The Future Of Breast Cancer

Advocating for cancer screenings

OCTOBER 2015A SPECIAL SUPPLEMENT TO

OCTOBER 12, 20152

Milestones, Recent Advances And The Future Of Breast Cancer

Salamanca woman advocates for cancer screenings after own brush with disease

Message from a survivor

October marks National Dental Hygiene Montha

State offi cials: Get your vaccine to fi ght against the fl u

Higher-quality images with lower dose: Olean Medical Group installs a new CT scanner

Treat skin with care

What Age Should Women Start Mammograms?

Exercise and ailments:How exercise can help prevent disease

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In the United States, breast cancer is the second-most common cancer in women, after skin cancer. It can occur in both men and women, but it is very rare in men. Each year there are about 2,300 new cases of breast cancer in men and about 230,000 new cases in women.

The number of new patients with breast cancer has decreased in the United States since 2002, likely as a result of a reduction in hormone replacement therapy use. In 2015, more than 80 percent of women diagnosed with breast cancer will be cured.

RISK FACTORS & PREVENTION

Most breast cancers are sporadic and occur without a family history of breast cancer. Hormones are substances made by glands in the body and circulated in the bloodstream. The hormone estrogen, which makes some breast cancers grow, is mainly made by the ovaries. Any prolonged, uninterrupted exposure to estrogen (early onset of periods, delayed menopause, no children, no breast-feeding) increases risk for breast cancer. Obesity, sedentary lifestyle, alcohol use and benign breast disease are associated with a higher risk of developing breast cancer.

Mutations of BRCA1 and BRCA2 — genes that produce proteins that suppress tumors — are associated with a 50 percent to 75 percent lifetime risk of developing breast cancer

and a 30 percent to 40 percent risk — BRCA1 — or 10 percent to 20 percent risk — BRCA2 — of developing ovarian- or fallopian tube-type cancer.

Women diagnosed with breast cancer may be a candidate for genetic testing and are advised to meet with a genetic counselor if: many women in her family have had breast or ovarian cancer, particularly before age 50; some women in her family have had cancer involving both breasts; there is both breast and ovarian cancer in her family; men in her family have had breast cancer; there is breast cancer in her family and either male relatives on the same side of the family have had prostate cancer at a young age; male or female relatives on the same side have had gastrointestinal cancers, such as that of the pancreas, gall bladder or stomach; or her family is of Ashkenazi, or eastern European, Jewish descent.

MAMMOGRAPHIC SCREENING

decreases death due to breast cancer by 23 percent in women 50 to 70 years old and by 15 percent among women age 40 to 50. Annual magnetic resonance imaging of the breasts should be performed in addition to annual mammograms among women with known inherited predispositions to breast cancer (i.e., BRCA mutations) beginning at age 25.

For patients with genetic predisposition, removing the ovaries reduces the risk of developing ovarian cancer by 85 percent and reduces the risk of

developing breast cancer by 40 percent to 60 percent for women who are BRCA mutation carriers, if performed before age 50. Bilateral mastectomy reduces the risk of developing breast cancer by more than 90 percent among women with BRCA mutations.

In 1998, results of the National Cancer Institute (NCI)-sponsored Breast Cancer Prevention Trial showed that the antiestrogen drug tamoxifen can reduce the incidence of breast cancer among women who are at increased risk of the disease by about 50 percent. In 2006, results of NCI's Study of tamoxifen and raloxifene showed that postmenopausal women at increased risk of breast cancer can reduce their risk of developing the disease if they take the antiestrogen drug raloxifene. The risk of serious side effects is lower with raloxifene than with tamoxifen.

In 2011, a study showed the aromatase inhibitor exemestane decreases risk for breast cancer by 65 percent and may be an option for breast cancer risk reduction in the future if it receives U.S. Food and Drug Administration approval.

TYPES OF BREAST CANCER

The breast is made up of glands called lobules that can make milk and thin tubes called ducts that carry the milk from the lobules to the nipple. Traditionally, breast cancer is classifi ed by site of origin and most common types are ductal cancer — which begins in the cells of the ducts — and lobular cancer — which begins in the cells of the lobules. In 2014, Researchers from

The Cancer Genome Atlas (TCGA) project, a joint effort by NCI and the National Human Genome Research Institute analyzed the DNA and other molecular changes in more than 30 types of human cancer, found that breast cancer is actually four different diseases, not just one, based on differing tumor characteristics. This fi nding from TCGA and other related projects may potentially lead to a new classifi cation system for cancer, in which cancers are classifi ed by their molecular abnormalities as well as their organ or tissue site of origin.

In 1986, the human oncogene HER2 Neu is cloned. Overexpression of the protein product of this gene occurs in about 20 percent to 25 percent of breast cancers — known as HER2-positive breast cancers — and is associated with more aggressive disease and a poor prognosis.

The molecular subtypes of breast cancer, known as “intrinsic subtypes,” each with specifi c gene expression signatures and clinical characteristics, are prognostic for recurrence following breast conservation or mastectomy. This helps us determine the additional treatment after surgery. In general, the luminal subtype includes the hormone receptor positive, HER2-negative breast cancers and is the most common subtype, with an incidence of approximately 67 percent.

The luminal A subtype is often low-grade and is associated with the best overall prognosis in terms of survival. The luminal B

By Dr. Neeta SoniSpecial to Twin Tiers Health

Milestones, Recent Advances And The Future Of Breast Cancer Dr. Neeta Soni

continued on next page

OCTOBER 12, 2015 5

subtype are often hormone and HER2-positive, are often higher grade and have a less favorable overall prognosis compared with luminal A. HER2 subtype does not express hormone receptors but are frequently HER2-positive and are more often high-grade.

The basal-like subtype is associated with the least favorable prognosis, with a high risk of death. They are often classifi ed as “triple-negative,” meaning they usually, but not always, are negative for hormonal and HER2 overexpression.

TREATMENT

Five types of standard treatment are used for breast cancer: Most patients with breast cancer have surgery to remove the cancer. Chemotherapy may be given before surgery to remove the tumor. When given before surgery, chemotherapy will shrink the tumor and reduce the amount of tissue that needs to be removed during surgery. Treatment given before surgery is called preoperative therapy or neoadjuvant therapy. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy, chemotherapy, hormone therapy, or targeted therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called postoperative therapy or adjuvant therapy.

SURGERY

In 1985, results from an NCI-supported clinical trial showed that women with early-stage breast cancer who were treated with breast-conserving surgery — a lumpectomy — followed by whole-breast radiation therapy had similar rates of overall survival and disease-free survival as women who were treated with mastectomy alone.

If a patient is going to have a mastectomy, breast reconstruction — surgery to rebuild a breast’s

shape after a mastectomy — may be considered. Breast reconstruction may be done at the time of the mastectomy or at some time after. The reconstructed breast may be made with the patient’s own non-breast tissue or by using implants fi lled with saline or silicone gel.

Sentinel lymph node biopsies has reduced the need for complete axillary lymph node dissection and risk for lymphedema. The sentinel lymph node is the fi rst lymph node to receive lymphatic drainage from a tumor. It is the fi rst lymph node where the cancer is likely to spread.

RADIATION THERAPY

Radiation therapy is a cancer treatment that uses high-energy X-rays or other types of radiation to kill cancer cells or keep them from growing. In August 2015, two studies showed a shorter radiation regimen of three to fi ve weeks causes fewer side effects and offers better quality of life compared with traditional regimen fi ve to seven weeks; and two studies suggest that regional lymph node radiation after early-stage breast cancer surgery reduces recurrence risk but doesn’t improve overall survival.

In July 2015, one of the largest studies done so far on the outcomes of brachytherapy suggested that brachytherapy after lumpectomy results in survival rates are similar to whole-breast radiation. In May 2015, a study suggested that women older than 60 diagnosed with luminal A breast cancer, who take hormonal therapy after surgery may not need radiation therapy.

HORMONE THERAPY

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and

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OCTOBER 12, 20156

circulated in the bloodstream and can cause certain cancers to grow. If tests show that the cancer cells have receptors — places where hormones can attach — drugs, surgery or radiation therapy can be used to reduce the production of hormones or block them from working. The hormone estrogen, which makes some breast cancers grow, is made mainly by the ovaries. Treatment to stop the ovaries from making estrogen is called ovarian ablation.

Tamoxifen represents the fi rst of a class of drugs known as selective estrogen receptor modulators, or SERMs, to be approved for cancer therapy. Anastrozole is the fi rst aromatase inhibitor — a drug that blocks the production of estrogen in the body — to be approved for cancer therapy. Aromatase inhibitors

decrease the body's estrogen by blocking an enzyme called aromatase from turning androgen into estrogen. Anastrozole and letrozole are two types of aromatase inhibitors.

CHEMOTHERAPY & TARGETED THERAPY

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body. This is called systemic chemotherapy. Many excellent drugs are available and are very effective in decreasing risk of recurrence as well as tumor burden.

Targeted therapy is a type

of treatment that uses drugs or other substances to identify and attack specifi c cancer cells without harming normal cells. Monoclonal antibodies, tyrosine kinase inhibitors and cyclin-dependent kinase inhibitors are types of targeted therapies used in the treatment of breast cancer.

Pertuzumab is an antibody that may be combined with trastuzumab and chemotherapy to treat breast cancer. It may be used to treat certain patients with HER2 positive breast cancer that has spread to other parts of the body. It may also be used as neoadjuvant therapy in certain patients with early stage HER2 positive breast cancer. Ado-trastuzumab emtansine is an immunotoxin that is made by chemically linking trastuzumab to the cytotoxic agent mertansine, which inhibits cell proliferation by blocking the formation of microtubules. This is called an antibody-drug conjugate. It is used to treat HER2 positive breast cancer that has spread to other parts of the body.

Tyrosine kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow. Tyrosine kinase inhibitors may be used with other anticancer drugs as adjuvant therapy. Lapatinib is a tyrosine kinase inhibitor that blocks the effects of the HER2 protein and other proteins inside tumor cells. It may be used with other drugs to treat patients with HER2 positive breast cancer that has progressed

after treatment with trastuzumab.Cyclin-dependent kinase

inhibitors are targeted therapy drugs that block proteins called cyclin-dependent kinases, which cause the growth of cancer cells. Palbociclib is a cyclin-dependent kinase inhibitor approved by FDA in February and is used with the drug letrozole to treat breast cancer that is estrogen receptor positive and HER2 negative and has spread to other parts of the body.

The improved understanding of the biology of breast cancer and the mechanisms associated with resistance to treatment has resulted in improved overall survival of both early-stage and metastatic disease. A greater awareness of the molecular subtypes has enabled the development of targeted treatments and has established the benefi t of certain chemotherapies for each specifi c subtype. Next-generation sequencing is revealing transformative and comprehensive insight on cancer genomics.

These technologies may allow personalized and targeted cancer therapy strategies based on specifi c mutations detected in a patient’s tumor cells. These methods are driving the development of “precision chemotherapy,” in which treatment choices are guided by the specifi c mutations present in individual tumors.

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OCTOBER 12, 2015 7

OCTOBER 12, 20158

If you would have asked Lauren Law fi ve years ago during her battle with a life-threatening disease if she would be alive in 2015, she probably would have replied with an unconvincing ‘yes.’

But, the Salamanca resident would have been right, and she considers herself lucky and blessed she’s still alive.

Six years ago, at age 51, she started to notice changes in her body. A cyst, which she had for years near her chest, didn’t appear the same. But, she said, she chalked up its odd appearance to typical physical changes that occur with age.

Her thought process changed in July 2009 when something traumatic happened with her body.

She was in her bathroom drying off after a shower when she noticed something odd about her chest. Her left breast had completely caved into her body.

“I tried not to panic, but when you see something like that happen right before your eyes, it’s startling,” she said.

She was also trying not to fret because she didn’t have health insurance.

“At the time, I thought, if there is something wrong with me, there is nothing I can do because I didn’t have insurance,” she said. “I found out that I was wrong.”

A friend alerted her to the Cancer Services Program of Allegany and Cattaraugus

Counties, which eventually provided Law with most of the assistance she needed to address her issue.

“They directed me with how to get set up with Medicaid. They provided me with a phone card so I could call doctors, and they gave me gas cards so I could afford to pay for trips to the doctor,” she said. “If it hadn’t been for everything they did for me, I wouldn’t have known what to do and I wouldn’t have been able to afford to get treatment.”

Within a couple of months of calling Cancer Services, Law received a mammogram, a biopsy of tissue from her breasts and a diagnosis.

She was nearly in stage 3 of breast cancer.

“I had three lumps in my left breast, and doctors discovered precancerous cells in my right breast,” she said.

A double mastectomy and lymph node removal followed within a month of her diagnosis. Following the surgeries, she had to receive chemotherapy every

two weeks for a year and then radiation treatment for two months.

“Everything happened so fast. I went from being healthy — tonsil removal was the only surgery I’d ever had — to becoming a human pin cushion whose insides were on full display for all the doctors to see,” she said. “I really didn’t have time to be sad, but let me tell you, I sure learned a lot from the experience.

“Early detection is so crucial to beating cancer. If cancer is caught early, the treatment may not have to be as aggressive as the treatment I had to receive. If I would have gone for annual screenings, the cancer would have been located sooner and I may have been able to keep both of my breasts.”

Since her bout with cancer, Law has made it a point to attend every screening recommended for her age. She also has any bumps, lumps, lesions or other physical abnormalities examined by a doctor as soon as she notices them.

“I feel so paranoid now, but the doctors don’t treat me that way. They are happy that I’m being proactive,” she said, adding that others should be proactive, too.

“I can’t stress enough that people should go for their annual tests and screenings. People also need to gain awareness of their own body.”

Women who aren’t sure where to go for screenings, or what to do to complete a self-exam, can call Cancer Services for help.

“I am so grateful for Cancer Services’ help and also for the amazing care I received from the doctors who treated me and for the overwhelming amount of support I received from my family and friends,” Law added. “Without all of those things, I’m not sure if I’d still be here today.”

By Darlene M. DonohueSpecial to Twin Tiers Health

Salamanca woman advocates for cancer screenings after own brush with disease

Olean Times Herald fi le photoLauren Law is a breast cancer survivor who is celebrating five years in remission.

years near her chest, didn’t appear

typical physical changes that occur

traumatic happened with her body.

afford to get treatment.”

Within a couple of months

to beating cancer. If cancer is caught early, the treatment may not have to be as aggressive as the treatment I had to receive. If I would have gone for annual screenings, the cancer would have been located sooner and I may have been able to keep both of my breasts.”

Law has made it a point to attend every screening recommended for her age. She also has any bumps, lumps, lesions or other physical abnormalities examined by a doctor as soon as she notices

“I really didn’t have time to be

sad, but let me tell you, I sure learned

a lot from the � perience.”

OCTOBER 12, 2015 9

After battling breast cancer and emerging as a survivor, Debbie Moyer’s message to others with the disease involves three basic principles: Be positive; involve your family; and, above all, stay busy.

Moyer, a resident of Bradford, shared her story on surviving breast cancer to provide hope and encouragement to other women and men affected by the disease.

Moyer said she received the devastating news seven years ago while working as a nurse at an obstetrics and gynecology offi ce with Bradford Regional Medical Center. At the time, she was a 45-year-old health professional who had regular mammograms and other check-ups.

While her mammogram results came back normal that year, she believed there was something wrong and went for additional tests at the Elizabeth Wende Breast Care clinic in Rochester. After she received the news she had cancer in one of her breasts, she decided to go to Cleveland Clinic in Ohio for treatment.

Moyer was proactive with the disease and opted for a double mastectomy for “peace of mind.” The surgery was immediately followed by numerous reconstructive treatments with a plastic surgeon.

After she healed from the surgery, she received 45 radiation treatments in Olean, N.Y.

Moyer said her husband, Greg, and daughters Darci and Ashtin, were her “rocks” and helped her through the entire ordeal.

“They did real well with it and were very supportive through the whole thing,” Moyer said.

Her husband and daughters also were a huge help when she returned home from the hospital. Her daughters helped her with the

basics, such as showering and cooking meals.

“I stayed upbeat because I didn’t want them to be sadder than what they already were. I never shed a tear,” Moyer recalled. “My husband never missed an appointment. He was so supportive, and my daughters were, too.”

Moyer said she returned to work three weeks after her surgery and worked throughout her radiation treatment, despite the fatigue that resulted. She remained upbeat in front of her fellow staffers, as they were quite upset about her illness.

“At the time, they took it harder than I did,” Moyer said. “I continued to work through it, and I did my daily thing.

“I felt really good, because there I was in scrubs and going to work every day. I kept positive because I wanted to get back to normal.”

And despite a few additional struggles with her follow-up treatments, she did return to normal. She is grateful for her “second chance” with life and all that affords her, including time with her husband, their daughters, their song-in-law and their two granddaughters.

Moyer also supports the Susan G. Komen breast cancer foundation at her new place of employment in the health and safety fi eld.

Moyer said she regularly organizes a Tree of Hope fundraiser, basket raffl es, breast cancer awareness projects and presentations for Komen. All proceeds are given to the foundation, which provides funds to uninsured and underinsured women fi ghting breast cancer.

“It’s not the end of your life,” Moyer said of the disease. “I was given a second chance — and I’m going to make the best of it.”

By Kate Day SagerSpecial to Twin Tiers Health

Message from a survivor

Photo submittedDebbie Moyer (second from left) owes much of her return to health after battling breast cancer to her family, Darci Corignani (remaining, from left), Greg Moyer and Ashtin Sirabella.

OCTOBER 12, 201510

Have you fl ossed lately?This October marks the sixth

consecutive year in which the American Dental Hygienists’ Association (ADHA) and the Wm. Wrigley Jr. Co. are collaborating during National Dental Hygiene Month to increase public awareness and education about the importance of proper dental care and oral health, and locals are following the initiative.

According to Dr. Stephen Barket of the Bradford Dental Center and Mount Jewett Health Center, “Flossing is just as important as brushing, and we encourage

members of the community to maintain regular check-ups even if no teeth are hurting, now and all the time.”

Correspondingly, the scope of focus this year during National Dental Hygiene Month centers upon the four components of proper oral care, which include brushing teeth twice daily, fl ossing at least once per day, rinsing with antimicrobial mouth rinse and chewing sugar-free gum as opposed to the alternative fl avored gum.

Dental hygienists are encouraged to instill upon patients and their community to “do the daily four” and work with their local

dentist on how to integrate proper oral health habits into their daily routine.

Throughout National Dental Hygiene Month, the ADHA and other collaborators will focus on assisting these hygienists in making a difference in their communities, as well as offering resources to help raise awareness and spread education on the matter.

Starting a conversation with your local dental hygienist on how to implement good oral care into your routine will not only benefi t dental health, but will also contribute to improved overall health. For, as Dr. Barket explained, “Oral health may be an indicator of a person’s overall health, so it is important to maintain dental care and attend appointments as you would any other health care provider.”

The Bradford Dental Center offers a variety of family dental services, including cleanings, fi llings and extractions, as well as same-day emergency care opportunities. The center has seven operatories and provides services for children as well as adults.

“We offer customized treatment plans to achieve the best results for every patient,” Barket continued. “Dental professionals utilize the latest in technology and the newest procedures to ensure quality dental care, in order to achieve healthy smiles for every person who walks through our doors; this time” — during National Dental Hygiene Month — “and every time.”

By Amber TurbaSpecial to Twin Tiers Health

October marks National Dental Hygiene Month

Dr. Stephen Barket

OCTOBER 12, 2015 11

With an unpredictable fl u season coming, a state health offi cial says the best means of prevention against infl uenza viruses is a vaccination.

In fact, the Associated Press reports at least 171 million doses of the fl u vaccine are expected to be given out this year.

“Flu is unpredictable and how severe it is can vary widely from one season to the next. When more people get vaccinated against the fl u, less fl u can spread through that community,” said state Department of Health press secretary Amy Worden.

Across the United States, fl u season can hit beginning as early as October and last as late as May.

“During this time, fl u viruses are circulating at higher levels in the U.S. population,” she said.

The contagious disease attacks the respiratory tract — the nose, throat and lungs — and is different from a cold. Flu-like symptoms include a fever, headache, tiredness (can be extreme), dry cough, sore

throat, nasal congestion and body aches.

The Department of Health recommends that those 6 months and older should get a fl u vaccine each year.

“Since each year the fl u strain may be different, it is important to get a fl u vaccine annually,” Worden said. “During a regular fl u season, about 90 percent of deaths occur in people 65 years and older.”

Those older than 65, pregnant or suffering from a chronic illness or disease should consult with their doctor regarding a fl u and pneumonia vaccination, according to the Department of Health.

Vaccines can come in other forms beyond needles. A needle-free device called a jet injector delivers the vaccine into a stream of fl uid that penetrates the skin, which is recommended for those 18 to 64, according to the AP. A nasal vaccine is also available, recommended for those 2 to 49.

Many vaccines are covered under private and government health insurance, typically without a co-pay, according to the AP. Out-of-

pocket costs range from $32 to $40.In addition to getting a vaccine,

the Department of Health suggests that individuals wash their hands thoroughly with soap and warm water and be careful what they touch.

“Cover your nose and mouth with hands or tissues when coughing or sneezing,” state health offi cials say. “Wash hands afterward to prevent spreading germs to doorknobs and other items. Discard tissues right way.”

The Department of Health also

recommends individuals get plenty of rest, eat properly and dress appropriately for the weather.

“When ill, prevent the spread of germs by staying home from school or the workplace, if possible,” state health offi cials say. “During fl u season, minimize time in crowded areas, such as shopping centers, and avoid contact with those at high risk for the fl u, such as the elderly and those with chronic illness.”

More information about the fl u in Pennsylvania can be viewed at www.fl ufreepa.com.

By Alex DavisSpecial to Twin Tiers Health

State offi cials: Get your vaccine to fi ght against the fl u

OCTOBER 12, 201512

Olean Medical Group has invested in higher-diagnostic-quality images at a lower dose to patients with the addition of GE Healthcare’s leading CT imaging technology.

The Optima CT 660 delivers high-quality images while delivering optimized dose levels, OMG offi cials say.

The Optima CT 660 is equipped with the exclusive Adaptive Statistical Iterative Reconstruction low-dose reconstruction technology that signifi cantly reduces dosage while maintaining the high image quality and low-contrast detectability needed for accurate diagnosis, offi cials explain.

“An accurate diagnosis is key to any health concern, and having

access to sophisticated medical technology is vital,” facility CEO Dan Strauch says. “At Olean Medical Group, we are very happy to have invested in Optima, enabling us to improve our imaging capabilities and investing in state-of-the-art equipment to better serve our patients.”

The Optima CT 660 system is a 64-slice scanner that allows for fast, high-quality images at optimized dose for patients young and old, large and small. It can be used across a wide spectrum of procedures, including cardiac, angiography, brain, chest, abdomen, orthopedic and more. It is environmentally friendly, with electronic innovations that cut power consumption by 60 percent, offi cials say.

According to the American Cancer Society, skin cancer accounts for the largest number of cancer diagnoses in the United States. Each year, nearly fi ve million Americans are treated for skin cancer, with most cases being nonmelanoma skin cancer, typically diagnosed as basal cell carcinoma or squamous cell carcinoma.

But skin cancer is not the only condition that can affect the skin. From rosacea to eczema to acne to psoriasis, the skin can be affected by numerous conditions, many of which can be both uncomfortable and embarrassing. Keeping skin healthy requires

effort, and there are many things men and women can do to protect their skin and reduce their risk for various conditions.

Schedule routine visits to a dermatologist. Dermatologists can treat and help prevent disorders of the skin, and men and women should make annual visits to their dermatologist to ensure their skin is healthy. Dermatologists can diagnose if a mark or a blemish is something benign or serious and provide information on various courses of treatment. As with any specialist, dermatologists may be well versed on new and innovative care. If anything on your skin seems suspect, visit a

dermatologist right away.Protect yourself from the sun.

The single best thing you can do for your skin is to protect it from the sun. Not only can a lifetime of sun exposure cause wrinkles and age spots, it can lead to cancer. Use a broad-spectrum sunscreen with an SPF of at least 15. Apply it every two hours or more often. Make sunscreen a part of your daily regimen, applying it as you would moisturizer or antiperspirant.

Quit the habit. The Mayo Clinic says smoking narrows tiny blood vessels in the outermost layers of skin, which decreases blood fl ow. This robs the skin of oxygen and nutrients it needs to stay healthy.

Smoking also can damage the collagen and elastin in the skin, which promotes elasticity.

Be gentle to the skin. Use mild cleansers and limit showers and baths to warm water. Moisturize dry skin if it is problematic. Pat skin dry after washing and do not tug or rub skin excessively.

Inspect skin regularly. Routinely check your skin for any changes and share any concerns with your doctor. Schedule annual skin checks as part of yearly physical examinations.

Taking these steps can help you maintain healthy skin and prevent ailments in the years to come.

Higher-quality images with lower dose: Olean Medical Group installs a new CT scanner

Treat skin with care

Photo submittedRadiology techs Lauren Keim (from left) and Ashlee Puffer assist Dr. Gil Witte, pulmonologist at Olean Medical Group, with a patient.

OCTOBER 12, 2015 13

Susan Goodman, later Susan Goodman Komen, was born in 1943 in Peoria, Ill. She was diagnosed with breast cancer at the age of 33.

She died of the disease at age 36 in 1980. Komen’s younger sister, Nancy Goodman Brinker, who believed that Susan’s outcome might have been better if patients knew more about cancer and its treatment, promised her sister she would do everything she could to end breast cancer. To fulfi ll that promise, Brinker founded the Susan G. Komen Breast Cancer Foundation in 1982.

There are many stories like

Susan’s. A few weeks ago, I delivered a mother who is 28 years old. She had a beautiful baby girl. At her postpartum visit, and after reviewing her family history, I ordered genetic testing that revealed the patient has a BRCA mutation, a gene that increases her risk for breast and ovarian cancer. Her newborn daughter has a 50 percent chance of having the mutation.

According to the Centers for Disease Control and Prevention (CDC), not counting some kinds of skin cancer, breast cancer in the United States is the most common cancer in women. It It results in the most cancer-related deaths among Hispanic women and the second-most among white, black, Asian/Pacifi c Islander and American Indian/Alaska Native women.

In 2012, 224,147 women and 2,125 men in the United States were diagnosed with breast cancer. There were 41,150 women and 405 men in the United States that died from breast cancer.

The American College of Obstetrics and Gynecology (ACOG), American Cancer Society, American Medical Association, American College of Physicians, American College of Radiology and American Academy College of Family Physicians recommends annual mammograms starting at age 40

unless the patient has signifi cant family history and is BRCA positive. In an interview with The Washington Post’s Dr. Kirsten Bibbins-Domingo, who is the president of The U.S. Preventive Task Force (USPTF), she recommended to start screening at age 50. However, she reported that the decision to start regular mammography screening before age 50 is an individual one based on a woman’s values, preferences and health history.

By Mazen Fouany, MD FACOG, Board Certifi ed OB/Gyn at Cole MemorialÕ s WomenÕ s Health CenterSpecial to Twin Tiers Health

What Age Should Women Start Mammograms?

Dr. Mazen Fouany, MD

continued on page 14

Photo submittedTamra Sickler performs a mammography screening at the Women’s Health Center at Cole Memorial Hospital in Coudersport, Pa.

OCTOBER 12, 201514

This decision should be made in partnership between women and their physicians. The USPTF agrees that patients with positive family history are candidates to start screening at 40.

As a member of ACOG, I recommend clinical breast examinations every one to three years in patients between 20 and 39 and annually after 40. Despite the low risk of having breast cancer at 40, I still recommend starting mammograms at 40 after discussing the risks with the patient and taking into consideration the stress and anxiety that abnormal tests may cause.

My rationale to start screening at 40 is that tumors detected at an early stage that are small and confi ned to the breast are more likely to be successfully treated, with

a 98 percent fi ve-year survival for localized diseases. After 18 years of follow-up, one initial study found that 89 percent of tumors measuring 1 centimeter or less were cured by primary surgery. Other studies have confi rmed these results, with 90 percent of patients experiencing 10-year (or longer) disease-free survival periods after tumors measuring 1 centimeter or less were detected by mammography, indicating the likelihood that the tumors had not yet metastasized before they were diagnosed and treated.

The potential adverse outcomes of breast cancer screening mammography include false-positive mammograms, false-negative mammograms and overdiagnosis. Stopping mammograms at age 75 is recommended in a patient with no prior history of breast cancer. Digital mammography and breast tomosynthesis are new techniques

that will defi nitely improve our ability to diagnose breast cancer and reduce the numbers of unnecessary procedures.

Here are some other tips:

• Breast self-awareness should be encouraged and can include breast self-examination. Women should report any changes in their breasts to their health care providers.

• Women should be educated on the predictive value of screening mammography and the potential for false-positive results and false-negative results. Women should be informed of the potential for additional imaging or biopsies that may be recommended based on screening results. • Breast MRI is not recommended for screening women at average risk of developing breast cancer.

• For women who test positive for BRCA1 and BRCA2 mutations, enhanced screening should be recommended and risk reduction methods should be discussed.

The Women’s Health Center at Cole Memorial Hospital in Coudersport, Pa., periodically offers free mammograms for uninsured and underinsured women ages 40-plus in connection with the Twin Tiers affi liate of Susan G. Komen. For more information or to make an appointment for women’s health services at Cole Memorial, call (814) 274-7101.

(Dr. Mazen Fouany is a board-certifi ed obstetrician and gynecologist at Cole Memorial’s Women’s Health Center)

continued from page 13

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The benefi ts of routine exercise are plenty. Daily exercise can improve mood, help reduce stress and make it easier for men and women to maintain healthy weights.

Regular exercise also can help men and women combat or reduce their risk for various ailments, including some potentially deadly diseases.

OsteoporosisOsteoporosis is a condition in

which bones become brittle and fragile from loss of tissue. Though

post-menopausal women are most susceptible to osteoporosis, anyone can get the condition, which can lead to fractures and other bodily injuries. But routine weight-bearing exercises, including strength training, walking and jogging, can strengthen bones and prevent osteoporosis and bone loss. A Nurses’ Health Study published in The Journal of the American Medical Association found that women who walked for four or more hours per week had 41 percent fewer hip fractures than women who walked less than one

hour per week.

Back painPeople experiencing back

pain may feel that inactivity is the best approach to overcoming it. But prolonged inactivity may only exacerbate back pain. Men and women dealing with back pain should always consult a physician for the best approach to alleviating their pain. Don’t be surprised if, during such consultations, your physician prescribes certain back exercises. According to www.spine-health.com, a Web-based resource for back and neck pain sufferers developed by a multi-specialty group of medical professionals, certain back exercises can distribute nutrients into the disc space and soft tissues in the back to keep the discs, muscles, ligaments, and joints healthy.

Heart diseaseAccording to the Centers for

Disease Control and Prevention, heart disease is the leading cause of death in United States, while Statistics Canada notes it is the second-leading cause of death among Canadians. Regular exercise can greatly reduce a person’s risk of developing heart disease by strengthening the heart, lowering blood pressure and helping the heart function more effi ciently. Even moderate physical activity can have a profound impact on heart health.

Type 2 diabetesA joint study from the American

College of Sports Medicine and the American Diabetes Association

found that participation in regular physical activity can prevent or delay type 2 diabetes, a potentially deadly condition, the prevalence of which has increased considerably over the last several decades. The American Diabetes Association recommends that people who already have type 2 diabetes check their blood glucose levels before and after exercise to see how their bodies react to different activities. Understanding such reactions can help people with type 2 diabetes prevent their blood glucose levels from getting too high or too low.

Exercise is essential to a healthy lifestyle. But while regular exercise can instantly improve your quality of life, it also can reduce your risk for a host of potentially deadly ailments.

Exercise and ailments:How exercise can help prevent disease

A person’s mind can play a large role in how quickly he or she is able to lose weight. Exercise and diet alone may not be enough, and positive thinking can provide the extra boost some people need. A Harvard study found that mind over matter may extend to weight loss as well. The study followed 84 cleaning women, half of whom were told that their physically demanding jobs met the requirements for exercise as set by the Surgeon General, while the other half weren’t given any information about their activity level and calorie burn. After a month’s time, researchers discovered that the group of women who were told that their work activity was good for them reduced their body fat, waist-to-hip ratio and body mass index. These participants had not changed anything else about their daily exercise and eating habits. The other group of women who were given no positive reinforcement did not lose any weight.

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