University of Pennsylvania Health System

Focus on Cancer

Friday, October 28, 2011

From Breast Cancer Survivor to Figure Competitor: How I Out-Muscled Cancer


Leslie Spencer is a professor of health and exercise science at Rowan University in Glassboro, NJ, where she coordinates both an undergraduate and graduate degree program in health promotion and wellness. She is married to Stuart Spencer, a Presbyterian minister, and they have two sons, Sam and Miles.

 
Ask the average person how someone’s body is likely to change over the course of cancer treatment and you’ll hear a variety of responses that might include:
  • Weight loss
  • Weight gain
  • Loss of muscle mass and strength
  • A general appearance of aging skin and the lack of a healthy glow
  • Chronic fatigue, resulting in less energy for both pleasure and work
  • Hair loss from chemotherapy treatments, though some people do not lose their hair at all
What you would not expect to hear is that this person became stronger, gained muscle, and that people told her she looked better after cancer treatment than she did before her diagnosis. Yet this is exactly what happened to me!

 
At age 44, I was diagnosed with aggressive cancer in both breasts. In April of 2009, I began my treatment journey with a double mastectomy. In August of 2010, I celebrated its conclusion by competing in my first women’s figure and fitness contest. In between were three additional surgeries (including a hysterectomy for cervical pre-cancer), 18 weeks of chemotherapy and six weeks of radiation therapy. Of the above list of expected symptoms, I managed to avoid the first three entirely and minimize the chronic fatigue. The hair loss from chemotherapy was unavoidable, but it grew back thick and healthy-looking.

 
It’s ironic that a life-long believer in health and fitness who becomes a college health professor should get cancer. When I was diagnosed, people were shocked. My whole life has been devoted to healthful and whole living. I’ve taught courses and written articles that focus on behavior change and what it takes to help people maintain good health habits, including cancer-avoiding ones. What’s not ironic, though, is that I responded to my cancer with the full force of the beliefs and habits I’ve cultivated over my life. As crazy as it sounds, cancer gave me an opportunity to put to the test all I’ve been espousing for the past two decades. What’s been really thrilling is to see that it works! Someone going through cancer treatment can buck the typical, often negative, reaction to it and instead approach it with expectations of improved fitness and an enhanced joy for living.

 
So what motivated me to train for a figure competition through cancer treatment? I did it to experience victory over cancer in a direct, unexpected and powerful way. I wanted to be known as the woman who was training for an athletic competition through her cancer treatment, not just a woman who was going through cancer treatment. Was cancer the dominant theme in my life during that time? Of course it was; I would be in a state of denial if I said otherwise. But that didn’t mean that cancer was the only theme in my life.

 
I also found it highly encouraging to have a vision for something to look forward to and be excited about beyond cancer. When you have cancer, it’s easy to fill every day with medical appointments and research on your treatment options and decisions you have to make. I remember taking “days off” from cancer, i.e. days in which I would have no cancer-related appointments, phone calls or internet research. Planning for the figure competition was a very satisfying way to spend a day off from cancer.

 
Finally, you might be wondering why I chose to pursue a figure competition and not a triathlon or other fitness goal. The answer is that the figure competition gave me something unique that a different goal would not have provided in the same way. It allowed me to feel beautiful to the point of being stage-worthy in a “glitter” bikini and four inch heels! After having both a mastectomy and hysterectomy, it was special to me to feel beautiful, feminine and sexy after losing the parts of my body that are associated with being female.

 
Did I win any trophies? No, but I didn’t need to. I knew I was a winner just being there. Since then, I’ve started a website and blog, Strong and Built, to support and inspire other women to aspire to their dreams after cancer. Please visit and share your story with me!

 
Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.
The Abramson Cancer Center is pleased to present the Focus on Women's Cancers Conference featuring:
20th Life After Breast Cancer
10th Focus On Gynecologic Cancers
Focus On Your Risk of Breast and Ovarian Cancer

 
Attend Penn Medicine’s Focus On Women’s Cancer Conference
Friday, October 28, 2011
7:30 am to 3:30 pm
Hilton Hotel, 4200 City Avenue, Philadelphia, PA 19131

 
Register and view the full agenda at The Abramson Cancer Center, or register by phone at 800-789-PENN(7366).

 
Please register for only one conference but feel free on the day of the conference to attend sessions at any of the 3 conferences.

 
Portions of the program will be livestreamed at PennMedicine.org/Abramson/WomensCancersLIVE on the day of the conference.

Thursday, October 27, 2011

Recommended Temperatures for Cooking Meat

According to the National Cancer Institute, cooking meat using high heat methods, including pan frying or cooking directly over an open flame, has been found to cause cancer in animals. Experts believe that this is due to chemicals called heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs) forming in meats when cooked at high temperatures. HCAs and PAHs are both carcinogens that are not widely found in food.

Although findings remain inconclusive if cooking at high temperatures causes cancer in humans, it is important to know the temperatures for cooking safely as determined by the United States Department of Agriculture:



Also, it is always good to remember the proper temperatures for serving and re-heating foods to avoid unwanted sickness due to consumption of spoiled foods:


Serving
  • Hot food should be held at 140°F or warmer.
  • Cold food should be held at 40°F or colder.
  • Perishable food should not be left out more than two hours at room temperature (1 hour when the temperature is above 90°F).
Leftovers
  • Discard any food left out at room temperature for more than two hours (1 hour if the temperature was above 90° F).
  • Use cooked leftovers within 4 days.
Information adapted from the USDA Food Safety and Inspection Service "Safe Food Handling Fact Sheet"
Content provided by the Joan Karnell Cancer Center.

Wednesday, October 26, 2011

An Alternative Therapy for Some Breast Cancer Patients


Gary M. Freedman, MD, is an associate professor of radiation oncology at the Perelman School of Medicine and physician at Penn Radiation Oncology.

For more than 25 years, breast-conserving surgery and radiation therapy have been standard alternatives to mastectomy for women with early stage breast cancer. Radiation after a lumpectomy reduces the risk of a recurrence in the breast, and for some women it may also improve survival. The past decade has seen many advances in radiation that aim to preserve the high rates of success, but often must choose between optimizing the treatment delivery and reducing acute or long-term side effects, or reducing cost and convenience of care.

Hypofractionation uses fewer, larger dose radiation treatments (also called fractions) usually given over a shorter time period when compared to conventional radiation fraction sizes.

Hypofractionated radiation has been associated with a reduction in the length of a course of treatment by two to three weeks compared to conventional schedules that can last as long as six to seven weeks. This reduced length of treatment reduces cost to patients and insurance payers, reduces costs of travel or lost days of work to patients, and reduces the inconvenience of daily radiation treatments. This is particularly important in today’s national concern for cutting health care costs.

Hypofractionated whole-breast radiation has been a major subject of research outside of the United States for more than a decade. Randomized trials have been reported from Canada and the United Kingdom that show low breast recurrence rates using hypofractionation with long-term follow up of five to 10 years. In addition, these large studies did not show significant differences in cosmetic appearance of the breast or other negative side effects in women treated with a shorter course of radiation.

Despite the successful outcomes in these randomized trials from Canada and the United Kingdom, there has not been significant adoption of hypofractionation in the United States. The American Society of Radiation Oncology convened a task force of experts to make consensus recommendations. After a review of the available literature and randomized trials, consensus was reached that hypofractionation should be used only for selected patients. This recommendation was based on the many clinical questions that still remain about hypofractionation that are not able to be addressed by the data from the existing randomized trials.

At Penn Medicine, selected women meeting these optimal criteria are being offered the shortened radiation schedule. Current trials could make hypofractionation even more widely accepted for patients with early stage breast cancer. The Radiation Therapy Oncology Group opened a phase III randomized trial in May 2011 that proposes to establish a whole-breast three-week hypofractionation schedule that can be applied to a broader patient population. The study will compare typical whole breast radiation given over four and a half to six and a half weeks to a shorter schedule of only three weeks.

In summary, prospective randomized trials outside of the United States have established the principle that hypofractionation may be used with acceptable low side effects and equally low breast recurrence rates as conventional fractionation. However, for hypofractionation to become more widely applied in the United States, more data are needed about the optimal radiation techniques and limits on patient eligibility. This data may come from a newly opened phase III trial in the RTOG now opening at Penn Medicine and locations across the country. If successful, hypofractionation may be more widely accepted for use in the majority of patients with early stage breast cancer in the United States.


Learn more about radiation therapy for breast cancer at Penn Medicine.

The Abramson Cancer Center (ACC) is pleased to present the Focus on Women's Cancers Conference featuring:


Friday, October 28, 2011
7:30 am to 3:30 pm

Hilton Hotel, 4200 City Avenue, Philadelphia, PA 19131


Register and view the full agenda at The Abramson Cancer Center, or register by phone at 800-789-PENN(7366).

Please register for only one conference but feel free on the day of the conference to attend sessions at any of the 3 conferences.


Portions of the program will be livestreamed at PennMedicine.org/Abramson/WomensCancersLIVE on the day of the conference.

Tuesday, October 25, 2011

From the Lab to the Gym: Strength Training Helps Breast Cancer Patients


A few years ago, Kathryn Schmitz, PhD, MPH, proved through the Physical Activity and Lymphedema (PAL)Trial that slowly progressive weight training reduced the likelihood that breast cancer survivors who had been previously diagnosed with lymphedema would suffer a flare-up, and reduced the risk of onset for those breast cancer survivors who had not previously developed lymphedema.

Lymphedema is a side effect that can begin during or after breast cancer treatment. When lymph nodes are removed, the vessels that carry fluid from the arm to the rest of the body are also removed making it harder for fluid in the chest, breast, and arm to flow out of this area. If the remaining lymph vessels cannot drain enough fluid from these areas, the excess fluid builds up and causes swelling that may be accompanied by numbness, discomfort, and sometimes infection. It isn't life threatening, but can last a long time.

The PAL study was groundbreaking, since clinicians had previously thought breast cancer survivors should be cautious about overusing their arms, paying particular attention to how much weight they lift, in order to prevent lymphedema. No one doubted the value of the findings of the PAL Trial, but translating the program into one that could be done by any breast cancer survivor, anywhere in the country, in a safe and simple way is not quite as easy as it might sound.

The Strength After Breast Cancer Program was created after Dr. Schmitz and her colleagues took the essential elements of the PAL Trial and developed a six-session physical therapy-based exercise program for breast cancer survivors.

Consisting of a physical therapy evaluation, lymphedema education session, and four group physical therapy sessions, the Strength After Breast Cancer Program teaches breast cancer survivors how to safely perform strength training exercises so that they can exercise on their own either at home or in a gym setting.

Though the exercise sessions during the PAL Trial were led by personal trainers, exercise sessions in the Strength After Breast Cancer Program are led by physical therapists. A training program was created to educate the physical therapists at Good Shepherd Penn Partners Rehabilitation (GSPP) about how to lead these exercise sessions. Logistics were addressed in order to ensure that this program was easy for participants to access while also being representative of the challenges that participants in other cities might face when enrolling in a similar program. Once the physical therapists were trained and ready to enroll patients into the program, they began working with the doctors at the Abramson Cancer Center to refer women o the program.

Dr. Schmitz and her team have been educating clinical providers at Abramson Cancer Center, so they can refer breast cancer survivors to this program. From the front desk staff to the nurse practitioners and medical oncologists, all providers who interact with breast cancer survivors at Abramson Cancer Center are aware of the benefits of strength training for breast cancer patients, and how women can join the program.

The first group physical therapy session for the Strength After Breast Cancer Program were held in August. The first four participants have completed the program and plan to take what they have learned to exercising independently at home or in the gym.

Dr. Schmitz said everyone involved is excited that these women now have the necessary tools to improve their lives post-cancer. It is been an amazing journey trying to get from the setting of a clinical trial to the rollout of a clinical program, and it’s been an incredible learning experience for everyone involved, she said.

Learn more about Dr. Schmitz's groundbreaking research here.

Learn more about the Strength After Breast Cancer Program or email fitpal@upenn.edu. To speak directly with a therapist about the program, please call 215-662-4793.

Learn more about Breast Cancer Treatment at the Abramson Cancer Center.

The Abramson Cancer Center is pleased to present the first Focus on Women's Cancers Conference featuring:

Attend Penn Medicine’s Focus On Women’s Cancer Conference

Friday, October 28, 2011
7:30 am to 3:30 pm
Hilton Hotel, 4200 City Avenue, Philadelphia, PA 19131

Register and view the full agenda at The Abramson Cancer Center, or register by phone at 800-789-PENN(7366).

Please register for only one conference but feel free on the day of the conference to attend sessions at any of the three conferences.

Monday, October 24, 2011

The Value of Adjuvant and Neoadjuvant Therapy for Breast Cancer

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2011 Update in Breast Cancer: Coverage of the American Society of Clinical Oncology (ASCO) Annual Meeting CME/CE Certified Course. The course is under the direction of Kevin Fox, MD, medical director of the Rena Rowan Breast Center. This is the last of four posts about the latest findings in treating breast cancer.

More News on Aromatase Inhibitors (AIs)
A group of bone health-related studies (Abstracts 516, 517, 518) presented at the 2011 ASCO conference provided some good news on bone loss. The studies showed that postmenopausal breast cancer patients undergoing endocrine therapy (aromatase inhibitors) do not experience an increase in their total number of fractures, despite having some level of bone loss.

Over a period of approximately six years, 5 percent of patients receiving aromatase inhibitors (AIs) suffered fragility fractures, the same percentage as occurred in the control group. Studies also show that exemestane may result in less bone loss than other AIs.

A third set of AI studies (Abstracts 522,523 525) strengthened the data supporting the proposition that women who experience endocrine-related symptoms, specifically arthralgia and bone pain, while taking AIs do have improved treatment efficacy.

Regional vs. Whole Breast Irradiation for Node-Positive Cancer
The controversy regarding the optimal treatment approach for breast cancer with one to three positive nodes has existed for some time. Current treatment guidelines call for regional lymph node irradiation (RNI) for all patients with four or more positive nodes, but have been less clear about the role of RNI in cases involving one to three nodes.

Another trial highlighted at the ACO conference, NCIC-CTG MA.20, bolsters the view that all node-positive breast cancer patients should be considered for RNI.

In this large, intergroup trial, women with positive nodes or high-risk node negative breast cancer were treated with breast-conserving surgery. They were then randomized to receive either standard whole breast irradiation (WBI) or WBI plus RNI. The study demonstrated a clear advantage for the WBI plus RNI group for five year overall and disease-free survival. They did experience modestly increased toxicity, mostly attributable to a slight increase in grade II lymphedema.

Focus on Neoadjuvant Therapy for HER2-Positive Breast Cancer
Neoadjuvant therapy, or therapy that is given before primary cancer treatment, is becoming a standard way to study new approaches to treating breast cancer. Angela DiMichele, MD, assistant professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, noted the emphasis on neoadjuvant therapy at the ASCO meeting, citing several studies for women with HER2-positive breast cancer, a group for which there is a growing number of treatment options.

The first (abstracts 505, 507) combined lapatinib and trastuzamab in a neoadjuvant setting without chemotherapy for women with HER2-postive tumors >3cms or >2cms with palpable nodes. The results were positive with an overall pCR of 28 percent and a 40 percent pCR in ER- negative patients and strengthened the evidence for the dual receptor blockade as the new standard of therapy for HER2-positive tumors. The study did have an 8 percent drop out rate resulting from toxicity, primarily diarrhea and acne form rash.

The other studies (abstracts 531, 532) looked at the results of adding chemotherapy to the dual receptor blockade. The first demonstrated a clear advantage to lapatinib and trastuzamab with anthracycline-taxane therapy in terms of pCR, but left unanswered issues as to whether the increased toxicity with chemotherapy is worth the risk and whether the pCR will translate into long-term survival.

Triple-Negative Breast Cancer
While the options for HER2-postive patients continue to expand and improve, the need remains to discover more effective therapies for the 15 percent of patients diagnosed with triple negative breast cancer (TNBC). While considerable attention was focused on TNBC at ASCO 2011, the meeting did not yield significant progress for women with this disease.

Several trials offered data suggesting that basal subtypes of breast cancer might be sensitive to platinum, but much more information is needed to clarify which subgroups of patients and under which circumstances will benefit from this therapy (Abstract 1015). Similar issues apply to the use of agents targeted to the mTOR and PI3K pathways (abstract 1016). The conclusion: For TNBC, a commitment to larger, well-designed trials with integrated, adequately-powered biomarker assessment are needed.

Abstracts can be found on the 2011 ASCO meeting website.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

Are you at risk for breast cancer? Attend Penn Women’s Cancer Conference – Focus on Your Risk of Breast/Ovarian Cancer

Are you a breast cancer survivor? Attend the Penn Women’s Cancer Conference – Life after Breast Cancer

Thursday, October 20, 2011

Tips for Food Safety

Most often people contract a foodborne illness, commonly referred to as food poisoning, when eating food that was not cooked properly or left out too long. What some may not realize is that foodborne illness can also occur when eating food that has been left in the refrigerator too long.
Over time, bacteria, such as listeria, can grow on foods stored in the refrigerator. Listeria is known to cause listeriosis, a serious infection that effects individuals, like cancer patients, with a weakened immune system. Here are some helpful tips to avoid foodborne illness from foods stored in the refrigerator:


Refrigerator Safety
  • Set your refrigerator temperature below 40°F. This keeps harmful bacteria from growing. Storing food in a refrigerator with temperatures higher than 40° increases the likelihood of food borne illness.
  • Sort through the contents of your refrigerator at least once a week.
Safely Enjoying Leftovers
  • Refrigerate all leftovers promptly. Perishable leftovers should not stay out of refrigeration longer than two hours. In hot weather (90°F or above), this time is reduced to one hour.
FoodKeeps Up To
Cooked fresh vegetables3 to 4 days
Cooked pasta3 to 5 days
Cooked rice1 week
Deli meat5 days
Meat:
- Ham, cooked and sliced3 to 4 days
- Hot dogs, opened1 week
- Lunch meat, prepackaged, opened3 to 5 days
- Cooked beef, pork, poultry, fish and meat casseroles3 to 4 days
- Cooked patties and nuggets, gravy and broth1 to 2 days
Seafood, cooked2 days
Soups and stews3 to 4 days
Stuffing1 to 2 days
Information adapted from American Dietetic Association "Refrigerator Safety" Content provided by the Joan Karnell Cancer Center

Wednesday, October 19, 2011

E! Reporter Giuliana Rancic Reveals She Has Breast Cancer

It’s a recommendation based on years of research: Beginning at the age of 40, all women should have an annual mammogram to check for breast cancer.

But some doctors are recommending women get mammograms before the age of 40.
Recently, Giuliana Rancic, entertainment reporter for the E! Network, revealed that at the age of 36, she has breast cancer.

Rancic and her husband had been trying to have a baby through in vitro fertilization (IVF) treatments. Before her third treatment attempt, her doctor told her she should have a mammogram. If there was any chance she could have breast cancer, hormones related to her pregnancy may accelerate the cancer.

In an interview on the “Today Show” this week, Rancic said she fought the idea, as she was still under 40 and had no familial history of breast cancer in her family. Soon after her mammogram, she was diagnosed with early stage breast cancer.

“Usually we don’t recommend routine screening before the age of 40, but each woman should discuss this with her health care provider and weigh her individual risk for breast cancer. Some women at high risk we will begin screening much earlier, even as early as 25 years,” says Emily Conant, MD, director of women’s imaging at the Hospital of the University of Pennsylvania.

Women who come to Penn Medicine for their mammograms are screened using a revolutionary new imaging process: digital breast tomosynthesis (DBT).

“DBT often allows us to see areas better than on regular digital mammograms, because the 3-D technology captures images of the breast at different depths and angles, all during the same compression as the regular mammogram,” says Dr. Conant. “In preliminary research, 3-D tomosynthesis imaging has been shown to reduce the number of false-positives and some false-negatives making mammography using the 3-D technique more accurate.”

Like a traditional mammogram, the breast is compressed for four to five seconds while a series of low-dose X-rays images are taken to capture high-resolution images of the breast. These imaged are then digitally “stacked” to construct a total 3-D image of the breast. This image allows radiologists to scroll through, and “peel apart” the layers of the breast to view the breast tissue at different depths and angles.

“DBT offers Penn radiologists a new kind of clarity, allowing them to manipulate and see parts of the breast that we couldn’t before,” says Dr. Conant. “Therefore, we can reduce some unnecessary imaging and stress for some women.”

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

The Abramson Cancer Center is pleased to present the Focus on Women's Cancers Conference featuring:
Attend Penn Medicine’s Focus On Women’s Cancer Conference
Friday, October 28, 2011
7:30 am to 3:30 pm
Hilton Hotel, 4200 City Avenue, Philadelphia, PA 19131

Register and view the full agenda at The Abramson Cancer Center, or register by phone at 800-789-PENN(7366).

Please register for only one conference but feel free on the day of the conference to attend sessions at any of the 3 conferences.

Portions of the program will be livestreamed at PennMedicine.org/Abramson/WomensCancersLIVE on the day of the conference.

Tuesday, October 18, 2011

How Weight and Hormones Affect Breast Cancer Outcomes

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2011 Update in Breast Cancer: Coverage of the American Society of Clinical Oncology (ASCO) Annual Meeting CME/CE Certified Course. The course is under the direction of Kevin Fox, MD, medical director of the Rena Rowan Breast Center. This is the third of four posts about the latest findings in treating breast cancer.

BMI and Cancer Outcomes
In recent years, the belief that obese breast cancer patients have worse outcomes has become somewhat entrenched in the cancer community. A North American Breast Cancer Group study presented in 2010 appeared to be confirmed those findings. But just one year later, data presented at ASCO 2011 data (abstracts 513, 514, 515), appears to contradict that belief.

Angela DeMichele, MD, associate professor of medicine and epidemiology at the Perelman School of Medicine at the University of Pennsylvania, said the combined analysis of five National Cancer Institute studies demonstrate no compelling evidence that obesity, a body mass index (BMI) of 30 or more, compromises breast cancer survival. The studies also show BMI does not affect estrone (the estrogen left after menopause, made primarily by body fat) levels in postmenopausal women.

Despite the discrepancy in the findings, Dr. DeMichele reinforced the need to encourage obese women to lose weight and provide active support to women undergoing hormonal treatment to help them avoid weight gain.

Exemestane Yields Impressive Results in Prevention Study
One of the most noted studies at this year's ASCO meeting was the MAP3 trial (abstract 504), which presented persuasive evidence that the aromatase inhibitor exemestane, has a significant effect in preventing invasive breast cancer in medium to high risk postmenopausal women. The study, released simultaneously in the New England Journal of Medicine, represents a "huge victory for chemoprevention," in the words of the Angela Bradbury, MD, who presented the study at the ASCO meeting.

In this large, multinational study, women who received exemestane had a 65 percent reduction in invasive breast cancer. This is a superior result to the 50 percent reduction seen in studies utilizing tamoxifen and raloxifen.

Over a three-year period, exemestane reduced the incidence of ductal carcinoma in situ and other precancerous conditions, and appeared to reduce the incidence of more aggressive breast cancers in those women who did develop the disease. In addition, the study found that the side effects; hot flashes, insomnia, and arthralgia; were not excessive and generally well tolerated by the study participants. Serious toxicities including fractures, other cancer, osteoporosis and cardiovascular events were not seen in the study participants.

While the MAP3 results are without question important and exciting, some experts question whether healthy women will take a drug that is associated with a spectrum of menopausal type symptoms, even to achieve an important goal of reducing invasive breast cancer. The answer may depend on a variety of factors including:

  • Level of individual risk
  • Age
  • Overall health
  • Conversations between women and their doctors as they become aware of this new study and its implications for preventing the second leading cause of cancer deaths in women

Abstracts can be found on the 2011 ASCO meeting website.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

Are you at risk for breast cancer? Attend Penn Women’s Cancer Conference – Focus on Your Risk of Breast/Ovarian Cancer

Are you a breast cancer survivor? Attend the Penn Women’s Cancer Conference – Life after Breast Cancer

Coming up next, The Value of Adjuvant and Neoadjuvant Therapy.

Monday, October 17, 2011

As Surgery for Breast Cancer Evolves, So Do Outcomes


Carla S. Fisher, MD, is an assistant professor of surgery at the Perelman School of Medicine and a breast surgeon. Dr. Fisher sees patients at the Rena Rowan Breast Center.

An article was published earlier this year in the Journal of the American Medical Association (JAMA) that challenged the current way we approach breast cancer treatment and surgery.

The article discusses the results of a randomized clinical trial that took place at many hospitals across the United States. In this trial, breast surgeons found that not every woman with breast cancer that has spread to the lymph nodes may need a full axillary (armpit area) lymph node dissection. As those of us in the medical community examine the results of this study and how they apply to our own patients, it seems appropriate to review a brief history of the evolution of surgery for breast cancer.

The history of the discovery and treatment of breast cancer is rich and one that has been documented back to the ancient Chinese and Egyptian cultures, as far back as 2600 BC. The most common forms of early treatment were medical remedies. In more “modern times,” beginning the 18th century, surgery became more common and well developed as a treatment for breast cancer. Surgery almost always involved removal of the entire breast (mastectomy).

Eventually, removal of all of the axillary lymph nodes and the pectoralis major muscle (one of the main muscles of the chest wall), a radical mastectomy, was also recommended. The surgery was always the same, regardless of the size of the breast cancer or presence of disease in the lymph nodes. This radical procedure, with some minor modifications, was practiced for over 70 years, well into the 20th century. In fact, many women may recall an aunt or grandmother who underwent a radical mastectomy with subsequent deformity of the chest wall.

Surgical techniques continued to become more refined and less morbid for the patient, but it was truly the discovery of the roles of radiation therapy, medical therapies (chemotherapy and endocrine treatment) and early detection (mammography) that propelled breast cancer treatment to where it is today. In the later part of the last century, breast conservation surgery was introduced. This surgery involved the removal of the cancer, without removal of the entire breast, followed by radiation therapy. Additionally, the sentinel lymph node biopsy technique was developed that allowed breast cancer staging without removal of all of the lymph nodes in the armpit area. If the sentinel nodes contained cancer only then would a full axillary dissection (removal) be performed in which the rest of the lymph nodes would be removed.

All of these surgical advances have given women with breast cancer more choices while maintaining or improving cancer care with less side effects and better cosmetic outcomes.

Now in 2011, we have evidence that suggests that even when breast cancer has spread to the axillary lymph nodes, we may not have to remove all of these lymph nodes. The important thing to point out is that while these findings are exciting and may represent a change for some women with breast cancer, the research and findings only apply to SOME women.

Not all women undergoing surgery for breast cancer will fall within the criteria used in this study, specifically women undergoing mastectomies. Younger women and women with certain types of breast cancer also may not qualify for this less aggressive surgery. What this study emphasizes, more than ever, is the importance of an informed discussion between patients, surgeons, medical and radiation oncologists.

At Penn, our multidisciplinary approach to breast cancer care gives us the opportunity to discuss the most up-to-date research, such as this recent publication, and determine how we can best apply it our patients.

Learn more about breast cancer treatment at Penn’s Abramson Cancer Center.

The Abramson Cancer Center is pleased to present the Focus on Women's Cancers Conference featuring:

Friday, October 28, 2011
7:30 am to 3:30 pm
Hilton Hotel, 4200 City Avenue, Philadelphia, PA 19131

Register and view the full agenda at The Abramson Cancer Center, or register by phone at 800-789-PENN(7366).

Please register for only one conference but feel free on the day of the conference to attend sessions at any of the 3 conferences.


Portions of the program will be livestreamed at PennMedicine.org/Abramson/WomensCancersLIVE on the day of the conference.
 

Friday, October 14, 2011

Proton Therapy for Lung Cancer Patients at Penn

Proton therapy is external beam radiotherapy in which protons are directed at a tumor. The radiation dose that is given through protons is very precise, and limits the exposure of normal tissues. This allows the radiation dose delivered to the tumor to be increased beyond conventional radiation doses. The result is a better chance for curing cancer with fewer harmful side effects.

Unlike X-rays, protons can be manipulated to release most of their energy only when they reach their target. With more energy reaching the cancerous cells, more damage is administered by each burst of radiation while sensitive, healthy lung tissue is better protected from the effects of radiation.

Thursday, October 13, 2011

Great Marinades for the Grill

Grilling is a great way to spice up your dinner routine. But grilling meat, poultry or fish can also expose you to carcinogens, cancer-causing agents.

When fat from meat drips into the flame, it creates smoke filled with polycyclic aromatic hydrocarbons. This smoke coats the food, which we ingest.

Another type of carcinogen is formed when meat is cooked over high heat. Extreme temperatures create a reaction in the meat that produces a cancer-causing effect.

The good news is that if you take a few precautions, you can enjoy the fun and food of outdoor cooking and stay healthy, too.

By using marinades and herb rubs on meats, poultry and fish during grilling, not only are you adding a lot of flavor, but you're providing protection from the formation of carcinogens.

Here are two recipes for marinades perfect for the grill:


HERB PACKED VINAIGRETTE
  • 2 Tbsp. red wine vinegar
  • ½ Tbsp. chopped shallots
  • 2 cloves chopped garlic
  • 2 tsp. each: chopped fresh basil, tarragon, oregano and parsley
  • Salt and pepper to taste
  • ¼ c. extra virgin olive oil
  • 4 cups of salad greens
Combine vinegar, shallots, garlic, herbs, salt and pepper. Whisk in olive oil in a medium bowl.

Just before serving, toss the greens with half of the mixture. Store the other half in the refrigerator for later use as a marinade. This will keep for 2-3 days.

HERB AND SPICE RUB
  • 1 Tbsp. each chopped fresh basil, tarragon, marjoram, thyme, rosemary and parsley
  • 1 Tbsp. ground pepper, cumin, curry powder and ground coriander
  • ½ tsp. cayenne pepper
  • 1 Tbsp. maple sugar
  • ½ tsp. salt
The above rub can be used for grilling meats, poultry and fish. Will accommodate approximately 1 lb. to 1 ½ lb. of meat.

Content provided by the Joan Karnell Cancer Center

Wednesday, October 12, 2011

New Scan Detects Lung Tumors Earlier Than Traditional Scans

Penn's Abramson Cancer Center is hosting a free conference about preventing lung cancer on Friday, October 14.

Register for this free conference, or follow #LungCancerACC on Twitter on Friday, October 14 for live updates from the Focus On Lung Cancer Conference.

When it comes to lung cancer, the numbers are not good. More people in the U.S. die from lung cancer than any other type of cancer.

Consider these facts:
  • In 2011, more than 220,000 Americans will be diagnosed with lung cancer and more than 156,000 people will die of lung or bronchus cancer.
  • Smokers are 10 to 20 times more likely to get lung cancer. About 90 percent of lung cancer deaths in men and almost 80 percent of lung cancer deaths in women are due to smoking.
  • There are more than 94 million current or former smokers in the U.S.
  • Among both men and women in the United States, lung cancer is the second most common type of cancer, accounting for more deaths than breast cancer, prostate cancer, and colon cancer combined.
Screening uses tests or exams to find a disease like cancer in people who don't have any symptoms. Because lung cancer often spreads beyond the lungs before it causes symptoms, a screening test that finds lung cancer early could save many lives.

In the past, no lung cancer screening test had been shown to lower the risk of dying from this disease. Studies involving spiral CT (or helical CT) have shown some promise in finding early lung cancers in heavy smokers and former smokers. So far, major medical groups have not recommended routine screening tests for all people or even for people at increased risk, such as smokers.

People who smoke, who smoked in the past, or who have been exposed to other people's smoke, as well as those who have worked around materials that increase the risk for lung cancer need to be aware of their lung cancer risk. They should talk to their doctors about their chances of getting lung cancer and the pros and cons of lung cancer screening.

For those who decide in favor of testing, the physicians in Penn Medicine’s Lung Cancer Program are experienced in lung scanning and the latest screening techniques for people at high risk.

For information about smoking cessation programs at Penn Medicine, visit PennMedicine.org/smoking or call 800-789-PENN (7366).

Join Our Lung Cancer Webchat Live from the Focus On Lung Cancer Conference
Lung cancer experts will answer questions about risk, diagnosis and treatment. Submit questions in advance, view and participate in the live webchat and read transcripts after the webchat.
Time: 12:15 PM, EST
Website: OncoLink.org/Webchat

Tuesday, October 11, 2011

Should You Be Screened for Lung Cancer?

When it comes to lung cancer, the numbers are not good. More people in the U.S. die from lung cancer than any other type of cancer.

Consider these facts:
  • In 2011, more than 220,000 Americans will be diagnosed with lung cancer and more than 156,000 people will die of lung or bronchus cancer.
  • Smokers are 10 to 20 times more likely to get lung cancer. About 90 percent of lung cancer deaths in men and almost 80 percent of lung cancer deaths in women are due to smoking.
  • There are more than 94 million current or former smokers in the U.S.
  • Among both men and women in the United States, lung cancer is the second most common type of cancer, accounting for more deaths than breast cancer, prostate cancer, and colon cancer combined.
Screening uses tests or exams to find a disease like cancer in people who don't have any symptoms. Because lung cancer often spreads beyond the lungs before it causes symptoms, a screening test that finds lung cancer early could save many lives.

In the past, no lung cancer screening test had been shown to lower the risk of dying from this disease. Studies involving spiral CT (or helical CT) have shown some promise in finding early lung cancers in heavy smokers and former smokers. So far, major medical groups have not recommended routine screening tests for all people or even for people at increased risk, such as smokers.

People who smoke, who smoked in the past, or who have been exposed to other people's smoke, as well as those who have worked around materials that increase the risk for lung cancer need to be aware of their lung cancer risk. They should talk to their doctors about their chances of getting lung cancer and the pros and cons of lung cancer screening.

For those who decide in favor of testing, the physicians in Penn Medicine’s Lung Cancer Program are experienced in lung scanning and the latest screening techniques for people at high risk.

For information about smoking cessation programs at Penn Medicine, visit PennMedicine.org/smoking or call 800-789-PENN (7366).

Learn about proton therapy for lung cancer.

Monday, October 3, 2011

OncoLink Launches New Cancer Risk Assessment Tool

Carolyn Vachani, RN, MSN, AOCN, is a nurse educator for OncoLink®, an award-winning cancer information website sponsored by Penn’s Abramson Cancer Center. She is an oncology advanced practice nurse and has worked in the areas of medical hematology and oncology, bone marrow transplant, clinical research, radiation therapy and staff development.

Carolyn Vachani, RN, MSN, AOCN
In my time as an oncology nurse, I have sat with many families who were processing a loved one’s new cancer diagnosis. No matter the scenario, the questions are similar:
  • How did this happen?
  • What caused this?
  • What do I do now?
People want to know their own cancer risk.

Friends and family rally around the patient, helping with meals, transportation and childcare. At the same time, many are also thinking: “Why my friend and not me?” It is only natural to think about one’s own mortality when a friend is faced with a cancer diagnosis.

What’s My Risk? is a comprehensive cancer risk tool at OncoLink designed to help individuals learn about the factors that determine their personal cancer risk and what they can do to decrease that risk. By completing a detailed questionnaire about their habits, lifestyle and health history, the program identifies their risk for cancer by creating a detailed report. The report includes information about each risk factor, how it affects cancer risk and resources to change those factors that can be changed.

Some good can come from a family member or friend being diagnosed with cancer. In the medical community, it is called a “teachable moment.” It is that time when a person is so affected by their loved one’s diagnosis that they vow, whether publicly or privately, to make changes in their life to reduce their risk of being in a similar situation. Maybe they’ll start exercising, make a diet change or quit smoking. So at this moment in time when they are most open to making changes, how do they know where to start? Do they really know what habits increase their cancer risk or how to go about changing them?

What’s My Risk? is a “teachable moment;” a chance to live healthier and reduce cancer risk.

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