Multi-disciplinary Care at Northwest Hospital

If you are facing a breast cancer diagnosis, you want confidence that your treatment plan is the best one possible. To ensure that each breast cancer patient of the Herman & Walter Samuelson Breast Care Center does, in fact, receive the best care, Northwest Hospital hosts monthly multi-disciplinary conferences that are connected to Sinai Hospital via teleconference.

These conferences are called “multi-disciplinary” because they consist of a meeting of doctors from different cancer specialties, including medical oncologists, radiation oncologists, surgeons, pathologists and endocrinologists. A genetic counselor, who can give insight into the chances a patient’s breast cancer will return after treatment, also attends.

Dawn Leonard, M.D., breast surgeon and medical director of the Samuelson Breast Care Center, leads the conferences. After she presents the details of a patient’s case, center radiologist Liba Goldblum, M.D., explains images of the patient’s tumors taken from mammography and breast MRI. Next, a pathologist goes over slides that show the molecular structure of the patient’s biopsied tumor. Finally, the specialists are invited to apply their specific areas of expertise to the case, and a dialogue about treatment ensues.

As each patient’s cancer diagnosis is as unique as that person is, the format is an effective way to make sure that no angle of a patient’s medical condition is left unexplored. Essentially, the monthly conferences give patients the benefit of “being seen” by a dozen or more physicians at the same time.

Through it all, patient privacy is protected. Only pertinent details are shared, such as age, ethnic background, medical history (especially history of breast cancer risk factors) and family history of breast or ovarian cancer. These are all factors that play into a patient’s breast cancer risk.

For patients who have a high chance of breast cancer returning after treatment, doctors may advise them to undergo a mastectomy – even if their breast cancer is at stage 0, the earliest it can be detected – to protect them from a future breast cancer diagnosis. The group of physicians will also make recommendations as to whether a patient should receive chemotherapy, drug therapy or radiation – and in what order. Finally, if a patient needs one or both breasts removed, the doctors will also discuss when and how breast reconstruction should be approached. Reconstruction is always viewed as part of the treatment for breast cancer so that, if she so desires, a woman can have back her original image as much as possible.

Finally, some of the cases handled at the conferences are particularly difficult, such as when the group considers a patient who has a stage 4, triple negative cancer diagnosis, which has a low survival rate. Given that some cancer treatments can be hard on some patients, how aggressively should such a cancer be treated? Is the treatment worse than the disease?

Sometimes the answers are best determined through a conversation between doctor and patient. However, the overall consensus of the cancer doctors is that the patient must always be given hope. Optimism is a powerful force in impacting a patient’s outcome, and, given hope, even some of the sickest patients move onto the road to recovery.
-Holly Hosler

LifeBridge Health Goes Pink

If you’ve been to Northwest Hospital after dark the last few weeks, you may have noticed a rosy glow cast over the main entrance. That’s because pink lights have been installed to mark October’s National Breast Cancer Awareness Month.

It sounds simple, but adding pink lights to the front of our main building and lobby makes a statement and creates awareness about this common cancer. Awareness is the first step in finding a cure, and awareness and education lead to early detection – the best cure we have right now.

When breast cancer is caught early, it is over 98 percent curable. However, early detection is only possible when a woman is getting her regular screenings. If you are a woman age 40 or older, a recent study indicates that yearly mammograms are recommended. (Depending on your personal risk factors for breast cancer, your doctor may want you to be screened at a younger age or more frequently.) Ask your doctor or nurse how to do a breast self exam. Then use this knowledge to examine your breasts every month.

Northwest Hospital is home to the Herman & Walter Samuelson Breast Care Center, where patients can get their mammograms in an inviting, spa-like atmosphere. We are the only mammogram provider in the area to offer our patients MammoPad® – a soft, warm pad that dramatically reduces the discomfort some women feel while getting a mammogram.

Meanwhile, Sinai Hospital's Employee Activities Committee is also showing its support for National Breast Cancer Awareness Month by holding a Think Pink Departmental Decorating Contest. If you are a Sinai employee, help decorate your office or unit with PINK in mind. All employees are encouraged to wear a pink ribbon, pink t-shirt or breast cancer awareness t-shirt on Friday.

If you’d like to schedule a mammogram with us, call the Herman & Walter Samuelson Breast Care Center at 410-601-WELL (9355).

Pilates for Pink At LifeBridge Health & Fitness

Pilates exercises can help you improve your range of motion, become more flexible, increase circulation, and strengthen your posture, while decreasing your back, neck and joint pain.

Now there's a way to try out Pilates while giving back to a great cause.

LifeBridge Health & Fitness is excited to be a part of Pilates for Pink. The premiere fitness center will host this Pilates class at 5:30 p.m. on Thursday, October 28 in Studio B. The class is taught by a master STOTT Pilates instructor.

Your $30 donation will not only allow you to take the class, but to receive a special Pilates for Pink bracelet. Proceeds benefit the Herman & Walter Samuelson Breast Care Center at Northwest Hospital and the Breast Cancer Research Foundation. Make checks payable to LifeBridge Health & Fitness.

Sign up at the Service Desk at LifeBridge Health & Fitness, 1836 Greene Tree Road in Pikesville. Space is limited. Call Kimberlee at 410-318-6831 for more information.

Cancer Screening Myths and Facts Discussed at Northwest

There are many opinions on cancer screening, whether it's who should get mammograms or when to start testing for cervical cancer. That's why the Alvin & Lois Lapidus Cancer Institute wants to help you receive the best information about when to get screened and what to get screened for, as well as help health care professionals encourage

Cancer Screening Myths & Facts for You and Your Loved Ones is a talk that will cover breast, colon, and lung cancer screening guidelines. Breast surgeon Dawn Leonard, surgical oncologist Arun Mavanur and oncologist Mayer Gorbaty will also discuss other cancers and when to screen, and a patient advocate will share.

The talk will be from 6:30 to 8:30 p.m. on Thursday, November 11 at Northwest Hospital's Pike & Owings Rooms. Those at risk for developing cancer or people who would like to motivate/encourage others to be screened should attend. Pre-registration is required, so call 410-601-9355 today.

Lymphedema Lecture on Wednesday at Sinai

If you've have lymph nodes removed, you are at risk for lymphedema, a disease that causes fluid to build up in soft body tissue

Sandra Praniewicz, physical therapist at Sinai Hospital's Lymphedema Clinic, will offer helpful tips on recognizing the signs and symptoms and preventing lymphedema at a Wednesday Lunch and Learn at the Alvin & Lois Lapidus Cancer Institute. The program will begin at noon in the Cancer Institute conference room.

"Our focus is often around people who have had breast cancer, but if you're had a surgery where lymph nodes are removed, you are always at risk," Praniewicz says.

Normally, when the lymph nodes drain properly, the lymph is returned to the bloodstream. But when the lymph system gets blocked, swelling can occur.

"There are exercises that can encourage lymphatic drainage. Lymphedema is not curable," she says.

In addition to breast cancer, those who have had surgery for uterine, prostate, lymphoma or melanoma are at risk for lymphedema.

To sign up for this program or for more information on lymphedema, call 410-601-9355.

Cancer Survivors Celebrate Life

by Jill Adler
Coordinator, Patient Information Services
Alvin & Lois Lapidus Cancer Institute, LifeBridge Health

Lime green goodie bags lined the hallway like proud soldiers Sunday afternoon at the Pikesville Hilton where over 100 cancer survivors, their family and friends came to celebrate LIFE. Survivors received a warm welcome as they were greeted by nurses and other staff with colorful leis representing their years of survivorship from months to over 20 years.

The foyer magically turned into a min-spa with six healing stations set up. Feet were rubbed, pressure points were gently releived and participants could be seen relaxing with headphones on a warm mat filled with healing crystals. Can you say Freedom to Relax!

If you could peel yourself away from the spa a sea of vendors including local cancer resources, LifeBridge Health program and services and several activity stations surrounded the main ballroom.

Roars of laughter would soon be heard from the crowd as they witnessed a funny lady sitting on a barstool with a tattered book on her lap. Such a lady could only be known as Kathy LaTour, the keynote speaker, an author, comic and breast cancer survivor. Ms. Latour shared entries from her journal that set the stage for each step in her cancer experience: discovery, diagnosis, treatment, chemo, hair loss, acceptance and lessons learned. She left the crowd feeling like they were all part of a great big inside joke.....lifted, lighter and more connected. In the picture above you can see me with Ms. LaTour and Erika Akers from Breast Friends.

Although bellies were full of laughter at day's end, there was still room for the sweetness of dessert thanks to Whole Foods and Debi's Cake Studio who donated beautifully decorated cakes.

Any day that starts with warm hugs and ends with sugary treats is indeed a cause for celebration!

To learn more about the Alvin & Lois Lapidus Cancer Institute, click here or call 410-601-WELL (9355).

Meeting with a Genetic Counselor

Editor's Note: A LifeBridge Health patient recently met with one of our genetic counselors. She graciously agreed to share her story in the hopes that it will help others.

A lot of women in my father’s side of the family have been diagnosed with breast cancer, which is why my doctor recommended that I meet with a genetic counselor. Knowing that one is genetically predisposed to a certain cancer can allow screening to occur more often and start at a younger age in attempts to catch any potential cancer at its earliest stage, when it is the most treatable.

There are two known gene mutations – BRCA1 and BRCA2 – that greatly increase one’s odds of getting breast cancer. That’s because these gene mutations interfere with the body’s ability to suppress tumors in the breast. It turns out that our bodies frequently make abnormal cells. However, the body also has mechanisms to rid itself of these irregular cells. When these mechanisms fail or aren’t working properly (as in the case of BRCA1 and BRCA2 mutation carriers), that’s when cancer can occur. Having the BRCA mutations increase a woman’s risk of breast cancer to anywhere from 60 to 85 percent. These same mutations also increase the odds of getting ovarian cancer to about 45 percent.

I went to the Alvin & Lois Lapidus Cancer Institute to meet with Shannan DeLany Dixon, M.S., C.G.C., a genetic counselor and director of the Master's in Genetic Counseling Program at the University of Maryland School of Medicine. Shannan regularly sees patients at Sinai and Northwest hospitals. First, she asked me questions related to my personal risk for breast cancer, such as when I had my first menstrual cycle, if I was ever pregnant, my age, if I had ever taken birth control pills, and how much I drank alcohol. Experts estimate that about 75 percent of breast cancer cases are attributable to these lifestyle factors and have nothing to do with our genes; 15 percent are caused by a combination of genetic and lifestyle factors; and 10 percent are inevitable based on genetic makeup.

Shannan mapped out my complete family tree, noting which family members had conditions such as breast cancer, severe diabetes, heart disease and stroke. (As part of her job, she searches for all known genetic-related diseases, not only breast cancer.) While my paternal grandmother and both of her sisters had breast cancer, my grandmother was the only one to get it when she was only 39; the other family members were all women in their 50s, 60s and 70s, when breast cancer is not unusual. Shannan mentioned that there could have been an environmental factor in the town in which they lived that would have caused this breast cancer cluster.

If my grandmother’s breast cancer had been caused by the gene mutation and not her environment or lifestyle, there is a 50 percent chance that I would have inherited a mutated gene from my father. However, as long as I haven’t also received the mutation from my mother, I would not have increased risk for breast cancer because of my genes.

Based on my family tree, Shannan estimated that there would be about a 6 percent chance that a genetic test would come back positive for me, which would not necessarily mean that I would have a cancer-causing mutation to my BRCA1 or BRCA2 genes. A positive test result might show “a variant of unknown clinical significance,” because there is some normal variation to BRCA1 and BRCA2 genes that researchers are still sorting out.

As it turns out, I decided not to move forward with the genetic test because my mother’s side of the family is largely cancer-free and no one in my family is known to have had ovarian cancer. (Had either of these factors been otherwise, my decision would be different.) Testing would have been an easy process, involving either a blood sample or a cell specimen collected from the inside of my cheeks. I was surprised to learn that my insurance would have covered almost the entire cost of the test.

Meeting with Shannan gave me tremendous peace of mind. I still run the risk for breast cancer (1 in 8 women will be diagnosed at some point in her life), but I now think it’s unlikely that I have a BRCA1 or BRCA2 gene mutation. This doesn’t mean I can let my guard down. I will still get my annual mammograms and do all that I can through diet and exercise to lead a healthy lifestyle – the best form of cancer prevention.

Do you have an increased risk for breast cancer based on certain lifestyle factors? Take LifeBridge Health’s free risk assessment at Know Your Health. There are also several helpful websites with information on genetics, such as the Family Cancer Genetics Network and Facing Our Risk of Cancer Empowered (FORCE).

Celebrate Cancer Survivors with LifeBridge Health

Are you or a loved one a cancer survivor?

If so, then join us for LifeBridge Health's Cancer Survivors Day, an afternoon of fun, information, companionship and education. Light refreshments will be provided. There will be a survivors celebration activity and a keynote speaker, Kathy LaTour.

LaTour is a nationally renowned humorist, inspirational speaker and cancer survivor. Diagnosed with breast cancer in 1986, LaTour went on to write The Breast Cancer Companion. She is the creator of the one-woman show “One Mutant Cell” and has served on on the board of the National Coalition for Cancer Survivorship.

Cancer Survivors Day will be from 2 to 5 p.m. on Sunday, June 6 at the Pikesville Hilton. There is no charge, and the event is open to the public. However, pre-registration is encouraged. Call today at 410-601-9355.

My First Mammogram, Part Two

Yesterday, a LifeBridge Health patient shared about her background and why she needed a diagnostic mammogram. In Part Two, she talks about her experience of getting a mammogram for the first time. To read Part One, click here.

While getting insurance coverage was easy for me, what was not so carefree was dealing my inherent fear of mammograms. I remember when my mom got her first mammogram at age 40 and the horror with which she relayed the experience to my dad. (She used the word “pancakes.”) Even my doctor told me to take two Tylenol beforehand, as getting a mammogram would be “excruciating.” On the other hand, two other women told me that mammograms did not hurt them. So along with my fear, I was also very curious about a procedure that could be described in such different terms.

I spent much of my time in the waiting room worried. Not worried about my lump, mind you; I was worried about the mammogram. I couldn’t even focus my mind well enough to read. All I could do is look at pictures in a fashion magazine.

Therefore it came as a shock when I had a very comfortable mammogram. Easy peasy. I think there were several reasons for this. For one, I chose the Herman & Walter Samuelson Breast Care Center at Northwest Hospital, where they have MammoPad® -- a warm, foam cushion that prevents one’s breast from being pressed against cold, hard metal during the x-rays. They use a new pad for each woman, so it’s completely sanitary. The pad doesn’t interfere with the images produced, so it’s also cleared by the FDA. (Having never had a mammogram with a MammoPad, my mom told me that she wishes she could get one, as she thinks it would make the mammogram a lot more comfortable.)

I also scheduled my mammogram for a time during the month shortly after my period, when my breasts would be less fibrous and not as tender. To prepare for the mammogram, I avoided caffeine (I postponed my daily cup of coffee until afterward), and I took two Tylenol as my doctor had advised.

The mammography tech was extremely nice, and she put me at ease as she was positioning me for the mammogram. The machine also didn’t compress my breasts as tightly as I expected it to. The process went so smoothly that I now know that my fears about mammograms were unfounded. While I think it definitely helps for pre-menopausal women to schedule their mammograms at the ideal part of their cycle, next time I will consider forgoing the Tylenol.

My mammogram didn’t find anything urgent, and because I’m very young, the breast ultrasound gave the radiologist better information about my particular situation. However, I no longer fear the test that may one day save my life.

If you’ve had a mammogram, what was your first one like? Have you used the MammoPad before? Sound off in the comments below.

My First Mammogram

One of our LifeBridge Health patients wrote the following account of her experience of finding a breast lump and having a diagnostic mammogram. Part One deals with finding a breast abnormality, specifically in a young woman. Part Two, which will be posted tomorrow, is about getting a mammogram for the first time.

I was watching TV one evening when a commercial for an area breast care center came on. It reminded me that I needed to do my monthly breast self-exam (BSE). As I approached my left nipple, I felt an unusual lump. Thinking it was monthly cycle-related, my first reaction was to check for a similar lump in my right breast. Nothing. Okay…, I thought, Maybe the lump will go away after my next period.

When it did not, I went to my doctor. She felt the lump too, and given my family history, she wanted me to get a mammogram even though I was only in my early 30s. My paternal grandmother had been diagnosed with breast cancer when she was 38. I had heard that women with a strong family history of breast cancer should have their first mammogram when they are 5 to 10 years younger than the earliest age at which their relatives were diagnosed with the disease.

Unfortunately, there are a few problems with having a mammogram at such an early age. First, young breasts tend to be very dense, so the X-rays can be hard to read, even if they are digital. (However, some studies suggest that digital mammography is better than traditional film-based mammography for detecting abnormalities in dense breasts. Digital mammography also delivers less harmful radiation than the old technology) My doctor also gave me a script for a breast ultrasound, which gave the radiologist better information in my particular case.

Additionally, health insurance providers may be reluctant to cover the cost of a mammogram before age 35. Women who need to be screened earlier because of certain risk factors will be required to produce a special order from their doctor. Even so, this order might be questioned by insurance. However, I had a palpable lump, so coverage was easy for me to obtain.

If you have found a lump in your breast, do you know what to do? Ideally, routine screening mammography catches breast cancer early, before a lump can be felt. That’s why the American Cancer Society recommends that women with low to average risk for breast cancer should have a baseline mammogram between the ages of 35 and 40 to provide a record of what’s normal for them, and then get a screening mammogram every year from ages 40 to 70.

If you want to know more about your personal risk for breast cancer, you can take a free health assessment here.

Reaching Underserved Populations with Lifesaving Breast Care Information

Earlier this week, I had the privilege of attending an afternoon tea at Northwest Hospital featuring a talk by Sandra Millon Underwood, R.N., Ph.D., F.A.A.N. Dr. Underwood is the 2010 Komen Visiting Professor, and she was making a stop at Northwest during her tour through Maryland.

As a professor at the University of Wisconsin-Milwaukee, Dr. Underwood’s area of research is how to reduce – and even eliminate – disparities between breast cancer detection and treatment among various socioeconomic and cultural populations.

When breast cancer is spotted early, the opportunity for survival increases, and over 98 percent of early detected cases of breast cancer are cured. However, if a woman is not getting regular mammograms – whether it’s because she does not have health insurance, cannot afford her co-pays or doesn’t understand she needs to have regular screening – this will result in breast cancer being caught much later than it otherwise would be.

“Pink is not the only color associated with breast cancer,” says Dr. Underwood.

That’s because black and green also have significance. While white women overall have higher incidence rates of breast cancer than black women, black women under age 50 not only have higher rates of breast cancer, but they are also more likely to die from the disease. For those whose issue is green – they cannot afford regular screening mammograms and treatment if breast cancer is detected – Dr. Underwood puts them in touch with a Center for Disease Control and Prevention screening program that provides these resources.

Women who know their individual levels of risk – based on ethnicity, family history, and health and lifestyle factors – will have a great understanding of what needs to be done to catch cancer early.

Dr. Underwood also spoke about her efforts to reach out to the women on the maintenance and janitorial staff at the University of Wisconsin-Milwaukee. These were women who set up and broke down the university’s community health educational events, but they were never encouraged to attend the events themselves. After talking with one of the janitors, Dr. Underwood realized that she needed to hold events specifically for these unreached women. She even hosted events in the middle of the night (2 – 3 a.m.) so that all of the female shift workers could have the opportunity to learn what they needed to know about breast cancer.

Are you interested in becoming a team captain for the 2010 Race for the Cure? Click here to sign up to attend an informational meeting.

To learn more about breast cancer services at LifeBridge Health, call 410-601-WELL (9355) or click here.

-Holly Hosler

LifeBridge Health Welcomes Komen Professor

LifeBridge Health employees, patients, faculty and affiliated physicians are invited to a tea on Wednesday that features the 2010 Komen Partnership Visiting Professor.

Sandra Millon Underwood, R.N., Ph.D., F.A.A.N., professor at the University of Wisconsin-Milwaukee, will speak about her research findings on how to reduce disparities in breast cancer detection and control among different populations.

Dr. Underwood has committed herself to developing strategies/interventions aimed toward improving the access of minority, economically disadvantaged, and medically underserved populations to state-of-the-art breast cancer detection and control programs and is world renowned in this field.

The event will be Wednesday, April 14, from 3:45 p.m. to 5:15 p.m. at the Reister and Owings Rooms at Northwest Hospital.

Amgen will be providing light refreshments. The Komen Partnership Visiting Professor lecture is made possible through a grant from Maryland Affiliate of Komen for the Cure and the University of Maryland School of Nursing.

The tea is limited to 50 attendees. Reserve your spot now by e-mailing Dr. Caryn Andrews at CAndrews (at) lifebridgehealth.org.

The Benefits of Aspirin After Breast Cancer

By Deb Kirkland, RN, BSN, MPH
Nurse Navigator, Herman & Walter Samuelson Breast Center at Northwest Hospital

A study conducted at Brigham and Women’s Hospital and Harvard Medical School, “Aspirin Intake and Survival After Breast Cancer,” suggests there is an associated decreased risk of distant recurrence of breast cancer and breast cancer death in women who were taking aspirin. The study results were published February 16 in the Journal of Clinical Oncology.

The 4,164 subjects were breast cancer survivors participating in the Nurses’ Health Study (NHS); these women were from all over the U.S., diagnosed with stage I to III breast cancer between 1976 and 2002, and were followed until June 2006 (or their death, whichever came first).

What can we conclude from this study? Women who took a simple baby aspirin 2 to 5 days per week had a 60 percent risk reduction of their cancer spreading distally and a 71 percent reduced risk of breast cancer death. Women who took aspirin 6 to 7 times per week lowered the risk of distal recurrence by 43 percent and had reduced risk of breast cancer death by 64 percent. Overall, these women taking aspirin had a 50 percent reduced risk of distal recurrence and 50 percent reduced risk in breast cancer death.

This was an observational study, which means it suggests a relationship, but is not designed to prove a cause and effect link. What we do know is that there is an association present between aspirin and a lower risk of recurrence or death. It is believed the aspirin’s anti-inflammatory properties are what contribute to the benefit.

What does this mean if you have had breast cancer? It's important to remember that in the study, the women started aspirin one year post-diagnosis. Aspirin is not indicated for patients currently undergoing chemotherapy or radiation. Women need to be aware there is associated risk involved with taking aspirin, such as bleeding and stomach problems, such as ulcers.

However, if you are a breast cancer survivor and you are taking aspirin for protective cardiac measures, there may be a benefit in reducing breast cancer recurrence. Data suggest further studies, such as clinical trials that include aspirin and other anti-inflammatory drugs, are needed to discover if there is a direct cause and effect link. Currently, there are various studies with the use of COX 2-inhibitors and other non-steroidal anti-inflammatory drugs in breast cancer. Studies have indicated these anti-inflammatory drugs may also reduce the risk of colon cancer.

Breast Cancer Treatments Discussed in Teleconference

by Holly Hosler

To learn about the latest research on treatments for breast cancer, a group of 25 LifeBridge Health doctors, nurses and technicians joined over 675 others around the country for the Living Beyond Breast Cancer’s San Antonio Breast Cancer Symposium Update teleconference yesterday.

Eric Winer, M.D., of the Dana-Farber Cancer Institute in Boston and faculty member of the Harvard Medical School, summarized the findings of about a dozen presentations from the 32nd annual symposium held December 9-13, 2009. The San Antonio Symposium is the largest annual international gathering of breast cancer researchers, and the LifeBridge Health clinicians were excited to participate in this informational and Q&A session on the most cutting-edge research in their field. The cancer conference is sponsored by the American Association for Cancer Research, Baylor College of Medicine and the UT Health Science Center.

Dr. Winer said that although the past year didn’t provide a striking number of breakthroughs for cancer treatment, the information shared at the symposium is expected to inform research and clinical trials for the next few years. For example, one example of results presented at the conference was a recent Duke University study of 300 patients. It showed that women with advanced breast cancer who receive a combination of Herceptin and Tykerb lived close to five months longer than those only given Tykerb. The combination of the two drugs focus on a protein called HER-2 that appears in large quantities in about a fourth of all breast cancers. Cases with the HER-2 protein tend to be more aggressive, but Herceptin and Tykerb work in tandem, with Tykerb going after HER2 and the receptor and Herceptin taking on the ER2 protein.

Dr. Winer said that the future of breast cancer treatment lies in the development of targeted biologic therapies, drugs that are used alongside chemotherapy and are delivered directly to cancer cells. Because these drugs can zero in on cancer cells, they are less toxic to patients.

However, each patient’s biological makeup is different. Therefore, research is constantly being performed to determine which breast cancer treatments work, in what situations they work, and in what combination they work best to shrink tumors and produce minimal side effects.

Dr. Winer concluded that it’s “inevitable that therapy will become personalized,” which is good news for future patients. Breast cancer is the second leading cause of cancer death in women, exceeded only by lung cancer, with around 40,000 women dying annually from breast cancer. However, when breast cancer is detected early at stage 0 or stage 1, survival rates are at 98 percent.

the year in medical media

As we say farewell to 2009, LifeBridge Health is taking a look at some of the major events of the past year. Today, we look at a few of the medical stories that received media attention in 2009.

It is the waning hours of the year, and as such it is customary for many to make "Top xxxx Lists!" as a way of making 2009 into an artificial entity that we will shortly wave a fond farewell to, for better or worse, and leave behind in favor of the uncertain newness of 2010. Trying to craft any such a list for the year in medicine is a mad folly, given the sheer amount of news and discoveries that happened every week of these past 12 months. That noted, what follows is my completely subjective shortlist of medical stories that received media attention in 2009.

The dominant story of the year was clearly the new strain of H1N1 influenza virus. From it's discovery at the end of March, through its spread throughout the world and official classification as a pandemic by the World Health Organization, no other issue came close to the "swine flu's" saturation of the media. Unfortunately, much popular news coverage of the outbreak has ranged from barely adequate to frankly horrible (ABC2's H1N1 Day of Answers was an excellent event, and a notable exception to this). Often focused on fearful hype or dismissive ignorance, many media reports chose to sensationalize and misrepresent certain aspects of the pandemic (vaccines side effects, for one) while not actually doing their job - objectively reporting facts in an informed way. Coupled with some poor choices in government communication to the general public, and a failure of manufacturers to deliver vaccine on the promised timetable, the end result was unnecessary public fear, confusion, and public health inadequacy where there should have been a smooth, strong response. In this, we are fortunate that the 2009 H1N1 strain is less virulent than it might have been. I'll be taking a much closer look at the pandemic to date, and future prospects, next week.

If there is one thing that rivaled influenza in terms of media coverage this year, it was the process to craft legislation for United States health care reform. As I type this, both the US House of Representatives and the Senate have passed separate reform bills after months of deliberation, and now face the difficult prospect of merging them together. To call what has led up to this point a "debate" would be particularly generous - the amazing variety of agenda-driven nonsense that has spewed out from various political factions and interest groups is staggering, and has often threatened to drown out the basic facts involved. Add to this that said basic facts are rather complex, and that there is no "right answer", and you end up with a media message that just cannot report the issues involved adequately. The process, and the conversations it has generated, say alot about we as a people, and both the strengths and weaknesses of our political process. Our current health system (cue cutting glare at most insurance companies here) is quite deficient in some ways, and the proposed legislation is an imperfect tool to bring about needed change, but it is a start.

In the midst of this incendiary health care mess, the US Preventative Services Task Force released a long-prepared update to their mammography screening guidelines in November. Based on solid science and cost-benefit analyses, they changed their recommendations to be that women at low risk of breast cancer should start discussing mammograms with their physicians at age 40 and get them routinely starting at age 50 (as opposed to just starting at age 40), and once started, getting them every two years instead of annually. What was done in order to reduce the costs and harms (due to false positive results leading to unnecessary surgery, among other things) to a population of women in whom mammography as a screening tool doesn't work as well to detect breast cancer was then portrayed by some elements of the media as a womens' rights issue or an example of healthcare rationing (neither being true). The fundamental point that many seemed to miss is that guidelines such as these for certain populations of people are not mandates for individual patients or physicians. At the end of the day, it is unlikely that many physicians will change their breast cancer screening practices based on these recommendations alone, and hopefully more women will have informed discussions with their physicians about mammography. I'll also be going into more detail on these and other screening recommendations in future weeks.

The last two medical media-related stories on my hit list have to do with interesting research that was reported to be far more significant than it actually was. October saw headlines about a study from Thailand that finally demonstrated an "effective" and "promising" HIV vaccination strategy using a combination of vaccines. Upon examining the study however, the results were that 31% less of the patients that had the vaccine combination acquired HIV when compared with those who did not, and after correction for leaving out some who were already HIV infected, this dropped to a 26% difference. This is a potentially interesting result, but given the variables and statistics involved, hardly qualifies for language like "promising" or "effective." October also brought reporting on another paper that described a virus called XMRV that was reported to be associated with chronic fatigue syndrome. The study described finding this pathogen in 3.7% of healthy patients, but in 67% of people diagnosed with CFS. While the paper itself was appropriately conservative in suggesting the association, several news outlets and at least one of the paper's authors were outspoken on this being a clear infectious link to a rather unclear syndrome. The problem with such bold statements here is that this study, while interesting, is certainly not definitive; patients labeled as having chronic fatigue syndrome may comprise multiple groups of people with different underlying disorders; XMRV is a poorly understood virus; and as with life in general, in medicine it is vastly important not to confuse correlation (saying that the virus is there in many of the patients that have the syndrome) equals causation (saying that the virus is the cause of the syndrome). Both of these stories do have merit behind them, and I look forward to further progress here in the coming year.

2009 has been a whirlwind of new medical information, hampered by frequently poor media dissemination of that information. Just as it is incumbent on various news outlets to embark on informed, non-sensationalistic science reporting, it is equally critical for the medical community and the lay public to seek out rational facts about medical issues, and evaluate media reports with a skeptical eye. May 2010 see better medicine reporting, for the more knowledgeable health of us all.

Breast Cancer is a Global Issue

By Deb Kirkland, RN, BSN, MPH
Nurse Navigator, Herman & Walter Samuelson Breast Center at Northwest Hospital

Breast cancer is the most common cancer in women around the globe. In 2002, there were 1.2 million cases globally, and over 400,000 deaths. The number of cases is projected to increase to 1.5 million each year. During the month of October, I had the unique opportunity to participate as a U.S. Delegate with Susan G. Komen for the Cure Global Mission in Cairo, Egypt.

Cairo, which has a population of 20 million people, has a visibly disturbing poverty level. After visiting the city's hospitals, National Cancer Institute, and Breast Cancer Foundations, it was an eye-opening experience to see and hear first hand about how the disease has impacted women there. Our latest cutting-edge tools to treat breast cancer would not translate well into such a setting; rather the goal is to apply methods that are appropriate, effective, and applicable.

But, sadly, problems with breast cancer awareness, early diagnosis, treatment and survivor rates are universal. In addition to those challenges, there are cultural stigmas that create major barriers to overcome. Lighting the pyramids pink at night for breast cancer awareness and holding the first Race for the Cure around the Great Pyramids, with over 10,000 participants and 300 survivors, was an initial effort to make it more acceptable to discuss this disease. To see survivors proudly wear their pink T-shirts in that culture was more impressive than seeing the pyramids themselves. You can see a picture here.

In the U.S., we survivors are proud and wear the pink as a badge of honor in surviving; in other cultures it is still taboo and many myths exist regarding the disease. Overall, it made me proud to be an American, proud to have the access and health care we expect. We have many treatment options and resources available that many countries do not.

Surgeon Responds to Mammogram Controversy

by Holly Hosler

By now, you have likely heard about the U.S. Preventive Services Task Force’s controversial new recommendation on Monday that most women should refrain from getting mammograms in their 40s. Their rationale is that most breast cancer is found in women after age 50, and that mammography spots too many false positives for women in their 40s.

So when should women get their first mammograms? Dawn Leonard, M.D., breast surgeon and medical director of Northwest Hospital’s Herman & Walter Samuelson Breast Care Center, says that current standards as outlined by organizations such as the American Cancer Society and the National Comprehensive Cancer Network should still be followed. Annual mammograms, in conjunction with annual clinical breast examination should begin for women starting at age 40 – and perhaps even earlier if a woman has a strong family history of breast cancer.

“When a woman has a family history of the disease, she should get her first mammogram 5 to 10 years before the earliest age of breast cancer diagnosis among her relatives,” says Dr. Leonard.

She also points out that even with advances in breast cancer diagnosis and treatment, there are still populations that are more vulnerable with higher breast cancer mortality rates. For example, breast cancer tends to strike African American women at a younger age than is often expected by the medical community, and their mortality rates are higher.

“Practice guidelines that post-pone mammographic screening and eradicate self and clinical examinations will have detrimental impacts on early diagnosis and cancer survival. The medical community and the advocacy community have worked tirelessly since the ’70s to empower women to be more aware of their breast health needs and to make choices that improve breast cancer survival. The recent USPSTF recommendations appear to be a step in the wrong direction,” concludes Dr. Leonard.

The American Cancer Society stands by its guideline that by age 40, all women should be getting an annual mammogram. This group also recommends that each woman get a baseline mammography between the ages of 35 and 40 so that doctors have a record of what is likely “normal” for her. Our bodies are all different, so if you are a woman aged 20 and older, it is important to do a self breast exam on a monthly basis. This way, you know what is normal for your own breasts, and when you feel something out of the ordinary, you can alert your physician. For directions on how to perform a breast self exam, visit the American Cancer Society.

Finally, the task force also made the statement that breast self exams are of no value. However the fact remains that, though at a much lower rate, breast cancer occurs among young women as well. I know of at least two women, without family histories of breast cancer, who were diagnosed with breast cancer before age 40. Had it not been for breast self exams, these women would not be with us today.

The Debate on Breast Cancer Campaigns

by Deb Kirkland, RN, BSN, MPH

Nurse Navigator, Herman & Walter Samuelson Breast Care Center

“Save Second Base” and “Save the Ta Tas” are common slogans used today in creating breast cancer awareness. Recently, there has been some controversy over the latest public service announcement, “Save the Boobs”* for breast cancer awareness month. One thing everyone would agree on, this video made an impact! If that was the purpose, it was accomplished. Some state it was too provocative and seemed more like a beer commercial. Others agree it served a purpose and created an impact, one that most of us will not forget.

Breast cancer was once considered an older woman’s disease; today we are changing the face of breast cancer, as it is being seen more in younger women. Awareness campaigns have become more creative in attempts of targeting younger audiences. These slogans target younger women, as well as younger men. In breast cancer, due to ineffective diagnostic screening tools in this younger population, breast self awareness (BSA) is the best tool we currently have. In women under 40 diagnosed with breast cancer, 80 percent of these lumps are detected by younger women themselves or by their significant other. While some may find this PSA inappropriate, it can also be taken as creative and targeting young men, making them aware. It is a sensitive topic and if educational statistics are provided in a dry manner, people may not always remember. In a flashy commercial…they do not forget! I personally like “Feel Your Boobies”. The slogans are trendy and catchy, as they are targeting younger women. It may seem more fun wearing one of these slogans, instead of the standard pink ribbon.

If you are participating in the local Komen MD race this Sunday, you can view their local campaign, “Support Your Local Breasts” (where you will see my picture) on their Web site to promote their Race for the Cure.

I think we have come a long way, as traditionally people did not talk about breast cancer. Today it is out of the closet and awareness campaigns are everywhere, from clothes, milk cartons, to golf clubs year round. The key to remember is the message behind all of it.

*Please note the video is only allowed for users 18 and older.

October is National Breast Cancer Awareness Month

LifeBridge Health is proud to be a part of many exciting events celebrating breast cancer awareness in October.

• Wednesday, October 7: A Women's Evening of Breast Health at the Herman & Walter Samuelson Breast Care Center at Northwest Hospital. Join breast surgeon Dawn Leonard, M.D., nurse navigator Deb Kirkland, R.N., and genetic counselor Shannan DeLany Dixon, M.S., C.G.C. at 7 p.m. as they discuss the hot topics in breast health.
  
  
• Saturday, October 17: Pilates for Pink! Join Pilates instructer PJ O'Clair at LifeBridge Health & Fitness at 10:30 a.m. A $30 donation for the Pilates class goes to the Breast Cancer Research Foundation and the Herman & Walter Samuelson Breast Care Center at Northwest Hospital. Call Kimberlee Strome at 410-318-6831 for more information.
  

• Sunday, October 18: Join the LifeBridge Health team for the 2009 Komen Maryland Race for the Cure! This year's race is in Hunt Valley. There is a $35 donation registration fee before race day/$40 on race day.

• Friday, October 23: 9 a.m. braVo! breakfast at Regalo, 1848 Reisterstown Road. Tickets are $25. Reserve early, as seating is limited. Call Tiffany at 410.484.9640 or at regalo (at) regaloframes.com. A portion of the proceeds from items purchased at the event will benefit the braVo! Financial Assistance Fund at LifeBridge Health.

• Saturday, October 24: The Red Devils Swim for Survivors! Register to swim as a team or join a team of four for the event, held at LifeBridge Health & Fitness. Each team will be assigned a lane for their 30-minute swim between 8 and 11 p.m. Prizes will be given to the team and individual raising the most money. A $30 registration includes food and beverages, T-shirt and raffle tickets. Click here to register.
  

Breast Cancer Screening Offered

If you're a woman, mark your calender for Wednesday, October 7. That's when we're inviting you to join us for an evening of frank and honest discussion about women’s breast health hosted by WJZ-TV 13 news anchor Mary Bubala.

Clinical breast exams will be offered on a first come basis, and all are encouraged to take tours of the new, spa-like Samuelson Breast Care Center. Light refreshments will be served.

SPEAKER PROGRAM

Dawn Leonard, M.D.
Breast surgeon
Medical director, Herman & Walter Samuelson Breast Care Center

Dr. Leonard will open the evening’s program with a discussion about regular screening and early detection of breast cancer.

Deb Kirkland, B.S.N., M.P.H.
Breast nurse navigator, Herman & Walter Samuelson Breast Care Center
Deb will talk about the importance of breast self exams/breast self awareness, especially in younger women. As a survivor, she will share her personal experience with breast cancer and how it evolved into the role of Nurse Navigator for breast cancer patients in the Breast Care Center.

Shannan DeLany Dixon, M.S., C.G.C.
Genetic counselor, LifeBridge Health
Assistant professor, Department of Pediatrics, Division of Human Genetics, University of Maryland School of Medicine
Shannan will discuss the key risk factors and warning signs of hereditary breast cancer. She will focus on the importance of a family history of cancer and talk about two key genes, BRCA 1 and 2. She will also cover what genetic testing can and cannot tell us, and how this information is useful to doctors and patients.

SCHEDULE

5:30 – 7:00 p.m. Registration, clinical breast exams and self-guided tours.
7:00 – 8:00 p.m. Speaker program and question and answer session.
8:00 – 8:30 p.m. Clinical breast exams and self-guided tours.

To register for a screening and/or the speaker program, call 410-601-WELL (9355).