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*

Who gets breast cancer?

But doesn’t breast cancer run in families?

Putting together a treatment plan

The possible contributory factors to breast cancer

Diagnosis

Other

DCIS and LCIS

Treatment

Other useful tips and therapies

Overall

Confused by it all??

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.

Who gets breast cancer?

Despite 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.

By 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 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.

Women 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.
• Women 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.

We ignore the contribution of beneficial bacteria at our peril

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.

Now, 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.

You 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

About 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 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

When told the side effects less than 20% of women want to take Tamoxifen

(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.

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

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.

Treatment 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.

Living Proofs - where women who beat breast cancer tell their stories

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.

Other 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

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

US studies show that exercise and complementary therapies are important

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.

If 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.

On 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.
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 independence comes at a price: We can only 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. The letters and e mails of gratitude and praise tell us we really do make a difference.

If you feel an independent voice is essential in cancer, please, please help by making a donation. Every little helps.

Confused by it all??

Well, we’re only trying to help you beat this disease. If you would like to have a Personal Prescription prepared for you, then click here. It will help you obtain the best information for your personal needs and particular cancer, and thus to make more informed choices and increase your chances of survival.

There is so much you can do to increase your chances of beating this disease. We simply want to help.

Please start now. Fill in our form click here or ring our Information Hotline on 01280 821211.

The CANCERactive Difference: Intelligent Information. Independent Voice.

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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.

Hallloween Fun

In celebration of Halloween (and my upcoming birthday), I'm taking a break from the serious stuff.

One of my favorite fun websites features bunnies re-enacting 30 second renditions of famous films. This month, they're featuring some re-enactments of films like "Scream," "The Shining," "Night of the Living Dead" and others. Go by and visit if you get a chance.

Reasons Why He Made The Decision, Part 1

"I believe that we are solely responsible for our choices, and we have to accept the consequences of every deed, word, and thought throughout our lifetime." ~ Elizabeth Kubler-Ross

Ten years before my father's suicide, he was diagnosed with prostate cancer. He had watched the disease ravage one of his brothers, ultimately leaving him paralyzed and at the mercy of other people whom he'd mistreated for years. My uncle's family apparently repaid him in kind and his long deterioration was accompanied by cruelty, I've been told.

My father was successfully treated for his cancer, but he was never able or willing to let go of the fear that he, too, would one day find himself unable to move, unable to think and completely dependent on others. No one, not the oncologists, not my mother, not I could make him see past his delusion. Of course, when my Mom had thyroid cancer, my dad was convinced she would die, too. Ever the optimist, my dad.

This was the beginning of the end for him.

Anniversary

" As anyone who has been close to someone that has committed suicide knows, there is no other pain like that felt after the incident. " ~ Peter Green

Ten years ago today, my dad grabbed a shotgun and went to a neighbor's house. He knocked on the door and asked the neighbor if he could borrow a bullet to kill a snake. My father took the bullet, walked out into the front yard and made the decision.

The Tale of Jasper Bottomhugger, Further Adventures in Crazy Land

"I believe that our Heavenly Father invented man because he was disappointed in the monkey." ~ Mark Twain

(Names have been changed to protect the innocent primates.)

Owner of Crazy Land and his wife, The Gatherer, have been friends of mine for over 30 years. Owner was friends with Hubby when they were in high school and I was introduced to him just as he started dating The Gatherer.

The Gatherer's father (before his recent death) was a successful businessman. One of his hobbies was hunting for wild mushrooms every year during a brief period of time in a specific place after heavy rain. This earns him the nickname of Mushroom Hunter. He didn't even eat them after he spent hours wandering around in the brush looking for them. Hunter gave them away, as did Owner, who always went along for the search. It was the thrill of the hunt that captivated the Hunter.

Mushroom Hunter and his wife, Patience (who's still living), acquired a Capuchin monkey about ten years ago. When he came to live with them, Jasper Bottomhugger (hereafter referred to as J.B.), was just a baby. His new "parents" stocked up on Huggies, baby powder, wipes and immediately ordered some outfits specially made for him from a lady in Abilene. I understand he looked fabulous in them.

Eventually, Hunter and Patience abandoned the Huggies when they noticed the diapers were chafing J.B.'s tiny monkey butt. I'm not sure how the potty training went, but I'm assuming they eventually mastered it. I'm certain Owner would have told me had it been a continuing issue. After a while, the outfits weren't as important, either, because J.B. began acquiring more expensive trinkets.

His first big gift from Hunter and Patience was a Jeep Cherokee. J.B. was allowed to play in the Cherokee whenever his monkey mind was so inclined. When Hunter and Patience took J.B. on his frequent trips to Dairy Queen, they always went in Jasper's Jeep. Unfortunately, DQ was one of the only restaurants they could take J.B. for a snack or dinner out. The Health Department is so picky about allowing monkeys in eating establishments.

During his formative years, the hours between 2:00 p.m. and 4:00 p.m. were reserved for J.B. bonding. Mushroom Hunter left his lucrative business for family time. No one, including their two daughters, were allowed to call and interrupt the primate love fest.

J.B. still lives with Patience and, no doubt, misses The Hunter terribly. Since the Mushroom Hunter died, Owner doesn't spend much time at the family farm. Hunter, along with Owner, were the silver hairs in his life. They were his role models. Sometimes I feel a little sad for him. Then I remember Patience's dedication to J.B.'s happiness and his many amenities, some of which involved massive additions to the family farm. I'm sure he's fine.

There are plenty more Jasper Bottomhugger stories to explore. They belong to the chronicle of Crazy Land. Stay tuned.

Making Treatment Decisions: Resources for Caregivers

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.

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.

Better and Worse

"The most authentic thing about us is our capacity to create, to overcome, to endure, to transform, to love and to be greater than our suffering." ~ Ben Okri

Better today. I took a nap yesterday and got 6 hours of sleep last night. It's stopped raining, the sun is shining. Though it's certainly not as frigid as my photograph would indicate, it feels that cold to me. I think the temperature is somewhere around 45 degrees. Anything under 60 degrees is cold to me.

We had sad news yesterday in Crazy Land. Crazy Employee's mom died of a heart attack Friday night. My co-worker and her youngest daughter were visiting her mom for the weekend. They'd had dinner together, along with some other family members in town for the Rose Festival weekend. I hate to refer to her as "Crazy Employee" under these circumstances, but that's the name I always use. She was really close to her mom and I know these are terrible days for her. Please say a prayer or keep a good thought for her and her family.

I wonder if my long-term sleep deprivation is related to the anniversary of my dad's death. That occurred to me a couple of weeks ago, but we're inching up to that black day, so I guess I'll find out soon. This morning I was thinking about the months and months when not a thought passed through my head. The mind was still. The only thing I had to focus on was the most immense pain I've ever experienced. An hour could seem like six. I was stuck, waiting for the pain to become more bearable. I had to wait a very, very long time.

I didn't mean to veer off into sadness and, as a matter of fact, I thought of an entertaining cluster of Crazy Land stories to share. The sunlight shining through my windows reminded me of that time. For the moment, I'm flooded with memories.

It must be time to work on my database. I'll try to get back to Crazy Land nonsense a little later today when I'm more settled.

Here's the Kaleidoscope Link

Kaleidoscope Fun

No Sleep Kaleidoscope Fun

"There will be sleeping enough in the grave." ~ Benjamin Franklin

I'm still not sleeping through the night. I woke up at 3:00 this morning and never went back to sleep. Since all of this began about three weeks ago, I've been able to get a normal amount of sleep over the weekends, but this weekend was different. On Friday night, I slept 7 1/2 hours, but Saturday night brought only four hours of sleep. I have no idea what's causing this.

There's a cold front blowing through today. I woke up this morning to the sound of rain. The temperature is dropping and the wind has picked up speed. I hate winter.

I'd love to say more, but the brain is barely functioning. In lieu of content, I offer the following link where you can build your own online kaleidoscope. Go there. It's amazingly fun.
Kaleidoscope Fun

You May Be Able To Help Us Learn More About Cancer

News about an American Cancer Society study from breastcancer.org
U.S. cancer group launches mass cancer study

WASHINGTON (Reuters) - The American Cancer Society said it was looking for half a million volunteers willing to let researchers watch them for the next 20 years to see if they get cancer.

The aim is to match similar big studies in Europe and Asia that are looking on a large scale for the environmental and lifestyle factors that cause cancer, the second-leading cause of death in the United States after heart disease.

"This type of study involves hundreds of thousands of people, with diverse backgrounds, followed for many years, with collection of biological specimens and assessments of dietary, lifestyle and environmental exposures," Eugenia Calle, managing director of analytic epidemiology at the American Cancer Society, said in a statement.

"It also requires active follow-up to discover if and when study participants develop cancer."

The group will recruit men and women between the ages of 30 and 65 who have never been diagnosed with cancer. They will give blood to be tested and answer questionnaires at various times over the next 20 years.

Similar big studies have confirmed the link between cigarette smoking and lung cancer, shown that obesity increases the risk of several cancers, and linked aspirin use to a lower death rate from colon cancer.

They have also found evidence that defied conventional wisdom, such as the Women's Health Initiative study that found hormone replacement therapy actually raises the risk of breast cancer, stroke and heart attack.

Financing Breast Cancer Treatment

I know a couple of women whose families have lost everything because of the enormous cost of treatment. Many of us don't have access to health insurance and, once you're diagnosed, premiums skyrocket. The following information comes from the Susan G. Komen Foundation.

Financing Issues-Medical Assistance

NeedyMeds.com
Drug assistance program information.
http://www.needymeds.com/

Partnership for Prescription Assistance
Drug assistance program information.
https://www.pparx.org/

Pharmaceutical Research and Manufacturers of America
Directory of pharmaceutical manufacturers' assistance programs.
http://www.phrma.org/

Y-Me National Breast Cancer Organization
Financial assistance for wigs, prostheses and mastectomy bras.
http://www.y-me.org/

CancerCare Linking A.R.M.S.(TM)
Financial assistance for some medications and medical supplies.
http://www.cancercare.org/

CancerCare
Financial assistance for diagnostic work-up, as well as information on drug assistance programs. See also Transportation Assistance.
http://www.cancercare.org/

Financing Issues-Transportation Assistance

American Cancer Society – Road to Recovery
Transportation assistance program.
http://www.cancer.org/

Mercy Medical Airlift
Air travel assistance for cancer patients.
http://www.mercymedical.org/

National Patient Air Travel HELPLINE
Air travel assistance for cancer patients.
http://www.patienttravel.org/

Lifeline Pilots
Air travel assistance for cancer patients.
http://www.airlifelinemidwest.org/index2.htm

Air Charity Network
Air travel assistance for cancer patients.
http://aircharitynetwork.org

Corporate Angel Network
Air travel assistance for cancer patients
http://www.corpangelnetwork.org/

CancerCare
Financial assistance for transportation to and from treatment and childcare when a parent is having tests or treatment. See also Financial Issues.
http://www.cancercare.org/

La Cosa Nostra Smokah

After twenty years, I quit smoking several years ago. I'd been working on it for several years before I actually stopped. I used nicotine gum for a year or two as my safety net, but I certainly wasn't above a couple of cigarettes on the weekend. It's been a long, long time since I had even a puff. It's one of those questions they ask every time I see an oncology doctor. "How many days has it been since you had one puff?" Of course, I see a lot of people rolling around in those motorized wheelchairs (probably because of their chemo or radiation related fatigue), heads wrapped in scarves or capped with a wig, smoking with a vengeance. Sigh.

Even after this long, I think about smoking pretty regularly. When I'm driving down the street and someone has their window open with a cigarette hanging out (to escape their own second hand smoke, I assume), I long to get close enough to inhale. I take note of everyone I pass anywhere who's smoking. I work with one woman who still smokes and there's a guy who chews tobacco (but who wants that?). I could go downstairs and ask the Foot Lady for one of hers. There might be a foot conversation I'd have to participate in, but I do that fairly regularly, anyway. I haven't asked for one.

That was a long introduction to what may be a less than entertaining anecdote. Many years ago, there was a hot dog vendor who used to hawk his wieners down on Sixth Street, our version of the French Quarter in New Orleans (we're not really in the same league at all). He had a great story to tell about being a mob snitch from New York who was in the Witness Protection Program and had had to assume a new identity to escape the retribution of The Family. In Texas, we're not too familiar with wise guys. We've got gangs, but I'd guess we have very few no La Cosa Nostra representatives living here.

The Wiener Man complained bitterly of being harassed by the police and, in fact, he may have been hassled by them. One year, he'd finally had enough. But it wasn't the cops that ultimately became unbearable. Austin was in the early stages of outlawing smoking in public places. You could still smoke in some segregated areas in restaurants and bars were pretty much excluded, but the places you could light up were severely limited. Wiener Man was outraged and decided to run for City Council.

It was a weird election year, no doubt about it. We had a couple of transgender folks running, one of whom (Leslie) lived in a little trailer that he had to move himself like a rickshaw. He became a kind of tourist attraction. He had a sizable number of financial supporters but, sadly, an equal number of people who hated him because of his penchant for hanging out on the streets of Austin in a speedo or a wedding gown (he loved heels and wore them with both outfits). The other transgender person was also homeless, but low key. I never knew where Jennifer Gale lived and she was always dressed appropriately, though clearly in need of some more hormonal intervention. Jennifer Gale (who still mounts a campaign at every opportunity) became the candidate of transgender acceptance.

Despite the entertainment value of Leslie in his speedo who had absolutely no platform whatsoever, it was the Wiener Man who stole the show. When it was his turn came to define his agenda, it took exactly two minutes. He paused dramatically and croaked,

"I'm a smokah." He reached into his sports shirt pocket and pulled out a pack of unfiltered Camels. He held them in front of the camera as proof, I suppose, that he wasn't just jacking us around. He was the real deal. As if the gravelly sound of his voice wouldn't have been proof enough.

"I wanna look out for the rights of my fellow smokahs. If you're a smokah and you're sick of bein' run outta the stores and restaurants, vote for me."

The smokah candidate did not win that year. Not too long after, he moved to sunnier digs in Florida. I don't know if he had to assume a new new identity, after having outed himself at least in this city. I think of him from time to time, when I long for a cigarette. I only wish he'd won. What fun that would have been.

Warm Cookies

"Think what a wonderful world it would be if we all, the whole world, had cookies and milk about three o'clock every afternoon and then lay down on our blankets for a nap." ~ Robert Fulgham

Ahhh...warm cookies. Crazy Employee has redeemed herself today by ordering warm cookies in celebration of Boss' Day. (I had to go into Owner's office and talk him into having one. He's on a perpetual on again, off again diet.) As for me, I indulged in two chocolate chip cookies and I'm in danger of lapsing into a sugar coma. (If this post ends suddenly, you'll know EMS probably had to be called.)

I have a rule about eating the stuff available in Crazy Land. We're awash in M&M's, peanut butter cups, Hershey's kisses--if it's candy, we probably have it. No one here should be eating any of it and I shudder to think how many pounds of sugar each individual in Crazy Land consumes annually. I'm not opposed to sugar. As a matter of fact, I have an enduring and passionate love for chocolate. I've spent several evenings in Houston, after a long day at M.D. Anderson, searching for an individual piece of chocolate cake. Just so you know. I'm as self-indulgent as anyone else.

About ten years ago, though, I discovered my penchant for eating as a way of dealing with stress. What did I eat? Yep. Candy. I don't recall any resulting weight gain, but once it dawned on me that anxiety led directly to sugar, I called a halt to eating anything that might be available at work. For a while, I couldn't even go by the receptionist's desk (the home of all death food). That created some problems for me, because half the staff is located on the other side of the building and the only way to get there is to walk past the receptionist's desk.

I have an excellent excuse for today. I'm back to sleeping about 4.5 hours a night. I need a sugar rush to keep me awake. Or, at least, to keep me awake until the coma ensues. Why no sleep? Who knows, but I'm guessing it's related to Crazy Land. I was fine over the weekend and actually got a reasonable amount of sleep.

I've now had conversations with virtually all of my co-workers and it's only Tuesday. Loathsome and I (well, mostly Loathsome) discussed his genius grandson. It was just like every discussion I've ever had with him. It's all about Loathsome; my job is to gaze admiringly at the perfection that is his very being. I did not disappoint. I've learned the hard way that admiring wins my freedom sooner than actually engaging in dialog.

The Information Superhighway is back after having taken a couple of days off to move into her new home. She's still feeling the sting of Crazy Employee's accusations that she's "mean" and "picks on" Crazy. It's good to have the Superhighway back. She's the most reasonable person here.

Her supervisor, Mr. Moneybags, arrived this morning in his favorite mood--enraged. We have no idea why other than that he's a white, middle-aged, bitter man who had reason to believe that his kind would rule the world. They still do, in fact, but there's just a tiny bit of interference by women, black people, Hispanic people and liberals. Furthermore, Jesus requires that he cast a wide net of hatred and fury. That's his version of Christianity, anyway.

I ran into Foot Lady who, under the guise of asking about the reconstruction ordeal, managed to work the conversation around to her feet. It was a banner day for her. She got to take not one, but both of her shoes off and make me look at her feet.

Hemorrhoids were the topic du jour with the Shunner. What's happened to me? I used to consistently give off the vibe of being a person with whom you'd never, ever, ever discuss anything even remotely related to intimate body parts or functions. The inhabitants of Crazy Land don't understand boundaries, though, and a disapproving raised eyebrow does nothing to restrain them.

Is there more? Of course there is. But the memory of warm cookies has cast a rosy glow on the whole week. I'm more entertained than annoyed. Note how easy it is to please me. Plus, I managed some yoga last night and the world is always brighter when I've twisted myself into positions with which my body is no longer remotely familiar. Cookies guarantee another round of it tonight. Proud Warrior and Gate Pose--suddenly the body wishes it had never walked by the receptionist's desk.

Harvard Women's Health Watch | October 2006

On becoming a breast cancer survivor

Getting through treatment is only the beginning.

The impact of breast cancer is as individual as the women who survive it. It can be an arduous though temporary challenge or an experience so transformative that it divides existence into two parts — before and after.

Perry Colmore has experienced the disease both ways. When she was 45, she was diagnosed with lobular carcinoma in situ, a noninvasive disease that signals an elevated risk for invasive breast cancer. Given the choice of preventive double mastectomy or simply removing the small tumor, she opted for a lumpectomy. “I breezed right along, assuming I’d be among the 80% who don’t have a recurrence,” she says.

And so she was — for seven years. Then a lump in her other breast turned out to be an invasive cancer that had already reached 12 lymph nodes. She underwent a mastectomy followed by radiation and chemotherapy.

Colmore has been cancer-free for more than a decade, but her health has suffered. Radiation treatments damaged one of her lungs, causing wheezing and breathlessness. She’s weathered bouts of pleurisy and pneumonia. And intensive antibiotic therapy for her lung diseases triggered severe diarrhea, resulting in a 40-pound weight loss.

Colmore’s experience isn’t typical, but it does suggest the range of later effects that can follow in the wake of breast cancer. The good news is that most breast cancer survivors are living long past the five-year survival benchmark of yesteryear. But many also find themselves facing the long-term consequences of the treatments that saved their lives.

Growing recognition of survivor needs

As the ranks of cancer survivors have swelled to more than 10 million, their health has attracted increasing attention from scientists and physicians. The Institute of Medicine (IOM) has formed an expert committee to consider the quality of life and care of cancer survivors. The panel’s report, From Cancer Patient to Cancer Survivor: Lost in Transition, published in 2005, acknowledged that cancer care too often ends when patients complete their initial treatments. There may be little communication between the patients’ oncology teams and their primary care doctors. The IOM advises physicians to craft a “survivorship plan” to guide health care in the years following treatment.

Several large cancer hospitals around the country, such as Dana-Farber Cancer Institute in Boston, Fred Hutchinson Cancer Research Center in Seattle, and Memorial Sloan-Kettering Cancer Center in New York, have already instituted special programs or clinics for survivor care. At these centers, clinicians specialize in keeping cancer patients healthy and strong, reducing the risk of subsequent disease and, for breast cancer survivors, recognizing and treating the effects of breast cancer therapy.

Schedule of follow-up exams for breast cancer survivors
Exam	When
Physical exam	Every 3–6 months during the first 3 years after treatment Every 6–12 months during the 4th and 5th year after treatment Annually after 5 years
Breast self-exam	Monthly
Mammogram	Annually
Pelvic exam	Annually
Source: Guidelines developed by the American Society of Clinical Oncology

Treatment’s toll on the body

Cancer survivors are at risk for two kinds of side effects from treatment: Long-term effects, which begin during therapy and persist after it is completed, and late effects, which arise months or even years after treatment has ended.

The most common long-term effects include the following:

Fatigue. About 30% of breast cancer survivors are fatigued for five years or more after successful treatment. Any number of physical factors, including anemia and inflammation resulting from radiation or chemotherapy and loss of muscle mass, can account for fatigue during and after treatment. The psychological toll of treatment can also be exhausting. Though there’s little research on the subject, many women continue to shoulder responsibilities for jobs and managing households during and following their cancer treatment. Who wouldn’t be exhausted?

Weight gain. For reasons that science hasn’t fully explained, women undergoing breast cancer chemotherapy gain an average of five to eight pounds. Moreover, the excess poundage is all fat, rather than a combination of fat and lean tissue.

Nerve damage. Surgery can damage nerves in the treated breast and chest, resulting in numbness or pain. Chemotherapy may affect peripheral nerves, particularly those in the hands or feet.

Late effects can include these:

Lymphedema. Up to 25% of breast cancer survivors experience some degree of arm swelling following the removal of underarm lymph nodes, which is essential for evaluating the extent of the disease. Lymph node excision can damage the lymphatic drainage system, causing fluid to build up in the arm on the affected side. Lymphedema can appear weeks or months after surgery and is exacerbated if the arm is injured or infected.

Menopause discomforts. After breast cancer treatment, many women take tamoxifen, a selective estrogen blocker, for five years to prevent a recurrence. On the positive side, tamoxifen increases bone density and improves cholesterol. But it also produces menopausal symptoms, primarily hot flashes and vaginal dryness.

Osteoporosis. Women who undergo menopause following chemotherapy have a higher rate of bone loss than women who have a natural menopause. Aromatase inhibitors, such as anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin), which are frequently a part of breast cancer therapy, block the production of estrogen in fat and other tissues. Treatment with these drugs is associated with a higher risk of fractures than tamoxifen therapy and may also be responsible for joint and muscle pain.

Subsequent cancer. Breast cancer survivors have an increased risk of developing cancer in the other breast. Also, some treatments increase the probability of developing certain other forms of cancer, although the risk is very low. For example, tamoxifen is associated with an increase in endometrial cancer risk, and high-dose cyclophosphamide therapy heightens the risk of acute myeloid leukemia.

Lung damage. Lung tissue can be damaged if radiation to the chest cavity reaches the lung. In about 1% of survivors, it leads to radiation pneumonitis, an inflammatory condition that usually occurs two to three months after treatment and can result in susceptibility to respiratory infection.

Congestive heart failure. Cardiac damage is increasingly rare as chemotherapy doses decline, but women who received high doses of doxorubicin (Adriamycin) may sustain damage to the heart muscle. Such damage can result in fluid buildup in the body and lungs, making it more difficult to breathe and exercise.

Breast cancer’s effects on the psyche

The end of treatment is one of the most stressful events in the cancer experience. Often friends and family expect a woman to be fully engaged in life the day she finishes treatment. But while a breast cancer patient may rejoice that radiation and chemotherapy have ended, she typically feels anything but normal. Not only is her body irrevocably changed, she’s also likely to be on uncertain emotional terrain.

“What others usually don’t realize is that the recovery from treatment may take as long as the treatment itself,” says Hester Hill Schnipper, Director of Oncology Social Work at Beth Israel Deaconess Medical Center in Boston. Schnipper and other health professionals who work with cancer survivors have observed that the emotional effects of cancer therapy are far less recognized than the physical effects, yet they are just as profound.

Typically, a woman marshals all her psychological defenses to get through treatment. When therapy is over, she can finally let her guard down but then may be flooded with intense and conflicting emotions. The occurrence and intensity of reactions vary from woman to woman, but most experience the following:

Fear and anxiety. For women who have just completed chemotherapy or radiation — or five years of tamoxifen therapy — the end of active cancer treatment can be disconcerting. After months of regular medical care and attention, they often find themselves abruptly severed from the oncology team that’s sustained them during treatment. Equally common, and more distressing, is the specter of recurrence, which can color every aspect of life.

Grief. Breast cancer brings loss — be it as minor as the claim to perfect health or as monumental as the ability to have children. Grieving is a natural response to loss, and it may take months or years to complete.

Erosion of self-image. The physical effects of treatment — loss of a breast, hair loss, weight gain, radiation burns, and surgical scars — are reminders of one’s vulnerability. Breast cancer survivors may feel that they’re less attractive and that their vitality is diminished. The adjustments can be especially hard for young women who are thrown into menopause by chemotherapy.

Changes in intimate relationships. It goes without saying that a woman’s sex life is affected by breast cancer. Illness is a notorious thief of libido. In addition, a survivor’s partner may feel breast cancer’s toll on body and body image as deeply as the survivor herself.

Effects on the family. Breast cancer is a family affair. Family members are likely to want to get the household back to normal after treatment ends, and they may not be patient with the partner or mother who needs more time to recover.

Resources for survivors After Breast Cancer: A Common-Sense Guide to Life After Treatment, Hester Hill Schnipper, Bantam Books, 2006 LIVESTRONG SurvivorCare 866-235-7205 (toll free) www.livestrong.org Cancer Survivors Network American Cancer Society 800-227-2345 (toll free) www.acscsn.org The Wellness Community 888-793-9355 (toll free) www.thewellnesscommunity.org Breast Cancer: Strategies for Living, a Harvard Medical School Special Health Report, Harvard Health Publications, 2006 Living Through Breast Cancer (from Harvard Medical School) by Dr. Carolyn Kaelin, McGraw-Hill, 2005 The Breast Cancer Survivor's Fitness Plan (from Harvard Medical School) by Dr. Carolyn Kaelin, McGraw-Hill, 2006

Being a survivor

Breast cancer is a rough storm, but many women weather it well, buoyed by gratitude for life, hope for the future, and the support of loved ones. Some, like Perry Colmore, use it as the fulcrum for a major life change. When breast cancer returned, Colmore was a newspaper editor. As she experienced the intensity of the disease, she decided that it was a story worth telling. She told it through the experiences of 40 breast cancer survivors in the photo-essay book, Living with Breast Cancer: 39 Women and One Man Speak Candidly about Surviving Breast Cancer (Andover Townsman, 1997).

Perry and her husband also took stock of their life together. Their children were grown, so they traded their suburban home for an apartment in the city and a house on the beach. She quit her job to devote more time to working with breast cancer patients. She now volunteers at a hospital as a companion for women undergoing treatment and leads a cancer support program at her church. “I can’t say that I’m happy I got cancer, but I’m happy with my life,” she says.

Getting the help you need

If you’re a breast cancer survivor, these steps may help:

Work closely with your primary care doctor. According to Jennifer Potter, M.D., director of the Women’s Health Program at Boston’s Beth Israel Hospital, it’s important to make sure your clinician has your complete cancer history — including surgical reports, radiology records, and drug information. At your first post-treatment visit, you may want to discuss your treatment experience and openly air your fears. If your doctor seems ill at ease with your new status, find one who has experience with cancer survivors.

Join a support group. Breast cancer survivorship may not be a sorority you ever intended to join, but its ranks are legion. It can be therapeutic to talk with someone who’s walked in your shoes. If you’re looking for a specific type of survivor group, for example, single women or mothers of teenagers, there’s a good chance you can find it — if not in your community, then possibly online.

Stabilize your relationships. If cancer has put a strain on your relationships or unearthed problems that took root earlier, consider getting help. A mental health professional can help you develop healthier ways of interacting.

Treat yourself. When you were sick, it was probably comforting to have others take care of you. You may not be a patient any more, but there’s no reason for the nurturing to end. Make a list of things that might give you pleasure — from a vase of fresh flowers to a visit to a day spa — and schedule them into your life.

Invest in the future. This can be something as small as planting an amaryllis bulb to bloom in a few months or as large as launching a new career. Planning for the future is one of the best ways to overcome the fear that it won’t be there.

Lonely

" The most I ever did for you was to outlive you. But that is much." ~ Edna St. Vincent Millay

For almost a year after my father killed himself, images repeatedly flashed in my head of myself pointing a pistol at my temple. They're back. My father's weapon of choice was a shotgun. I guess my brain can't wrap itself around that vision. After all, I have long legs, but short arms. I could have shot myself with my feet, maybe, but toe dexterity would have probably been insufficient to the task.
I don't find the images as disturbing as I once did, but I'm cataloging the advent of the ten year anniversary of his death. So here it is.

I've been struggling to find some good memories, something positive in our relationship. It seems more critical this year than any other. I always come up empty. My therapist wonders why it's so important to me, why I'm so queasy about admitting to the "hate" part of my love-hate feelings about him. The answer is simple: I wish there were something positive, I long for the simplicity of love without dire complexity.

I have compassion for him, forgiveness in some large measure, I pity him for his desperate childhood and his desolate mental illnesses. But then I have those flashbacks and all I can feel is rage, contempt and despair. How might my life have been had his been different?

It would certainly have been less labyrinthine. I have the ability to see every side to every issue, to find goodness in people when it's buried under layer upon layer of hatred and anger. These are good things, right? On the whole, I think they are, but they leave me perpetually sitting on the fence, unable to find clarity about people and events. It's all complicated to me.

And I'm a very complex, very hidden person. If you don't know the events that shaped me, how can you understand my beliefs and behavior? How can you understand my choice of solitude at all costs? I choose to keep my secrets. They're fantastical. They're incomprehensible. They're an open invitation to judge me and where I came from. They make me very lonely.








U.S. Breast Cancer Death Rate Drops

Good news and bad news from the American Cancer Society, brought to you by WebMD. http://www.webmd.com/breast-cancer/news/20070925/us-breast-cancer-death-rate-drops?ecd=wnl_brc_100907

But a Race Gap Persists in America's Breast Cancer Death Rate

By Miranda Hitti
WebMD Medical News

Reviewed by Louise Chang, MD

Sept. 25, 2007 -- The American Cancer Society (ACS) today reported that U.S. breast cancer deaths continue to drop, but that decline still hasn't reached all ethnic groups.

That news appears in the ACS' biannual report on breast cancer in the U.S.

According to the report, breast cancer deaths declined by 2.2% annually from 1990 to 2004, partly due to earlier detection and advances in treatment.

But there are racial gaps in those figures, the report also shows.

Breast Cancer Race Gap

The ACS reports that breast cancer deaths dropped 2.4% per year from 1990 to 2004 in white and Hispanic women, compared with 1.6% annually in African-American women.

Women's breast cancer death rates didn't change during that time among Asian-American/Pacific Islanders, American Indians, and Alaska natives.

The precise reasons for those racial patterns aren't clear. Genetics may play a role, but other factors including income and access to medical care are also important.

"A woman today has a lower chance of dying from breast cancer than she's had in decades," says Harmon Eyre, MD, chief medical officer for the ACS, in a news release.

"Unfortunately, not all women are benefiting at the same level," says Eyre, noting that by 2004, breast cancer death rates were 36% higher in African-American women than in white women.

The ACS estimates that about 40,460 U.S. women will die of breast cancer in 2007 -- and that about 2.4 million women living in the U.S. have a history of breast cancer.

But breast cancer isn't U.S. women's leading cancer killer -- lung cancer is -- and heart disease kills more U.S. women than all cancers combined.

Latest Breast Cancer Statistics

In the new report, the ACS predicts that an estimated 178,480 new cases of invasive breast cancer will be diagnosed this year among U.S. women.

Invasive cancer has spread from its starting point into surrounding breast tissue. Most breast cancers are invasive.

The ACS also estimates that 62,030 new cases of in situ breast cancer (cancer that hasn't spread beyond its starting point to other breast tissue) will be diagnosed in 2007.

Breast cancer is far more common among women than men. The ACS predicts that in 2007, about 2,030 cases of breast cancer will be diagnosed in men, accounting for about 1% of all breast cancers.

The ACS estimates that 450 men will die of breast cancer in the U.S. this year.

Breast Cancer Rarer?

Breast cancer is U.S. women's most common cancer (except for skin cancers), but it may be becoming rarer than in the past.

Don't race past that word "may." Undetected breast cancers due to missed mammograms may be contributing to the trend.

The ACS reports a 3.5% drop per year in breast cancer cases from 2001 to 2004.

That decline follows a sharp rise in breast cancer cases from 1980 to 1987 that slowed until 2001 and then headed down.

Why the turnaround? The ACS notes two possible reasons.

Reason No. 1: Many women halted hormone replacement therapy (HRT) starting in 2002, after the Women's Health Initiative linked HRT to breast cancer risk. Researchers continue to debate that risk.

Reason No. 2: Mammography rates are down. Some women may have breast cancer and not know it. That would make breast cancer rates look lower than they really are.

Mammography isn't a perfect test, but it's the best way to screen women for breast cancer.

Breast Cancer Perspective

A woman living in the U.S. has a 12.3% (1 in 8) lifetime risk of developing breast cancer, states the ACS report.

But remember, that's a general number about a woman's odds of developing breast cancer at some point in her life -- not this year, or even this decade.

Breast cancer becomes more common with age, but it can also strike before menopause, so the ACS encourages women to learn what's normal for their breasts and to get lumps checked by a doctor.

Most lumps aren't breast cancer. But don't assume that a lump is no big deal. Check with your doctor to find out -- and remember, if it is breast cancer, the sooner it's detected, the better your chances may be of survival.