breast cancer basics: part three

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Part threeRecovery

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Take control of your Breast Cancer risk and diagnosis

St. John’s Oncology Department offers information on:Screening & Education

Diagnosis & Staging

Treatment

Wellness

October is breast cancer awareness month.Call 739-7531 to schedule your annual mammogram.

months after chemotherapy.

St John’sOncology Services

Dr. John Ward, Huntsman Cancer Institute

Judy Basye, RN, OCN, Director and Certified Breast Cancer Navigator

Anna Schwartz, PhD, FNP, FAAN


Anna SchwartzFNP, Ph.D, FAAN

Exercise is one of the most important things cancer survivors can do both during and even many years following treatment. Scientific studies consistently demonstrate the benefits of exercise for cancer survivors during and following treatment. Studies of cancer survivors show statistically significant effects of exercise on heart and lung function, muscle strength, balance, fatigue, depression, body weight, bone density and quality of life. In fact, research shows that exercise may reduce

risks for recurrence and development of other cancers. As a matter of fact, exercise is the best intervention for cancer-related fatigue. People often say they are “too tired to exercise,” but once they muster the strength to get up and move around they are amazed at how much better they feel both physically and emotionally.

The American College of Sports Medicine Guidelines for exercise recommend that all cancer survivors, and adults, get at least 150 minutes of moderate aerobic

exercise per week. Exercise as simple as walking around your house or around the block can not only make you feel better physically and emotionally, but also give you added health benefits. All cancer survivors, whether actively receiving treatment or many years beyond treatment, should be instructed to exercise. There

are no physical limitations that make exercise “impossible;” one simply needs to learn to exercise around his or her physical limitations.

Take a positive step forward in your survivorship and start moving. Begin slowly, well below the level of physical activity that you think you can do. Our brains always think we are super-human, but bodies that have been “resting” need time to become strong and fit again. If you aren’t sure where to start or what to do, or have lingering problems from treatment, such as lymphedema or numbness in your hands and feet, you might want to ask your health care team for guidance on how to safely start an exercise program.

Let’s be frank, many of you find exercise completely aversive and would prefer to sit and watch TV or work at your computers. But, if you start slowly and don’t push yourself to the point of exhaustion and pain, then exercise won’t be unpleasant. Find a friend or take your dog and head out the door for a short walk. The distance doesn’t matter, and if you only walk to the corner and back that’s OK. You will be taking your first step in moving forward to a healthier life.

Goals really help to keep you motivated and give you a reason to get up and move. Make short term, achievable goals and maybe even set a long-term goal, such as walking in a cancer charity event. It’s amazing the power and energy you will feel walking and being with other survivors and that energy will carry you forward to continue your commitment to exercise.

There’s no question that it’s hard to change your lifestyle from being sedentary to being active, but if you stick with exercise for even eight or 10 weeks, you will see impressive changes in your body, mind and spirit that will buoy you onward in your quest to being the

healthiest you can be. Getting through cancer takes determination, courage and will that gives you the inner strength to successfully take the steps to live a healthy physically active life.

Anna Schwartz, FNP, PhD is the oncology nurse practitioner at St. John’s Medical Center and an affiliate professor at University of Washington. She is the author of “Cancer Fitness: Exercise programs for patients and survivors,” Simon & Schuster 2004.

Anna Schwartz

Exercise and cancer: Start moving!

The American College of

Sports Medicine Guidelines for exercise recommend

that all cancer survivors, and adults, get at

least 150 minutes of moderate

aerobic exercise per week.

Healing MovesExercise aids in breast cancer recoveryBy Taniesha RobinsonContent That Works Features

Treatment for breast cancer often leaves survivors with stiffness and pain in their arms and shoulders, restricting movement. Fortunately, there’s an everyday solution to this common problem: exercise.

Physicians have long prescribed arm and shoulder exercises after surgery to prevent pain in the areas surrounding the cancer, but a new review of 24 research studies comprising 2,132 breast cancer patients finds that exercise programs can also help patients recover shoulder and arm movement.

Today, a team comprised of a wide range of health professionals including surgeons and oncologists work together to provide optimal care after breast cancer treatment.

“This review demonstrates that early involvement of a new team member who manages exercise or physical therapy is also useful for the best outcome,” says Douglas Blayney, M.D., medical

director at the University of Michigan’s Comprehensive Cancer Center.

According to the review, starting exercise within the first to third day after surgery might result in better shoulder movement in the early weeks following surgery. However, “starting exercise that soon after surgery may cause more wound drainage and require drains to remain in place longer than if exercise is delayed by about one week,” says lead review author McNeely, an assistant professor of physical therapy at the University of Alberta and clinical researcher at the Cross Cancer Institute, Canada. Wounds healed, on average, a day later with early exercise.

Fourteen of the reviewed studies compared improvements in shoulder and arm movements of post-treatment groups of women who received an exercise pamphlet with those who did not. Those who followed structured programs including physical

therapy regimens in the early postoperative period showed a significant improvement in shoulder range of motion.

Blayney said he finds few things as disheartening as witnessing breast cancer survivors in long-term follow-up who are burdened with a “frozen” shoulder or daily use of a lymphedema sleeve, an elastic compression garment worn over the arm to help move fluid and reduce swelling.

“Implementation of modern primary treatment strategies—including early intervention with suitable exercises—should reduce the incidence of these heartbreaking complications,” Blayney says.

The Cochrane Collaboration, an international organization that evaluates medical research, published this review, which drew evidence-based conclusions considering the content and quality of existing medical trials on the topic.© Content That Works Features

TVN file photo


It’s very disturbing that

patients under 40 had the highest

discontinuation and non-adherence rates,

because those patients have the longest life

expectancy.

Dawn Hershman, MD, associate professor of

medicine and epidemiology at Columbia University

Medical Center

Taniesha Robinson Content That Works Features

It seems that breast cancer survivors are bringing new meaning to the descriptive phrase “young and rebellious.” A new study of women with early-stages of breast cancer finds that fewer than half of breast cancer survivors adhere to their prescribed hormonal therapy regimen. Those women under age 40 are even less likely to complete the term for medicinal treatment.

“We were surprised to see that so many young women stopped treatment early, despite the fact that the therapy has a proven track record of reducing breast cancer recurrence,” says Dawn Hershman, MD, the study’s leader and associate professor of medicine and epidemiology at Columbia University Medical Center. “Perhaps we need to do a better job of making patients aware that to get the full benefit of treatment, they need to take their medications on time and

for the full duration.”Hormone therapy, such as tamoxifen and

aromatase, commonly lasts up to five years, yet only 40 to 60 percent of women with hormone-sensitive breast cancers finish the course of their treatment. Hershman and her colleagues examined automated pharmacy records of 8,769 women diagnosed with stage I, II or III of hormone-sensitive breast cancer between 1996 and 2007. Thirty-two percent of women in the study had discontinued hormone therapy by the 4.5-year mark, and only 72 percent of those who continued actually finished on schedule. Women under age 40 were more likely to discontinue therapy.

“It’s very disturbing that patients under 40 had the highest discontinuation and non-adherence rates, because those patients have the longest life expectancy,” Hershman says. “If we can better understand the issues surrounding compliance with hormonal therapy, this might help us understand why patients don’t adhere to other treatments that

are moving out of the clinic and into the home, such as oral chemotherapy, as often as we would like.”

There are several factors that could be contributing to this trend, Hershman says. Joint pain, hot flashes and fatigue are all side effects that can push women to stop therapy. High insurance or medication costs and not completely understanding the benefit of therapy may also be factors, Hershman adds.

“This new study reaffirms some worrisome trends for women completing hormonal therapy, and brings up the larger issue of non-compliance for cancer therapies in general,” says Jennifer Obel, an American Society of Clinical Oncology breast cancer expert. She adds that she and other researchers “need to identify reasons why patients don’t take their drugs before [they] can find ways to reverse this trend.” © Content That Works Features

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Hormone holdoutAn alarming number of breast cancer patients stop meds before treatment has ended

Don’t forget to donate to the Susan G. Komen Foundation when you visit Broulim’s throughout the month of October.

Photo by Content That Works Features


Knowledge from experience: Kathy Rowbury tells her story

Fred Crane shows his battle scars after dealing with breast cancer.

Lisa NyrenTVN Staff

Fred Crane doesn’t let anything get in his way. Not even cancer.

A famed PRCA rodeo announcer and regular voice heard over the loudspeakers at the Teton County Fair Grounds, Fred, 59, was diagnosed with breast cancer last spring.

He is one of the 1,970 men who have or will be diagnosed with breast cancer this year.

But he’s over it now, and he’s moved on.

He’s currently undergoing chemotherapy treatment, and that hasn’t slowed him down a bit. Last month he was featured in a television commercial promoting tourism in Wyoming doing what he does best—wrangling.

The TVN interviewed Fred earlier this month and he commented that chemo wasn’t that bad.

“I went jet skiing Friday,” he said.

Fred is a familiar face in the Valley. When he’s not announcing or wrangling, Fred runs the Broken Spur in Driggs. He’s there most days with his two dogs, Ozzy and Shorty.

The shopkeeper actually walked around with a fluid-like lump in his chest for five or six years. This year, while in Rexburg for a skin check, Fred had the lump biopsied.

“I didn’t want it to be breast cancer,” he said.

Fred had a radical mastectomy on his left side. That didn’t stop him

either. He was in and out of the hospital for surgery in one day.

“I’m still waiting for the big epiphany,” said Fred. “Pretty much everything is [still] the status quo.” Except, he said, lifting his white cowboy hat, he’s suffering from “a bad case of mange.” The chemo is doing a number on Fred’s hair, like it does with most patients.

Fred will undergo radiation when his chemo treatments are over.

And the wrangler isn’t worried about the future, or about a possible relapse.

“I wasn’t in charge before I had cancer, and I ain’t in charge now,” he said.To contact Lisa Nyren e-mail [email protected].

local voices

Hormone holdoutAn alarming number of breast cancer patients stop meds before treatment has ended

Photo courtesy Fred Crane

Even cowboys get breast cancer: Fred Crane’s story

I wasn’t in charge

before I had cancer, and

I ain’t in charge now.

Fred Crane,Breast cancer

survivor

Lisa Nyren TVN Staff

Kathy Rowbury knows cancer all too well. She’s battled breast cancer herself and is one of four siblings in her family who have had cancer, either of the breast or the ovaries. Both her grandmothers had breast cancer. An aunt on her mother’s side died of cancer. In 2005, one of her sisters succumbed to ovarian cancer shortly after being diagnosed.

“It’s always been something I’ve known,” said the Child Nutrition Director for Teton School District.

What’s interesting about Kathy’s story is that it points to research that still needs to be done, specifically on how heredity and genetics play a role in cancer development.

After Kathy’s grandmother was diagnosed with cancer, Kathy’s mother was tested for the breast cancer gene (BRCA). There are two types, BRCA1 and BRCA2. These genes are part of a class of genes called tumor suppressors. Mutations in these genes increase the risk of developing breast and ovarian cancers, among others, in both men and women. Generally when family members develop breast cancer, others in the family will be tested for the gene.

Kathy’s mother’s BRCA test was negative. Kathy was tested herself and received the same result.

But it’s obvious that there’s something else that science has yet to discover.

“I hope they find out whatever genetic thing is happening in my family,” Kathy said.

Kathy’s lump was found after a mammogram, on her right side just below the nipple. This made her ineligible for a lumpectomy due to the lump’s location, she said. The lump was just over 2 centimeters and was invasive ductal carcinoma. It was also estrogen receptor positive. Because of this, Kathy, 52, now takes an estrogen blocker daily.

Her diagnosis came in April of 2007. She had a mastectomy on May 1 and began chemotherapy on May 21. She underwent six chemotherapy treatments, which ended on Sept. 4,

2007.“You just do what you have to do

and get on with life,” she said.In addition to the mastectomy,

Kathy had all her lymph nodes removed during surgery because her doctor discovered that the cancer had spread to her sentinel node. The sentinel node is the lymph node closest to the tumor. Generally cancer spreads to lymph nodes first, so doctors will test the sentinel nodes in most patients. If the sentinel node is affected, it and surrounding lymph nodes are removed.

Like other cancer patients receiving chemotherapy, Kathy lost her hair. She waited to have it cut until “it was coming out in clumps,” she said. But she wore a wig afterwards that so closely resembled her natural hair, people who did not know her well could not tell the difference. Even so, going bald was difficult for Kathy.

“It was harder for me to lose my hair than to lose my breast,” she said.

The chemo also caused Kathy to lose her appetite. And her body ached all over.

“Even the hair I didn’t have on my head ached.”

But Kathy was not alone during her treatment and recovery. Her husband, Craig, was there by her side the whole time. And Kathy, Sue Beard, and another woman, who all attended church in Tetonia, were diagnosed within months of each other.

“It’s amazing how many people [breast cancer] is affecting,” Kathy said.

Through it all, Kathy has kept a positive outlook on life, and she values every last one of her experiences.

“If I had to give up the things I’ve learned [to not go through cancer], I’d do it all over again,” she said. “The whole experience taught me a lot of things.” The most important to Kathy is her relationship with the Savior. “I think I’ve become a better person,” she said.

Kathy’s sisters have similar stories. Her youngest sister, Clenna, was recently diagnosed with ductal carcinoma that was HER2-positive. HER2 stands for human epidermal growth factor receptor 2, and patients who test positive for this often have aggressive forms of cancer.

Clenna recently finished

chemotherapy treatments after having a mastectomy.

Clenna and Kathy’s older sister, Annette, had her ovaries removed earlier this year, and her doctors found cancer in one of the ovaries. Luckily, her cancer was contained.

Their oldest sister, Marlene, had ovarian cancer, but she was diagnosed too late to recover. She received her diagnosis on Sept. 1, 2005 and passed away less than three weeks later, on Sept. 20.

One sister in their family, Sherrie, is so far clear of any cancer, as is their brother, Clyde.

Kathy has four children of her own, who are all grown and married, and who are cancer-free.

Since her own treatment and recovery Kathy attended a Susan G. Komen Race for a Cure event in Nevada a couple years ago. A company her son, Jared, works for, Roche Constructors, Inc., was her sponsor. Kathy attended the event with her daughter-in-law, Kylie, and her grandson, Dax.

“It was a really good experience,” Kathy said. “It’s just an uplifting

experience.”And it didn’t hurt that Chip and

Dales’ dancers handed out roses to all the survivors, she added.

Kathy’s advice to other women is to get mammograms.

“They’re not that bad,” she said. She urges women to conduct self breast exams while laying down and while standing up. Do it before you get out of bed and while your in the shower, she suggests.

And if you develop cancer, keep a positive attitude.

“Losing a breast is not the worst thing that can happen to you,” she said.

To contact Lisa Nyren e-mail [email protected].

Photo courtesy of Kathy Rowbury

Kathy Rowbury with her husband, Craig, at the National Elk Refuge in December, 2007, three months after Kathy completed chemotherapy treatment.

Kathy Rowbury with her extended family in Salmon, Mother’s Day weekend, 2009. Back row from left to right: Ben (nephew), Kathy, Beth (sister-in-law), Bryce (son-in-law), Eric (nephew), Rachel (niece), Becky (niece). Front row from left to right: Catherine (daughter-in-law), Devon (grandson) and Katie (niece).

Photo courtesy of Kathy Rowbury

local voices


Dawn KlingensmithContent That Works Features

Foods that do the best job of nourishing our bodies may, at the same time, cause certain cancers to “starve”—at least in a figurative sense.

For example, fresh or frozen berries might inhibit a tumor’s ability to form blood vessels, and without a blood supply, the tumor cannot survive.

Other foods can help prevent cancer from forming in the first place.

“The relationship between food and cancer is complex,” says Dr. Mark Fesen, a Hutchinson, Kan.-based oncologist and author of “Surviving the Cancer System” (AMACOM, 2009). Scientific studies can be confusing or even contradictory, but the consensus among doctors and researchers is that a daily diet rich in fruits, vegetables and whole grains can protect against a wide range of cancers.

However, “Your total amount of calories eaten is the most important factor in the risk of developing cancer,” Fesen says. “Obesity is linked to several cancers, including prostate, colon and breast cancers.”

Substitute fish, poultry and beans for red and processed meats whenever possible, advises epidemiologist Dr. Julia Greer, University of Pittsburgh School of Medicine.

As for supplements, “The only one I recommend is vitamin D,” which reduces the risk of colorectal and breast cancer, says biochemist Richard Beliveau, chairholder in cancer prevention and treatment at the University of Quebec at Montreal.

Not all of the following cancer-fighting foods are suitable for people undergoing treatment. Cancer patients have special dietary needs they should discuss with their physicians. For example, “Your protein needs increase during treatment,” Greer says, “and because of side effects such as mouth and esophageal sores, eating acidic foods such as tomatoes and citrus fruit is a very bad idea.”

Berries Berries are bursting with compounds that can slow the growth and metabolism of cancerous cells. An antioxidant in raspberries has been shown to inhibit cervical cancer growth and may decrease pancreatic cancer risk and skin cancer cell division.

Citrus fruits Rich in vitamin C, which may fight breast cancer, citrus fruits may also reduce the risk of esophageal cancer. The fruits’ pectin may lower the risk of ovarian cancer and delay the growth of cancerous cells in men diagnosed with recurrent prostate cancer.

tomatoes Tomatoes contain lycopene, which is linked to a decreased risk of pancreatic and prostate cancers. Go ahead and hit the sauce—heating tomatoes does not destroy lycopene; in fact, it enhances it. Ounce for ounce,

tomato paste, spaghetti sauce and ketchup contain more lycopene than a raw tomato, Greer says.

Whole grains High intake levels of whole grains correlate with reduced pancreatic, colon, endometrial and ovarian cancer risks.

grapes Red varieties contain high levels of resveratrol, which can decrease or stop the growth of breast, prostate, pancreatic, stomach, liver and colorectal cancers.

tart Cherries This fruit naturally depletes the body of cancer-causing substances. They can also slow the growth of cancerous cells, particularly in the case of colon and breast cancers.

pomegranates Pomegranates contain four chemical components that have been shown to inhibit prostate cancer cell growth. Antioxidants found in pomegranates and their juice may also help prevent breast and lung cancer cells from dividing and can even kill cancer cells.

leafy greens Leafy greens, such as spinach, can decrease the risk of breast, colon, skin, lung, head, neck, ovarian and stomach cancers. “Watercress intake, in particular, is associated with decreased ovarian cancer,” Greer says.

garliC and onions Garlic may reduce stomach cancer and women’s risk of colon cancer. Onions may play a role in fighting lung, colon, bladder, skin, prostate, stomach and endometrial cancers, as well as leukemia. Red and yellow onions pack the most nutritional punch.

nuts and seeds Nuts and seeds contain healthy monounsaturated fat, which has been shown to protect against breast cancer. The mineral selenium—found in certain kinds of nuts—may inhibit the development or growth of prostate, lung and bladder cancer cells, while also protecting against colon cancer.

green tea “Tea is the best source of anti-cancer compounds called catechins, and green tea contains about three times as much as black tea,” Greer says. One study showed that drinking three or more cups of green tea each day reduced the recurrence rate of Stage I breast cancer.

dark ChoColate Extracts of dark chocolate can inhibit the formation of breast, colon and prostate cancers, and can decrease the division rate of liver cancer cells. A 2003 Cornell University study compared the anti-cancer properties of certain beverages and found that unprocessed cocoa had nearly twice the amount of antioxidants as red wine and up to three times more than green tea. © Content That Works Features

Community Cancer ScreeningsThe best hope for treating and beating cancer starts here, with early detection. Take advantage of our FREE and reduced-cost cancer screenings.

Pre-registration is required.535-ICAN (4226)

• Free screenings for breast, skin, oral, and colon cancer.

• Reduced-cost prostate cancer screening ($15 PSA).

• Reduced-cost digital mammogram coupon ($75)

• Risk factor analysis for cervical, ovarian and other gynecological cancers

• Door prizes drawn every hour.

Many foods are touted as helping cancer survivors get and stay well

Photo by Content That Works Features


Teton Valley News & Broulim’s have teamed together for

National Breast Cancer Awareness Month

Go into Broulim’s during October to donate to the Susan G. Komen Foundation.

these people who have already donated to the Susan G. Komen FoundationBroulim’s and the Teton Valley

News would like to thank all those who donated to Breast Cancer

Awareness last week.

Kaitlyn Conner for Susan ConnerBette Vereloust

Whitney WaddellKadin WaddellAlisha HorrocksJaymy CalilnaJane MackayPeter MackayKimberly Day

Mary Carol StaigerLaune SwanJen Calder

Macy WalkerAmy Birch

Ashlynn HansenKarey Hoff

Kelly Wood for Candi Palmer—Egin survivor 6 years!Seth Robinson

For Martha StokerR. Villers, England

Dani, Hunter & Morgan JohnsonHeather Holcomb

Leanne MorseLorraine MillerJen Bandow

Thomas KincaidKevin BradshawTressa Brasher

And Others

Many foods are touted as helping cancer survivors get and stay well

Anna SachseContent That Works Features

There is no way to be ready for the unwelcome return of cancer—no matter how well a patient coped with and recovered from the illness the first time.

Don’t assume the process will unfold the same way it did on the first go-around.

“When cancer comes back, it usually gets harder and harder to treat, and the doctors have to pull out bigger guns,” says Kimberly Stump-Sutliff, registered nurse and associate medical editor for the American Cancer Society. The treatment will likely be more intense and the outcome may be different, so you have to be prepared for new and potentially more difficult physical consequences.

Your loved one may also react differently from how they did before. While some patients might

be ready to fight the cancer again as soon as they hear the news, it is also perfectly normal to feel disappointed, sad, anxious, depressed or angry at the doctor or their own body.

“I always tell patients that they are entitled to those feelings—cancer sucks,” Stump-Sutliff says. “But then I tell them that they can’t live in that mindset, so let’s focus on what we’re going to do

next.” Nevertheless, you ultimately have to allow

your loved one to make his or her own decisions about the course of treatment. Be patient, open-minded, communicative and supportive. Some may choose to rally for another round of chemo. However, if a patient decides he or she no longer wish to continue treatment, you must respect those wishes, even if you don’t agree, Stump-Sutliff says.

“Maybe that’s just how they feel right this second, and tomorrow they will wake up and be ready to fight it again. But you can’t make

a cancer patient do something they don’t want to do.”

Getting your loved one’s health care providers involved may also be helpful, as they can weigh in on the likelihood that further treatment will be effective.© Content That Works Features

Photo by Shelly Perry

Navigating a relapseThey made it through cancer once. How do you best help someone who has to do it all over again?

When cancer comes back, it usually gets harder and harder to treat, and the doctors have to pull out bigger guns.

Kimberly Stump-Sutliff, registered nurse and associate medical editor for the American Cancer Society

breast cancer basics: part three

Documents

benefits of exercise

exercise impossible

studies of cancer survivors

breast cancer risk

cancerrelated fatigue

breast cancer awareness

physical limitations

valleys tetonstake control