Early Detection is NOT the Same as Prevention

The State of Maryland recently convened a team of researchers, patients and doctors to develop an anti-cancer plan they call the Comprehensive Cancer Control Plan.  Control? Interesting word, but not one I want to hear from government.  http://trap.it/TWQBWX.  However, the plan has some merit.   Ann Taylor, vice president of support services at Atlantic General Hospital, explains that “The state plan is superior to one released in 2004 because it focuses on individual ownership of health with emphasis on nutrition and continued screenings for cancer.”  I like this.  I also liked what Frances Phillips, Deputy Director of the Maryland Department of Health and Mental Hygiene, had to say: “We know now that so much cancer is preventable or survivable with early detection and good treatment. There are also chapters on pain management and support for families burdened with cancer. It’s important we keep in mind that cancer is a disease that affects virtually every Maryland family.”

 However, what I didn’t like is that they confuse readers by suggesting that prevention is the same thing as detection. “Prevention methods include blood tests for colon cancer and mammograms to check for breast cancer. Other methods for cancer screening include PET scans, MRI scans and CT scans, which can be expensive since they use advanced equipment.”  Sorry, Mr. Phillips, but while screening is great, it does not prevent most cancers (the exception being colonoscopy [before polyps become cancerous]and paps and maybe a few others).  Screening does not prevent breast cancer.  One could argue that screening sometimes discovers the pre-cancerous LCIS, but for all the women whose screening did not detect anything less than cancer, one needs to be careful.  One does not have to have LCIS to develop cancer, and is involved in very few cases.

 I have heard so many women say, “But how could this have happened, I get a mammogram every year!”  Too many women are led to believe that screening is preventive.  Not true; screening allows for early detection.  The jury is still out whether or not early detection saves lives, but for sure it saves quality of life (i.e. less horrific and toxic treatment).    Ms Taylor goes on to say “Our focus is to prevent recurrence in patients who have had cancer. We work with programs to fit patients into breast and cervical, colonoscopy screening.”  Screening does not prevent recurrence, it detects it so it can be treated or managed.

So, my feeling is that while I applaud the State of Maryland for taking action, they need to understand the facts and not delude people into thinking that by undergoing screening, they will reduce risk.  They need to beef up efforts to educate people on real preventive measures such as maintaining a healthy weight, moderate exercise, a healthy diet, giving up smoking, reducing inflammation, avoiding environmental toxins and reducing stress.

Elyn Jacobs

elyn@elynjacobs.com

http://elynjacobs.blogspot.com

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Elyn Jacobs is President of Elyn Jacobs Consulting, Inc. and a breast cancer survivor.  She empowers women diagnosed with cancer to navigate the process of treatment and care, and she educates about how to prevent recurrence and new cancers.  She is passionate about helping others get past their cancer and into a cancer-free life.

Why the Race is going in the Wrong Direction

Much progress has been made in Breast Cancer awareness. However, being aware of cancer neither prevents nor cures cancer. If I told you that I am aware my kitchen window is broken, would you cheer? Would my telling you this fix my window? Would it prevent another ball from coming in the window? No. I think the race for the cure is over. I ask you, who would benefit from finding the cure? Women, not drug companies right? But it is becoming painfully obvious that money is not being spent on a cure, but rather on drugs and talking about cancer. We now need to spend money and energy on the prevention of cancer as well as exploring new and less toxic treatments for cancer. What’s new and worthy of research and trials? Read on.

Scientists are aware of a virus that initiates cancer in mice. Could this virus be responsible for cancer in humans? Maybe; scientists estimate that approximately 40% of all human breast cancers may be related to a virus. This virus, called the human mammary tumor virus, is nearly identical to a virus found in mice. (mouse-mammary tumor virus) that causes breast cancer in 95% of the animals it infects. If it can be proven that this virus causes human breast cancer, a vaccine could be developed to protect against it, and new therapies could be developed that could treat those women whose breast cancers are caused by it. It’s time we stop racing and start researching. To learn more, please see this documentary film, It’s Time to Answer the Question, nominated Best Film of the Year 2010 by Rethink Breast Cancer: http://www.youtube.com/watch?v=K4SCKJ1l27o.

There are at least two promising vaccines in the works. One, which is being conducted by Dr Brian J. Czerniecki, MD, PhD at the University of Pennsylvania, is already being tested in women with breast cancer—and is showing remarkable but under-reported results. He is currently the principle investigator for a vaccine trial for patients with DCIS. What is unique about Dr. Czerniecki’s trial is that it examines the efficacy and safety of vaccines in a much earlier setting, even before invasive cancer is present. The results from this trial are particularly exciting as they open the door for the use of vaccines as cancer prevention tools as opposed to treatment of late stage disease. To read more about Dr. Czerniecki’s vaccine, please visit:
http://www.penniesinaction.org/messagefromuschi4.html
http://www.penniesinaction.org/vaccine%20explanation.html
http://www.penniesinaction.org/about4.html

Another exciting study, spearheaded by Professor Vincent Tuohy of the Cleveland Clinic, has the potential to produce the first preventive breast cancer vaccine that also has therapeutic potential for women with Stage IV breast cancer. In May 2010, Professor announced that he had successfully developed the first preventive breast cancer vaccine, capable of preventing breast cancer in 100% of mice and also capable of slowing the growth of tumors that had already formed. Tuohy, a recipient of prior R01 grants from the NIH (the most prestigious funding available), is ready to begin Phase I trials (safety testing) in women. If Tuohy’s vaccine is safe and effective, it could eliminate 95% of breast cancer in this country, and possibly become an important therapeutic treatment for the 3 million breast cancer survivors now living in the USA. However, for this vaccine to become a reality, Professor Tuohy must receive the necessary funding. For more information on Tuohy’s paper, please see this link: http://www.nature.com/nm/journal/v16/n7/abs/nm.2161.html
To view a short video of Tuohy’s work, please see this link: http://www.youtube.com/watch?v=QffAJmyALb0

Exciting news? Yes, however, here is the big question. I talk a lot about cancer, cancer prevention and treatments. I go to as many conferences as I can. Why is it that there is so little talk of viruses and vaccines for breast cancer? I have Dr Kathleen Ruddy and Janet Hanson to thank for the information included it this blog. I am grateful to have learned of the new possibilities. However, for these and other cancer vaccines to begin to save lives, we need to stop talking and start funding the right studies. Now the challenge is not to keep aimlessly racing…it’s time to put some money in the hands of these skilled researchers and to let them test their theories.

Dr Ruddy sent me a blog she wrote last night, I love her idea of changing National Breast Cancer Awareness Month to National Breast Cancer Action Month. It’s about time we focused on action instead of pretty pink ribbons. To read her blog, please view: http://breastcancerbydrruddy.com/?p=2894

Elyn Jacobs
elyn@elynjacobs.com
elynjacobs.blogspot.com

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Elyn Jacobs is President of Elyn Jacobs Consulting, Inc. and a breast cancer survivor. She empowers women diagnosed with cancer to navigate the process of treatment and care, and she educates about how to prevent recurrence and new cancers. She is passionate about helping others get past their cancer and into a cancer-free life.

Mastectomy? Know Your Options

A woman came to me for help last week; a small breasted woman with early stage breast cancer. She wanted to discuss her options with me. Her preference would be to have a mastectomy, but she was afraid of the cosmetic outcome. She was embarrassed to admit this concern as her doctor had commented that her cancer should be her first priority. I assured her that cancer treatment with a good cosmetic result is possible. I asked her if a nipple-sparing mastectomy (NSM) with the incision through an inframammary fold (IMF) was offered. She just stared at me.

I explained that in some circumstances NSM was possible and that although there are no long-term studies, the five year studies show no increased risk for NSM over skin-sparing mastectomies. It was possible that she would not have to endure additional surgery to reconstruct her nipples and that the outcome would be more natural looking. I also explained that with an IMF (under the bra-line) incision, the scar can be hidden in a natural crease. The relief on her face was amazing.

Why, I ask myself, do more doctors not offer these procedures. Are these procedures more time consuming, more difficult or are some doctors simply not current on new developments in breast cancer treatments and surgical options? Have they lost sight that there is life after cancer? After all, isn’t life-after cancer the main reason for treating cancer? Perhaps the surgery takes longer or is more difficult? I consulted an expert on NSM, IMF MX, Dr Alex Swistel, of the Weill Cornell Breast Center, and his response was that this approach is more difficult and it requires specialized training as it requires instruments that can reach as far as that in a conventional mastectomy. Many experts that have tried it abandoned it for that reason; however, this procedure is best for keeping blood supply to the nipple without cutting around it and really hides the scar very well. This procedure certainly is not for everyone, but reports are now showing virtually no recurrence in the nipple even after 10 years. (Studies done in Italy seem to have the longest follow-up.)

I recently attended a conference on new developments in the treatment of breast cancer: “2011 Meet the Experts: Breast Cancer Education.” I had the opportunity to hear what is new, and also to ask questions of the panelists. Dr Eleni Tousimis, of the Weill Cornell Breast Center, spoke at length on the latest technological advances in the treatment of breast disease and on minimally invasive techniques, including the latest on NSM. Dr Joshua Levine, of the New York Eye and Ear Infirmary, spoke about the benefits of using one’s own tissue for reconstruction (autologous breast augmentation). Microsurgery has come a long way since its invention by vascular surgeons in the 1960s. The term refers to any surgery involving a surgical microscope. And it has found one of its best applications in breast reconstruction. Through microsurgery, surgeons are able to harvest healthy tissue from one part of a woman’s body and reattach it to the breast area. Through the careful process of attaching blood vessels, microsurgery allows patients to have natural looking breasts made from their own, living tissue. Another benefit is the minimized impact and injury to muscles, allowing patients to enjoy a faster, fuller recovery than with earlier flap reconstruction. For more information, please view the following link.
http://www.naturalbreastreconstruction.com/procedures.aspx

Many women choose implants over flap reconstruction methods. While breast reconstruction with implants may not always yield as realistic-looking results as tissue-based reconstruction methods, the procedure is less risky and requires less surgery. Generally, implant-based reconstruction results in less scarring and poses fewer risks to the patient than tissue-based reconstruction, making it an attractive option for women who prefer less invasive procedures. I am grateful for my wonderful team, Drs Alex Swistel and Mia Talmor. I chose silicone implants, have my very own nipples and I must say I don’t look as if I have had a mastectomy.

Exciting times in the world of breast cancer surgery. However, one thing I heard at the aforementioned conference was quite disturbing: 30% of all women treated for breast cancer do not choose reconstruction. It is one thing to choose not to have reconstruction; it is quite another to decline it because no one has either offered it or explained that insurance companies are required to cover the costs. Are doctors not discussing this with their patients? Are patients not aware this is an option? Clearly not all options are for everyone, but an informed patient is an empowered one.

I had the opportunity to discuss NSM and other reconstruction issues with Dr Paul Baron, co-founder of the Charleston Breast Center and expert on NSM. He was incredibly informative and I asked him if I could borrow both his knowledge as well as a blog he wrote for The Reconstruction Network: “Who Can Have a Skin-Sparing and Nipple-Sparing Mastectomy and Why”. I have attached the link below as I think you will find it most informative.
http://breastreconstructionnetwork.com/who-can-have-a-skin-sparing-and-nipple-sparing-mastectomy-and-why/

While we are still waiting for the cure, much progress has been made in surgical and reconstructive procedures for breast cancer. Oncoplastic surgical techniques can be used to remove the cancer while achieving excellent cosmetic outcomes. NSM and IMF are not an option for all women, and certainly women will have preferences on reconstruction options. However, women need to know that they have options. Information is power and it has never been more important to be informed and knowledgeable about your medical care. My goal is to get this information to women and to empower them to make choices that fit their own individual needs.

For more information on NSM and reconstructive options, please visit:
http://diepflap.com/nipple_sparing_mastectomy.html
http://diepflap.com/br_treatmentoptions.html
http://aes.sagepub.com/content/31/3/310.abstract


To locate doctors who perform NAM, IMF, and DIEP reconstruction, email me and I will assist you.

Elyn Jacobs
elyn@elynjacobs.com
http://elynjacobs.blogspot.com



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Elyn Jacobs is President of Elyn Jacobs Consulting, Inc. and a breast cancer survivor. She empowers women diagnosed with cancer to navigate the process of treatment and care, and she educates about how to prevent recurrence and new cancers. She is passionate about helping others get past their cancer and into a cancer-free life.

Remission

The other day I was asked by a representative from a cancer organization how long have I been in remission. I didn’t know what to say; I am four years out and no one had ever asked me that. I did not answer the question but rather said that I had cancer in 2007. Remission is a bad word. One needs to believe that cancer has been beaten. Remission implies that it is only a matter of time before the cancer returns. By definition, remission is the period of time during which symptoms of a disease are reduced (partial) or undetectable (complete). In the case of breast cancer, remission means that tests and imaging do not show evidence of the cancer, and that a doctor cannot see signs of the cancer during a clinical exam. It does not mean the same thing as cure. Doctors almost never use the term cure; rather, they usually talk about remission. Mine never spoke of either, just said I would be fine and that I should not worry about recurrence. It’s not that he was guaranteeing me my cancer would not return, he simply stated that I need not worry. He is right; can my cancer come back? Sure, but I choose to believe that it will not, and worrying about it is not going to prevent recurrence, but could likely encourage one. Microscopic collections of cancer cells often go undetected in all humans, not just in those of us who have had cancer. Therefore, while we are all at risk for cancer, you don’t see others saying, “Ah, but my cancer cells are in remission”, do Ya? No, and often these cells will be eliminated before they can cause trouble.

I am not living in denial; I am not ignorant of the nature of cancer. I know that for many, remission is a wonderful word. However, it’s time to change the attitude. The mind-body connection to cancer is strong, but so is the beast itself. Cancer remission is like roach control. As long as you put out the traps, no roaches….but that does not mean you have solved the roach problem. Eventually the roaches will win. We need to find a cure so that we can put the word remission in the circular file. We as humans can only do so much. We can eat better, reduce our stress, and live better. However, we need to find a cure for those who are in the battle of their lives; we need to stop racing and start curing. Clear-mission is what we need, not remission.

Elyn Jacobs
elyn@elynjacobs.com

**********************************************************
Elyn Jacobs is President of Elyn Jacobs Consulting, Inc. and a breast cancer survivor. She empowers women diagnosed with cancer to navigate the process of treatment and care, and she educates about how to prevent recurrence and new cancers. She is passionate about helping others get past their cancer and into a cancer-free life.