raising our voices - new hampshire breast cancer coalition · launched in 2010, the national breast...
TRANSCRIPT
"NBCC grassroots advo-
cates across the country
are reaching out to organi-
zations, researchers,
elected officials and, yes,
presidential candidates to
endorse Breast Cancer
Deadline 2020®.”
Nancy Ryan, President
NHBCC
Inside This Issue
To Screen or Not To
Screen………………1
A Word from the
President…………...2
In Remembrance….2
NHBCC Thanks
Donors……………...3
Thoughts on Annual
SABCS……………..4
Support Services
Fund………………...8
To Screen or Not To Screen? By Nancy Ryan, President, NHBCC
(Opinions in this article are those of
the author. The New Hampshire
Breast Cancer Coalition does not is-
sue breast cancer screening guide-
lines. NHBCC educates women about
screening controversies and encour-
ages them to make informed deci-
sions about screening.)
In the October 15, 2015, issue of the
Journal of the American Medical As-
sociation, the American Cancer Socie-
ty (ACS) published revised breast
cancer screening guidelines, reigniting
confusion about when and how often
a woman should have mammograms.
The new ACS guidelines recommend
women begin screening at age 45 (up
from age 40) and continue once a
year until age 54, then every other
year for as long as they are healthy
and likely to live another 10 years
(www.cancer.org).
WHO IS AFFECTED BY SCREEN-
ING GUIDELINES?
The breast cancer screening guide-
lines discussed in this article apply to
healthy, asymptomatic women who
are believed to be at average risk for
breast cancer. They do not apply to
women who experience or have expe-
rienced symptoms such as lumps, a
discharge, a strong family history, a
history of radiation to the chest, breast
biopsies or who know they carry a
mutation in the breast cancer genes
BRCA1 or BRCA2.
WHO ISSUES SCREENING GUIDE-
LINES?
At least six organizations, including
ACS, the World Health Organization
(WHO), National Comprehensive
Cancer Network (NCCN), American
College of Radiology (ACR), Ameri-
can College of Obstetricians and Gy-
necologists (ACOG) and the United
States Preventive Services Task
Force (USPSTF) publish breast can-
cer screening recommendations.
Many organizations have different
recommendations. (In the UK, for in-
stance, the UK National Screening
Committee invites women ages 50-70
for screening every three years.) This
variation tells us that there is no magic
age to begin screening or how often to
screen. Controversy is most heated
around the guidelines for women
younger than 50 years of age.
(continued on page 6)
Winter 2016 Volume 22, Number 1
Raising Our Voices New Hampshire Breast Cancer Coalition
2
A Word from the President — Breast Cancer Deadline 2020® Update By Nancy Ryan, President, NHBCC
Launched in 2010, the National Breast
Cancer Coalition’s Breast Cancer
Deadline 2020® is a comprehensive,
strategic plan to know, by January 1,
2020, how to end deaths from breast
cancer. The plan includes science,
legislation and grassroots action.
The scientific
component of
Breast Cancer
Deadline
2020® is the
Artemis Pro-
ject®, focusing
on primary
prevention
(preventing
breast cancer from developing) and
understanding and preventing metas-
tasis (the process by which cancer
cells spread throughout the body).
Artemis participants are ready to begin
the preclinical phase of a preventive
vaccine. The metastasis group is in-
vestigating how the immune system
interacts with dormant tumor cells.
Furthermore, a seed grant was award-
ed “to create a database containing
genomic and clinical data from breast
cancer patients.”
Legislation called “The Accelerating
the End of Breast Cancer Act” (S. 746/
H.R. 1197) will establish a 10-
member, time-limited panel to oversee
the Deadline and to identify promising
research not currently being prioritized
to prevent breast cancer and metasta-
sis. As of January 25, 2016, S. 746
has 49 co-sponsors and H.R. 1197
has 228 co-sponsors. A tip of the hat
to all four members of New Hamp-
shire’s congressional delegation for
becoming co-sponsors of the Acceler-
ating the End of Breast Cancer Act:
Senator Jeanne Shaheen, Senator
Kelly Ayotte, Representative Annie
Kuster and Representative Frank
Guinta.
NBCC grassroots advocates across
the country are reaching out to organi-
zations, researchers, elected officials
and, yes, presidential candidates to
endorse Breast Cancer Deadline
2020®. In New Hampshire, Governor
Maggie Hassan, our entire congres-
sional delegation and nearly fifty mem-
bers of the New Hampshire state leg-
islature have endorsed the Deadline.
Our next president (whoever that may
be) must stand with those who are
calling for an end to breast cancer. My
Iowa colleagues, Christine Carpenter
and Lori Seawel, and I are reaching
out to secure Deadline endorsements
from presidential candidates. As of
January 25, 2016, (in alphabetical or-
der) Jeb Bush, Chris Christie, Hillary
Clinton, Lindsey Graham, Bobby
Jindal, John Kasich and Martin O’Mal-
ley have endorsed the Deadline
(although several have dropped out or
suspended their bid for the presiden-
cy).
To help secure endorsements for
Breast Cancer Deadline 2020®, con-
tact NHBCC at (603) 659-3482.
In Remembrance, Christine Way “Christine P. Way, (nee Mattern), 64, of Stow, MA, died September 17, 2015, after years of making every day count in the face of breast cancer.” This is the first sentence of the obitu-ary for Chris Way, whose sister, Grace Mattern, of Northwood, New Hamp-shire, invited NHBCC to share Chris’ story and blog with our breast cancer community. Chris was originally diag-nosed with breast cancer in 1991 at the age of 40. Following a recurrence in 2010, Chris began posting essays
on a website called “A Cancer Jour-ney With Chris, Thoughts and strug-gles of living with metastatic can-cer” (chriscancerjourney.wordpress.co
m/). In Chris’ own words, she started her blog “to have a public place where people can read the essays on my cancer journey. They are in-tended to provide support to others with difficult medical conditions.”
Reprinted here with permission of Chris’ husband is her April 23, 2015 journal entry called “Doorways.”
Doorways I am in a journaling class to explore my own life. In one of the last ses-sions the class was to pick a picture of a doorway and journal about it. The picture I chose and what I wrote is so relevant and current to my life right now that I was urged by some classmates to share my thoughts. Here in quotes is what I wrote.
“These doors go on and on; they could be infinite. There is a sense that your life can continually change. You don’t stay long in one place but each day brings a new challenge. Life both in the sentient world and the world of energy are in a constant flowing motion.
Pay attention to the space you are in but stay open to all the possibilities to come. It is the small things that matter. It is the becoming that be-comes the being. Always becoming. Pay attention to the process; that is who you are.”
When we journal in class we have a short time on each prompt so often what comes out is so honest. The sentiment above was the constant question from a philosophy professor I had in college. Is life about being or becoming? Since I have been diag-nosed with my cancer it is even clearer to me now than before, that we are in a constant state of change and it is the process that matters. Live life the best you can all the time.
A memorial service for Chris Way was held on Saturday, October 3, 2015 at the First Parish in Concord, Massachusetts.
3
ABTECH, Inc. - Swanzey, NH Alliance Data, Charna Pratt
ANuDu, Hair Salon and Beauty Spa - Lee, NH Bank of New Hampshire - Rochester, NH
Boarding for Breast Cancer - Redondo Beach, CA Concord Country Club - Concord, NH
Crescent Group, LLC, dba McDonald’s Ron Currier’s Hilltop Chevrolet - Somersworth, NH Delhaize American Shared Services Group, LLC -
Statewide Hannaford Supermarkets Duston Country Club Ladies League - Hopkinton, NH
Elavina Salon and Spa - Manchester, NH Fresh of Nashua - Nashua, NH
Gateways Community Services - Nashua, NH Green Envy Salon & Spa - Manchester, NH
Ryan Hadley, Screwballs Softball - Keene, NH Hampshire Family Dental - Raymond, NH
HandCraft Wine by Cheryl Indelicato - Monterey, CA Hollis Brookline (NH) Rotary Club
Kaizen Academy, LLC - Raymond, NH Koehler Landscape Construction Services - Amherst, NH
Lake Sunapee Bank - Sunapee, NH Laliberte Landscaping, LLC - Candia, NH
La-Z-Boy Furniture Gallery & Fallon’s Furniture - Manchester & Merrimack, NH
Lewis’ Towing & Auto Repair - Merrimack, NH Liberty Mutual - Dover, NH
Long Term Care Partners, LLC - Greenland, NH M.S. Walker - Somerville, MA
Macy’s Foundation Manchester High School Central Activity Fund - Manchester, NH
Merchants Automotive Group - Hooksett, NH Muddy Paw Sled Dog Kennel, LLC - Gorham, NH
NH Dept. of Administrative Services, Wellness Committee NH State Assoc. of Emblem Clubs - Hudson, NH
NH Women’s Golf Association, Stephanie Thomas Memorial Golf Tournament - Portsmouth, NH
NHTI, Concord’s Community College ONEHOPE Foundation - Newport Beach, CA
The Pinkerton Academy - Derry, NH Portsmouth Lodge of Elks No. 97 - Portsmouth, NH
Sree J. Raman, DMD PLLC - Manchester, NH Seabrook Girls Softball - Seabrook, NH
Souhegan High School Activity Fund - Amherst, NH Southern NH University Women’s Basketball - Manchester, NH
Unite for HER - Pocopson, PA United Steel Workers of America - Laconia, NH
NHBCC extends a Hearty
“Thank You” The New Hampshire Breast Cancer Coalition expresses deep gratitude to our individual donors and for the many community
fundraisers that support our mission. Listed here are the corporations, businesses and individuals whose unique community
fundraising activities or grants during 2015 provided critical financial support for NHBCC.
4
Thoughts on the 38th Annual SABCS
By Nancy Ryan, President, NHBCC
The 38th Annual San Antonio Breast
Cancer Symposium (SABCS), held from
December 8th to December 12th, 2015,
hosted over 7,500 attendees from over
95 countries. With hundreds of posters,
dozens of research presentations, ple-
nary lectures, “Hot Topics” sessions for
advocates and networking opportunities,
the information was overwhelming. As I
navigated the symposium, one word
kept coming to mind: complexity.
Research is revealing breast cancer to
be a far more complex disease than
when I was diagnosed in 1989. For
many years breast cancer treatment
decisions were based on tumor size,
lymph node status, tumor grade (how
abnormal the tumor cells and tissue look
under a microscope) and hormone re-
ceptor status (hormone receptors are
proteins that may signal cells to grow).
Treatment was often a “one size fits all.”
Today, patient education, research de-
sign and treatment decisions are im-
pacted by a deeper understanding of
cancer biology, genetics, complex bio-
logical pathways, treatment toxicities
and immunotherapy. All this, and more,
was presented at the 2015 SABCS.
SUBTYPES
Today, breast cancer is generally
grouped into four subtypes based on
many factors. The four subtypes, ac-
cording to hormonal status, are:
Luminal A: characterized as being estro-
gen receptor positive and/or progester-
one receptor positive (ER-positive and/
or PR-positive), HER2-negative (HER2
is the human epidermal growth factor
receptor 2, which promotes cancer cell
growth).
Luminal B: ER-positive and/or PR-
positive and HER2-positive.
Triple Negative (also called basal-like):
ER-negative, PR-negative, and HER2-
negative.
HER2 type: ER-negative, PR-negative
and HER2-positive.
One example of research involving sub-
types was presented from a Danish
Breast Cancer Cooperative Group study
hinting “chemotherapy improved DFS
(disease free survival) in 468 non-
Luminal A patients, but had no benefit in
165 Luminal A patients.” Aleix Prat, MD,
Ph.D., a medical oncologist, comment-
ed, “Results of this new study show us
that not only are subtypes prognostic,
but also predictive of chemotherapy
benefit.” The study sample was small
and based on tissue samples collected
25 years ago. Still, the finding may war-
rant further investigations of patients (by
subtype) treated with more current
chemotherapy to learn who might safely
forego toxic treatments.
GENOMIC ASSAYS
These are tests that analyze the activity
of multiple genes in early stage breast
cancer to predict treatment response
and/or outcome, which helps to guide
treatment. Several genomic tests are in
use for breast cancer including Onco-
type DX®, MammaPrint, Mammostrat
and Prosigna assay. Each test analyz-
es the activity of a unique, different
number of genes. Genomic Health, Inc.,
developers of the Oncotype DX® ge-
nomic test that analyzes the activity of
21 genes from a patient’s own tumor,
announced in San Antonio the results
from multiple studies that reconfirm this
test accurately predicts clinical out-
comes in patients with early stage, inva-
sive breast cancer.
Genomic Health, Inc. has also devel-
oped a diagnostic test for patients diag-
nosed with ductal carcinoma in situ
(DCIS). DCIS is the presence of abnor-
mal cells in the ducts, which have not
invaded other parts of the breast. An
estimated 60,000 women in the US are
diagnosed with DCIS annually. Because
we cannot predict which women with
DCIS will subsequently develop invasive
cancer, most patients are treated with
surgery often followed by radiation and
hormonal therapy. The Oncotype DX®
test for DCIS is an assay that examines
tissue removed during surgery to help
determine which women might subse-
quently develop invasive cancer and
therefore need more treatment, and
which women can safely forgo addition-
al treatment.
NEO-ADJUVANT TREATMENT
Neo-adjuvant treatment is chemothera-
py administered before surgery and in-
cludes subsequent evaluation of the
tumor response. A pCR or “pathologic
complete response” indicates no active
cancer cells remain. One presentation
considered patients with HER2-negative
breast cancer who received neo-
adjuvant chemotherapy, but, unfortu-
nately, were found to have residual dis-
ease when surgery was performed.
A study from Japan (CREATE-X or
Capecitabine for Residual Cancer as
Adjuvant Therapy) showed that adding
capecitabine (Xeloda) to adjuvant thera-
py following surgery extended disease-
free and overall survival for these pa-
tients. The study raised concerns be-
cause capecitabine is “quite toxic” ac-
cording to Steven Vogl, MD, a breast
cancer specialist from New York City.
This study exemplifies the increasing
complexity of risks and benefits by intro-
ducing neo-adjuvant treatment.
(continued on page 5)
5
(SABCS, cont. from page 4)
TOXICITIES
Some breast cancer treatments (such
as Herceptin®, a targeted treatment for
patients whose cancer cells make too
many copies of the gene HER2) in-
crease the likelihood of cardiovascular
damage in patients with early-stage
breast cancer. A five-year study by re-
searchers at the University of Alberta
and Alberta Health Services (the MAN-
TICORE trial, Multidisciplinary Approach
to Novel Therapies in Cardiology Oncol-
ogy Research) showed that beta-
blockers and ACE inhibitors (heart med-
ications) help prevent a drop in heart
function from cancer treatment. This is
doubly important because it may allow
the patient to continue treatment unin-
terrupted and also prevent heart failure.
Co-investigator Dr. Edith Pituskin noted,
“We think this is practice-changing…
This will improve the safety of the can-
cer treatment that we provide.” Other
attendees suggested “practice-
changing” potential is there, but more
study is needed.
In her summary of the symposium,
Carol Matyka (Massachusetts Breast
Cancer Deadline Action Network) noted,
“The good news: growing evidence that
we can reduce/eliminate toxic treat-
ments like chemo and radiation for
SOME breast cancers. The challenge:
Identifying the individual patients who
will or will not benefit from these treat-
ments.”
IMMUNOTHERAPY
Immunotherapy has interested cancer
researchers on and off for decades, but
is currently receiving much attention.
Some research focuses on checkpoint
inhibitors, a class of agents that inhibit
pathways that block the body’s immune
response to foreign cells, freeing up the
immune system to attack and kill tu-
mors. In MedPage Today, staff writer
Charles Bankhead summarized a pre-
liminary, small clinical study from the
SABCS meeting showing that a sub-
group of patients with advanced hor-
mone-sensitive breast cancer had
“infrequent but durable responses to the
immune checkpoint inhibitor pembroli-
zumab (Keytruda).” Another investiga-
tional antibody called atezolizumab led
to “confirmed objective responses in 10
of 24 patients when used in combination
with nab-paclitaxel (Abraxane).” These
are small studies, but indicative of this
very active, and complicated, area of
research.
EDUCATION
With so many variables, educating pa-
tients and the general public about
breast cancer research and treatment is
also becoming more complex. For in-
stance, symposium attendees cited the
rising rates of mastectomy in the United
States (including bilateral mastectomy)
despite evidence reaching back to clini-
cal trials conducted in the 1980’s show-
ing equivalent survival with lumpectomy
plus radiation for early breast cancer.
But in one SABCS presentation, a re-
view of insurance claims for breast sur-
gery from 2000 to 2011 revealed,
“Mastectomy with reconstruction is more
costly and has more complications after
surgery than lumpectomy with whole-
breast irradiation, while the rate of can-
cer recurrence and survival is essential-
ly the same under both regi-
mens.” (Mastectomy No Better Than
Lumpectomy For Early Breast Cancer,
National Public Radio, December 10,
2015).
This trend towards more mastectomies
is worrisome. In the symposium’s Wil-
liam L. McGuire Memorial Lecture, Nor-
man Wolmark, MD, cited social media’s
role in medical decision-making. Are
patients distrustful of scientific evidence
or their physicians (and more likely to
believe what they read on Facebook or
Twitter)? Or are they fueled by fear? As
Susan Love, MD, wrote in her SABCS
summary, “We seem to be losing our
respect for science.”
FINAL THOUGHT
This article covers only the tip of the
“research iceberg” presented at the
2015 SABCS. The complexity of breast
cancer research, treatment and educa-
tion underscores the urgency of Breast
Cancer Deadline 2020®, the National
Breast Cancer Coalition’s comprehen-
sive, strategic plan to know, by January
1, 2020, how to end deaths from breast
cancer. Many of the SABCS presenta-
tions focused on treatment. Breast Can-
cer Deadline 2020® focuses on primary
prevention and understanding and pre-
venting metastasis — the two areas of
research where progress will, indeed,
save the most lives.
To read more about the 2015 San Antonio Breast
Cancer Symposium, here are several helpful re-
sources: https://www.sabcs.org/Resources
http://www.cancertodaymag.org/EventCoverage/
Pages/toc.aspx
http://www.medpagetoday.com/MeetingCoverage/
SABCS
Volunteers
Welcome
Thanks to many of you, news of the
good work that NHBCC is doing in
New Hampshire has spread. While
this is very exciting, it also creates
challenges.
As a grassroots, all volunteer organi-
zation, we are often in need of more
helping hands including help repre-
senting NHBCC at local events and
interest in future Board positions. If
you would like to support NHBCC
with the precious gifts of your time
and talent, please give us a call at
(603) 659-3482 or email: NancyAlic-
[email protected]. As always, thank you
for supporting NHBCC.
6
(To Screen or Not to Screen cont. from page 1)
RESPONSE TO THE ACS GUIDE-
LINES
The response to the new ACS guide-
lines was predictable. Screening propo-
nents were up in arms. Others, citing
analyses by the US Preventive Services
Task Force (USPSTF) and the
Cochrane Collaboration, noted that
mammograms have not resulted in the
breast cancer mortality reduction we
hoped for twenty or thirty years ago.
Donald Berry, a biostatistician at the MD
Anderson Cancer Center in Houston,
Texas, stated in The Cancer Letter
(October 23, 2015), “Rather than picking
an arbitrary starting age, the most hon-
est recommendation we can make to
women is that we don’t know what to
recommend. We should help them un-
derstand why that is so by communi-
cating in an unbiased fashion the pros
and cons of screening depending on
age…and the associated uncertainties.”
Also in the Cancer Letter (October 23,
2015), Otis Brawley, MD, FACP, chief
medical officer for the ACS, stated, “In
the case of mammography for breast
cancer, there have been years of overly
simplistic messaging hyping the benefits
and not recognizing the limitations.”
UNITED STATES PREVENTIVE SER-
VICES TASK FORCE
The revised ACS guidelines come clos-
er to those recently updated by the US
Preventive Services Task Force
(USPSTF). Created in 1984, the
USPSTF is an “independent, volunteer
panel of national experts in prevention
and evidence-based medicine.” The
USPSTF provides rigorous reviews and
independent analyses, free of conflict-of
-interest, to help physicians and patients
decide what is right for them. The
USPSTF published its revised “Final
Recommendations” in the Annals of In-
ternal Medicine on January 12, 2016:
“The USPSTF recommends biennial
screening mammography for women
aged 50 to 74 years. The decision to
start screening mammography in wom-
en prior to age 50 years should be an
individual one. Women who place a
higher value on the potential benefit
than the potential harms may choose to
begin biennial screening between the
ages of 40 and 49 years. The USPSTF
concludes that the current evidence is
insufficient to assess the balance of
benefits and harms of screening mam-
mography in women aged 75 years or
older.” (http://
screeningforbreastcancer.org/)
The omnibus government spending bill
passed by Congress in December 2015
includes language from the “Protecting
Access to Lifesaving Screenings
Act” (PALS Act) mandating a two-year
moratorium on the implementation of the
recommendations by the USPSTF on
breast cancer mammography screening.
Unfortunately, in my opinion, the mora-
torium reflects a disregard for the integ-
rity and independence of the very agen-
cy created to review the evidence for
effectiveness of clinical preventive ser-
vices and to develop recommendations
for these services.
The National Breast Cancer Coalition
(NBCC) issued this statement in re-
sponse to the updated USPSTF guide-
lines:
“We at NBCC support the final breast
cancer screening recommendations by
the USPSTF and view them as good
news for women. The USPSTF guide-
lines, among the many other versions
out in the public, best reflect the actual
science of population screening. The
recommendations also are in keeping
with NBCC’s long-held position that the
public should be given much more infor-
mation about the harms and benefits of
mammography screening so that wom-
en can make better informed decisions.”
COCHRANE COLLABORATION
The Cochrane Collaboration has also
conducted rigorous analyses of breast
cancer screening trials. The Cochrane
Collaboration comprises a group of
37,000 contributors from more than 130
countries who “work together to produce
credible, accessible health information
that is free from commercial sponsor-
ship and other conflicts of interest.”
Among other conclusions, the Cochrane
Collaboration offers the following per-
spective on screening for breast cancer
(http://www.cochrane.org/CD001877/
BREASTCA_screening-for-breast-
cancer-with-mammography):
If we assume that screening reduces
breast cancer mortality by 15% and that
overdiagnosis and overtreatment is at
30%, it means that for every 2000 wom-
en invited for screening throughout 10
years, one will avoid dying of breast
cancer and 10 healthy women, who
would not have been diagnosed if there
had not been screening, will be treated
unnecessarily. Furthermore, more than
200 women will experience important
psychological distress including anxiety
and uncertainty for years because of
false positive findings…Recent observa-
tional studies show more overdiagnosis
than in the (earlier) trials and very little
or no reduction in the incidence of ad-
vanced cancers with screening.
WHAT ABOUT DUCTAL CARCINOMA
IN SITU (DCIS)?
Ductal carcinoma in situ (DCIS) is a
term to describe abnormal cells growing
in the ducts that may or may not pro-
gress to invasive breast cancer. Be-
cause women are living longer and
more women are having mammograms,
the incidence of DCIS increased over
seven-fold from 1980 to 2007 (National
Breast Cancer Coalition). The ACS esti-
mates that about 60,000 US women
receive this diagnosis annually.
(continued on page 7)
7
(To Screen or Not to Screen cont. from page 6)
Because we cannot tell which women
with DCIS will subsequently develop
invasive breast cancer and which DCIS
can safely be left alone, we treat all
these women with surgery and often
radiation and hormonal therapy. This
can lead to “overtreatment,” which may
come with significant harms. Despite the
uptick in DCIS diagnoses, the number of
invasive breast cancer diagnoses is not
dropping (National Breast Cancer Coali-
tion). Even with the addition of newer
technologies, such as 3-D mammogra-
phy (breast tomosynthesis), we do not
know if finding and treating all these
DCIS lesions will affect mortality.
BIOLOGY MATTERS
Not all breast cancers are alike. Sharon
Begley, writing in the Boston Globe
(October 20, 2015), summarized what
we know about screening this way:
It turns out that some cancers detected
by mammograms would never have
posed a threat to a woman’s health or
life. Others are so slow-growing that
even if they’re not detected until they
cause symptoms, they’re treatable. Still
others are so aggressive that even
catching them early is too late.
SHARED DECISION MAKING
The New Hampshire Comprehensive
Cancer Collaboration (NHCCC) has
convened a team of volunteers who are
working to educate New Hampshire citi-
zens about the value of Shared Deci-
sion Making in health care. The In-
formed Medical Decisions Foundation
(http://
www.informedmedicaldecisions.org/)
defines Shared Decision Making (SDM)
this way:
Shared decision making (SDM) is a col-
laborative process that allows patients
and their providers to make health care
decisions together, taking into account
the best scientific evidence available, as
well as the patient’s values and prefer-
ences. SDM honors both the provider’s
expert knowledge and the patient’s right
Make checks payable to: NH
Breast Cancer Coalition.
Mail to: NHBCC, 18 Belle Ln,
Lee NH 03861-6438 or
donate via PayPal at
www.nhbcc.org.
NHBCC welcomes your partic-
ipation even if you are unable
to contribute this year.
NHBCC is a non-profit, tax
exempt organization. All dona-
tions are tax deductible.
SUPPORT THE NEW HAMPSHIRE
BREAST CANCER COALITION TODAY
I would like to receive NHBCC news and updates.
I am willing to help on NHBCC projects or committees.
Enclosed is my financial contribution to support NHBCC’s mission and work.
Name (print)_______________________________________________________
Street/Apt.________________________________________________________
City____________________________ State_____________ Zip_____________
Email Address_____________________________________________________
Telephone Number _________________________________________________
Enclosed is: ___$20 ___$50 ___$100 ___$200 ___OTHER
to be fully informed of all care op-
tions and the potential harms and
benefits.
In my opinion, any way you look at
the data, the benefits of mammogra-
phy are modest for women under 50,
increase as a woman ages and are
unknown for women ages 75 and
older. Cancer screening recommen-
dations do vary and change over
time. This is why it is so important to
make your decisions about screen-
ing in consultation with a trusted
health care provider.
For additional viewpoints about screening for
breast cancer, visit these websites:
http://www.uspreventiveservicestaskforce.org/
Page/Document/UpdateSummaryFinal/breast-
cancer-screening1
http://www.acr.org/About-Us/Media-Center/
Press-Releases/2015-Press-
Releases/20151020-ACR-SBI-Recommend-
Mammography-at-Age-40
http://bcaction.org/resources/breast-cancer-
action-toolkits/
http://nordic.cochrane.org/mammography-
screening-leaflet
18 Belle Lane | Lee, NH 03861-6438
Change Service Requested
PLACE STAMP HERE
Support Services Fund Update Since NHBCC designed and launched the Support Services Fund
(SSF) in 2006, we have assisted over 500 New Hampshire breast
cancer patients navigate difficult and trying financial crises during
their breast cancer treatment. The SSF is a fund of last resort for
women, men and families who need help paying for the basic neces-
sities of daily living, so they can focus on their breast cancer treat-
ment and getting well. A month’s rent, heating oil or propane, utilities,
car repair, child-care, a medical co-pay or COBRA — expenses
many of us take for granted — are a few of the expenses that the
SSF covers. This program is made possible only by the support and
generosity of individuals, businesses and corporations who want to
help. As an all-volunteer organization, NHBCC puts every SSF dollar
to use immediately to assist patients and make a meaningful differ-
ence in their lives. If you, or someone you know, is battling breast
cancer and might need financial assistance from the NHBCC Sup-
port Services Fund, visit our web site (nhbcc.org) to download an
application form. Complete the one page application and take it to
your social worker to sign. NHBCC is here to help.
Year Amount
Requested Amount Authorized
2014 $172,578 $82,000
2013 $ 67,126 $45,069
2012 $204,955 $47,631
2011 $112,070 $60,018
2010 $180,777 $36,922
2009 $ 28,076 $11,629
2008 $ 88,168 $12,881
NHBCC receives requests for more financial expenses than
we are currently capable of fulfilling. With your support,
NHBCC can provide additional critical financial aid to
breast cancer patients in need. To help, visit
www.nhbcc.org.