from the lymph nodes under your arm (axilla), or both.
- Clinical history: This is a short description of you and how the breast abnormality was found. It also describes the kind of surgery that was done.
- Clinical diagnosis: This is the diagnosis the doctors were expecting before your breast tissue sample was tested.
- Gross description: This section describes the tissue sample or samples. It talks about the size, weight, and color of each sample.
- Microscopic description: This section describes the way the cancer cells look under the microscope.
- Special tests or markers: This section reports the results of tests for proteins, genes, and how fast the cells are growing.
- Summary or final diagnosis: This section is the short description of all the important findings in each tissue sample.