Living Beyond Living Beyond Breast Cancer:Breast Cancer:Celebrating a Celebrating a New NormalNew Normal

A Breast Cancer SymposiumA Breast Cancer Symposium

Saturday, May 30, 2009Saturday, May 30, 2009

Cronin Auditorium, Hospital of Saint Raphael 1450 Chapel St, New Haven CT 06511

Women’s Center for Breast Women’s Center for Breast Health at the Hospital of Health at the Hospital of

Saint Raphael Saint Raphael

May 30, 2009May 30, 2009

What can I do to stay What can I do to stay healthy?healthy?

What Increases the Risk of What Increases the Risk of Breast Cancer ?Breast Cancer ?

• MultifactorialMultifactorial– GenderGender– AgeAge– Family historyFamily history– Personal historyPersonal history– Dense breast tissueDense breast tissue– Radiation to chest Radiation to chest

What Increases the Risk of What Increases the Risk of Breast Cancer ? Breast Cancer ?

• Not having children, or having them Not having children, or having them later in lifelater in life

• Recent use of birth control pillsRecent use of birth control pills

• Long-term use of combined hormone Long-term use of combined hormone replacement therapyreplacement therapy

• AlcoholAlcohol

• Lack of ExerciseLack of Exercise

Factors with No Defined LinkFactors with No Defined Link

• High fat dietHigh fat diet

• Underwire brasUnderwire bras

• AntiperspirantsAntiperspirants

• Breast implantsBreast implants

• PollutionPollution

• SmokingSmoking

• Night workNight work

Traditional Breast Cancer Traditional Breast Cancer TreatmentTreatment

• SurgerySurgery

• RadiationRadiation

• ChemotherapyChemotherapy

• Hormonal TherapyHormonal Therapy

Breast Cancer Treatment Breast Cancer Treatment 20092009

• Individualized treatment planningIndividualized treatment planning

• Genetic testingGenetic testing

• Genomic profilingGenomic profiling

• Complementary and Alternative Complementary and Alternative MedicineMedicine

• Therapies can be hard on the body Therapies can be hard on the body and mindand mind

• Complementary therapies to ease Complementary therapies to ease side effect, anxiety, and promote side effect, anxiety, and promote sense of well beingsense of well being

The goal of complementary medicine is to The goal of complementary medicine is to balance the whole person — physically, balance the whole person — physically,

mentally, and emotionally — while mentally, and emotionally — while conventional medicine does its work. For conventional medicine does its work. For

many people diagnosed with breast many people diagnosed with breast cancer, complementary medicine has cancer, complementary medicine has

helped to:helped to:

relieve symptoms relieve symptoms ease treatment side effects ease treatment side effects

improve quality of lifeimprove quality of life

Complementary medicine Complementary medicine treatmentstreatments

• AcupunctureAcupuncture • AromatherapyAromatherapy • Chiropractic TherapyChiropractic Therapy • Guided ImageryGuided Imagery • HypnosisHypnosis • JournalingJournaling • MassageMassage • MeditationMeditation • Music TherapyMusic Therapy • Progressive Muscle Relaxation Progressive Muscle Relaxation • Reiki Reiki • Shiatsu Shiatsu • Spirituality and Prayer Spirituality and Prayer • Support Groups Support Groups • Tai Chi Tai Chi • YogaYoga

The National Center for The National Center for Complementary and Alternative Complementary and Alternative

Medicine (NCCAM)Medicine (NCCAM)• Division of NIHDivision of NIH• NaturopathyNaturopathy: a system in which the body is encouraged : a system in which the body is encouraged

to heal itself through changes in nutrition and lifestyle to heal itself through changes in nutrition and lifestyle • Ayurveda: a system in which the body, mind and spirit Ayurveda: a system in which the body, mind and spirit

are integrated to prevent or treat health problems are integrated to prevent or treat health problems • Meditation: a practice that encourages clearing of the Meditation: a practice that encourages clearing of the

mind and inward focus mind and inward focus • Creative therapy: such as art or music, in which patients Creative therapy: such as art or music, in which patients

express their feelings and hopes through drawing, express their feelings and hopes through drawing, painting, singing or playing a favorite instrument painting, singing or playing a favorite instrument

• Yoga: which uses controlled breathing and postures Yoga: which uses controlled breathing and postures

How many people seek How many people seek complementary therapy?complementary therapy?

• 2002 National Health Interview Survey, (Centers for Disease 2002 National Health Interview Survey, (Centers for Disease Control and Prevention). Control and Prevention). – 36% of U.S. adults are using some form of CAM.36% of U.S. adults are using some form of CAM.– 62% if megavitamin therapy and prayer for health reasons are 62% if megavitamin therapy and prayer for health reasons are

included included

• July 2000 issue of the July 2000 issue of the Journal of Clinical OncologyJournal of Clinical Oncology found found that that – 69% of 453 cancer patients had used at least one CAM therapy as 69% of 453 cancer patients had used at least one CAM therapy as

part of their cancer treatment. part of their cancer treatment.

• December 2004 issue of the December 2004 issue of the Journal of Clinical OncologyJournal of Clinical Oncology – 88% of 102 people with cancer who were enrolled in phase I 88% of 102 people with cancer who were enrolled in phase I

clinical trials (research studies in people) at the Mayo clinical trials (research studies in people) at the Mayo Comprehensive Cancer Center had used at least one CAM therapy. Comprehensive Cancer Center had used at least one CAM therapy.

The National Center for The National Center for Complementary and Alternative Complementary and Alternative

Medicine (NCCAM)Medicine (NCCAM) • Acupuncture to relieve neck and shoulder Acupuncture to relieve neck and shoulder

pain following surgery for head or neck pain following surgery for head or neck cancer cancer

• Ginger as a treatment for nausea and Ginger as a treatment for nausea and vomiting caused by chemotherapy vomiting caused by chemotherapy

• Massage for the treatment of cancer pain Massage for the treatment of cancer pain

• Mistletoe extract combined with Mistletoe extract combined with chemotherapy for the treatment of solid chemotherapy for the treatment of solid tumors tumors

What have clinical trials What have clinical trials shown? shown?

– Green teaGreen tea– Vitamin DVitamin D– TurmericTurmeric

• Nutritional supplements must be taken in addition Nutritional supplements must be taken in addition to conventional surgery, radiation and to conventional surgery, radiation and chemotherapy to achieve improved outcomes chemotherapy to achieve improved outcomes reported in clinical trialsreported in clinical trials

• 1997, a panel of experts at the National Institutes 1997, a panel of experts at the National Institutes of Health (NIH) Consensus Conference found of Health (NIH) Consensus Conference found acupuncture to be effective in managing acupuncture to be effective in managing chemotherapy-associated nausea and vomiting chemotherapy-associated nausea and vomiting and in controlling pain associated with surgeryand in controlling pain associated with surgery

When considering Complementary or When considering Complementary or Alternative Medicine, what questions Alternative Medicine, what questions

should I ask my health care providers?should I ask my health care providers?

• What benefits can be expected from this therapy? What benefits can be expected from this therapy? • What are the risks associated with this therapy? What are the risks associated with this therapy? • Do the known benefits outweigh the risks? Do the known benefits outweigh the risks? • What are the potential side effects? What are the potential side effects? • Will the therapy interfere with conventional Will the therapy interfere with conventional

treatment? treatment? • Is this therapy part of a clinical trial? If so, who is Is this therapy part of a clinical trial? If so, who is

sponsoring the trial? sponsoring the trial? • Will the therapy be covered by health insurance? Will the therapy be covered by health insurance?

Through Treatment and Through Treatment and BeyondBeyond

• NutritionNutrition

• Physical FitnessPhysical Fitness

• SexualitySexuality

• Stress ManagementStress Management

Women’s Center for Breast Women’s Center for Breast Health at the Hospital of Health at the Hospital of

Saint Raphael Saint Raphael

May 30, 2009May 30, 2009

Healthful EatingHealthful Eating

Mary Malloy, R.D.Mary Malloy, R.D.

Physical FitnessPhysical Fitness

Cathy Rives, MS, PTCathy Rives, MS, PT

Regaining Intimacy Regaining Intimacy After TreatmentAfter Treatment

Lois Spivack, PhDLois Spivack, PhD

ASK THE EXPERTSASK THE EXPERTSThomas Fynan, MD, Medical OncologyThomas Fynan, MD, Medical Oncology

Vanna Dest, APRN, Genetic Vanna Dest, APRN, Genetic CounselingCounseling

Joyce Chung, MD, Radiation OncologyJoyce Chung, MD, Radiation Oncology

Nhu Ngo, MD, PathologyNhu Ngo, MD, Pathology

Amy Sherman, MD, Breast ImagingAmy Sherman, MD, Breast Imaging

Denise Barajas, MD, SurgeryDenise Barajas, MD, Surgery

Stress ManagementStress Management

Lori Ratchelous, MSWLori Ratchelous, MSW