17 October 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.

16 October 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.

Log On 60%

Mr. Moneybags called on the intercom to tell me he was going to shut the server down and reset it.

Two minutes later, someone knocked on my door. Guess who? Loathsome.

"What did your computer do this morning?"

"You mean what's it doing now?"

Loathsome looks confused now that I've posed that question. Try again.

"What's the problem with it?"

It was doing things he'd never seen before and wouldn't allow him to log on. I suggested that he wait a few minutes until Bags reset the server and try again.

"No, that's not it. I've already done that three times, " he said.

I tried to explain why he should try one more time. Sometimes Loathsome gets this look on his face that's part confusion, part frustration, part dumb suffering. If he were a horse, I'd shoot him to end his misery. Instead, I proceeded to his office. I restarted and it got stuck. We did this four times and finally I restartedt in safe mode. At least that way Loathsome could look at his email and surf the net for whatever hugely important tasks must be accomplished today.

I went back to my office and finished up some work on my computer, then went to make some copies in the foyer in our suite of offices. While I was copying, I noticed Loathsome's shadow like carrion ready to lunch on dead meat. Dead meat. That would be me.

"Did you get an email from me?"

I had no idea.

"I don't know. Why?"

"It's not working," he said. I was about to go back to his office when Moneybags appeared at the printer right next to the copier I was using. Bags told Loathsome to log on again.

"Huh?" The famous Loathsome response to everyone, generally repeated 3 times before you can move on to the next sentence.

Moneybags said, "Log on again. Log on again."

Loathsome looked at me like I was his life line. "All the way?"

No, I did not tell him to log on 60%, but you know I wanted to.

Nine days.

15 October 2008


Ten days until the 11th anniversary of my father's suicide.

Grief never ends.

Chemo Brain

From breastcancer.org

“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.