Breast Cancer

Tips if You’ve Found a Breast Lump

I regularly receive emails and texts from friends and readers who are concerned about breast lumps. It can be nerve racking if you or a loved one has found a breast lump!

What are my suggestions?

1. Try not to panic, if you can. Remind yourself not to let your emotions be controlled by that which you don’t know. You found something that may or may not be of concern. You’ll need more information before you know if this is something that warrants a lot of your emotional energy.

2. Take some comfort in the statistics. Only a small number of breast lumps turn out to be cancerous. In fact, if you’re in your early 20s-50s, there’s at least a 90% chance that the lump is non-cancerous (benign). For those of you in your mid-50s or older, 80% of lumps are benign. In the overwhelming majority of cases, breast lumps are found to be fibrocystic and normal.

3. Wait until after your next period to see if you can still feel the lump. Women’s breasts and breast tissue change throughout their cycle. If you’re unsure about how to perform a breast self-exam, this video from Georgetown University Hospital is informative.

4. If you still feel the lump after your next period, then schedule an appointment for a clinical breast exam. A clinical breast exam is a more thorough breast exam performed by a medical professional. Your primary care physician or gynecologist can perform a clinical breast exam, but you also can make an appointment with a breast surgeon. Men can see their internist or general practitioner to examine a new mass on their chest, and then get a referral, if needed. For those of you without insurance, all Planned Parenthood centers offer clinical breast exams. In the DC area, you can also go to Capital Breast Care Center by the Eastern Market Metro.

Following the clinical breast exam, the health care professional will decide how best to proceed. Options include:

  • Waiting six months to follow up with another clinical breast exam. That’s a common reaction to lumps found in younger women. I appreciate the statistics, but you also have the right to ask for a follow up in three months.
  • Ordering a sonogram (ultrasound) and/or a mammogram. I had my first benign breast lump removed at the age of 26. Over the next three years, I had three more lumps biopsied and/or removed. All of the information that my doctors needed was obtained from sonograms and biopsies. Medical professionals typically don’t order mammograms for women under the age of 35 since younger breasts have denser tissue that lead to false positives. Sonograms provide a better reading than mammograms for denser breasts. If you’re under the age of 35, ask your doctor whether a mammogram is right for you.
  • Ordering a breast biopsy, if the above methods didn’t yield a conclusive result. Breast biopsies are done on an outpatient basis and do not require you to be under anesthesia. For more information about the different types of breast biopsies, check out this link from Mayo Clinic. If you require a biopsy, try not to jump to the worst possible conclusion. According to the University of Michigan, only 15% of biopsies performed turned out to be cancerous.

5. Reach out for support. Chances are that a female friend or relative has gone through this process before. Ask them for their advice.

6. Use online resources in a restrained manner. You can look online for information, but stick to reliable sites from medical institutions and cap how much time a day you spend searching about lumps and biopsies. Don’t let information overload increase your anxiety!

I’m not a doctor, but I do care. Since I was diagnosed, I’ve let it be known that I’m happy to serve as a resource for those with questions. Feel free to reach out anytime via citygirlblogs (at) gmail. And, please, regardless of gender identity, stay on top of your breast health! xoxo

What If You Have The Breast Cancer Gene?

What happens if you test positive for the breast cancer gene?

If you carry the BRCA-1 or BRCA-2 gene mutation, your doctor or genetic counselor will present you with several options:

  • Surveillance: You’ll need a clinical breast exam every six months, and a mammogram and breast MRI once a year. The hope with this approach is that if there’s subsequent evidence of breast cancer, it will be caught early.
  • Surgery: A second option is to obtain a preventative or prophylactic mastectomy to significantly reduce your risk of ever getting breast cancer. (On average, 60% of people testing positive for BRCA-1 or BRCA-2 will be diagnosed with breast cancer in their lifetime. Having a preventative mastectomy brings that number down to 10%.) Women may also elect to have their fallopian tubes and ovaries removed before or after menopause to drop their risk of ovarian cancer to 10%. Those surgeries also reduce a pre-menopausal woman’s chance of getting breast cancer in half.
  • Medicine: The birth control pill reduces a woman’s chance of developing ovarian cancer. However, that benefit will need to be weighed against an increased risk of getting breast cancer in those BRCA-positive women who take the pill for more than five years. The drug, tamoxifen, has also been shown to drop breast cancer rates in half for women with increased risk.

(The above options are described in greater detail on the Mayo Clinic website.)

Whichever path you choose, your doctor or genetic counselor will help you broach the subject with family members who might need to be tested. For those of you who test positive for BRCA-1 or BRCA-2 and are looking for more information or support, check out FORCE (Facing Our Risk of Cancer Empowered). In 2000, FORCE coined the term, “previvor."

If you are unsure if you have an increased risk of heredity cancer, you can take this short quiz. The questions can spur discussion with your relatives about family health history, and the answers are worth reviewing with your doctor.

It’s important to remember that testing negative for BRCA-1 or BRCA-2 doesn’t mean that you won’t get breast or ovarian cancer. (I’m proof of that.) Whether or not you have breast cancer in your family, remember to perform monthly breast self exams, get a clinical breast exam once a year, and talk with your primary care physician or gynecologist about when you should start getting annual mammograms.

Breast Cancer Gene Testing

How much do you know about the breast cancer gene and genetic testing?

Are the following statements true or false?

1. There is only one breast cancer gene.

FALSE. At present, there are two known breast cancer genes, BRCA-1 and BRCA-2. Researchers continue to search for additional gene mutations that play a role in hereditary breast cancer.

2. Before getting tested for the breast cancer gene, you'll need to meet with a genetic counselor.

TRUE. It’s common practice to meet with a genetic counselor before breast cancer gene testing. The genetic counselor will review your family history with you and discuss the benefits and risks of getting tested. The counselor will also review your options if the results are positive.

3. Testing for the breast cancer gene consists of a mammogram and a blood test.

FALSE. A simple blood test can reveal whether or not you test positive for BRCA-1 or BRCA-2. It’s worth noting that one US laboratory handles BRCA testing, and thus, it can take several weeks to receive the results.

4. Men can get tested for the breast cancer gene.

TRUE. Men can get breast cancer and can also carry the breast cancer gene. If a man tests positive for BRCA-1 or BRCA-2, he has an increased risk of developing breast cancer, testicular cancer, prostate cancer and pancreatic cancer.

5. Insurance companies will cover breast cancer gene testing for all females.

FALSE. The cost of the test ranges from several hundred dollars to several thousand dollars. (My insurance company covered 90% of the cost of the test, and I still needed to pay $270.) The test is generally recommended for men and women over the age of 18 who have been diagnosed with breast cancer or who have a family history of breast or ovarian cancer.

6. If you test positive for BRCA-1 or BRCA-2, you will definitely develop breast cancer.

FALSE. Having the breast cancer gene does not mean that you will get breast cancer. However, testing positive for BRCA-1 or BRCA-2 significantly increases the likelihood that you wil develop brest cancer in your lifetime. According to the National Cancer Institute, 12% of women in the general population will be diagnosed with breast cancer in their lifetime as compared to 60% of women with the breast cancer gene mutation.

Women who test positive for BRCA-1 or BRCA-2 also have a 15-40% chance of developing ovarian cancer. The average woman in the general population only has a 1.4% chance of being diagnosed with ovarian cancer.

7. The majority of breast cancer patients test positive for the gene mutations.

FALSE. The Mayo Clinic states that, “BRCA gene mutations are responsible for about 5% of breast cancers and about 15% of ovarian cancers.”

 

So, readers, how did you do?

Next Post: What are the options if you test positive for BRCA-1 or BRCA-2? What’s a previvor?
 

One Foot In Front Of The Other

Four years ago, this blog didn’t exist. I was in a relationship with Lawyer Boy and thinking that I needed to end things for my own well being.

Three years ago, I was blogging regularly and getting the hang of Twitter. I was living with “Buckeyes” Boy, but I began to question his sincerity.

Two years ago, I was recovering from my second round of chemotherapy. The drugs caused me to hemorrhage and soon, I would be thrown into medical menopause. I was in need of companionship during treatment and was spending time with Mr. Agency and Best Boy.

One year ago, I was teaching my first semester at American University. I was dating on occasion, but my priorities had shifted. I had recently finished treatment and was busy with events and fundraisers for five different breast cancer charities.

In four years, my journey has taken a lot of twists and turns. I never imagined just how much undergoing chemotherapy would change my life. My blog isn’t as much of a priority now, and I’m far more selective about which charities I support. I seek stability from my relationships with friends and my significant other and have neither the time nor the inclination for drama. I find more joy out of teaching than I thought possible.

Professionally, it’s been a big month for me, as:

  • I was featured in the October 2012 issue of The Washingtonian about sex and cancer;
  • My Facebook status update, “It’s October 1st. We’re f*%&ing aware. To quote Redman, it’s time for some action,” inspired a post on Forbes.com; and
  • I was quoted in an article about healthy eating during chemotherapy on Today.com.

I’ve been trying to reconcile how I’ve tried to be public about my journey to help and educate others with the fact that I wish this wasn’t my journey at all. I’m happier than I’ve ever been, and I’m very appreciative of all the blessings that I have in my life. Nonetheless, not a day has passed in two years during which I haven’t been frustrated by some lingering chemotherapy side effect. I often wish that I could click my heels and go back to the way things were before cancer. I know that I’m doing what I am meant to do with my life, but that doesn’t mean the past two years have been easy. Is life ever really that simple?

I don't know where I'll be in a year, although I hope that my career and relationship continue on this same path. I'll just keep putting one foot in front of the other and see where life takes me next.

Has your life taken a twist or turn that was simultaneously very difficult and very positive?

Please Think Before You Speak

I communicate regularly with other young women who have battled or are battling breast cancer. It continues to amaze and disappoint me to hear the comments that loved ones and acquaintances will say to a patient during their cancer journey.

Earlier this month, Blisstree posted an article on its site entitled: “Real Survivors Talk: 7 Things Not To Say To Someone With Breast Cancer.” Written by Hanna Brooks Olsen, I was honored that my thoughts were included in the piece. After I was diagnosed, I made a vow to do what I could to serve as a resource for other women fighting breast cancer. And, I’ll do my best to educate well-intentioned people who want to say the right thing, but don’t always know what that is. As I’ve mentioned in previous posts, asking open-ended questions and listening go a long way!

Image Credit: Blisstree.com

The slideshow from Blisstree can be accessed via this link. I’ve been on the receiving end of all but two of these comments. What other zingers come to mind?

“You know you can wear a wig, right?”

“You look great, except for your hair.”

“You’ve gained weight!”

“I always wanted to get a boob job.”

“Now that you’re done with treatment, I hope that things are going to go back to normal.”

Any variation of how a patient is using cancer to get attention or shirk day-to-day responsibilities.

Which slide on Blisstree made you roll your eyes the most? Have you heard a comment that made you shake your head?

Let’s Trash Cancer!

Do you know what it means to “Trash Cancer?”

Trash Cancer is a movement started by Fran Drescher, cancer survivor and founder of the nonprofit, Cancer Schmancer. On September 29, 2012, 10,000 people across the United States gathered to learn about toxic chemicals in our homes, food and personal care products. I was honored to host a Trash Cancer Party at Peacock Café in Washington, DC, and am still shocked at some of the sobering statistics and facts.

  • In the US, 1 in 3 women and 1 in 2 men will be diagnosed with cancer in their lifetimes.
  • 90% of cancers are environmental and lifestyle related.
  • There’s aluminum in many toothpastes, astringents and anti-perspirants.
  • Eating one extra sausage or three slices of bacon a day increases a person’s risk of pancreatic cancer by 19%.
  • Most lipsticks contain lead.
  • Consuming hot dogs put children at nine times the risk for childhood leukemia.
  • The US hasn’t banned the use of PVCs (containing chemical phthalates) in soft vinyl children’s toys, PFCs in non-stick cookware, and formaldehyde in baby shampoo.
  • “Wrinkle-free” products typically contain cancer-causing chemicals.

We can become better consumers, though, and choose products that don’t contain too many of the 80,000 chemicals that are potentially toxic and unregulated or underregulated by the federal government.

You can check out how your products rank on a 0-10 scale (with 10 being the best) on the Trash Cancer site. You’ll be surprised at what you discover! For instance,

  • I had switched to using natural fragrances, based on advice from many breast cancer organizations. In reality, the natural fragrances by Pacifica score the same as my preferred Hanae Mori perfume.
  • The OPI and Essie polishes that I love? An overwhelming majority of nail polishes contain numerous toxic chemicals and rate a ‘1’ on the Good Guide scale. (If anyone finds a good nail polish that gets a high ranking, please let me know!)
  • I expected brands like Burt's Bees, Bliss or Lavanilla to score high across the board. Some products in their lines did. Some didn't.

It might seem overwhelming to change many products at once. Cancer Schmancer recommends that we make one or two small steps toward change. After I was diagnosed with cancer and researched how many bath products contain parabens and phthalates, I began using soap, lotion and shower gels that are paraben and phthalate-free. (The skin is our largest organ, after all.) Now, I’ll tackle fragrance and at least some of my lipsticks.

Will you join me in becoming aware of what you’re putting in, on or around you?

CHECK the labels on the products you use (especially the first three ingredients) and visit TrashCancer.org to research your products.

CHOOSE options for change.

CHANGE by taking a small step toward a healthier lifestyle.

Does Shaving Your Head in Support Make a Difference?

Singer Kellie Pickler shaved her head earlier this month as a sign of solidarity with her best friend, Summer Miller. Summer has a family history of breast cancer and was diagnosed with the disease in June at the age of 35. In a segment for “Good Morning America,” Kellie and Summer discussed shaving their heads together, highlighted the need for early detection, and encouraged women not to wait until 40 to get a mammogram.

Coverage of the act was extremely positive. Kellie was referred to as a “celebrity activist,” and one article noted that it’s unknown just how many “cancer patients were moved by her gesture.”

Kellie’s act clearly meant a lot to her and Summer, and that in and of itself is worthy of praise. I don’t doubt that she is a loving best friend, and I’ll keep Summer in my thoughts and prayers.

As a breast cancer survivor and advocate, how did I feel about the video?

1. A close friend of mine offered to shave her head as a show of support when I was going through chemotherapy. (I think she felt as though she was too far away geographically to help with the day-to-day so she wanted to make a grand gesture.) I thanked her for the offer and her ongoing friendship and support, but told her that I was vehemently against her doing it.

By the point that my friend had reached out, I had already started chemotherapy. I was so sick that being bald was the last thing on my mind. I also didn’t believe that having a friend shave her head would have made me feel any better. In fact, having a friend make herself look different at a minimum or worse at a maximum would just have made me feel worse. I was completely bald for six months. Would my friend shave her head every week to stay bald as long as I did? Would she — or anyone who hadn't had chemotherapy — really understand the range and intensity of side effects I was experiencing?

2. Kellie is a celebrity with a genuine desire to help the cause. I thus wish that she had done any or all of the following:

  • Donated her hair to Locks of Love or Beautiful Lengths. (Locks of Love is a nonprofit that uses donated hair to make wigs for financially disadvantaged children and young adults who have lost their hair from a medical condition. Beautiful Lengths is a partnership between Pantene and the American Cancer Society to provide hairpieces made from donations to women battling cancer.) Through shaving her head and then donating her hair, Kellie could have educated women about these nonprofits and how a donation of as little as 8" of hair can make a difference;
  • Connected with a cancer organization like St. Baldrick’s Foundation and set up an online fundraising page for people to donate who were inspired by her act. (St. Baldrick’s shavees shave their heads in solidarity with kids battling cancer, while raising money from family and friends with the Foundation); and
  • Provided accurate and more specific information such as:
  • All adult females should be conducting breast self-exams every month and getting a clinical breast exam from a doctor every year.
  • If a woman has a history of breast cancer in her family, then she should begin getting mammograms annually at the age of 35. If she doesn't, then she should get a baseline mammogram at 35 and begin annual mammograms at 40. Annual mammograms before the age of 40 aren’t supported by research because younger women have denser breasts, thus leading to more false positives.
  • And, finally, many young women don’t know what to do when they’ve found a lump. They also don’t realize that the overwhelming majority of breast lumps are benign (non-cancerous).

When Kellie shaved her head in solidarity with Summer, it was a special moment between two best friends. Given Kellie's reach and visibility, I just hope that the efforts and education don’t stop there.

Readers, how do you feel about what Kellie did? Are you a patient or survivor who was moved by the video? Do you regard Kellie as a celebrity activist?

After treatment

A friend recently asked me a question about what happens after a cancer patient is done with treatment.

“My cousin finished radiation in the spring and is in remission, but she’s been having a tough time. Most of the family doesn’t want to talk about her cancer anymore; they’re just ready for things to go back to normal. Why do you think that 'The After' is so difficult?” she inquired.

 There are several reasons why it can be tough for patients once treatment is over.

1. Being diagnosed with cancer causes you to experience a range of emotions from numbness to denial to anger. Once surgery and treatment start, you will need to focus all of your physical and emotional energy on getting through the journey. There’s rarely the luxury of time or strength to process all that is happening. It’s difficult enough to handle your essential responsibilities – in and out of the hospital. Once treatment is done, there are less loved ones around, fewer medical appointments, and a lot of time with your thoughts. The intense emotional reflection thus tends to happen once you're in remission.

2. Doctors won’t always inform you that you might not feel better once you’re done with treatment. Chemotherapy and radiation take a toll on your blood counts in a cumulative manner. By the time you’re finished, your counts may be the lowest that they’ve been, thereby causing increased fatigue, iron deficiency and risk of infection.

3. There’s the misperception that life can just go back to normal once you're done with treatment and in remission. That’s rarely the case.  Physical side effects from treatment can linger for several years and make it difficult to return to your pre-cancer routine. There are constant reminders of what you endured. You have scars, your hair is gone, and you have the immune system of a newborn. Emotionally, you may feel confused, fearful of a recurrence, and depressed at how much your life, appearance and health have changed. You'll need time to adjust to several new normals in a short time period.

4. Your medical team will do its best to ensure that you cross the finish line into remission. But, once you’re cancer free and done with treatment, you'll go from having frequent contact with health care professionals and regular exams to sporadic visits and tests. You may feel as though you’ve lost your safety net when you’re told that you don’t need to see your doctor for months.

5. Following a cancer diagnosis, there’s an outpouring of support. The overwhelming majority of your loved ones will recognize that you will have to focus on yourself and your health. Likewise, those who are in a position to care for you will give of their own time and talents to do so. When you’re done with treatment, though, the people in your life will want everything to go back to normal. There will be the erroneous expectation that you’ll be able to handle all of your old responsibilities at the same pace and with the same stamina as before. Few will understand that you are still experiencing side effects that may include pain, sleep disturbances, digestive problems, menopause, chemo brain, fatigue, and nerve and muscle weakness. Well-intentioned comments, disinterest in hearing about your health, and unrealistic expectations might make you feel overwhelmed, misunderstood, weak or depressed.

6. There are many resources for patients during treatment, but there aren’t the same outlets for after treatment is done. Research reveals that 30% of breast cancer survivors experience depression after treatment and 20% experience body image issues. Talk to your doctor about options for counseling, medication, yoga, meditation, physical therapy and support groups before you finish treatment. Even if you don’t avail yourself of any of those resources, it’s worth having the referrals if and when you need them.

What are your thoughts on how to make post-treatment easier for survivors and loved ones?

CBCC Silk Scarf Giveaway

Capital Breast Care Center (CBCC) provides culturally appropriate breast cancer screening services and promotes health and wellness to women in the Washington, DC area, regardless of their ability to pay. Their services include clinical breast exams, mammograms, ultrasound-guided biopsies, Pap smears, and pelvic exams. CBCC performs mammograms on 2,000 DC area women annually. 100% of all private donations made to Capital Breast Care Center goes to the provision of services to women in need.

If you live in the DC area and have health insurance, you can make an appointment at CBCC for your annual clinical breast exam or mammogram. Your insurance company will be billed the customary fees for the service that you receive, and those dollars will help defer the cost of the same services to a woman without insurance. More information about the Gift of Life program is available here.

On a related tangent, over the past year, I’ve become far more selective about which products I purchase to support breast cancer organizations. Media and nonprofits have drawn attention to the downside of pinkwashing. Breast Cancer Action recommends asking the following questions before buying a pink product:

1. Does any money from this purchase go to support breast cancer programs? How much?

2. What organization will get the money? What will they do with the funds, and how do these programs turn the tide of the breast cancer epidemic?

3. Is there a "cap" on the amount the company will donate? Has this maximum already been met?

4. Does this purchase put you or someone you love at risk for exposure to toxins linked to breast cancer? What is the company doing to ensure that its products are not contributing to the breast cancer epidemic?

With those guidelines in mind, I purchased two of CBCC’s signature silk scarves for me and a lucky reader. Designed by Ibahna Creations, these scarves add sparkle to any wardrobe! Scarves are $45 (plus $2.00 shipping and handling) and can be purchased here. $25 of the purchase price goes to fund Capital Breast Care Center's services, such as screening mammograms and patient navigation. 

 

Would you like to win a CBCC signature silk scarf?

If so, comment with “Keep up the great work, CBCC!” by Friday, September 21, 2012, to enter. One winner will be chosen randomly via Random.org. The winner must reside in the United States or Canada.

Recess

I hadn’t planned on joining Congress in taking a recess during August, but apparently, I, too, needed a break from blogging. Ironically, though, the past month has been anything but uneventful.

The Boobs (or “Foobs,” as some of us in the breast cancer community call them): The first week after my reconstructive surgery was rougher than I had previously indicated. See, the surgery had ended, but I surprisingly woke up while I was still in the Operating Room. That’s not supposed to happen under general anesthesia! I began screaming, “It’s too soon! It’s too soon!” As I was moved onto the gurney and wheeled into the Recovery Room, I felt very dizzy and got sick. Those symptoms continued for the next five days.

One week later, I noticed that my left breast looked sunburned. It was pink in color, swollen, slightly painful and warm to the touch. I wasn’t sure what was going on so I paged my doctor on the weekend. She recommended that I meet her at her office on a Sunday. (Yes, it helps to have doctors like this who go above and beyond!)

The thought was that I had developed an odd reaction or mild infection. She put me on more antibiotics. In total, I’ve been on antibiotics for all but five days out of a two-month period!

Two weeks later, the “sunburn” is slightly better. The left side is still swollen, though, and the surgeon thinks that my skin is having an abnormal reaction to everything that has transpired. The hope is that it will improve naturally over the next month or two.

Teaching: To say that I love teaching at American University would be an understatement! Nevertheless, it might not have been the best move to agree to teach a seven-week online class during my season of surgeries! (I'm sure I should have rested and relaxed a lot more than I did.) The summer class required me to be online so much that I just didn’t have the energy to be writing outside of that.

The Man: If I’ve had free time over the past month, I’ve spent it with my loved ones. The Man is definitely at the top of that list! Since surgery, he’s handled every ride, every dog walk, every grocery store run and every doctor’s appointment. I’m not sure what I’ve done to deserve someone as wonderful and caring as him in my life, but I feel grateful.

I hope that all of you had a relaxing and fun summer! How did you spend your holiday weekend?