Tag Archive for: cancer

Breast Cancer: Your Stories

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When Paula took over the message January 17 and told you about her experience with breast cancer, it produced a great number of responses. Most people wanted to let her know that she was not alone and that they were survivors as well. In my opinion, a few of the responses absolutely needed to be shared, so that’s what I’m doing this week. I’m not going to identify the people in any way, but they know who they are.

Why do this? Because every day, some reader, maybe you or maybe someone in your family, will get . . .

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Paula’s Turn: I’m a Survivor!

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For a week in October, I had breast cancer. But maybe I should start at the beginning.

In September I got my usual mammogram and was called back for more images, which had happened before so I wasn’t worried. But this time, the radiologist saw something and recommended a biopsy. An ultrasound-guided core biopsy was done September 30; I love to know how things work, so the best part for me was watching the procedure on ultrasound. The worst part was the dozen or so mammograms done just before the biopsy to pinpoint the tumor’s location. These were done on a mammogram machine that produces more detailed images, but the most interesting part of that was the machine’s pressure read-out. Almost 30 pounds, ladies: stack three 10-pound bags of sugar on your—well, let’s move on.

The following Monday, we got the results: it was cancer, an invasive ductal carcinoma. Friday we saw the surgeon who recommended breast-sparing surgery, commonly called a lumpectomy. She said, “I’ve got a cancellation Monday,” and I said, “I’ll take it!” I lived with the knowledge that I had cancer only from Monday October 6 to Monday the 13th, just a week, and then it was gone. What’s amazing is that something that sounds so major can be accomplished with outpatient surgery; I was at the hospital only a few hours and then home. The pain was minimal.

I was lucky in many ways: the tumor was small, only 0.9 centimeters (about the size of a frozen pea), and slow growing; it was minimally invasive, just starting to breach the duct walls. It was also estrogen-positive, which means I have a good chance of heading off recurrences by taking Femara, an estrogen-blocking medication; years ago, my mother was part of a clinical trial for Femara and took it for five years after her lumpectomy, so I have no qualms about taking it as well. The pathology report showed that the margins were clear—doctor-speak for “We got it all!” In addition, my cancer was in my right breast, which kept the radiation farther away from my heart, and that’s a plus.

Next step: radiation. I was fortunate to qualify for hypofractionated radiation therapy as has been in the news recently and in Chet’s Tuesday message; it’s a shorter course of higher doses resulting in less overall radiation. My radiation oncologist recommended 16 general breast radiation treatments, followed by seven more-concentrated treatments. I asked him if radiation improved the survival rate, and he said, “Not really, but it’s been shown to reduce recurrence of cancer.” Good enough for me; I’d rather go through the radiation regimen than worry about whether any of the little varmints escaped and were setting up shop elsewhere. Radiation started mid-November and was done before Christmas. The treatments themselves are quick—in the room and out again in 15 minutes or less—and even though I felt fine all through the process, it’s an every-day schedule, Monday through Friday, so it gets wearing after a few weeks. I pushed my way through the schedule and only after it was done did I realize how exhausted I was; much napping ensued.

There are three reasons I’m telling you my story. First, I want you to know that if you’re going through breast cancer treatment, you know one more person who made it through just fine, and odds are you will, too.

The second is to remind you to do your monthly self exams. Since my tumor was in the back of my breast, I never felt it, but many women find their tumors themselves. And if your significant other wants to help, that’s good, too; a small but significant number of tumors are found by husbands, so let’s take all the help we can get.

Third, I want to encourage you to get your mammograms regularly and on time so if anything goes wrong you catch it early—for several reasons:

  • You’ll want the tumor to be tiny so the whole process will be as small and fast as possible—shorter, less complicated surgery, less radiation, and so on, but the best reason is to avoid chemotherapy, which takes a much greater toll than radiation. Luckily I didn’t need chemotherapy.
  • The larger the tumor, the more tissue is removed, and thus the larger the divot in your breast; mine was close to the chest wall and small enough to blend in without leaving a noticeable dent. It also left a relatively small scar; very low necklines are out, but I don’t wear them anyway. I hope I don’t seem vain, but appearances matter to women; the less damaged we feel, the better we feel about ourselves.
  • You want to minimize the amount of radiation needed because the effect is like a sunburn, and in some areas, a really severe sunburn. Now I know why pink is the color associated with breast cancer: that’s what color your skin is after they’ve zapped it several times. But like a sunburn, it clears up quickly.
  • Most important you want to catch it while it’s small enough to be detected but hasn’t spread. According to the information I was given (and there was a lot), 100 days is the estimated average time it takes for breast cancer cells to double in number; the range is from 23 days to 209. At 100 days to double, it would take nine years to reach 0.5 centimeter, and only one more year to reach 1.0 centimeter. I’m living proof that a tumor can be caught in that interval and eliminated, but I’m glad I didn’t wait another year.

I was also lucky to get treatment by Betty Ford Breast Cancer Services and their associates at Lemmen-Holton Cancer Pavilion in Betty Ford’s hometown of Grand Rapids, and it was phenomenal; the people were especially friendly and helpful, and I’ve never gotten so much information and emotional support for a health issue. Let me add that we all owe an incredible debt to Betty Ford because breast cancer treatment wouldn’t be nearly as advanced as it is now if she hadn’t spoken up: weeks after becoming First Lady, she had a mastectomy for breast cancer on September 28, 1974. Her openness about her cancer and treatment opened a national dialog about a disease that we’d all been reluctant to talk about.

So I’m a breast cancer survivor, and you may be wondering why I’m wearing red, not pink. Here’s why: as much as I appreciate and have benefited from the work of all the women in pink who’ve helped advance the state of breast cancer research and treatment, more women still die of heart disease—so I’ll continue to Go Red because I think that’s where more attention needs to go. When you talk to your doctor about scheduling your mammogram, ask her about a cardiac stress test as well. It’s no more fun than a mammogram, but it’s important for living the best life you can for as long as possible.

Paula

 

P.S. Now for something lighter: check out this link to “An Open Letter to the Mammogram Machine at Beth Israel Hospital” by Amelia Blanquera; all of us who’ve encountered one can appreciate this humorous look at her “relationship” with the machine.

 

Coping with Radiation Damage

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At some point in the future, people are going to look back at this time of cancer treatment as barbaric, but it’s the best we have today and we can’t use undiscovered treatments. However, we can help limit the damage radiation may cause to healthy tissue.

I may sound like a broken record, but it all starts with eating more vegetables and fruit; they contain vitamins, minerals, and phytonutrients in the proper proportions to help your body. Cruciferous vegetables and berries are better choices but all are great. Green tea has phytonutrients that are beneficial if you can . . .

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Breast Cancer: Radiation Therapy

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Last week’s messages sparked questions related to breast cancer, so this week we’ll look at an improvement in radiation therapy for breast cancer that’s been in the news recently.

The most important thing to understand is that there are many different forms and degrees of breast cancer. The only way to understand the type of breast cancer you may be facing is to discuss it with your physicians. Some of the terms are estrogen-positive or -negative, invasive or contained, HER2-positive or -negative, and many more. If you don’t understand the words, get a full . . .

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Cancer: Do Your Best

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We’ve spent this week looking at whether many forms of cancer are just due to bad luck or whether other factors come into play. Based on the statistics derived from comparing the lifetime rate of getting a specific cancer and the cell division rate of the tissues, about two-thirds of cancer cases are due to chance. That leaves genetics and lifestyle choices to make up the rest—and remember, breast and prostate cancers were not included in the analysis.

Some cancers, lung cancer for example, are influenced by habits such as smoking. Colon cancer is influenced by genetics . . .

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Cancer: Timing is Everything

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We’re continuing our look at whether the development of cancer is simply bad luck or if there could be more to it (1); most of all, we need to look at why we’re at risk for cancer when cells divide. Let’s start there.

The reason we’re most at risk when cells divide is that’s when they’re vulnerable to mutations—mistakes in copying the cell’s DNA. Cancer cells are typical tissue cells that multiply faster than they should; their DNA is damaged and they aren’t “behaving” normally. The damage to the DNA most . . .

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Cancer: Just Bad Luck?

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There’s nothing like starting the New Year with a bang, and I don’t mean firecrackers. A couple of scientists found a different way to shake up health news with a recently published paper in the journal Science (1). While the title of the article, “Variation in Cancer Risk Among Tissues Can Be Explained By The Number Of Stem Cell Divisions,” didn’t seem too exciting, the interpretation of their statistical analysis was. The headlines from every news service and newspaper were similar to the Message headline: Is getting cancer just bad luck? The answer is yes and no . . .

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Forks Over Knives

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I like writing the Saturday messages because it allows me to review scientific articles or controversies in health in a little more depth. Today I’m going to give you my thoughts on the movie Forks Over Knives, written and directed by Lee Fulker. The movie was exactly what I thought it would be, and at the same time completely different from what I expected. Let me give you a summary of the movie, what I thought was good, and what I found lacking.

Summary

Forks Over Knives chronicles the careers of two scientists, T. Colin Campbell and Campbell Esselstyn, and how they arrived at the same conclusion: plant-based diets will eliminate or dramatically reduce the degenerative diseases we face today such as heart disease, diabetes, and cancer. There are a couple of other well-known plant-based diet activists including Dr. John McDougall and Dr. Neal Barnard from the Physicians Committee for Responsible Medicine (PCRM).

The movie also tracked several people, including the writer, who changed to a plant-based diet and experienced a reduction or elimination of medications, weight loss, and dramatic improvements in measures of health such as blood pressure and blood cholesterol.

As you watch the movie, you’re drawn into the purported benefits of the plant-based diet—everyone would want the results the people in the movie got. The science presented seemed to be clear, from the rodent studies that Campbell used to determine that protein causes cancer to the ongoing study by Esselstyn tracking the cardiovascular health of people given up for dead by their cardiologists. Switch to a plant-based diet and you can give up all medications, improve your sex life, lose weight, improve your fertility, and live longer. Who could argue with that?

What I Liked

In the opening paragraph, I said that the movie was different from what I thought it would be so let me cover that first. I thought this would be the typical “show the slaughterhouse to gross people out” approach, but they didn’t do that at all. That’s a plus, because we get enough violence in other movies.

I thought they did a good job of explaining endothelial cells and why they’re integral to the health of your cardiovascular system (I’m covering that in an upcoming American Heart Month message, so if you don’t know about them, you will.) Ditto for C-reactive protein, the blood measure of inflammation in the body. They also mentioned, but didn’t explain in detail, the role of nitric oxide in the body. I think that’s central to the concept of why a plant-based diet is essential for health.

What I Found Lacking

Most of the problem I had was with T. Colin Campbell’s research, including rodent studies and what he’s most famous for, the China Study.

In his rodent research, he spent years studying the effects of protein on the development of cancer, according to the movie. Basically, he suggested that when you expose rats to animal protein at 20% of caloric intake, they develop cancer. If you lower it to 5%, they stop growing cancer. In one study, he claims they could turn off the growth of cancer like a light switch by switching from 20% to 5%, and then turn it back on by jumping up to 20% again.

What he didn’t say was important. The rats did not spontaneously develop cancer as suggested; only those exposed to high levels of a nasty carcinogen called aflotoxin developed liver cancer with the high-protein diet. And it wasn’t a common protein; it was casein, one of the two proteins found in milk. To make the leap from a protein no one (or no animal) would ever find in nature to suggesting that all protein causes cancer is a stretch—actually it’s like jumping the Grand Canyon. To make this research meaningful, a follow-up study needs to be done using a variety of protein; if that yields the same results, then it’s time to see if the same process applies to humans. But to not give all the details of that research while making such sweeping claims was inappropriate.

Let’s turn to the China Study, one of the largest studies of its kind. Campbell and a Chinese counterpart headed a study to find out the causes of cancer in China. The simple answer was that as dietary protein levels increased, so did all types of cancer; rural areas had the lowest protein intake and the lowest rates of most cancers, while urban areas had a much higher protein intake and thus more cancers. Seems simple, doesn’t it?

Not so fast. There are at least three very important variables that we know affect cancer rates that they didn’t address in the research or the movie:

  • What was the difference in physical activity levels in the rural versus urban areas? The majority of the people in rural areas were farmers who were physically active all day long. We know activity affects disease, so to leave that out of the equation makes the results suspect.
  • The volume of food was different between the rural and urban areas: those in rural areas chronically under eat. Intermittent famine has benefits even if it’s just one day a month. Total caloric intake could more than explain the difference in cancer rates.
  • The people in rural areas weighed less than their urban counterparts. Excess body fat is a risk factor for several types of cancer, including breast and prostate cancer.

As for Dr. Esselstyn, while he has demonstrated that his approach to a plant-based diet will literally bring people back from heart death, there were other factors that have to be considered: he talked with his patients every two weeks; they had cooking sessions in patients’ homes; they had group meetings on a regular basis; his wife taught them how to cook vegetarian meals.

Here’s my question: how do we know that it wasn’t the additional attention that was important to those patients and made the difference in their health? The relationship between mental state and health may be fuzzy, but it exists; people with untreated depression are sick more. I’m not suggesting the diet wasn’t important, but the personal attention had to account for part of the program’s success. Would you get that level of attention from your doctor? If not, you might not get the same results.

The Bottom Line

There’s a scene in the movie that really captures the essence of what I believe: Campbell implies that the members of some of the committees of the USDA are too closely tied to agri-business, and that influences the recommendations the committee makes. Dr. David Klurfeld heads the Committee on Human Nutrition of the USDA. In response to the accusation that committee members have a conflict of interest, he said that there’s also an inherent conflict of interest by Campbell, Esselstyn, and others who promote a plant-based diet: they have chosen a position and defend it with only the data that supports their position. I couldn’t agree more. The problem with the movie is it provides only one view of a very complex subject while omitting important facts and variables.

Having said that, I think you should rent or buy the movie and watch it, because I think moving to a diet that is 80% to 90% plant based is really important for our health. When combined with reducing the refined foods in our diet and eating quality protein, that’s the nutritional approach that will benefit your heart and cardiovascular system.

What are you prepared to do today?

        Dr. Chet