Blog Highlights:

• Martina Navratilova describes her initial reaction when informed she had ductal carcinoma in situ (DCIS) breast cancer
• “This was my personal  9/11″ says Navratilova
• For those of you just confronting the diagnosis of cancer, read below for a list of what I would recommend

This interview of Martina Navratilova with Robin Roberts (herself a breast cancer survivor) describes the initial emotional reaction that women go through when informed: “you have breast cancer”.  In her case, there was a “good news/bad news” circumstance, for her diagnosis was “ductal carcinoma in situ” (DCIS). This is actually a precursor of invasive breast cancer and associated with a very low risk of relapse or dying of breast cancer. Nevertheless, the diagnosis can strike fear and uncertainty because breast cancer can be a “silent killer” and it can occur – and recur – without warning or symptoms.

I can imagine how Martina felt when informed that she had breast cancer.  She is one of the most athletically fit women in the world and is the Health and Fitness Ambassador to the American Association of Retired Persons (AARP). She exercises regularly, has a healthy diet, drinks very little alcohol – and yet that doesn’t protect her against cancer.

Listen to the emotional reaction as she described her initial encounter with the diagnosis of breast cancer in this interview:  “This was my personal  9/11”…. “I couldn’t think, couldn’t move”…..“The emotions took so much strength out of me.” She is no doubt an emotionally strong person in other domains of her life, but facing the diagnosis of cancer is very unsettling. These are typical reactions of women and men when confronted with the diagnosis of cancer.

• First: “I made a plan.”
• She engaged a support system around her. As Martina stated, it is difficult sometimes to ask for help, especially among women who are inherently caregivers themselves. Her friends accompanied her to the surgical treatment and supported her through the experiences.
• She talked about it in a public forum. It was not only therapeutic for her, but her message is vitally important for other women.

The treatment options for DCIS vary enormously. They range from a lumpectomy (or segmental mastectomy) alone, to lumpectomy plus radiation, to mastectomy. What is right for you depends upon the size of the tumor and other features of the tumor such as the “nuclear grade”.  Martina revealed that she had a Grade 3 DCIS tumor, which is associated with a higher rate of relapse within the breast after lumpectomy alone.  So she and her doctors elected to add radiation therapy to the breast in order to reduce the risk of relapse.

In another article titled “Why Are Biomarkers Important for DCIS Breast Cancer Patients?“, I have discussed a new advance in using biomarkers in patients with DCIS that can help partition patients with this condition into very low risk for breast relapses (and therefore more safely allow for conservative treatments) compared to other presentations of DCIS associated with a higher risk of breast relapses for which breast radiation therapy or even mastectomy might be appropriate.

In retrospect, should she have done anything differently? Well, yes. She skipped a few years and did not have an annual mammogram, as we have recommended for someone of her age of fifty-two years old. “I let it slide. Everyone gets busy, but don’t make excuses,” she said. A central theme of her message (which I totally support) is: “Everyone (in my age group) should have a mammogram every year.”  Good advice!!!

For those of you just confronting the diagnosis of cancer, here is what I would also recommend ( in addition to the valuable advice above):

• Be a student of your cancer. Learn the basic facts from reliable sources, including our own websites www.patientresource.net
• Know the stage of disease and the details of the pathology report
• Know  the options for treatment that would apply to your circumstance. For example, if you have breast cancer look at the charts of treatment options from our companion website patientresource.net
• Be prepared to engage your cancer doctors with good questions and an attitude that you are a partner in the decision-making. You and your doctor will make a “joint decision” that blends together the doctors medical opinion plus your input in selecting treatment options (when they are equal in outcome) that takes into account your own philosophy about potential benefits and risks of various options when they are available.

I’m convinced after 35 years of counseling and treating cancer patients that an informed, educated patient will always get better care and enjoy a better quality of life. Make sure you are focusing on information that is pertinent to your own diagnosis and stage of disease. Don’t get misled by information that is too general or by reading about aspects of diagnosis and treatment that don’t apply to you. It can lead to unnecessary anxiety or, conversely, to unjustified complacency.

Cancer is a complex and diverse collection of diseases, so getting the right information from trusted and reliable sources that is directly pertinent to your situation is key. Look at comprehensive websites for cancer patients, such as www.patientresource.net,  www.cancer.net, and www.cancer.org as starting places for information. Be sure to talk with your doctor and the staff in order to be sure that the information you are gathering correctly applies to your situation.

Cancer does not discriminate in any way! It affects rich and poor, famous and infamous, powerful and weak, all with an equal vengeance. It can affect whole families. I know….both of my parents died of cancer.

Senator John Kerry had prostate cancer, and his wife Teresa Heinz was recently diagnosed with breast cancer. These are two of the most common cancers that affect Americans. Both of them had an early diagnosis because of screening tests. Senator Kerry’s prostate cancer was discovered by a PSA test (a test that is becoming more common) and his wife by a screening mammogram. In this video, Teresa speaks out against the recommendations for mammography screening by the US Preventative Health Task Force, as I have done in a recent blog (see “Raging Debate on Mammography Guidelines“).

Hopefully both Mr. and Mrs. Kerry have a very successful outcome. We are grateful that they have come forward with their cancer story. It raises hope among us….we are all in this battle together!

I recently saw a re-run of an interview on Oprah with Christina Applegate, and she explained why she chose a double mastectomy for the treatment and prevention of breast cancer. I cannot share the Oprah video, but above is another good segment discussing this topic.If you want to see a text version of her interview, go here to Oprah’s website.

Christina Applegate and Sheryl Crow both had breast cancer, but they chose a different surgical treatment for their disease. Christina chose double mastectomy with breast reconstructive surgery while Sheryl Crow chose a lumpectomy only. See my blogs on Sheryl Crow at http://mycanceradvisor.com/2009/04/20/121/ and http://mycanceradvisor.com/2009/06/28/cheryl-crow-talks-with-her-surgeon-about-her-experience-with-breast-cancer/.

As Christina Applegate discussed on the Oprah Winfrey Show, she was very satisfied with her choice and with the results. Likewise, when Sheryl Crow discussed her results on YouTube (with her surgeon no less) she was very satisfied with the symmetry of her breast after surgery. These two stars illustrate how different choices can lead to appropriate results in individual breast cancer patients. Sometimes the size or multiple areas of breast cancer will medically necessitate a mastectomy. In other circumstances a woman may choose a single mastectomy (or a double mastectomy) out of concern for recurrences in the breast at a later time. In effect they are choosing a form of cancer prevention through a mastectomy. On the other hand, a lumpectomy (almost always with breast irradiation) is another equally good option for other women who want to keep their breasts in tact and understand that there is a possibility (of 8-10%) that their breast cancer will return in one or the other breast. Women who have a strong family history, who have had multiple biopsies, who have difficult breasts to follow on X-ray, or who have inherited susceptibility genes (BRAC-1/2), or certain types of breast cancer (especially Lobular Carcinoma) are at increased risk for having a second breast cancer at a later time. If a woman chooses this option, then careful follow-up with screening and chemo prevention (with hormone therapy) should be their treatment plan.

For Christina Applegate, she won’t ever have to have a mammogram again or worry about the prospects of recurring breast cancer or of dying from it. Both choices are medically appropriate and must be tailored to the “risk avoidance” philosophy of the patient and their own perception about how the surgical choice affects their quality of life.

She has formed a Foundation that helps women at high risk for breast cancer that do not have adequate insurance or financial capability to cover essential breast screenings get financial help. See her website at http://www.rightactionforwomen.org/.

For more information about this subject see my previous blogs on Surgical Treatment Options for Breast Cancer and In the Operating Room: Breast Reconstruction. For detailed information about breast cancer staging and treatment go to our companion website, patientresource.net.

This is an inspiring and informative interview with Congresswoman Debbie Wasserman Schultz (D-Florida) and Robin Roberts of Good Morning America. She shares her experience and discusses how she approached her children about her disease. I would recommend this to cancer patients as one approach to talking with your children about their cancer without it being a threatening, fearful experience.

Schultz reveals that she had her first mammogram at age 40, which was normal, but then found a lump in her breast a year later that turned out to be a breast cancer. There were many considerations that she discusses about her surgical treatment options, about the impact of her genetic testing and about the timing of telling her children, 9-year-old twin girls and a 5-year-old boy. She had an early breast cancer detected, and also obtained genetic testing and discovered she was positive for the BRAC 2 gene. She was heading for a lumpectomy, but instead decided on double mastectomy after learning the results of genetic testing. The removal of the opposite breast was a strong consideration in her circumstance, even though it is an extreme form of cancer prevention, because she faced 65% odds of having a later recurrence in her normal (opposite) breast. Since she was BRAC2+, she also faced a high risk of developing ovarian cancer, so she elected to have her ovaries removed as another component of cancer prevention surgery.

Soraya was one of my favorite singers! Unfortunately, she had a very strong family history of breast cancer, including in her mother and her sister. She developed breast cancer while she was in her 30s. Soraya became a well-known breast cancer advocate and was a spokesperson for the Susan B. Koman Foundation for the Cure She died in 2006 at age 37. Watch this video to hear her story and her message about breast cancer.

Melissa Etheridge is a Grammy Award winning singer who developed breast cancer that spread to a lymph node. After surgery, she had adjuvant (added) chemotherapy. This video is an A&E Biography of the Year (2005) segment in which Melissa describes discovering the breast lump, her surgery, and her ordeal with chemotherapy. She came away from her experience with a strong appreciation for her life and her health, which she captured in some of her songs.

Here’s more information from patientresource.net:

Chemotherapy for breast cancer is most commonly used as adjuvant treatment; it may also be used as the primary treatment for metastatic breast cancer or as neoadjuvant therapy for large tumors. Chemotherapy is usually given as a combination of two or three drugs, sometimes given together and sometimes given after one another (sequentially).

Most chemotherapy drugs for breast cancer are given through an injection in a vein (intravenously), with the infusion lasting 30 to 90 minutes, depending on the drug. Chemotherapy is usually given in the doctor’s office or an outpatient clinic.

Chemotherapy is given in cycles, which consist of a treatment period (usually 1 day) followed by a recovery period (usually 3 weeks). The recovery period allows the noncancerous cells in your body to repair themselves from damage caused by chemotherapy before you receive more treatment. Some cycles may be shorter or longer (such as 14 or 28 days). A typical course of treatment is four to eight cycles, but the number of cycles can vary depending on the type of treatment and the response.

Some chemotherapy regimens are preferred because of their effectiveness in terms of response and survival, but other combinations are also often effective. Choosing a chemotherapy regimen involves considering not only whether there is benefit but also how much benefit in relation to the side effects. In addition, certain drugs or types of drugs may be more effective for tumors with specific characteristics. For example, anthracycline drugs (doxorubicin, epirubicin, or pegylated liposomal doxorubicin) have improved survival for women with HER2-positive tumors but not HER2-negative tumors. Researchers continue to study various combinations of chemotherapy drugs, as well as the genetic make-up of tumors, to determine which regimens offer the best chance of a long period of disease-free and overall survival for women with specific types of tumors.

As with radiation therapy, chemotherapy drugs may damage healthy cells that divide rapidly, and you will have blood drawn before each treatment session to check the level of your blood cells. Treatment may be delayed until your blood cells reach a healthier level. You should tell your doctor about side effects you have from chemotherapy. If the effects become severe, another chemotherapy drug may be more appropriate and you can feel better during treatment.

For women receiving chemotherapy for late-stage cancer, the disease response to treatment will be evaluated to ensure that the chemotherapy regimen is effective. If it is not, your doctor will select another regimen for second-line therapy. The chemotherapy regimen can also be changed if breast cancer recurs during adjuvant treatment for early-stage cancer.

This is a fascinating interview between music superstar Sheryl Crow and her doctor, breast cancer surgeon Dr. Kristi Funk, who originally diagnosed Sheryl. In it, Sheryl talks openly about her breast cancer and her diagnosis, how she confronted the disease and how she faced the array of treatment options.