By Jayant (JP) Parthasarathy Listen to JP on the SBC podcast, Breast Cancer Conversations : Revolutionizing Breast Cancer Detection with JP Parthasarathy, founder and CEO of Astrin Biosciences “Do you have a family history of cancer?” is a standard question doctors ask all their new patients. It’s a crucial indicator of when, how often, and for which cancers a person should be screened. But there’s another question that both doctors and patients should consider when it comes to breast cancer: “Do you have dense tissue?” If you’re not sure what that means, or how you can find out if you have dense breasts, don’t worry. This article will tell you what you need to know about dense tissue and why this information is important for breast cancer detection.  Breast density describes the type and amount of tissue someone has. While some women have almost all fatty tissue, others can have more or entirely fibrous tissue, making their breasts more dense. Breast density is not something that can be felt; it’s only determined during a woman’s first mammogram . While it’s incredibly common – over half  of women over 40 have dense breasts – it can multiply someone’s chances of developing breast cancer by up to six times  – more than family history. For those with fatty tissue, a typical mammogram will clearly reveal any existing tumors as white marks. For those with dense tissue, however, the fibers also appear white, obscuring doctors’ view of any tumors. In women with extremely dense breasts, the whole breast may appear white. Today, doctors use ultrasounds and MRIs as supplemental screening for people with dense breasts since they provide higher sensitivity and clarity than mammograms, but this is a band-aid on a bigger problem. Women with dense breasts need a more effective and sustainable screening option.    How to Screen Dense Breast Tissue for Cancer   Detecting and treating breast cancer as early as possible is one of the best ways to save lives. The American Cancer Society (ACS) reports  that nearly 100 percent of women diagnosed with localized breast cancer survive five years past their diagnosis, compared to 32 percent for those diagnosed with distant spread. Screening is a powerful early detection tool, and the ACS recommends  that most women start annual mammograms after they turn 40.  Once they’re eligible, all women should get a mammogram – not only for early cancer detection, but also to learn whether they have dense breasts. From there, most women with dense breasts need supplemental screening. Unfortunately, this isn’t as seamless a solution as it should be.  Most people with dense breasts are referred for a breast ultrasound , which can search through dense tissue to identify tumors using high-frequency sound waves. An ultrasound may find two to three  more cancers per 1,000 women than mammograms, but can still miss  several cases. Additionally, while ultrasounds are low-risk, painless, and usually covered by insurance, they lead to false positives more than 90 percent  of the time. This can cause unnecessary distress for patients.  A smaller portion of women may be referred for a breast MRI, which uses magnets and radio waves to create an image of the breast. These are even more sensitive than mammograms; however, they’re also more invasive , more expensive , more likely to yield false positives   and less likely to be covered by insurance . Beyond the individual-level impact, our healthcare infrastructure and the shortage of radiologists  isn’t prepared to schedule, perform, and pay for the 40 million women who would need them each year.  How Blood Tests Can Improve Breast Cancer Outcomes While mammograms and ultrasounds remain the go-to standard of care for women with dense breasts, innovation in cancer screening is essential. Advances in cancer science and technology are creating new opportunities to catch breast cancer earlier than ever. Rather than waiting for a tumor to form to find it via imaging, highly sensitive blood tests can identify cancer at stage 0 by analyzing a small blood sample before any signs or symptoms are felt. While researchers have attempted to detect cancer through blood tests in the past, breast cancer has specifically been one of the most difficult to uncover. Unlike lung or colorectal cancers, experts estimate that detecting breast cancer in the blood would require technology 10  times more sensitive than what is currently available. Now, thanks to breakthroughs in machine learning, catching breast cancer through blood tests may now be made a reality through proteomics – the proteins that breast cancer cells use to communicate with one another. Proteins are the functional units of cells, meaning they reveal what cells are doing in real time. If cells are acting in a way that indicates cancer, proteins will be the first signals. Using artificial intelligence (AI), scientists have been able to sort through signals that are now 1,000 times more sensitive than previously possible to find the ones relevant to cancer, then inform the next best steps in a care plan. For women who have dense breasts, and even those who don’t, highly specific blood tests can be a revelation, increasing access to the early detection they need for better breast cancer outcomes. More accessible and less invasive than today’s screening options, highly sensitive blood tests could be the missing piece of the breast cancer detection puzzle.  These innovative testing technologies are currently in development and will become more widely available to oncologists and patients over the next few years. In the meantime, it’s important to continue to advocate for better screening options for women with dense breasts. Understanding breast density and available screening options is a great place to start; then you can take those learnings to your next doctor’s appointment.  Ask your doctor about your breast cancer screening options and eligibility. If you’re eligible for a mammogram, it’s time to schedule one. Whether or not you have dense breasts, talk to your doctor about blood test options that may work well for you.  Note: This article offers general information and does not replace professional medical advice. Make sure to discuss your options with your healthcare provider. About the Author: Jayant (JP) Parthasarathy is the founder of Astrin Biosciences, a St. Paul, Minneapolis-based cancer intelligence company transforming detection and treatment via deep proteomics and AI. Motivated by his father’s cancer diagnosis and passion for research, he left his role as deputy chief science officer at UnitedHealth Group to launch Astrin in 2021. JP serves on the board at the Hennepin Healthcare Research Institute and holds a Ph.D. in Brain Machine Interfaces from the University of Minnesota. Read More: What Are Dense Breasts Addressing the Unique Challenges of Breast Cancer in People Under 40 Unleashing the Potential of AI in Breast Cancer Screening, Diagnosis, and Treatment Understanding Your Pathology Report: A Comprehensive Step-By-Step Guide On the Podcast: Breast Cancer Conversations Revolutionizing Breast Cancer Detection with JP Parthasarathy, founder and CEO of Astrin Biosciences Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

Crisis Text Line : Text HOME to 741741 for free 24/7 support. A breast cancer diagnosis is more than a physical challenge—it’s an emotional one, too. Fear, anxiety, and uncertainty can be overwhelming, often leading to distress or depression. It’s okay to feel scared or frustrated, but remember that you don’t have to face it alone. Support from loved ones, counseling, and peer-to-peer groups  can make all the difference. Understanding the Link Between Breast Cancer and Mental Health Emotional Toll of a Diagnosis A breast cancer diagnosis can be overwhelming. Feelings of fear, uncertainty, and sadness are common, especially in the early stages of diagnosis and treatment planning. If this sounds familiar, you’re not alone. Studies show that nearly 25% of breast cancer patients experience clinical depression , while up to 50% report heightened anxiety  at some point. Effects of Treatment on Mental Health Cancer treatments such as chemotherapy, radiation, and hormonal therapy can contribute to mood changes . Side effects like fatigue , hormonal fluctuations, and chronic pain  may increase your feelings of helplessness and distress. Talk to your doctor to learn whether any of your prescribed medications may also impact your mental health. Survivor’s Guilt and Fear of Recurrence As breast cancer survivors, many of us experience guilt about surviving  while others do not. Additionally, the fear of recurrence can lead to persistent anxiety, making it challenging for you to enjoy post-treatment life. Maybe you’ve experienced “scanxiety,” or high stress levels before your oncology follow-ups and scans. Recognizing Signs of Depression and Anxiety As someone experiencing breast cancer treatment, survivorship, and/or living with metastatic breast cancer, you can team up with your caregivers and oncology team to recognize signs of clinical depression and anxiety disorders. Some common signs include: Persistent sadness, hopelessness, or numbness Loss of interest in activities you once enjoyed Sleep disturbances (insomnia or excessive sleeping) Changes in your appetite or weight Fatigue that doesn’t improve with rest Increased irritability, anger, or frustration Difficulty concentrating or making decisions Feelings of worthlessness or excessive guilt Panic attacks or constant worrying about your health and the future If you experience these symptoms for over two weeks, seeking professional support is essential. 5 Strategies for Addressing Mental Health Challenges 1. Seek Professional Help Psychologists, psychiatrists, and oncology social workers specialize in cancer-related mental health challenges. Therapy options like cognitive behavioral therapy   (CBT) have been proven effective in managing depression and anxiety in people experiencing breast cancer. If you have severe symptoms, your healthcare team may recommend antidepressants or anti-anxiety medications  alongside therapy. It’s important to discuss medication options with your entire oncology team as well as mental health professionals to avoid interactions with your cancer treatments. 2. Build a Support Network Social support plays a significant role in mental well-being. Connecting with support groups   can provide emotional relief and shared experiences, which can help individuals feel less isolated. Join SurvivingBreastCancer.org  every Thursday for breast cancer support groups, including special meetups for metastatic breast cancer, early stage breast cancer, and inflammatory breast cancer: https://www.survivingbreastcancer.org/thursday-night-thrivers-meetup 3. Incorporate Mind-Body Practices Research supports the benefits of yoga , meditation , and mindfulness practices in reducing stress and improving mood among people with breast cancer. These activities can offer relief from emotional distress. Join SurvivingBreastCancer.org  for our numerous yoga, Pilates, meditation, writing, and art programs: https://www.survivingbreastcancer.org/events 4. Maintain Physical Activity Engaging in regular physical activity, even in small amounts, has been shown to reduce symptoms of depression and anxiety in cancer patients .   The American Cancer Society recommends at least 150 minutes of moderate weekly exercise to improve overall well-being. 5. Practice Self-Compassion Being kind to yourself is essential . Adjusting to life with or after breast cancer takes time, and it’s okay to have difficult days. Journaling, engaging in creative outlets, and resting can help cultivate a positive mental outlook. Breaking the Stigma Around Mental Health and Cancer Many people with cancer hesitate to talk about their mental health struggles due to stigma. However, mental health is just as important as physical health . Advocacy and awareness can help change this narrative. If you or a loved one are experiencing depression or anxiety due to breast cancer, reaching out for help is a sign of strength, not weakness . Count On Us for Information, Resources, and Support Breast cancer and mental health are deeply interconnected. Recognizing and addressing depression and anxiety  is a crucial part of holistic cancer care. By seeking support, incorporating wellness strategies, and advocating for mental health awareness, you can improve your emotional well-being and overall quality of life. Remember, you’re not alone. Rely on your healthcare team, loved ones, and support networks like SurvivingBreastCancer.org  to help you through this time. Whether you’re newly diagnosed with breast cancer , are navigating survivorship, living with metastatic breast cancer, or are the loved one of someone experiencing breast cancer, you can count on SurvivingBreastCancer.org to keep you informed. We provide educational information to help you better understand symptoms , testing, treatment options , surgery, etc., and podcasts  that feature professionals, advocates, and caregivers who share valuable information. Your donations  enable SurvivingBreastCancer.org , a community dedicated to empowering those affected by breast cancer, with knowledge, understanding, and a network of care, to offer resources and support every day, every month, and every year.  Crisis Text Line : Text HOME to 741741 for free 24/7 support. Note: This article offers general information and does not replace professional medical advice. Make sure to discuss your options with your healthcare provider. Read More: The Psychological Impact of Breast Cancer: Strategies for Coping Managing Fatigue During Breast Cancer Treatment Survivor’s Guilt and Metastatic Breast Cancer The Impact of Breast Cancer on Self-Image On the Podcast: Breast Cancer Conversations Why Every Breast Cancer Survivor Should Try Pilates with Guest Nina Prol Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

In a world where medical treatments are often fast-paced, clinical, and isolating, many cancer patients are seeking complementary practices that address the emotional, spiritual, and mental toll of a diagnosis. One increasingly recognized method is forest bathing, also known by its Japanese name shinrin-yoku—a therapeutic, mindful immersion in nature. While it may sound poetic, the science and impact behind forest bathing are profound. For individuals navigating breast cancer or other types of cancer, forest bathing offers a grounded, evidence-based approach to holistic healing that supports the body, mind, and spirit. What Is Forest Bathing? Forest bathing (shinrin-yoku) originated in Japan in the 1980s as a public health initiative to counteract the negative effects of technology, urbanization, and work-related stress. Unlike hiking or jogging, forest bathing is not exercise—it’s the act of mindfully experiencing the forest through your senses. You slow down, breathe deeply, and intentionally observe the sights, sounds, textures, and smells of your surroundings. You may sit quietly in a “sit spot,” walk slowly, or engage in gentle guided meditations. There’s no destination—only presence. Studies conducted by Dr. Qing Li, a physician at Tokyo’s Nippon Medical School and one of the world’s leading researchers in forest medicine, show that forest bathing: Reduces cortisol (a stress hormone) Lowers blood pressure and heart rate Improves sleep and concentration Boosts immunity by increasing natural killer (NK) cells, which help fight cancer Reduces anxiety and depression symptoms For cancer patients, these benefits are especially meaningful. Why Forest Bathing Matters for Cancer Patients Receiving a cancer diagnosis is life-altering. Whether you're managing chemotherapy side effects, navigating post-surgical recovery, or living with metastatic disease, the emotional burden can be heavy. Forest bathing offers a restorative pause. As many cancer survivors on the Breast Cancer Conversations  podcast have shared, nature provides more than a backdrop—it becomes a partner in healing. Here’s how: Reduces Stress and Anxiety Cancer treatment often brings persistent stress, which can weaken the immune system and worsen fatigue. Forest bathing lowers cortisol and helps regulate the nervous system, supporting a calm, parasympathetic state where the body can rest and repair. Boosts Immune Function One of forest bathing’s most compelling benefits is its ability to enhance immune defense. When we breathe in the forest air, we’re also inhaling phytoncides—natural essential oils released by trees to protect themselves from bacteria and insects. These compounds stimulate the production of natural killer (NK) cells, which are crucial in the body’s fight against infections and tumor cells. In Dr. Li’s research, participants who engaged in two days of forest bathing had increased NK cell activity for up to 30 days post-visit. This is especially promising for people with compromised immunity during chemotherapy or immunotherapy. A Mind-Body-Spirit Approach: Forest Bathing as Holistic Healing Forest bathing isn’t just a physiological practice—it reconnects us to something deeper: meaning, presence, and purpose. For many cancer patients, a diagnosis can prompt a spiritual crisis. The podcast guest from the Breast Cancer Conversations  episode titled “Nature’s Healing Fosters Human Connection”  described how forest bathing allowed her to reconnect with the wholeness of her identity beyond diagnosis. She shared how the trees felt like witnesses—offering silent companionship when she needed it most. “When I couldn’t recognize myself in the mirror after surgery, the forest reminded me who I was. There was no judgment there, just stillness and love.” This relational quality of nature—where individuals feel seen and supported—is a hallmark of forest therapy’s healing potential. How to Practice Forest Bathing During or After Cancer Treatment Whether you live near a lush forest or an urban park, forest bathing is accessible to nearly everyone. You don’t need hiking gear, stamina, or a guide—just willingness and time. Here’s a step-by-step guide to get started: 1. Choose Your Space Local forest preserve, botanical garden, park, or even your backyard Look for spaces with trees, gentle paths, and minimal noise 2. Leave Devices Behind Unplug to fully engage your senses Avoid distractions like headphones or podcasts 3. Slow Down and Tune In Begin with deep, slow breaths Use your senses: Sight: Watch how light filters through leaves Smell: Inhale the earthy, piney air Sound: Listen to birds, wind, and rustling leaves Touch: Feel the texture of bark or moss Taste: Bring a herbal tea or simply savor clean air 4. Use the S.O.A.R. Method A common forest therapy guide acronym: Settle – Physically arrive and breathe Open – Let go of distractions Attune – Tune in to surroundings Receive – Notice what nature offers you 5. Reflect (Optional) Journal your experience Note any thoughts, feelings, or sensations Share with a support group or therapist if helpful Adapting Forest Bathing for Accessibility For patients who are immunocompromised, fatigued, or have limited mobility, virtual forest bathing or indoor nature immersion are effective alternatives. Ways to bring nature inside: Nature sound recordings (waterfalls, birdsong, wind) Live houseplants or fresh flowers Nature videos or forest-view screensavers Essential oils like pine and cedarwood You can also: Sit by a window and observe trees or the sky Touch natural objects like stones, leaves, or shells Create a dedicated “nature corner” at home with calming objects What the Research Says: The Science Behind Forest Bathing and Healing Here are some additional evidence-based insights: A 2010 study in the International Journal of Immunopathology and Pharmacology  showed that forest bathing significantly increased NK activity and anti-cancer proteins in women with breast cancer. A 2020 Korean study found that just 90 minutes of forest exposure decreased cancer-related fatigue and improved mood in patients undergoing chemotherapy. A 2019 review in Frontiers in Psychology  concluded that forest bathing is a powerful tool for trauma recovery, emotional regulation, and spiritual integration—making it ideal for post-diagnosis survivorship support. Nature Is Not a Luxury—It’s a Lifeline Forest bathing is far more than a wellness trend; it’s a scientifically backed, soul-nourishing practice that reminds us of who we are beneath the layers of stress, illness, and expectation. For cancer patients and survivors, it provides something that’s often missing from conventional treatment: a space for emotional safety, self-reflection, and spiritual renewal.

By Dennis Mensah, BSN, RN Cancer treatments such as chemotherapy, radiation, and surgery often lead to side effects like nausea, weakness, and appetite loss. A well-structured diet can help counteract these effects , promote healing, and strengthen your immune system. This guide explores the importance of nutrition in breast cancer recovery, the benefits of plant-based diets, essential supplements, and expert tips to enhance well-being. Tips from Nutrition Specialists for Recovery Cancer treatment is hard enough; what simple strategies can you apply to support your nutrition? To enhance recovery and well-being, nutrition specialists recommend the following strategies: Focus on whole foods: Prioritize whole, nutrient-dense foods over processed options to maximize health benefits. If you receive outpatient treatment at a cancer center or hospital, consider bringing healthy snacks with you on treatment days. Stay hydrated: Drink at least eight glasses of water daily. Herbal teas and broths can provide additional nutrients while keeping you hydrated. A personal reusable water bottle is your best friend! Plan meals in advance, or ask loved ones to start a meal train for you: Meals prepared ahead of time will ensure you have access to nutritious options, even on low-energy days. Seek professional guidance: A registered dietitian specializing in oncology nutrition can provide personalized meal plans and expert recommendations, including nutritional counseling tailored to your individual needs. Managing Side Effects Side effects like nausea and fatigue  can make eating challenging. What should you do if you start to dread mealtimes during cancer treatment? Nutritionists recommend consuming small portions of nutrient-dense meals , such as smoothies, soups, and soft fruits, throughout the day. Staying hydrated is equally important, as dehydration can contribute to fatigue and impact overall well-being. Antioxidants for Your Immune System A strong immune system is essential for recovery. Antioxidants  from fruits and vegetables that contain nutrients such as vitamins A, C, E, and D, along with minerals like zinc and selenium, help your body combat infections and promote healing. Incorporating a variety of fruits, vegetables, whole grains, and lean proteins ensures essential nutrients for immune support. Berries, leafy greens, and cruciferous vegetables like broccoli and kale are particularly beneficial. The Importance of Protein Your body requires ample protein to rebuild tissues and maintain muscle mass. Lean protein sources such as chicken, fish, beans, and legumes support this healing process. The Benefits of a Plant-Based Diet Studies suggest that a plant-based diet rich in fruits, vegetables, whole grains, nuts, and seeds may reduce cancer recurrence risk and improve overall health. Benefits include: Fiber: A plant-based diet  provides ample fiber, which supports digestive health, regulates blood sugar, and promotes a balanced gut microbiome, which is essential for a strong immune system. Weight management: Maintaining a healthy weight is crucial, as excess weight can increase the risk of cancer recurrence. A plant-based diet is nutrient-dense yet lower in calories, making it a healthy choice for weight management. Heart health: Breast cancer survivors, particularly those who have undergone certain treatments, may be at higher risk for heart disease . Plant-based diets help lower cholesterol and regulate blood pressure, supporting overall cardiovascular health. What About Nutritional Supplements? While whole foods should be your primary source of nutrition, supplements may be necessary in some cases. Consult with your oncology team before starting any supplements. Some options include: Multivitamins: For patients with dietary restrictions or poor appetite during treatment, a daily multivitamin   may help fill nutritional gaps. Vitamin D: This vitamin plays a role in immune function   and blood pressure regulation. Since many individuals have a deficiency, supplementing vitamin D under medical guidance can be beneficial. Omega-3 fatty acids: Found in fish oil and flaxseed, omega-3 fatty acids possess anti-inflammatory properties and support heart health , which is particularly important for breast cancer survivors. Nutrition as a Key to Recovery Nutrition plays a vital role during and after breast cancer treatment. Adopting a plant-focused diet, incorporating essential nutrients, and following expert recommendations can help you improve your overall well-being and long-term health. Remember, every meal is an opportunity to nourish your body and promote healing. Note: This article offers general information and does not replace professional medical advice. Make sure to discuss your options with your healthcare provider. About the author: Dennis Mensah, BSN, RN is a columnist and freelance writer. Read More: Breast Cancer and Heart Health: The Connection You Need to Know About The Sunshine Vitamin: Harnessing the Power of Sunlight for Your Health Nutrition, Mindset, and Empowerment: Thriving Beyond Cancer Managing Fatigue During Breast Cancer Treatment: Tips for Conserving Energy After Your Breast Cancer Diagnosis: Planning Your Next Steps Treatment Tips & Questions to Ask Your Medical Oncology Team Navigating Cancer Treatment: Top Tips from an Oncology Pharmacist On the Podcast: Breast Cancer Conversations What a Holistic Nutritionist Wants Every Cancer Patient to Know About Food & Wellness with Cindy Fortuna Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

In Italy today, breast cancer remains the most commonly diagnosed cancer among women, accounting for 31% of all female cancer cases. While Italy’s overall cancer mortality is 6% lower than the EU average, and its cancer survival outcomes are among the best in Europe, the picture is far from uniform across the country. A Strong Public Health System With Uneven Access Italy’s National Health Service provides comprehensive cancer care free of charge, a major distinction from the U.S. healthcare model, where access often hinges on insurance coverage. Yet access in Italy is not entirely equitable. Regional disparities are pronounced, especially between the wealthier north and the south and islands. Northern regions boast better access to radiotherapy, higher screening rates, and more consistent adoption of genetic testing (e.g., for BRCA mutations), while southern areas lag in both infrastructure and participation. Screening and Early Detection: A Work in Progress Population-based breast cancer screening is offered to women ages 50–69 (with some regions expanding to 45–74), but only about 54–56% of eligible women participated in 2022—below pre-pandemic levels. Participation varies widely by region: in Calabria, fewer than 12% of eligible women took part, while northern regions approach near-universal coverage. Opportunistic (non-programmed) screening is higher in underserved areas, but this introduces inconsistencies in quality and follow-up. Importantly, Italy is working to implement genetic screening pathways for those at high risk of hereditary breast cancer. The goal is to make BRCA testing available nationwide by the end of 2025, aligning with Europe’s Beating Cancer Plan. What Influences Breast Cancer Risk in Italy? Italy performs better than most EU countries on several modifiable risk factors for cancer. The Mediterranean diet—rich in vegetables, fruits, legumes, and olive oil—combined with relatively low alcohol consumption and lower obesity rates, contributes to Italy’s favorable breast cancer outcomes. In fact: Adult obesity in Italy is the lowest in the EU Overweight and obesity are more common in lower-income and southern populations, highlighting health equity concerns Alcohol consumption is 20% lower than the EU average Daily fruit and vegetable intake is high by European standards However, there are several concerning trends, including: Air pollution remains a major issue , with Italy ranking in the highest quartile among EU nations for exposure to PM2.5 particles—an environmental risk factor increasingly linked to breast cancer. Teen smoking and binge drinking rates are on the rise , especially among girls, potentially foreshadowing future increases in cancer incidence. HPV vaccination coverage remains inconsistent across regions, though national recovery plans are underway. Survivorship and Quality of Life Italy has one of the highest five-year cancer prevalence rates in Europe—about 6% higher than the EU average. This reflects the country’s aging population, earlier detection, and relatively strong survival outcomes. However, support for survivors varies, and gaps persist in psychological support and rehabilitation services—particularly in regions with fewer resources. Is Treatment Different from the U.S.? Yes and no. Italy and the U.S. both employ evidence-based approaches to breast cancer treatment, including surgery, radiation, chemotherapy, targeted therapies, and hormone therapies. However, differences emerge in delivery, including variation in: Access and equity : In the U.S., out-of-pocket costs and insurance gaps often limit access. In Italy, treatment is universally covered—but regional inequities affect access to timely, specialized care. Genetic testing : While both countries are expanding BRCA testing, the U.S. has broader commercial availability, whereas Italy is standardizing access through its public health plan. Screening uptake : The U.S. has higher mammography rates overall, though often linked to opportunistic screening rather than structured programs. What’s Next? Italy’s National Oncology Plan 2023–2027 is a bold effort to close these gaps. It aims to expand screening, increase HPV vaccination rates, implement BRCA testing across all regions, and improve the quality of survivorship care. However, delays in implementation and uneven regional commitment pose challenges. A new national Steering Committee was announced in 2024 to help accelerate progress. As Italy continues to advance in cancer care, ensuring equitable access across its diverse regions—and addressing environmental and behavioral risk factors—will be key to shaping a future where all individuals receive the timely, high-quality care they need.

By Laura Carfang A cancer diagnosis is life-changing. For individuals navigating breast cancer, the focus often centers on survival—completing treatment, managing side effects, and getting back to “normal.” Unfortunately, for many survivors, what follows is far from familiar. The emotional, physical, and relational impacts of cancer can linger long after treatment ends, especially when it comes to sexual health and intimacy. The Silent Struggle of Sexual Health Post-Cancer Breast cancer treatments such as chemotherapy, radiation, hormone therapy, and surgeries like lumpectomies or mastectomies can have profound and lasting effects on a person’s body and self-image. Additionally, people may experience fatigue, joint pain, scarring, or premature menopause, all of which can contribute to a decrease in sexual desire and satisfaction. Equally as impactful are the emotional scars; feelings of vulnerability, grief, or anxiety about being desirable or worthy of love. This often-overlooked aspect of survivorship deserves more attention. People diagnosed with breast cancer are frequently left to cope with these changes in silence, uncertain how they can talk about their experiences with healthcare providers, partners, or even themselves. Hormones, Identity, and Emotional Well-Being Hormonal treatments used to reduce the risk of cancer recurrence can abruptly induce menopause , even in younger patients . Sudden hormonal changes can affect not just vaginal dryness and libido, but also mood, mental clarity, and emotional resilience. The result is a complex interplay of physical symptoms and psychological shifts that many are unprepared for. Many individuals describe this experience as a loss of identity where the person they knew in the mirror feels unfamiliar . These changes can deeply affect confidence, especially when re-entering intimate relationships or dating post-treatment. For partners, it can also shift the dynamics of a long-standing relationship, leaving both individuals unsure how to reconnect. The Power of Support and Communication One of the most effective ways to navigate this new terrain is through open communication—both with oneself and with partners. Survivors and thrivers can find comfort and strength in talking to partners about their changing needs, fears, and desires. Emotional intimacy—feeling seen, heard, and valued—lays the groundwork for physical closeness to return on new terms. Supportive partners can play a crucial role in the healing process. Gestures of care, empathy, and acceptance, like offering comfort during hair loss or affirming beauty beyond scars, can be deeply meaningful. However, these conversations don’t always happen organically, and many survivors benefit from structured support like therapy, couples counseling, or peer-led support groups . Healthcare professionals  also have a responsibility to initiate and normalize discussions about sexual health. Too often, these conversations are left out of survivorship care. Providing education about what to expect physically and emotionally during and/or after cancer treatment empowers patients to prepare for and navigate what’s ahead. Breaking the Silence, Finding Community Sexual health during and after cancer is not a niche concern—it’s a central component of healing and quality of life. Those diagnosed with cancer deserve access to evidence-based resources, compassionate care, and community spaces where they can share their stories without shame or stigma. Whether you’re in a new relationship, rebuilding a connection with a long-time partner, or rediscovering your relationship with your own body, know that you are not alone. Sexual health is a valid and vital part of your recovery. It’s okay to seek support. It’s okay to grieve, and it’s okay to hope for joy, closeness, and connection again. Note: This article offers general information and does not replace professional medical advice. Make sure to discuss your options with your healthcare provider. Read More: The Impact of Breast Cancer on Self-Image Breast Cancer and Fertility Breast Cancer in Young Women: Common Questions Answered Empowering Yourself: Questions to Ask Your Doctor After a Breast Cancer Diagnosis On the Podcast: Breast Cancer Conversations Rebuilding Intimacy Post-Diagnosis: A Conversation on Sexual Health and Relationships with Tiffini Sharifi Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

Hearing the words “ You have breast cancer ” marks the beginning of a life-altering experience filled with uncertainty, fear, and countless decisions . However, that experience doesn’t end when treatment is complete. Survivorship brings its own set of challenges, whether treatment has finished or continues indefinitely.  For many, including those living with metastatic breast cancer  who may never be done with treatment, a new reality unfolds — one that involves ongoing emotional, physical, and psychological healing . Fatigue, anxiety, body image concerns , and lingering pain can persist, regardless of where someone is in their process. It’s during this deeply personal and often overwhelming time that some individuals turn to something unexpected yet profoundly supportive: hypnosis. Once viewed with skepticism, hypnosis has gained credibility in recent years as a complementary therapy that offers relief and empowerment . More than a party trick or stage act, clinical hypnosis is a focused, guided process that helps individuals tap into their subconscious mind to ease stress, manage pain, and promote healing. For those diagnosed with breast cancer, hypnosis is emerging as a compassionate tool to help heal from this experience. By fostering a sense of calm, control, and resilience, hypnosis can play a significant role in helping individuals reconnect with themselves and begin to feel whole again. What Is Hypnosis? Hypnosis , also known as hypnotherapy, is a state of deep, focused relaxation  that enables individuals to access their subconscious mind. Guided by a trained practitioner, people in a hypnotic state can develop increased awareness, manage pain, and reduce anxiety. While hypnosis has sometimes been misunderstood or portrayed inaccurately in popular media, clinical hypnotherapy   is evidence-based  and increasingly used in medical settings to help patients cope with serious illnesses, including cancer. Hypnosis is a state of focused awareness that allows you to remain awake while being deeply calm and still. In this relaxed state, people often feel more at ease and open to positive suggestions. Guided by professionals trained in hypnotherapy, hypnosis can help you explore and shift emotions, perceptions, sensations, memories, thoughts, or behaviors in ways that support healing and well-being . How Hypnosis Can Help With Breast Cancer Managing Pain and Side Effects: Research shows that hypnotherapy reduces the perception of pain during and after surgery . A study published in 2024 found that cancer patients who used hypnosis before surgery reported less pain, less fatigue, and less nausea compared to those who did not . Reducing Anxiety and Depression: A cancer diagnosis can trigger overwhelming fear, anxiety, and even depression. Hypnotherapy promotes deep relaxation, helping the mind unwind and release stress. According to the National Library of Medicine , hypnosis has been found effective in reducing anxiety and improving emotional well-being for cancer patients . Supporting Emotional Healing: People diagnosed with breast cancer often carry invisible scars — feelings of grief, changes in body image, or fear of recurrence. Hypnosis can be a tool to process trauma   and rebuild self-confidence, especially during survivorship. Improving Sleep and Energy Levels: Insomnia and chronic fatigue  are common among individuals in treatment and/or recovering from breast cancer. Hypnotherapy encourages the body’s natural relaxation response, helping improve sleep quality and overall energy. Enhancing Treatment Outcomes: When combined with traditional therapies, hypnosis may help patients feel more in control of their healing process. Some hospitals and cancer centers now offer hypnotherapy as part of integrative oncology programs. SurvivingBreastCancer.org Offers Free Online Hypnosis Recently, SurvivingBreastCancer.org expanded our robust lineup of support offerings by introducing a free online hypnosis program, specifically designed to help you navigate the emotional and physical challenges of a breast cancer diagnosis and treatment. The next program, Hypnosis: Move Your Body , takes place from 8:00-9:00 PM EDT on July 23. The following session, Hypnosis: Eating Mindfully , is scheduled for August 20. SurvivingBreastCancer.org ’s hypnosis program complements a wide range of other thoughtfully curated resources designed to promote healing and resilience. You can access guided meditations  to ease anxiety, participate in expressive art therapy sessions  that foster creativity and emotional release, and join the Reiki circle of care  to experience energy-based healing in a supportive, community-oriented setting.  These free offerings provide a valuable lifeline for anyone navigating life before, during, or after breast cancer treatment, making comprehensive care more accessible and empowering survivors to take an active role in their healing journey. Is Hypnosis Safe? Yes. When performed by a certified hypnotherapist or a trained medical professional, hypnosis is considered a safe practice. It’s non-invasive, drug-free, and tailored to each individual’s needs. However, it’s essential to note that these hypnosis courses do not constitute medical advice or replace medical treatment. Count on Us for Information, Resources, and Support  Hypnosis is not a cure for breast cancer, but it can be a profoundly healing tool for recovery. From pain management to emotional support, hypnotherapy offers individuals a way to reconnect with their inner strength and promote holistic healing. If you or a loved one is navigating breast cancer, consider speaking with your care team about adding hypnosis to your wellness plan. Whether you’re newly diagnosed with breast cancer , are navigating survivorship, or are the loved one of someone experiencing breast cancer, you can count on SurvivingBreastCancer.org to keep you informed. We provide educational information to help you better understand symptoms , testing, treatment options , surgery, and other related topics. Additionally, we offer podcasts  featuring professionals, advocates, and caregivers who share valuable insights and perspectives. Your donations  enable SurvivingBreastCancer.org — a community dedicated to empowering those affected by breast cancer with knowledge, understanding, and a network of care — to offer resources and support every day, every month, and every year. Note: This article offers general information and does not replace professional medical advice. Make sure to discuss your options with your healthcare provider. Read More: Empowering Yourself: Questions to Ask Your Doctor After a Breast Cancer Diagnosis How Cancer Trauma Can Impact Your Life – and Ways to Move Forward The Impact of Breast Cancer on Self-Image Managing Fatigue During Breast Cancer Treatment: Tips for Conserving Energy On the Podcast: Breast Cancer Conversations Beyond Medicine: Forest Therapy and Cancer Recovery with Regan Stacey Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

By Abida Taher, MD, PhD The American Cancer Society estimates that about 316,950 new cases of invasive breast cancer will be diagnosed in women in 2025 . More than 30-35% of patients undergoing cancer treatment will suffer from oral complications . A number of breast cancer treatments, including chemotherapy, and some targeted therapies like Herceptin (trastuzumab) and newer treatments like bispecifics (Datroway) can cause painful oral side effects, including mouth sores, teeth sensitivity, and dry mouth.  Apart from cancer treatment, many other medications, including antidepressants, antihistamines, decongestants, diuretics, blood pressure medications, and certain pain relievers, can cause oral issues. Regardless of the type of treatment you are getting, maintaining good oral health goes a long way in easing your treatment experience and supporting your body as it constantly adjusts to your new reality. The Oral Cavity (Or Mouth) is All About Balance A healthy mouth is a balance of saliva flow and consistency, bacteria, diet , cleanliness, and minimal plaque. Cancer treatment can disturb this balance and cause complications that interfere with your treatment and adversely affect your quality of life.  Establishing an optimal oral care routine and being prepared with knowledge and products to help deal with the side effects of treatment is important. Too many patients wind up with complications ,  ultimately leading to tooth loss. Your dentist can help you maintain tooth structure and keep you comfortable through treatment . They will make treatment recommendations based on your caries risk assessment, as well as your type of cancer and cancer treatment. Delaying dental treatment and leaving problem areas may result in a delay of cancer treatment in the future. The American Dental Association  lists the following common oral side effects from cancer treatment: Cavities, also known as caries Teeth and gum sensitivity Changes in taste Dry mouth Jaw stiffness Oral sores or mucositis These side effects can cause difficulty in eating, talking, or swallowing. The changes in your immune response will also make it harder to fight oral infections. Having a preventative protocol can help significantly decrease the severity of these side effects and help you maintain a good quality of life. Oral Health Recommendations for Cancer Patients Here are some recommendations that can help with your oral health during cancer treatment: Decrease cavity risk by brushing with a fluoride or hydroxyapatite toothpaste at least twice a day. Flossing will reduce your chances of developing cavities on the interproximal surfaces or in between your teeth. However, if you have never flossed before, do not start during cancer treatment. Avoid foods and drinks that are high in sugar. Sugar-free candies or chews, especially those made with Xylitol, will help stimulate saliva flow. Not only does the flavor stimulate saliva flow, but just chewing does as well. Limiting refined sugars as well as the length of exposure to sugary foods is important. You are at more risk of developing decay if you have a piece of candy or sugary gum in your mouth all day versus eating it all at once and then drinking water. The combination of a sugary diet and bacteria leads to a lower pH or acidic environment in the mouth, which demineralizes the enamel. Keeping your oral cavity hydrated and reducing dry mouth will help bathe the teeth and help fight decay. Mouth rinses such as salt and baking soda mixes help keep the oral tissues moist and help combat the development of oral ulcerations. A basic pH mouth rinse (such as a salt and soda rinse) neutralizes the pH and can even help remineralize your tooth enamel. Use a super soft toothbrush, especially when your oral mucosa is irritated. Visit your dentist every 3 months for an exam and for any personalized treatment based on your oral health to prevent complications later. As always, make sure your cancer care team  and your dentist are communicating with each other regularly to optimize your care. Take charge of your oral health to assist your body as it adapts to your cancer treatment. Note: This article offers general information and does not replace professional medical advice. Make sure to discuss your options with your healthcare provider. About the Author: Abida Taher, MD, PhD Founder, uncancer.com Read more about our team and products at www.uncancer.com Read More: Osteonecrosis of the Jaw: A Little-Known Side Effect of Breast Cancer Treatment Empowering Yourself: Questions to Ask Your Doctor After a Breast Cancer Diagnosis Packing a Care Bag for Cancer Treatment Nutrition After a Cancer Diagnosis On the Podcast: Breast Cancer Conversations What a Holistic Nutritionist Wants Every Cancer Patient to Know About Food & Wellness with Cindy Fortuna Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

By Jennifer Caspari, Ph.D. As a clinical psychologist living with cerebral palsy, a group of disorders that affect movement and muscle tone, I understand firsthand what it is like to live daily life with uncomfortable and unpleasant symptoms. I walk with a limp and experience chronic pain and fatigue. In addition to my lived experience, much of my career as a psychologist has focused on health psychology, helping individuals with acute and chronic health conditions, including breast cancer, enhance their functioning and quality of life. A lot of loss can come with breast cancer. You may not be able to do certain activities you enjoy, or have to do them differently. Your role around the house or at work may change for a variety of reasons, such as undergoing treatment or having limited energy. At times, it may feel nearly impossible to live well with breast cancer and have a daily routine that feels meaningful.  Yet, it is possible to live well, which I define as spending time doing activities that are connected to your values, not struggling with or fighting against things that you cannot control or change in the moment, coming back to the present moment when caught up in unhelpful thoughts or future worries, slowing down, and cultivating a balanced perspective that acknowledges the complexity of your experience. 6 Tips for Living Well With Breast Cancer Slow Down You may be a “human doer,” constantly pushing to complete task after task, and struggling to slow down and rest, to feel OK with rest. Yet, humans are not robots. You have a finite amount of energy , and slowing down and taking time to rest and decompress allows you to refill your tank so you can do things that are meaningful to you. For example, sit, take some slow breaths, making the exhale part of the breath slow and long. Play some music you like, or take a brief 2 to 5-minute break between tasks and stretch or drink some water. Taking longer breaks is helpful too. You are allowed to just be. Engage in Values-Based Behaviors Life can feel smaller when living with breast cancer. You may feel isolated and less able to do activities. When your energy is limited, it’s natural to focus on the “have tos” of life. “What do I have to get done today?” Pause and consider what is meaningful and important to you, your values, and align your behavior with your values. Ask yourself, “What is meaningful to me to focus on today?” and take action that moves you in the direction of our values. And remember, you don’t have to do it all or complete activities. Practice taking small steps in the direction of your values.                    Drop the rope in the tug-of-war with things that you cannot control or change in the moment   It is natural to fight against what is unpleasant and what you don’t like. However, doing so tends to just amplify distress, because you become caught in an unwinnable tug-of-war. Accepting the present moment means allowing the moment to exist as it already is and not fighting it. Acceptance doesn’t mean you have to like it, or that you don’t take steps to change unhelpful behavior. Rather, you are freeing up energy, as you are not using energy fighting against reality, which allows you to engage in helpful and values-based behaviors. Come back to the present moment when you feel caught up in unhelpful thoughts or future worries It can be helpful to deliberately and purposely think about the past or future so that you can learn from your behavior and plan for future events. Yet, it is problematic when your mind is thinking about the past or future in a nondeliberate and spinning manner, thinking about the same thing over and over without a helpful outcome . This type of mental spinning can lead to increased stress, exhaustion, irritability, anxiety, and distress. Practicing coming back to the present moment allows you to deliberately direct your attention to your experience in the present moment, versus being stuck in your head. You can do this by taking a slow breath and noticing the sensation of the air moving in and out of your body. Or, looking around and naming 5 things you can see. Tip: Join SurvivingBreastCancer.org for live meditation sessions , or visit our on-demand meditation library ! Cultivate a balanced perspective that acknowledges the complexity of your experience You may zoom in and only focus on certain aspects of your experience, particularly aspects that are unpleasant or that you feel frustrated or upset by. However, multiple things, even contradictory things, can occur at the same time. If you practice acknowledging all aspects of your experience, you can make a more intentional choice about how you want to act versus focusing on only one aspect of your experience and acting out of habit or comfort. One way to practice this is by using the word “and” instead of “but.” Intentionally using the word “and” allows for complexity and dichotomy in your experience. “And” acknowledges, includes, and expands what precedes it. For example, you may say to yourself, “I am tired AND I would like to see my friend,” and then consider what feels most helpful to you right now.  Practice Body Neutrality Body neutrality includes cultivating a neutral attitude toward the body that is realistic, mindful, and flexible. It involves appreciating the broad functionality of the body and recognizing that self-worth is not based on appearance . You can practice this by respecting and taking care of your body, reminding yourself what your body can do (e.g., breathe), even when coping with body changes and challenges, and holding your thoughts about your body lightly and flexibly, as they will likely change over time.  Note: This article offers general information and does not replace professional medical advice. Make sure to discuss your options with your healthcare provider. About the Author: In my new book,  You Are More Than Your Body: 30+ Evidence-Based Strategies for Living Well With a Chronic Illness—By a Clinical Therapist Living With Cerebral Palsy , I offer a variety of coping skills that aim to increase acceptance, empower you to engage in values-based action, and enhance quality of life. Jennifer Caspari, Ph.D., is an Associate Psychologist with Cognitive Behavior Therapy Associates of Denver (CBT Denver – cbtdenver.com ). Dr. Caspari specializes in delivering evidence-based psychotherapies to adults with acute and chronic health issues, including chronic pain, chronic fatigue, sleep difficulty/insomnia, cancer, body image issues, disordered eating, and other health concerns (e.g., diabetes, tinnitus, adjustment to disability, etc.). She also provides evidence-based psychotherapies for stress/adjustment issues, grief, anxiety disorders, depression, mood disorders, relationship concerns, and trauma. Dr. Caspari has expertise in health psychology, helping clients to live full and meaningful lives with acute and/or chronic illness and chronic pain.  Her collaborative, warm, and empathetic approach focuses on enhancing functioning, the ability to engage in values-based behaviors, and overall quality of life. Dr. Caspari aims to support clients in gaining awareness of their thoughts, emotions, and behaviors and to translate that insight into helpful and personally worthwhile changes in their daily lives. She views much of her role as helping clients enhance their cognitive, emotional, and behavioral flexibility to improve their well-being. Dr. Caspari has an extensive skill set in evidence-based psychotherapies with diverse populations. For example, she is trained in Cognitive Behavior Therapy (CBT), CBT for Insomnia (CBT-I), CBT for Chronic Pain (CBT-CP), Behavioral Activation (BA), Acceptance and Commitment Therapy (ACT), Mindfulness-Based Cognitive Therapy (MBCT), Cognitive Processing Therapy (CPT), and Skills Training in Affective and Interpersonal Regulation (STAIR). She earned her undergraduate degree in psychology from American University and a master’s degree in community counseling from George Washington University. She earned her Ph.D. in counseling psychology from the University of Denver. Dr. Caspari is the author of You Are More Than Your Body: 30+ Evidence-Based Strategies for Living Well with Chronic Illness – By a Clinical Therapist Living with Cerebral Palsy , and has provided multiple trainings for mental health professionals, including a national course with PESI on Acceptance and Commitment Therapy for Chronic Pain. Read More: Managing Fatigue During Breast Cancer Treatment: Tips for Conserving Energy Breast Cancer and Mental Health: Recognizing and Addressing Depression and Anxiety The Impact of Breast Cancer on Self-Image Harnessing the Power of Hypnosis for Breast Cancer On the Podcast: Breast Cancer Conversations Beyond Medicine: Forest Therapy and Cancer Recovery with Regan Stacey Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

If you or someone you love is navigating breast cancer treatment, the possibility of developing lymphedema can feel overwhelming. The thought of facing another challenge may bring a mix of fear, confusion, and frustration. Fortunately, you’re not alone. Many individuals with breast cancer experience lymphedema, and with the right knowledge and support, you can manage it effectively. Taking the time to understand what lymphedema is, why it happens, and how it progresses through different stages can make the condition feel less intimidating. More importantly, learning about proven strategies to reduce swelling, prevent flare-ups, and stay active can help you or your loved one regain control. With the right tools and resources, it’s possible to live comfortably, protect your health, and move forward with confidence. What Is Lymphedema? Lymphedema  is a chronic condition that occurs when the lymphatic system can no longer circulate lymph fluid effectively, leading to a buildup of protein-rich fluid in the soft tissues. This accumulation causes painful swelling, most commonly in the arms or legs, but it can also affect the chest, hands, trunk, abdomen, face, or genitals. Over time, lymphedema can lead to skin thickening, tissue changes, and increased discomfort. Breast cancer-related lymphedema (BCRL) often develops after treatments that involve removing or irradiating lymph nodes, particularly under the arm. These interventions disrupt normal drainage, causing fluid to back up in the arm, breast, chest, or hand. While lymphedema can range in severity, early diagnosis and proper management are essential to reduce symptoms and prevent progression. To learn more, listen to the Breast Cancer Conversations  podcast episode “ What Is Lymphedema? ” Who’s at Risk for Lymphedema? Doctors don’t yet fully understand why some individuals develop lymphedema while others don’t. However, the risk increases significantly for those who have undergone the removal of multiple lymph nodes and received radiation therapy to the axillary (underarm) area during cancer treatment. Lymphedema affects approximately one in five people treated for breast cancer and can appear at any point, sometimes even years after treatment has ended. This unpredictability highlights the importance of ongoing awareness and monitoring. There are also a few individual risk factors, including: High body mass index (BMI) Infection or inflammation in the limb Injury, vascular disease, or skin conditions Gene-related vulnerability (primary lymphedema is rare) Lymphedema Symptoms Lymphedema can cause a variety of symptoms, which may develop gradually and worsen over time. Common signs include: Swelling in part or all of the arm or leg, including the fingers or toes A sensation of heaviness, tightness, or aching Reduced range of motion Recurring infections Hardening or thickening of the skin (a condition known as fibrosis) If left untreated, lymphedema can interfere with daily activities and increase the risk of complications. Severe cases may limit mobility, lead to frequent infections such as cellulitis, and cause long-term skin changes or breakdown. Early diagnosis and medical care  are key to managing symptoms and preventing progression. Lymphedema Treatment Options While lymphedema currently has no cure, a range of surgical  and nonsurgical treatments can help manage symptoms, reduce swelling, and improve quality of life. Lymphaticovenous Anastomosis (LVA) — Also Known as Lymphovenous Bypass Surgeons perform a minimally invasive outpatient procedure to reroute lymphatic fluid by connecting lymphatic vessels directly to tiny veins, effectively bypassing damaged or removed lymph nodes. It requires only small incisions and involves minimal blood loss. LVA can significantly reduce swelling and, in some cases, restore normal function to the affected limb. Vascularized Lymph Node Transfer (VLNT) In this outpatient procedure, surgeons use green dye to locate healthy lymph nodes — usually from the abdomen — and transplant them into the area with lymphatic obstruction. These transplanted nodes promote the growth of new lymphatic pathways and can improve drainage over time. Laparoscopic Omental Lymph Node Transfer (Omental Transplant) Surgeons use the omentum — a fatty layer in the abdomen rich in lymph nodes — in a minimally invasive procedure to help restore lymphatic circulation. Surgeons access and transfer omental lymph nodes through laparoscopic techniques, reducing recovery time and scarring. Nonsurgical Treatment Options Exercise Gentle, targeted exercises  can stimulate lymphatic flow and prepare the affected limb for daily tasks. A certified lymphedema therapist can create a personalized routine focused on low-impact muscle contractions. Avoid strenuous activity unless advised otherwise by your healthcare provider. Consult the National Lymphedema Network  to find a certified lymphedema therapist near you. Manual Lymphatic Drainage (MLD) A specialized form of massage encourages the movement of lymph fluid out of the swollen area. However, doctors advise against it for individuals with active infections, blood clots, or certain underlying conditions. Always consult your healthcare team before starting MLD. Pneumatic Compression Therapy A sleeve worn on the affected arm or leg connects to a pump that periodically inflates, applying pressure to help move lymph fluid away from the extremities. Compression Garments Custom-fitted sleeves or stockings apply consistent pressure to the affected limb, improving lymph fluid flow. These garments are essential during exercise. A healthcare professional can help determine the right fit and whether a custom garment is needed. Bandaging Multilayer bandaging encourages lymph fluid to move back toward the core of the body. Bandages should be snug around the fingers or toes and gradually looser toward the torso.  Complete Decongestive Therapy (CDT) CDT  is the gold standard in lymphedema care. It combines several approaches — manual lymphatic drainage, compression therapy, targeted exercise, and skin care — into a comprehensive treatment plan tailored to the individual. Tips to Lower Your Risk of Developing Lymphedema While no method can guarantee lymphedema prevention, specific proactive steps may reduce your risk or help manage symptoms if they appear: Stay alert to changes:  Notify your doctor right away if you notice any changes in size, color, temperature, or sensation in the area of your body that received cancer treatment, including the skin. Exercise safely:  Ask your cancer care team or a certified lymphedema therapist about exercises tailored to your condition . The correct movements can promote healthy lymph flow and may reduce your risk or help manage lymphedema if it develops. Maintain a healthy weight:  Excess body weight increases your risk of lymphedema and can make symptoms more complicated to control. Healthy eating and regular physical activity are essential parts of long-term management. Avoid unnecessary pressure:  Refrain from wearing tight-fitting clothing, jewelry, or undergarments that put pressure on the chest, arms, wrists, waist, legs, or genitals. Compression garments are the exception, but be sure they fit correctly, and follow your care team’s guidance when using them. Count on Us for Information, Resources, and Support If you’re living with or supporting someone with breast cancer, knowledge is power. While lymphedema may feel daunting, it’s manageable. Seek guidance early, lean on professionals and the community, and know that with the right tools, you can thrive. Whether you’re newly diagnosed with breast cancer , are navigating survivorship, or are the loved one of someone experiencing breast cancer, you can count on SurvivingBreastCancer.org to keep you informed. We provide educational information to help you better understand symptoms , testing, treatment options , surgery, and other related topics. Additionally, we offer podcasts  featuring professionals, advocates, and caregivers who share valuable insights and perspectives. Your donations  enable SurvivingBreastCancer.org — a community dedicated to empowering those affected by breast cancer with knowledge, understanding, and a network of care — to offer resources and support every day, every month, and every year.  Note: This article offers general information and does not replace professional medical advice. Make sure to discuss your options with your healthcare provider. Read More: Understanding Lymphedema Surgical Methods for Treating Lymphedema Treatment for Lymphedema Lymphedema is a Chronic Condition & Why I Love Swimming What is Breast Cancer Rehab? Exercise and Breast Cancer Recovery On the Podcast: Breast Cancer Conversations The Prehab Plan Surgeons Wish You’d Start Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

Recovering from breast cancer is deeply personal, and for many survivors, regaining strength, confidence, and energy is a key goal after treatment. The good news? Exercise is one of the most effective tools to support your physical, emotional, and mental recovery. Keep reading to explore how exercise supports breast cancer recovery , how to get started safely, and what types of movement offer the most significant benefits. Why Exercise Matters After Breast Cancer Research shows that regular physical activity is vital after breast cancer treatment. A 2019 study highlighted by the National Cancer Institute found that breast cancer survivors who engaged in regular physical activity had a 42% lower risk of death from any cause compared to those who were inactive . Exercise can: Reduce fatigue Improve physical functioning Support emotional well-being Lower the risk of recurrence Improve overall survival According to the American Cancer Society, survivors should aim for at least 150 minutes of moderate-intensity activity each week . Physical and Emotional Benefits of Exercise Exercise offers a powerful boost to both physical health and emotional well-being. Regular physical activity strengthens the body, supports heart health , and improves energy levels, whether through a brisk walk, a dance class, or strength training. Importantly, it helps reduce stress, elevate mood, and enhance mental clarity, making it a vital tool for overall wellness. Physical Benefits: Reduces cancer-related fatigue Strengthens bones and muscles, especially important for those on hormonal therapies Improves cardiovascular health Helps manage weight gain, which treatments like chemotherapy or steroids often cause. Emotional and Mental Health Benefits: Eases anxiety and depression Boosts self-esteem and body image Helps manage stress Improves sleep quality Is It Safe to Exercise After Treatment? Exercise is usually safe but highly recommended, even during treatment. However, you should always: Get clearance from your health care provider , especially if you’ve had surgery, lymph node removal, or are undergoing treatment. Work with a cancer exercise specialist  or physical therapist  who understands your unique needs. Start slow and listen to your body — you don’t need to go from zero to 5K overnight. If you’ve had lymph nodes removed, take steps to prevent lymphedema . Learn more about lymphedema here . What Kinds of Exercise Are Best? 1. Walking Walking offers a low-impact option, provides easy accessibility, and actively boosts energy and mood. Need some extra motivation to get those walking shoes on? Join SurvivingBreastCancer.org  at our annual Tell Cancer to Go #TakeAHike  fundraiser on October 25 – you can participate from anywhere in the world! 2. Strength Training Strength training is a good way to rebuild muscle lost during treatment. It’s best to use light weights or resistance bands under supervision first. 3. Stretching and Flexibility Exercises These exercises support recovery after surgery or radiation. Gentle yoga or guided physical therapy can improve mobility. Join us for free virtual yoga programs !  4. Aerobic Exercise It supports heart health and fights fatigue. Examples include cycling, swimming, and low-impact aerobics. 5. Mind-Body Practices Yoga, tai chi, and pilates are excellent for managing stress and restoring balance. Check out SurvivingBreastCancer.org ’s upcoming movement classes . Getting Started: Tips for a Safe Exercise Routine Starting a new exercise routine is an exciting step toward better health, but it’s essential to prioritize safety from the very beginning. Whether you’re returning to fitness or trying it for the first time, taking a few precautions can help prevent injury and set you up for long-term success.  Here are practical tips to help you safely ease into your routine: Begin with short sessions  (10-15 minutes) and increase gradually. Focus on consistency over intensity . Wear supportive footwear  and stay hydrated. Track your progress  and celebrate small victories. Join a survivor-focused fitness group — SurvivingBreastCancer.org offers movement programs  specifically designed for the cancer community. Count on Us for Information, Resources, and Support  Every person’s cancer experience is different. Whether you’re just starting to regain strength or already back in your sneakers, every step counts . Exercise isn’t just about recovery — it’s about reclaiming your body, energy, and joy. Start where you are, do what you can, and keep going. You’re not alone — and you’re stronger than you think. Whether you’re newly diagnosed with breast cancer , are navigating survivorship, or are the loved one of someone experiencing breast cancer, you can count on SurvivingBreastCancer.org to keep you informed. We provide educational information to help you better understand symptoms , testing, treatment options , surgery, and other related topics. Additionally, we offer podcasts  featuring professionals, advocates, and caregivers who share valuable insights and perspectives. Your donations  enable SurvivingBreastCancer.org — a community dedicated to empowering those affected by breast cancer with knowledge, understanding, and a network of care — to offer resources and support every day, every month, and every year.  Note: This article offers general information and does not replace professional medical advice. Make sure to discuss your options with your healthcare provider. Read More: Exercise and Breast Cancer What is Breast Cancer Rehab? Managing Fatigue During Breast Cancer Treatment: Tips for Conserving Energy Breast Cancer and Heart Health: The Connection You Need to Know About The Impact of Breast Cancer on Self-Image On the Podcast: Breast Cancer Conversations From Diagnosis to Downward Dog: How Yoga Can Heal Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

“How are you sleeping?” It may seem like a simple check-in, but for oncology teams, this question carries weight because the quality of your sleep can directly impact how your body responds to cancer, treatment, and recovery. Sleep and Breast Cancer: Why Rest Is More Than Just Beauty Sleep At SurvivingBreastCancer.org , we know that getting a good night’s sleep is easier said than done, especially when you're juggling the emotional, physical, and mental toll of a diagnosis. However, there's an encouraging reminder: while lack of sleep doesn’t cause cancer, good-quality sleep helps your body heal, restore, and fight . Let’s dive into why sleep matters, how it connects to breast cancer, and twenty sleep strategies to help you reclaim your rest. The Science of Sleep and Cancer Emerging research shows a strong relationship between sleep and overall health, including cancer outcomes. In particular, non-respiratory sleep disorders and disrupted circadian rhythms  (your internal body clock) have been linked to cancer progression and impaired immune function. Sleep disturbances can disrupt the balance of two key hormones: 1. Cortisol Known as the "stress hormone," cortisol should naturally decrease at night to allow your body to rest. Chronic elevation of cortisol levels, often due to poor sleep, can suppress the immune system and increase inflammation, creating an environment where cancer cells may thrive. 2. Melatonin This hormone plays a role in regulating your sleep-wake cycle and is also believed to possess antioxidant properties  that protect cells from DNA damage. Some studies suggest melatonin may also inhibit estrogen production —a relevant factor for hormone receptor-positive breast cancers. Sleep Apnea and Cancer Risk Obstructive sleep apnea (OSA) has been associated with an increased risk of cancer mortality. During OSA episodes, your airway becomes blocked during sleep, reducing oxygen levels and leading to frequent awakenings (and often loud snoring). Over time, these frequent oxygen drops and sleep fragmentation can create systemic stress and inflammation. If you're a snorer or experience daytime fatigue, it's worth talking to your doctor about a sleep study. A diagnosis and treatment (like a CPAP machine) could not only improve sleep but also reduce long-term health risks. The Emotional Side: Why Sleep Feels So Hard During Cancer If you’re undergoing treatment, in survivorship, or living with metastatic disease, insomnia can be a frustrating, persistent companion. Fear, stress, medication side effects, hormonal changes, and chronic pain can all contribute to restless nights. Sleep disturbances among cancer patients are common, with studies estimating that 30–50%  of people in active treatment experience insomnia—and those numbers don’t always improve after treatment ends. Rather than blaming yourself or forcing sleep to happen, we encourage you to approach sleep like healing: with curiosity, compassion, and gentle experimentation. 20 Sleep Strategies for Cancer Survivors and Thrivers Whether you’re in active treatment or learning to thrive post-diagnosis, here are 20 evidence-based hacks and holistic tips  to help improve your sleep over time: Keep a Consistent Sleep Schedule: Go to bed and wake up at the same time daily—even on weekends. Apps like Sleep Cycle or Calm can help track your sleep patterns. Wake Up During Optimal REM Cycles: Sleep apps can analyze your REM cycles and wake you gently within a window that prevents grogginess. Cut Back on Fluids and Stimulants: Limit caffeine after lunch, reduce alcohol, and stop drinking large amounts of fluids in the evening to avoid nighttime trips to the bathroom. Warm Bath + Cool Room + Warm Feet: A warm shower followed by a cooler bedroom (60–67°F) and cozy socks can help signal the body to wind down. Use an Eye Mask if Your Room Isn’t Dark Enough: Even small light sources can disrupt melatonin production. Ditch Screens Before Bed: Blue light from phones and tablets suppresses melatonin. Power down at least 60 minutes before bed or use "night mode" features. Exercise (But Not Too Late): Daily movement—preferably in daylight—can help regulate your sleep cycle. Avoid high-intensity workouts within 2 hours of bedtime. Create a Calm Sleep Environment: Soothing colors, blackout curtains, and a clean, peaceful room can improve rest. Say No to Pets in the Bed: Your furry friend may be adorable, but even small movements can disrupt your sleep cycle. Take a Power Nap: If you nap during the day, keep it to 20–30 minutes. Long naps can throw off your nighttime rhythm. Journal Before Bed: If racing thoughts keep you awake, jot them down. A bedside notebook can also capture middle-of-the-night worries. Practice Deep Breathing or Meditation: Try guided meditations, breathwork, or yoga nidra to ease into sleep. Use Calming Scents Like Lavender: Aromatherapy (with oils, diffusers, or sprays) may help you relax faster. Try Progressive Muscle Relaxation: Starting at your toes, slowly tense and release each muscle group, moving up to your head. Visualize Something Peaceful: Like artist Patti Smith’s approach to insomnia, imagine comforting scenes or people you love. It helps shift your focus from stress to serenity. Get Morning Sunlight: Expose your eyes to natural light for 15–30 minutes shortly after waking to help regulate your circadian rhythm. Check Your Pillow: The wrong pillow can cause neck strain and discomfort. Replace pillows every 12–18 months, and choose one suited to your sleep position. Review Your Magnesium Levels: Magnesium supports relaxation. Some people benefit from supplements (including magnesium glycinate or calcium-magnesium blends)—check with your provider first. Try a Weighted Blanket: These provide gentle pressure that may reduce anxiety and promote calm. Use a White Noise Machine: Sound machines with settings like ocean waves, rain, or soft static can help mask background noise and lull you to sleep. Sleep is not a luxury—it’s a vital part of your recovery and long-term health. Whether you’re newly diagnosed, living with MBC, or navigating survivorship, prioritizing sleep is a form of self-care that’s often overlooked. Start small. Try one or two strategies at a time. Listen to your body, be patient with yourself, and remember: sleep doesn’t have to be perfect—it just needs to be healing.

The power of positive thinking is so pervasive today that many doctors and nurses strongly recommend developing a positive mental attitude to prevent sickness, help overcome medical setbacks, and assist in recovery from cancer surgery. Indeed, there is healing power in positive thinking, but can you heal yourself just by being positive, optimistic, and focused? Many believe that positive thoughts can prompt physiological changes that strengthen your immune system, decrease pain, and provide stress relief. The “Power of Positive Thinking”, a self-help book by Norman Vincent Peale, published in the last century, first proposed the method of "Positive Thinking". It aimed to ensure that one could achieve a permanent, fruitful, and optimistic attitude through the constant positive influence of their conscious thought. This was to be accomplished through affirmations/visualizations, thus allowing one to attain higher satisfaction and quality of life. Similarly, in the book “The Secret” by Rhonda Byrne, the Law of Attraction is explored and suggests that whatever energy, thoughts, or visualizations you put out into the universe, you will receive. Therefore, if you send out negative vibes or think something negative will happen, it probably will. If you send out positive vibes, positive things will be returned. How to Develop Positive Beliefs and Drive Expectations to Activate Self-Healing Start by applying the right kind of positive thinking to direct your subconscious mind to help heal your body and improve your life, including: Direct your conscious and subconscious mind to help you heal Apply positive thinking. Don’t worry, be happy. "Worry only takes the joy out of your day." Find a way to focus on the positive. What are you grateful for? Start a mental list of the things and people in your life that you are thankful for. Be optimistic Imagine you can see your cancer, take a deep breath, and now, as you exhale, visualize the cancer floating away and leaving your body. If you are experiencing pain after surgery, say “hello” to your pain, acknowledge that you can feel it, perhaps your pain has a particular color, or name. Experience the sensation, and then, tell your pain that it is time for it to leave and say “goodbye”. Develop a positive attitude. By enabling your conscious and subconscious mind to be more optimistic, you tend to attract greater positivity into your life. Migrate Towards Positive Thoughts and Positive Beliefs The changes begin when one’s subconscious mind begins to adopt the new belief system. It then starts to guide you to those opportunities that help you improve your health. Once you begin to calm your mind, the subconscious begins to calm the body, leading to better health. When your mind begins to focus on what you want and stops being negative, you will begin to see dramatic changes. Try the following: Create a belief system that allows you to heal Develop a new positive, optimistic attitude and outlook. Eliminate negativity. Surround yourself with people who make you smile, laugh, and are encouraging. Remove limitations Remain focused on what you want. This isn’t to say never be upset or that you cannot have a bad day, we all go through our ups and downs; Everyone has their good days and bad days. However, the Power of Positive Thinking is a mindset, a way of life. You have to believe in yourself and get your subconscious mind and inner self working for you. You have to give them the right instructions, and they’ll bring you what you want and more. You can help to heal yourself and improve your life when you’re positive, optimistic, and focused on improvement. References: The Science of Positive Healing Thoughts - https://articles.mercola.com/sites/articles/archive/2016/02/04/healing-thoughts.aspx Can Positive Thinking Help You Heal? | Psychology Today https://www.psychologytoday.com/blog/owning.../can-positive-thinking-help-you-hea... Can positive thinking make you well? - CNN - CNN.com https://www.cnn.com/2011/12/05/health/positive-thinking-deepak.../index.html Healing With Positive Thinking - Affirmations For Positive Thinking www.affirmationsforpositivethinking.com/Healing-with-Positive-Thinking.htm The Science of Healing Thoughts - Scientific American https://www.scientificamerican.com/article/the-science-of-healing-thoughts/ Positive Thinking Improves Physical Health | Psych Central https://psychcentral.com/lib/the-power-of-positive-thinking/ Positive Thinking, Faster Recovery - ABC News abcnews.go.com/Health/story?id=117317 Can Positive Thoughts Help Heal Another Person?: NPR https://www.npr.org/templates/story/story.php?storyId=104351710

By Jasmine Shukla & Laura Carfang The results of the Oncotype Dx are a recurrence score, a number which ranges from 1 through 100. The higher number is associated with a greater probability of the cancer returning, and that the patient will receive greater benefits from undergoing chemotherapy. If the number is lower, studies have found that there is little added benefit of adding chemotherapy as part of the patient's treatment plan. These scores suggest the risks and chances of breast cancer’s return even after therapy and surgery. The result or outcome serves as a point of reference for a dialogue between the patient and the oncology team to determine the best course of action. What is the Oncotype Dx Test? The Oncotype DX is a genomic test that analyzes the behavior of 21 genes and, through an algorithm, predicts the likelihood of how effective chemotherapy would be for a particular individual. We know there are several benefits of undergoing chemotherapy, but the choice to put our bodies through such a potent and toxic treatment does not come easily. Those diagnosed with breast cancer and their medical oncologists need to discuss the pros and cons of a chemotherapy regimen, the timing of chemotherapy (neoadjuvant, i.e., before surgery, or adjuvant, meaning after surgery), and understand that it may not be for everyone. A research study called "Trial Assigning Individualized Options for Treatment” (TAILORx) set out to determine whether chemotherapy is beneficial for women who have mid-range Oncotype DX tumor recurrence scores. This trial—the largest breast cancer treatment trial ever conducted—showed that endocrine therapy alone was as effective as endocrine therapy plus chemotherapy in women with certain types of early-stage breast cancer. The results of this trial have been implemented immediately into practice after its announcement at the American Society of Clinical Oncology . When is the Oncotype Dx Test Used? The Oncotype Dx test is used in two main scenarios. If the breast cancer has not spread beyond the milk ducts, (ductal carcinoma in situ), it will help doctors understand the woman's risk of the cancer coming back, or returning, as well as provide insight into the benefits the woman would receive from radiation therapy after DCIS surgery. If the early-stage cancer is estrogen-receptor positive, the Oncotype DX test can help frame the conversation for how likely the woman would benefit from chemotherapy after surgery. Who is Eligible For the Oncotype Dx Test? This test isn't for everyone. The thought of not needing to have chemotherapy sounds like a dream to many breast cancer patients. However, many find that they are not candidates for the Oncotype Dx test because the cancer has already spread to their lymph nodes. The following conditions may mark a potential candidate for the Oncotype Dx Test: You have recently been diagnosed with stage I or II invasive breast cancer The cancer is estrogen-receptor-positive There is no cancer in your lymph nodes (lymph-node-negative breast cancer) You and your doctor are making decisions about chemotherapy The results of the Oncotype Dx test must be given enormous significance and is to be conducted without any glitches, as the resulting consequence leads to an essential decision about the effectiveness and recurrence. Each test is unique, as it will never be the same for any two people, and predictions for each individual will vary. Proper consultations with medical specialists are always necessary to ensure the safety of the patient and avoid complications. ASCO has provided the latest guidelines and recommendations here . Oncotype Dx Test Cost The American Society for Clinical Oncology and National Comprehensive Cancer Network Guidelines now include the ODRS in their treatment guidelines for early breast cancer. However, the test is expensive and costs approximately $4000 per patient in the United States. Oncotype Dx Recurrence Score Chart Oncotype DX test recurrence scores (ODRS) are a way for oncologists and patients to discuss the next steps of a treatment plan. While it is easy to find information on how the Oncotype DX is scored, it is important to read the fine print that determines the charts. The following is a general guideline for various ODRS ranges: Score 0 to 17: considered a low recurrence score, and the chance that your cancer will return is low. This score also suggests that the benefits of chemotherapy may not be worth the risks for you. However, please remember a low recurrence score does not mean that your cancer will definitely not come back. Score 18 to 30 : considered a medium recurrence score, and the benefits of chemotherapy for you are uncertain. Your doctor will discuss with you what this means and take in all of the factors that are specific to your diagnosis and cancer characteristics. Score 31 to 100: considered a high recurrence score. If you have a high recurrence score, the chance that your cancer will return is somewhat high, and adding chemotherapy to your cancer treatment may help keep the cancer from coming back. It’s important to note that a high recurrence score does not mean that your cancer will definitely come back. Oncotype Dx Test Reliability The Oncotype DX has a significant impact on decision-making in adjuvant therapy recommendations, but the scoring system is not as definitive as it may seem. Age and stage play a significant role in interpreting these results. According to the TAILORx study, women 50 and younger with an Oncotype Dx score of 16-25 may benefit from both hormone therapy and chemotherapy in the treatment plan. Similarly, a result of 39 for women who are in stage 0 with DCIS is considered low risk for local recurrence, and the benefits of radiation do not outweigh the risks. It’s important to know that you may qualify for an Oncotype DX test and that the results are a starting point for a deeper conversation with your oncologist. Significant advancements are being made in the breast cancer community, including opportunities for patients to limit the toxicity they're exposed to. However, treatment plans are individual-specific, and every patient must choose the treatment path that works for their unique physiology and preferences. Listen to our latest podcast with Dr. Jordana Phillips . Watch our latest video References Dialani V, Gaur S, Mehta TS, Venkataraman S, Fein-Zachary V, Phillips J, et al. Prediction of low versus high recurrence scores in estrogen receptor-positive, lymph node-negative invasive breast cancer on the basis of radiologic-pathologic features: comparison with Oncotype DX test recurrence scores. Radiology . 2016;280:370–378. Siow, Z. R., De Boer, R. H., Lindeman, G. J., & Mann, G. B. (2018). Spotlight on the utility of the Oncotype DX® breast cancer assay. International journal of women's health , 10 , 89–100. doi:10.2147/IJWH.S124520 Sparano JA, Gray RJ, Makower DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer. N Engl J Med. 379(2):111-121, 2018.

By Contributing Editor, Madhumitha Sabhanayagam TCHP Chemo Side Effects - What can we do? When breast cancer first entered the spotlight, the most talked-about subject, other than cancer itself, was chemotherapy. Chemotherapy, though sometimes not the most common way to treat breast cancer, is often the first option that jumps into most people’s minds, quickly followed by concerns of hair loss. The side effects of chemotherapy are appropriately notorious. Many of you have experienced these side effects first-hand and the toll it takes, not only on your person but also on your mental and emotional health. In recent days, I have come across several survivors discussing the aggressive side effects of the TCHP chemotherapy regimen for breast cancer treatment. TCHP Regimen TCHP is made up of four different chemotherapy drugs. TCHP drugs target cancer cells or slow down the growth of pre-existing cancer cells and include: T - Taxotere (Docetaxel) C - Carboplatin (Paraplatin) H- Herceptin (Trastuzumab) P- Perjeta (Pertuzumab) TCHP chemotherapy is usually administered before (to shrink the tumor) or after surgery (to eliminate any rogue cancer cells). The entire chemo regimen is designed to be given in several cycles, and treatment can last anywhere from 5 to 6 months. Follow-up medications, treatments, and check-ups may all be necessary depending on each individual’s treatment path. TCHP Side Effects Because of the four-way combination of the drugs, the regimen presents a slew of side effects that can wreak havoc on an individual and their day-to-day activities. Some of the common chemo side effects include: Diarrhea Hair loss Low white blood cells Nausea Fatigue Vomiting Anemia Upset stomach Constipation Decreased heart function So what causes TCHP to have side effects? The chemotherapy's aggressiveness in attacking cancer cells can also harm normal cells. For example, it may attack the cells that stimulate hair growth or the cells that release the hormone that stimulates hunger. This results in hair loss and loss of appetite. TCHP Chemo Experience The most impactful side effect for most TCHP chemo survivors is weight loss. The treatment takes a toll on your appetite and the ability to find anything appetizing. Nausea is constant, and if you do get hungry, food tastes absolutely abhorrent. Many survivors experience drastic weight loss and have little energy to participate in day-to-day activities. It is important to try to consume calories however possible; consider nut butters for a great high-protein and calorie-dense option. Ask your oncology team if they can refer you to a nutritionist as well if you are having a tough time eating enough food. Though TCHP side effects are significant, there is light at the end of the tunnel for patients. Oncology teams are investing more time and effort to reduce the severity of side effects. For example, to combat chemotherapy-induced hair loss, there is a new method called scalp cooling. Patients can wear a mask during treatment that cools the scalp and minimizes hair-cell damage. Though relatively new, some oncology centers have seen success with scalp cooling, as well as one of our very own SBC members, who shares her experience with cold caps on our podcast Breast Cancer Conversations . Chemotherapy Diet Restrictions The lack of appetite, nausea, and continuous vomiting can result in dehydration and loss of protein in the body. When experiencing such symptoms, drinking plenty of fluids becomes extremely important. Water, electrolytes, and soup are great sources of hydration. It is best to avoid strong flavors that could trigger nausea; prioritize simple-tasting (bland, unfortunately) food. Nausea-inducing foods include spicy, greasy, fatty, and high-sugar foods. For some chemotherapy patients, ramen, oatmeal, lemons, sour patches, and apple sauce are the only foods they can eat and keep down. Try eating several small meals throughout the day to avoid large meals that may be overwhelming while undergoing TCHP chemotherapy. Doctors advise conscious protein inclusion into chemotherapy patients' diets. Focus heavily on milk or a plant-based and protein-rich alternative, eggs, beans, and cheese, as they provide the protein needed to replace the cells you may have lost during treatment. Check out tips on managing chemo side effects and our recommendations on vitamin D and calcium . Emotional Effects of Chemotherapy Emotional and psychological effects are evident when undergoing TCHP chemotherapy. Bouts of helplessness and extreme depression are normal experiences for patients. If this is you, it is important to note that you are not alone in experiencing these effects. A good way to combat psychological decay is to invest in therapy and to assert conscious control of your psychological well-being. Feeling out of control is the biggest stressor for most cancer survivors. Therapy can take a variety of forms, including: Speaking with a counselor or social worker Taking a walk with a friend or Engaging in light yoga or other exercises Breathing exercises at home No matter what form your therapy takes, it's important to carve out time for yourself, even during TCHP chemotherapy treatment. To be in charge of all the knowledge your oncology team presents to you, have your medications and aid tools ready to combat the side effects of TCHP. At the same time, ensure that you still bring a sense of normalcy to your life by engaging in hobbies and activities that serve as a pleasant distraction. Battling cancer is a rough and rarely straightforward path filled with ups, downs, and several hurdles for patients to overcome. Fortunately, some tools can help aid patients along their journey. Many support groups and forums at local oncology centers and online offer great advice and programs to help soften the blow of cancer. Voice your concerns and do not be afraid to be heard. TAKE UP SPACE and BE SEEN. Do not suffer alone..

By Jessica Wise Disclaimer: This post is not intended to be taken or received as nutritional advice nor is the author able to offer nutritional advice. Each patient who is interested in statements made herein should consult with a qualified medical professional to learn more. Soy foods are naturally cholesterol-free, low in saturated fat, and high in fiber. In many ways, soy foods are an excellent source of protein and a great alternative to red or processed meat; however, there is conflicting information regarding the potential effect of soy consumption on breast cancer development. While some experts emphasize the beneficial effects of soy foods, others believe soy may increase a person’s risk of developing breast cancer. Let us begin by understanding why this might be. Phytoestrogens and Breast Cancer Natural soy foods contain phytoestrogens, plant-based estrogen compounds. Since estrogen is linked to certain types of hormonal breast cancer, many individuals fear that soy can increase their risk for breast cancer development. There have been several research studies conducted to assess the association between soy consumption and breast cancer development; animal studies have primarily established a positive correlation between soy consumption and breast cancer, but human population studies have not produced this same result. Soy foods are a staple in traditional Asian diets, making the intake of soy foods across the lifespan of Asian men and women much higher than that of American men and women. Recent studies have tried to understand the potential effect of soy consumption on breast cancer development in Asian women, and the evidence does not indicate a detrimental effect. In fact, the evidence points to a beneficial effect; consumption of soy foods may lead to a decreased risk of breast cancer among Asian and Asian American women. In the US, soy consumption often comes from soy additives in foods or processed soy foods. Processed foods are known to increase a person’s risk for cancer, so perhaps the focus should shift to prioritizing whole soy foods like edamame and tofu. For those concerned about eating soy foods and their risk of breast cancer development, there is no need to add soy to your diet. Like any food, consuming soy in moderation is important. The following is a list of phytoestrogen foods that are healthy in the unprocessed state: Tofu Tempeh Edamame Linseed (flax) Sesame seeds Barley Lentils Alfalfa Mung beans Apples Carrots References: Korde, L. A., Wu, A. H., Fears, T., Nomura, A. M. Y., West, D. W., Kolonel, L. N., Pike, M. C., Hoover, R. N., & Ziegler, R. G. (2006). Childhood soy intake and breast cancer risk in Asian-American women. Cancer Epidemiology and Prevention Biomarkers , 15 (12 Supplement), B163–B163. Phytoestrogens: Benefits, risks, and food list . (n.d.). Retrieved June 11, 2020, from https://www.medicalnewstoday.com/articles/320630 Ziaei, S., & Halaby, R. (2017). Dietary Isoflavones and Breast Cancer Risk. Medicines , 4 (2).

By Abigail Johnston When I was initially diagnosed with breast cancer in 2017, we thought I was Stage II. In light of that information, which we now know was erroneous, I chose to do a lumpectomy, and once the tumors were removed, my doctor recommended that we have them tested to see if chemotherapy was right for me. My mother, at that time, was a 14-year breast cancer survivor, and so this was news to all of us. As soon as my doctor suggested it, I did some research. I discovered that the Oncotype Dx test provides a breast recurrence score. They explain it this way on their website : “The Oncotype DX Breast Recurrence Score test provides a genomic-based, comprehensive, individualized risk assessment for early-stage invasive breast cancer in adjuvant and neoadjuvant settings. “ This score is recognized now as the standard of care by American Society of Clinical Oncology (ASCO®), the National Comprehensive Cancer Network (NCCN®), the St. Gallen Consensus panel, the National Institute for Health Care Excellence (NICE), the European Society for Medical Oncology (ESMO) and the German Association of Gynecological Oncology (AGO). That’s a lot of really smart and really dedicated people determining that this is a good test. What is the TAILORX Study? Further, the testing was validated by the TAILORx study. The Oncotype Dx website describes the study in this way: “The landmark TAILORx trial enrolled 10,273 patients from over 1,000 sites who were candidates for adjuvant chemotherapy as per NCCN Guidelines and monitored their 9-year outcomes. The trial investigated the clinical utility of Oncotype DX Breast Recurrence Score test to confidently predict the patient population who will substantially benefit from chemotherapy. Patients with Recurrence Score (RS) results 0-25 showed excellent outcomes when treated with endocrine therapy alone, while patients with RS results 26-100 are known to have significant chemotherapy benefit.2 TAILORx also showed that standard clinical risk features alone are not sufficient to determine chemotherapy benefit - often leading to overtreatment or undertreatment of patients. Only the Oncotype DX Breast Recurrence Score test provides clarity for adjuvant treatment decisions.” My then medical oncologist explained it this way — he said, “We have 20 years of tumors stored in a warehouse and we’ve studied their characteristics to create a database. This database then tells us the details of each person’s disease progression by looking at the genomics of each cell.” Basically, the history and experiences of more than twenty (20) years of the treatment of breast cancer give us some indications of how cancer even now might behave, and if chemo is indicated. The TAILORx trial was still going on at that time (in 2017,) and the scores were validated even more after I underwent the testing. Patients who are diagnosed with early-stage, ER+, HER2- breast cancer, whether node positive or negative, are eligible for this test. I checked all the boxes for this test, and off my tumor went after they’d cut it out of me to be tested. Oncotype vs Mammoprint One difference between the Oncotype DX testing and Mammaprint (their competitor) is that while Mammaprint gives a yes or no answer to the likelihood of chemo helping, the Oncotype DX test provides a numerical value that is either in the definitely no help range, the gray area range, or the definitely yes chemo would help range. My then medical oncologist preferred the more detailed information of the Oncotype Dx test because it allowed him to apply his experience and clinical judgment to the result. Oncoptype of 27 My result was 27, on the high end of the gray area. When we sat down with my then medical oncologist to discuss the next steps, he shared with us that in his experience, anyone with a score over 25 could benefit from chemo. His personal experience has been validated by the TAILORx trial. He left the decision to do or not to do chemo up to us, but the report we received showed us the difference in the danger of recurrence if I didn’t get chemo and if I did. The difference was over 10 percentage points, and my husband and I decided that it would be best to proceed with chemo even though we’d been hoping to avoid it. And thank God we did. Starting Chemotherapy It was at my first chemo appointment that someone in my medical oncologist’s office, by mistake, checked the box for my tumor markers to be tested. Since the tumor markers came back extremely high, I underwent more testing, and we discovered that I’d actually been Stage IV from the beginning, and the pain/limp I had in my right leg was a 5 cm tumor that was threatening to shatter my right femur. My then medical oncologist and my current medical oncologist have not been able to explain why the oncotype dx score wasn’t in the definitely would benefit from chemo range since the cancer had already spread through my blood to take up residence in my bones. That stumped the various tumor boards too. The bottom line is that no test is 100% accurate and specific to each individual person. Yet, the additional information provided by the tests we have available assists the doctors in making the best possible recommendations for the patient to then decide what is best for him/her. Knowledge truly is power, and the more information, the more knowledge, the better each team can determine the best treatment for the individual patient. Check out the podcast with Abigail on Breast Cancer Conversations More articles by Abigail: Understanding Piqray Germline Mutations and the ATM Gene About the Author: In 2017, at the ripe old age of 38, while living in Orlando, Florida, I was diagnosed with Stage IV Metastatic Breast Cancer after feeling a lump in my left breast while tandem nursing my boys, who are now 7 and 5. The summer of 2017 was a rollercoaster of emotions as I faced four body and life-changing surgeries amidst chemo and radiation.  Once the whirlwind had settled a bit and I’d completed transitioning my clients and staff at my law firm to another law firm, my husband, two boys and I moved to Miami to live with my family.  Looking back, I’m astonished at how much has changed, how much we have overcome as a family, and how everyone has adjusted.  While I don’t actively practice law, I use my education and training in a variety of ways for the breast cancer community, advocating for patients and thrivers.  I have started my own non-profit, Connect IV Legal Services, where I recruit lawyers to do pro bono work for Stage IV patients. I’m also active in many local and national organizations, volunteering and adding my voice to educate and persuade others to connect with and help my community.  You can connect with me by checking out my blog, www.NoHalfMeasures.blog , or following me on Twitter , Instagram , Facebook , LinkedIn , or YouTube ! - Abigail Johnston

Is there a relationship? Studies indicate that there may be a correlation between cancer and the shingles virus. Talk about one’s body multi-tasking in a most adversarial way! During a recent survivingbreastcancer.org virtual meet-up , a number of the community members stated they had developed shingles. The conversation stimulated significant follow-up inquiries, and the topic is worth a deeper look than anecdotal evidence. What We Do Know Shingles is caused by the same virus that causes chickenpox, also known as the varicella zoster virus. Once a person contracts chickenpox, the virus may remain in their body and become inactive. Years later, the virus can reactivate, causing shingles (herpes zoster). According to the U.S. Centers for Disease Control and Prevention, nearly 30% of people in the United States will develop shingles, and about 1 million cases occur in the country each year. Newly diagnosed cancer patients may be at increased risk for this painful skin condition. Patients with a solid tumor in the breast had a 30% higher risk of shingles than people without cancer. “Among patients with solid tumors, the greater risk was largely associated with receiving chemotherapy treatment, rather than with the cancer itself” (Jiahui Qian, Journal of Infectious Diseases). Can Shingles Cause Breast Cancer? The shingles virus has never been formally connected to cancer, but it has the potential to be confused with rashes that are linked with cancer cells. Shingles can develop on or near the breast, tending to favor the torso. When presented on the breast, symptoms typically follow this progression: Very sensitive skin, often accompanied by pain or numbness A red rash develops within a week The rash develops blisters The blisters break to form scabs After several weeks, the blisters heal Nerve pain continues for up to one year Can Cancer Patients Use the Shingles Vaccine? Vaccines are available for treating shingles, but due to a lack of data, these vaccines are not yet recommended for use in the cancer patient group. Also in development is a shingles vaccine that uses an inactivated form of the virus. These advances suggest that vaccines show promise as a way to prevent shingles and its complications in cancer patients. As always, we recommend that those diagnosed with breast cancer consult their oncologist at the first sign of shingles. Shingles Vaccine Shingrix ‘Important’ For People With Cancer The shingles vaccine is recommended for adults older than 50 years; however, Zostax, a live-virus vaccine, may not be suitable for patients with immunodeficiency or immunosuppression, including those with cancer. The vaccine combines glycoprotein E with an adjuvant system that enhances immunologic response. Read More. Herpes Zoster in Breast Cancer: A Case Report A 65-year-old female patient with breast pain, severe edema, irritation, and itching in the left breast was admitted to the emergency department. This patient had a history of breast cancer four years previously, which metastasized to the lungs and lymph nodes in her neck. This patient was treated with radiotherapy and chemotherapy, and a total mastectomy for several years. The breast often appeared swollen, erythematous and red, or inflamed. Read More. Shingles More Likely to Develop in People With Cancer The large prospective study examined the risk of shingles before and after a cancer diagnosis and across a range of cancer types among more than 240,000 adults in Australia between 2006 and 2015. The risk for shingles was 30 percent higher in those with solid organ cancers, such as cancer located in the lung, breast, prostate, or other organ, compared with someone without cancer. Read More. Shingles Prevention In the United States, Shingrix was approved by the Food and Drug Administration (FDA) in 2017 and is preferred to Zostavax. Studies suggest that Shingrix offers protection against shingles for more than five years. Shingrix is a nonliving vaccine made of a virus component. It is given in two doses, with two to six months between doses. Shingrix is approved and recommended for people age 50 and older, including those who've previously received Zostavax or had shingles. Read More.

By Guest Blogger, Amy Hardwick What if you could begin to regain your range of motion in just five minutes a day? Have you been cleared by your doctor to begin gentle movement but not sure where to begin? Try these 5 simple stretches every day to get started. Where Do I Begin? When movement is uncomfortable, it can be hard to motivate ourselves to do it consistently. Your incision sites are tender and the scar tissue is limiting your range of motion. Add to that the fact that you have likely been resting and recovering, which often means extended periods of time sitting and lying down. In the wise words of Meryl Streep, “Start by starting.” The task of healing may at times seem daunting. Start small. Be consistent and celebrate each step forward along the way. Trust that your body is resilient. The simple truth is that repetition creates results. While you may not be able to carve out longer chunks of time every day, you can likely find five minutes to practice these yoga stretches to gain back your range of motion over time. Before you begin, be sure you are cleared by your doctor to do gentle movement. Listen to your body and honor where it is at each day and each step of the process. Snow Angels Just like when you were a kid! Lie on your back and stretch your legs out long (or support under your knees with a pillow). Begin with your arms by your sides and your palms facing up to the ceiling. Keeping your arms connected to the ground, inhale and move your arms up overhead. As you exhale, sweep your arms back by your sides...just like making snow angels, you will likely feel a stopping point along the way. You want to come to that point but not push past to where there is pain. Repeat with palms facing down to the ground and palms facing in towards your sides. Backstroke Stay lying on your back with your arms by your sides. This time, as you inhale, reach one arm up towards the ceiling and then overhead. As you exhale, lower the arm back by your side. Repeat back and forth with each arm for one minute. Like snow angels, you will likely reach a resistance point. Go to that but not past that. Heart Melting Pose Begin in Table Top Position (hands and knees) with your shoulders stacked over your hands and your hips stacked over your knees. Keep your hips stacked there and walk your hands forward until your forehead comes to, or towards, the ground. A block or a pillow for support under your forehead can be great if the mat feels really far away! This looks a lot like child’s pose but with your hips over your knees instead of back to your heels. Shoulder Opener with a Strap You can do this one seated or standing and you will need a yoga strap or any type of belt or scarf that is fairly long. Hold one end of the strap in each hand and take your arms out to a wide V-shape in front of you. As you inhale lift your arms overhead and as you exhale reach your arms behind you. Repeat back to front and front to back a few times. Go slowly and move with your breath. You want there to be tension on the strap and feel the end range of motion without pain. Fallen Angel at the Wall Stand with the right side of your body along the wall. Stretch your right arm straight back from your shoulder with your palm pressing into the wall. You will likely feel the stretch just by doing that, but if not begin to turn your chest away from the wall. Keep your hand active as you press it into the wall. Repeat for the left side. Go slowly, be patient, listen to your body, and celebrate each small step forward. Yoga can help to heal not only your body but your relationship to it as well. Amy Hardwick is a yoga teacher and Reiki master who specializes in creating online content to support people during cancer treatment and recovery so they can practice from the comfort of their own home. She is an E-RYT that is passionate about bringing the tools of yoga outside of the traditional studio environment to support integrative cancer care. A student at heart, she has trained with Memorial Sloan Kettering Cancer Center and Inner Peace Yoga Therapy. Her classes and programs are down-to-earth, and offer practical tools that are tailored specifically for people in active treatment and survivors looking to recover and rebuild. For more information on yoga for cancer care programs: www.amyhardwick.com

Spending time outdoors can offer many physical, mental, and emotional benefits for anyone going through breast cancer. Enjoying time in nature and getting daily sunlight offers the chance to disconnect from the world, diminish stress and anxiety, and regroup and refocus. While sunlight is a great source of vitamin D and helps stave off depression, it's crucial to remember the importance of sun protection year-round, not just during the summer. Monitoring UVB (Ultraviolet B radiation) exposure is especially important if you are undergoing chemotherapy or radiation treatment for cancer. Many chemotherapy medications and immunotherapies can increase sun sensitivity, also referred to as photosensitivity, which can leave skin more susceptible to burning. Common chemotherapy drugs known to cause photosensitivity include Gemzar (gemcitabine), Adriamycin (doxorubicin), and Taxotere (docetaxel). Avoid sun exposure as much as possible while undergoing chemotherapy and up to two months after. Like chemotherapy, radiation therapy can also leave patients vulnerable to the sun’s rays. The skin of the area being treated with radiation therapy can have a propensity to burn, and this area can be vulnerable for years after radiation therapy has ended. It is also important to keep the treated area covered as much as possible. UV-Protective Clothing and Sunscreen Some of Laura's favorite UV protective clothing comes from UV Skinz . Rhonda, the Founder of UV Skinz, lost her 32-year-old husband to skin cancer. Because of this disease, Rhonda and her three boys were determined to help families live sun-safe through education and innovative products. Unprotected sun exposure while receiving chemotherapy or radiation therapy can make you more vulnerable to skin cancer as well, including the most serious form of skin cancer: Melanoma. Melanoma is a type of skin cancer that develops when cells called melanocytes begin growing uncontrollably. Melanoma can be tricky to spot because it may present itself in many different shapes and colors. The good news is that you can protect yourself by doing regular skin checks and using the ABCDEs to monitor any areas that may be concerning. The ABCDEs stand for: A symmetry: If you draw a line halfway through your lesion and the two halves do not match, you should consult your dermatologist. B order: Melanoma borders are usually uneven, scalloped, or notched. C olor: Melanoma usually presents itself in multiple colors, meaning that it could have different shades of brown, tan or black. Melanoma can also be shades of blue, white, or red. D iameter: If the diameter of the mole is greater than 6 millimeters, or the size of a pencil eraser, you should get it checked out by your dermatologist. E volving: Be aware of a spot that is itching, bleeding, crusting, increasing in shape or size, or increasing in elevation. Protecting Yourself The best way to protect yourself from the sun while receiving chemotherapy or radiation therapy is to apply broad-spectrum sunscreen, protecting you from UVA and UVB rays. A high-SPF sunscreen should be applied at least 30 minutes before venturing outside to allow for the sunscreen to absorb into the skin and should be reapplied every 80 minutes or after swimming or sweating. The Environmental Working Group has a great guide on some of the best sunscreens with the least harmful chemicals! You should also try to avoid planning your outdoor activities between the hours of 10 AM and 2 PM, when the UV rays tend to be strongest. Seeking out shade and wearing long layers will also protect you from the sun’s rays. Additionally, wearing a long-brimmed hat can offer protection for your face, ears, and neck. You can also protect your eyes by wearing sunglasses that block both UVB and UVA rays, protecting the thin skin around your eyes and reducing the risk of cataracts. Lastly, avoid tanning beds, especially while undergoing chemotherapy or radiation therapy. Studies have shown that your risk of developing skin cancer goes up by 15% for every four tanning bed visits, and your skin is even more vulnerable when you are in treatment. If you are still craving a healthy glow, opt for a store-bought tanning lotion or have a spray tan done professionally. Content Across The Web Sun Care After Breast Cancer ( Breast Cancer Now ) You may be concerned about the effects of hot weather during and after breast cancer treatment. Breast cancer treatments such as radiation and chemotherapy can make skin much more sensitive to the sun.Take care in the sun by covering your skin and wearing a hat. Use a sunscreen with a high sun protection factor (SPF) and avoid the hottest part of the day (11am–3pm). Read More. Why Skin Exams Must Be Part of Breast Cancer Discussions ( Affiliated Dermatology ) Very few people realize the correlation between breast cancer and skin cancer. Simply put, the diagnosis of one of these cancers significantly increases the risk of the other. While reasons for the association are not completely understood yet, we know there are amplified risk factors that play a role in the connection. Radiation treatments, hormone changes during therapy, a biological or genetic link, and environmental factors may all play a part in the breast/skin cancer connection. Read More. Everything You Need To Know About Melanoma ( Healthline ) Melanoma is a specific kind of skin cancer. It begins in skin cells called melanocytes. Melanocytes produce melanin, the substance that gives your skin color. When melanoma is diagnosed in the early stages, most people respond well to treatment. But when not caught early, it spreads easily to other parts of the body. Read More. Summer Skin Care ( BreastCancer.org ) Sunshine feels great — especially after a long, cold winter. Getting some sun is a good way to improve mood, energy level, and sense of optimism. But too much sun exposure can be dangerous. It can cause skin cancer, cataracts, wrinkles, and painful burns that may permanently damage skin. It can also make side effects of some chemotherapy worse. Read More.

What is Osteonecrosis of the Jaw? Osteonecrosis of the jaw (ONJ) is a possible side effect of some breast cancer treatments. It is a condition that results in the death of bone tissue in the jaw. ONJ can lead to pain, infection, and exposure of the teeth. Around 2% of breast cancer patients may experience this side effect. The exact cause of Osteonecrosis of the Jaw is not known, but it may be related to a decrease in blood supply to the jawbone. It is most commonly seen in patients who take drugs that belong to a group called bisphosphonates, which are used to reduce bone loss and prevent fractures. Other risk factors include radiation therapy or chemotherapy. The symptoms of Osteonecrosis of the Jaw usually appear four to eight weeks after starting breast cancer treatment. These can include pain or swelling in the mouth, loosened teeth, exposed bone or tissue in the gums, difficulty opening your mouth wide enough for eating or brushing your teeth, unusual bleeding from the gums, and bad breath. What are the Symptoms of ONJ? Symptoms of ONJ include jaw pain, tooth loss, and exposed bone in the mouth. The condition can also make it difficult to eat and speak. The most common symptom of ONJ is pain in the jaw, which can range from mild to severe. Other symptoms include: Swelling or infections around the gums Numbness or tingling in the jaw Jawbone exposure (seen as a hole in the gums) Redness Drainage from wounds Exposed bone Loose teeth Problems chewing or swallowing If you are undergoing cancer treatment and experiencing any of these symptoms, be sure to tell your oncologist or dentist right away. Osteonecrosis of the jaw can be difficult to diagnose, but if you experience any of the above symptoms, it is important to seek medical advice. Your doctor or dentist will likely perform a physical exam and may order X-rays or other imaging tests. What Causes ONJ? ONJ is most commonly seen in patients who have received intravenous bisphosphonate therapy, either as part of their cancer treatment or to prevent osteoporosis. Bisphosphonates are drugs that help to strengthen bones and reduce the risk of fractures. However, in some cases, they can cause the jawbone to deteriorate. ONJ is caused by a reduction in blood flow to the jawbone. This can be the result of cancer treatments that reduce the levels of minerals in the blood, such as bisphosphonates or denosumab. Chemotherapy and radiation therapy can also lead to ONJ. What are Bisphosphonates? Bisphosphonates are a type of drug commonly used to treat bone loss in people with breast cancer. They work by reducing the activity of cells that break down bone, ultimately leading to increased bone density and reduced risk of fractures. Bisphosphonates are typically administered as an injection or intravenous infusion. While there are many benefits to taking these drugs, Osteonecrosis of the Jaw is a rare but possible side effect. Breast cancer patients often take bisphosphonates to lessen the skeletal-related issues that come with metastatic disease and to stop the bone loss caused by adjuvant therapy. Outside of cancer treatment, bisphosphonates have been studied for their potential to directly inhibit breast tumor cell growth and spread. One example of a bisphosphonate is Zometa. Zoledronic acid is a drug that's given to reduce the risk of breast cancer spreading to the bones and other parts of the body. Zometa works by reducing the activity of cells that break down bone, ultimately leading to increased bone density and reduced risk of fractures. Zometa can be administered as an injection or intravenous infusion. What are the Side Effects of Bisphosphonates? Common side effects of bisphosphonates include nausea, vomiting, constipation, diarrhea, and abdominal pain. Bisphosphonates can also cause Osteonecrosis of the Jaw (ONJ). ONJ is a rare but serious condition that causes damage to the jawbone. It is typically caused by a decrease in blood. What is the Risk of Developing ONJ? The risk of developing Osteonecrosis of the Jaw is low, with estimates ranging from 0.3-3%. The risk increases with the duration of therapy and total cumulative dose received. A large phase III randomized study found that receiving 3 to 5 years of bisphosphonate treatment after surgery and chemotherapy for early-stage breast cancer doesn’t improve survival any more than receiving 2 years of bisphosphonate treatment. The study also found that receiving more than 2 years of bisphosphonate therapy increases the risk of Osteonecrosis of the Jaw. It is important to weigh the benefits and risks of taking any drug, including bisphosphonates. If you have breast cancer and are considering taking a bisphosphonate, discuss it first with your oncologist. That being said, the risk of Osteonecrosis of the Jaw is still low and should not be a cause for undue concern. Diagnosing Osteonecrosis of the Jaw ONJ is diagnosed through a combination of medical history, physical examination, and imaging tests. Your doctor will ask about your medical history and any bisphosphonate therapy you've received. They will also perform a physical examination of your mouth and jaw. Imaging tests such as X-rays, CT scans, and MRIs may also be ordered to get a closer look at the Jawbone. How is Osteonecrosis of the Jaw Treated? There is no one-size-fits-all approach to treating ONJ. Your doctor will work with you to develop a treatment plan that meets your individual needs. ONJ is typically treated with a combination of medication and surgery. In some cases, a dental prosthesis (false teeth) may be required. Because ONJ is caused by a lack of blood flow to the jawbone, treatments focus on increasing blood circulation to the area. Oral surgery is typically only recommended if other treatments or medications have not been effective. There are many factors to consider. Antibiotics may also be prescribed to help prevent or treat an infection in the jaw, gums, or tooth. While there is no guaranteed way to prevent ONJ, maintaining good oral hygiene during cancer treatment may help reduce your risk. Questions to Ask Your Oncologist About ONJ Before visiting your oncologist, make note of and consider asking the following questions: What are the risks of taking a bisphosphonate? How can I reduce my risk of Osteonecrosis of the Jaw? How will Osteonecrosis of the Jaw be diagnosed and treated if it occurs? What other treatments or medications can I take to reduce my risk of Osteonecrosis of the Jaw? Are there any alternative treatments available if Osteonecrosis of the Jaw occurs? How will Osteonecrosis of the Jaw affect my quality of life and treatment plan? Conclusion Osteonecrosis of the jaw is a rare but serious side effect that can be caused by bisphosphonate therapy for treating breast cancer. It occurs when there is a reduction in blood flow to the jawbone and can lead to pain, infection, and exposure of the teeth. If you are currently undergoing treatment for breast cancer, be sure to watch for symptoms of ONJ and notify your oncologist or dentist right away if you experience any jaw pain, tooth loss, or exposed bone in the mouth. By catching ONJ early and getting proper treatment, you can help manage this condition and improve your quality of life during and after cancer treatment. If you experience any symptoms of ONJ, it's important to see your doctor right away for an evaluation.

Breast cancer casts a shadow over the lives of countless people across the globe, affecting both the afflicted and their loved ones. The National Breast Cancer Foundation paints a heartrending picture, forecasting that an estimated 316,950 women and 2,800 men will confront the devastating diagnosis of invasive breast cancer in 2025. Diagnosing breast cancer early, before it spreads, greatly amplifies a person’s chances of successful treatments. Early warning signs are crucial in offering a pivotal advantage in early detection and treatment. Continue reading to explore some of the most common warning signs of breast cancer you shouldn’t overlook. Common Breast Cancer Symptoms 1. Lumps in the Breast or Underarm According to the American Cancer Society , one of the most common signs of breast cancer is a new lump in the breast or underarm, including any lump, knot, or hardening of the breast tissue. Lumps are often painless, and not all are cancerous, but they should be reported to a doctor immediately. Regular self-exams can aid in early detection. 2. Change in Breast Size, Shape, or Appearance The National Breast Cancer Foundation notes that a change in the size or shape of the breast could indicate breast cancer, including swelling, thickening, shrinkage, or asymmetry, particularly if it affects only one breast. 3. Nipple Changes Check for any nipple changes , including turning inward, leaking fluid, or scaling or flaking on the nipple or areola, which could be signs of breast cancer. In addition, nipple inversion or retraction can be a sign of breast cancer. It's important to note that not all cases of nipple inversion or retraction indicate cancer. Some people may have naturally inverted nipples due to other benign conditions. 4. Unexplained Breast or Nipple Pain While pain in the breast is commonly associated with menstrual cycles, persistent pain that doesn’t align with the menstrual cycle can be cause for concern. 5. Nipple Discharge Other Than Breast Milk Bloody, yellow, or green fluid, especially when emitting from one nipple, could signal breast cancer. The exception is discharge that occurs while squeezing the nipple, which is likely benign . 6. Swelling Under the Arm Lymph nodes can swell for various reasons, but if you notice swelling in your underarm lymph nodes, promptly report it to your care physician. Swollen lymph nodes are one of the top signs of breast cancer . 7. Changes to Breast Skin Breast skin changes like redness, thickening, or pitting are listed by the American Cancer Society as potential breast cancer signs, warranting immediate medical attention. Additionally, redness or flaky skin in the nipple or breast area can be associated with breast cancer. A rash resembling eczema on the breast could indicate Paget’s disease of the breast , a rare type of breast cancer. See your doctor about any persistent rashes. Though not a common symptom, increased visibility of veins on the breast’s surface can suggest a blockage in a blood vessel caused by a lump or increased blood supply to the breast. It’s a sign that can accompany tumor growth and indicate an underlying issue like breast cancer. 8. Itchy or Irritated Breasts While itchiness can result from various conditions like allergies and dermatitis, continuous itchiness should not be ignored, especially when accompanied by other symptoms. 9. Rapid, Unexplained Weight Loss While not breast-specific, unintentional rapid weight loss can signal metastatic breast cancer , advises the National Cancer Institute. Note any inexplicable weight loss and consult your doctor. Count On Us for Information, Resources, and Support Understanding and recognizing the early warning signs of breast cancer can significantly affect the prognosis and treatment. Early detection can lead to less invasive treatments and higher survival rates. Always consult your doctor if you notice any changes or symptoms, and prioritize regular screenings. Whether you’re newly diagnosed with breast cancer , are navigating survivorship, or are the loved one of someone experiencing breast cancer, you can count on SurvivingBreastCancer.org to keep you informed. We provide educational information to help you better understand symptoms , testing, treatment options , surgery, etc., and podcasts that feature professionals, advocates, and caregivers who share valuable information. Your donations enable SurvivingBreastCancer.org to offer resources and support every day, every month, and every year. Note: This article is designed to provide general information and is not meant to replace professional medical advice. Always discuss your options with your healthcare provider. Learn more: Different Types of Breast Cancer Breast Cancer Risk Factors SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

Research and discussion continue to accelerate among scientists and oncologists regarding the optimal duration and dosage of immunotherapy for cancer patients. Immunotherapy has revolutionized cancer treatment by harnessing the body's immune system to target and attack cancer cells, leading to more durable responses and better outcomes for some patients. Latest Findings in Immunotherapy Research At the recent San Antonio Breast Cancer Symposium (December 2023), two topics that received perhaps the greatest scrutiny and discussion were the optimal duration of immunotherapy treatment and dosage reduction efforts.  On December 26, 2023, the Wall Street Journal published an article by Brianna Abbott and Jared S. Hopkins describing how immunotherapies weaponize the immune system to attack tumors. They claim that immunotherapy has extended the lives of people with melanoma, lung, and bladder cancers. Immunotherapies have also proven lucrative for pharmaceutical companies with an estimated global market value of $226.38B in 2024 . However, some patients may be receiving surplus dosages of immunotherapies, exposing them to possible side effects and avoidable costs without risk of recurrence. Preliminary research suggests that lower dosages or shorter treatment times could be sufficient for optimal results, but pharmaceutical companies haven’t funded the studies needed to confirm the findings. How Long Should Your Immunotherapy Treatment Be? While immunotherapy has shown promising results, especially in certain cancer types — including melanoma, lung cancer, breast cancer, and some types of lymphomas — the approach to timing and duration of treatment is still evolving. Oncologists are continuously evaluating and refining treatment strategies based on new research findings and patient outcomes to optimize the benefits of immunotherapy for cancer patients. However, determining the ideal duration or timing to stop or modify immunotherapy remains a topic of exploration and debate. Some key considerations in this area include: Sustained Response :  For some patients, continuing immunotherapy beyond the standard duration may sustain the response, preventing cancer recurrence or progression. Long-Term Side Effects :  Extended use of immunotherapies can lead to immune-related adverse events, which may affect the patient's quality of life. Balancing treatment efficacy with side-effect management is crucial. Patient-Specific Factors :  Response to immunotherapy can vary significantly among individuals. Factors such as tumor type, stage, genetic makeup, and overall health influence the decision-making process. Combination Therapies :  Researchers are exploring combinations of immunotherapy with other treatments (like chemotherapy, targeted therapy, or radiation) to optimize effectiveness while potentially minimizing side effects. Biomarkers and Monitoring :  Biomarkers are being studied to identify patients who benefit most from continued immunotherapy and those who might safely discontinue treatment without compromising outcomes. Regular monitoring is crucial to detect any signs of disease recurrence. Clinical Trials :  Ongoing clinical trials aim to determine the most effective dosing schedules, treatment durations, and combinations of immunotherapies to maximize benefits and minimize risks. In conclusion, while immunotherapy has shown promising results, especially in certain cancer types, the approach to timing and duration of treatment is still evolving. Oncologists are continuously evaluating and refining treatment strategies based on new research findings and patient outcomes to optimize the benefits of immunotherapy for cancer patients.

At survivingbreastcancer.org , a 501(c)(3) non-profit, we seek to offer community, support, education, and health and wellness assistance for breast cancer survivors and their caregivers. A topic that frequently arises in our community is the issue of partners, boyfriends, girlfriends, fiancés, husbands, family, and friends "divorcing" (literally and figuratively) themselves from the breast cancer diagnosed patient. This divorce/broken relationship rate may run as high as 50% or more, according to breast cancer thriver Abigail Johnston. The reasons are numerous, but selfishness and being overwhelmed, i.e., lack of understanding of the role of a caregiver, appear to be the leading factors. One of our Breast Cancer community guest bloggers eloquently posted the following: “Our relationship started to spiral downward, and very quickly. In fact, deep down inside, I knew as soon as a month after my diagnosis that “forever” wasn’t going to happen. But I held on. Even after he laughed at me and called me pathetic when I had trouble getting into the car a week after my 10-hour mastectomy surgery, with drains distending from my sides, I held on. Even after our fight, because I had to shave my head when my hair wouldn’t stop falling out, I held on. Even after sitting through a 5-hour chemo, crying, because a fight had gotten so bad that he shoved me into the car door, 10 minutes prior to walking through the cancer hospital door, I held on. Even after he told me he would rather not spend New Year's with me because I wouldn’t be any fun due to a chemo infusion I had a few days before, I held on. In retrospect, in the beginning, I do think he cared. However, ultimately, it was too overwhelming for him. Cancer is messy. It’s dark and scary and forces you to face your own mortality. Want to know a secret? It’s like that for you AND the people around you. It is, indeed, something that not everyone can handle, and you know what? That’s okay. However, over the past two years, I’ve learned that I would rather surround myself with people who CAN handle it. I would rather be with a man who understands that I’m worth more than a phone call, two days before a surgery, telling me that he no longer wanted to be in a serious relationship because the past 6 months had been too hard on him and he was too young to be going through such a trying ordeal.” Feelings of Fear and Helplessness When a couple faces an illness like cancer that threatens their entire way of life, there are bound to be feelings of anger, fear, helplessness, bitterness, and exhaustion. While they wade through these feelings, they are also faced with new roles they have to fill (or can’t fill), financial uncertainty, and a complicated future including many trips to the oncologist, surgery, possible overwhelming financial obligations, etc. Partners may struggle with their new roles and feel inadequate—or overwhelmed. If there were underlying problems in a relationship before an illness, the added strain may prove to be too much. As partners face the reality of their mortality, what they really want in life and what they’re willing to give up come into sharp focus. According to recent studies (all credited below CB), it seems like women were less well-supported by their partners than men were while undergoing treatment for serious illnesses. The study found that couples were far more likely to separate if the female partner was the one being treated. The effect of divorce on health risks is also well researched, but less understood is how health, or the lack of it, may affect the risk of divorce. Another study (CB) of older couples finds that marriage is more likely to end in divorce when the wife is ill than when the husband is ill. That study finds the risk of marriage ending in divorce when a spouse falls ill is higher when that spouse is the wife. Illness can stress a marriage in a number of ways. One way that a spouse's illness can stress a marriage is when the healthy spouse is the primary caregiver and may also have to take on sole responsibility for supporting the household. Another stressor can be differences in the quality of care. A third study (CB) found that wives are generally less satisfied with the care they receive from their husbands, probably because - and this applies to older men in particular — men have not been raised to be caregivers in the same way as women and may feel uncomfortable when thrust into the role. Serious illness is a life -or- death experience that can make people stop and think about what is important in their lives. A fourth study (CB) found a significant gender difference in divorce following the illness of a spouse. They were interested in people who were married at the start of the study period, and because they wanted to examine the effect of falling ill during that period, they excluded marriages where a spouse was already sick at the beginning of the study. Age was tied to an increased chance of getting a serious illness, with husbands experiencing higher rates than wives. While the onset of illness in the husband was not linked with a raised chance of divorce, illness in the wife was linked to a 6% higher risk of being divorced before the end of the study period. This was a significant gender difference. A cancer diagnosis brings physical and emotional challenges, requiring both excellent medical care and a strong personal support system. When a couple chooses to divorce or separate during this time, managing the personal loss can present another hurdle. As difficult as this can be, there are strategies that can help you cope. Does the Blame Rest With a Cancer Diagnosis? It can be tempting to blame a separation or divorce on cancer, but most experts agree that it’s far more likely that the stressors related to the disease simply highlight weak areas that already exist within a relationship. The intensity of emotional and physical stress during this time magnifies patterns of behavior within relationships, as couples confront changing roles and responsibilities. The caregiver may need to step up to take over tasks that the patient previously handled, which can be a difficult transition; both partners will need to learn to manage and express feelings of fear, resentment, anger, anxiety and grief that arise; and, financial stressors may develop, especially if the patient is unable to work or if outside help has to be brought in to handle household or childcare. In the end, solid marriages may even be further strengthened by the true partnering of spouses in together facing the threat that the cancer poses to their relationship. While some troubled marriages improve, with cancer refocusing the partners on what is truly important in life. In other teetering marriages, a cancer diagnosis represents the final blow, leading to separation, as this additional set of fears and issues simply overwhelms one or both partners. In some cases, couples may make it through the treatment phase together but find that the survivorship phase presents an entirely new type of stress that highlights underlying problems in the relationship. For some survivors, a cancer diagnosis inspires the desire to make healthier choices in their lives, and that may include ending an unhealthy relationship. A fifth study (CB) indicates that issues that arise in a relationship during cancer can make patients aware of problems and inspire them to make changes. They may recognize, they now have a different direction in life, but the other person isn’t really interested in this new direction. Like any other crisis, if one person feels like he or she has developed or changed, and the other person hasn’t grown, they can outgrow each other. Navigating Your Way Whatever the underlying causes of a divorce or separation, employing strategies (CB) to cope with the new reality and ensure your own well-being is essential. Work to gain perspective and to recognize that this is what was happening in this situation, this is how you feel, and this is how you can feel. Focusing on the future during the treatment phase will also benefit you physically. While it’s true that the timeframe for recovery— physical, emotional and spiritual—varies depending on the type and stage of cancer and the treatment received, letting negative emotions about the end of the relationship take precedence isn’t going to help your healing process. And if you’re not able to move forward on your own, then it’s time to reach out for professional help. Look For Help If you’re facing a separation or divorce, your personal network can be invaluable—family members, friends, your faith community or even work colleagues can provide social support and practical help. A cancer support group like survivingbreastcancer.org and others or individual therapy can also help you cope—not just as a person with cancer but also as a person without a partner. Look for services or groups that can tailor support to your situation and provide insight. The end of any marriage can be frightening, depressing, and challenging for the former partners. The addition of a cancer diagnosis, which comes with its own fears, threats, issue,s and concerns, dramatically compounds the enormous challenges that result from separation or divorce. For the cancer patient whose spouse has left, the attention, involvement, and support of loving family and friends can play an important and significant role in their cancer care and quality of life—providing for the patient’s physical, emotional, medical, and practical needs. Steps to take to minimize the threat of divorce/breakdown of a relationship after a breast cancer diagnosis. Communication, as always is the key. Talk to your partner. Express yourself. Find some time for each other. Schedule time if you have to Start somewhere Find a comfortable place Talk as often as possible Be reassuring Consider outside therapeutic help Write it down Use texts, emails, etc, to help extend the conversation It is understood that Breast Cancer is typically a heinous diagnosis, resulting in some form of the following: surgery, chemo/hormonal treatments, and radiation, and the myriad side effects associated with all of the above. Generally, it is not good for relationships, but good relationships can be made stronger by sharing hardship. As our previous guest blogger stated: " Cancer is messy. It’s dark and scary and forces you to face your own mortality. Want to know a secret? It’s like that for you AND the people around you. It is, indeed, something that not everyone can handle and you know what? That’s okay." We’d love to hear your stories associated with loss of friends, companions, family members and loved ones following your breast cancer diagnosis. The following links/ articles were reviewed to assist this blog. Special call out to all of the various doctors, therapists, and journalists involved in elevating this conversation. • First Comes Breast Cancer, Then Comes Divorce - Beth Gainer ... bethgainer.com/first-comes-breast-cancer-then-comes-divorce • Divorce after breast cancer | Cancer Survivors Network • Cancer Hard on Marriages - WebMD www.webmd.com/.../cancer-cause-divorce-women • Breast Cancer And Divorce: The Struggle To Embrace Hope After ... blog.thebreastcancersite.greatergood.com/breast... • Divorced due to Breast Cancer? ~ Pink Lotus Power Up pinklotus.com/.../divorced-due-to-breast-cancer • Cancer and Divorce - Cancer Fighters Thrive www.cancerfightersthrive.com/cancer-and-divorce • Breast Cancer and Divorce treato.com › Conditions › Breast Cancer • Divorce is a more likely end to marriage when wife is ... www.medicalnewstoday.com/articles/290583.php • You and Your Partner - breastcancer.org • www.breastcancer.org › … › Sex and Intimacy

Did you know that certain breast cancer treatments can increase the risk of osteonecrosis of the jaw? Though it is rare and only a small number of people will develop osteonecrosis of the jaw, it is a serious side effect. And since we believe in breast cancer education and the power of knowledge, let’s learn about osteonecrosis and its symptoms, stages, treatment, and management together. What is Osteonecrosis? Osteonecrosis is the death of bone cells due to a decrease in blood flow, which may result in pain and, in more extreme circumstances, bone collapse. Studies have shown that osteonecrosis, exclusively in the jaw (ONJ), is a rare side effect that results from certain medications—bisphosphonates and denosumab. Such medications, like Zometa, are often prescribed to breast cancer patients to prevent bone loss or even metastasis to the bone . Radiation exposure in the jaw area and certain dental procedures can also cause ONJ. ONJ is identified by visible bone in the mouth. Varying levels of both pain and swelling in the mouth are the most common symptoms. Other symptoms include numbness in the mouth and loose teeth. In serious cases, infection of the jaw may also occur. Osteonecrosis of the Jaw Stages Exposed bone is present in all stages of Osteonecrosis of the jaw and is classified by the following stages: Stage 1: No symptoms Stage 2: Pain, swelling, or infection of the jaw Stage 3: Pathologic fracture, extra-oral fistula, or osteolysis (breakdown of bone tissue) Osteonecrosis from Bisphosphonates Because bone loss (osteoporosis) can occur in women receiving breast cancer treatment, they may be prescribed bisphosphonates. Bisphosphonates function to prevent bone loss and strengthen bones. A rare side effect of taking bisphosphonates is osteonecrosis, particularly in the jaw. The cause of bisphosphonate-related osteonecrosis is still unknown. Chemotherapy treatment while taking bisphosphonates is a risk factor for ONJ. Osteonecrosis of the Jaw Treatment Fortunately, osteonecrosis of the jaw is often not life-threatening. ONJ can be treated with antibiotics, oral rinses, and dental treatments. In more severe stages of ONJ, surgical removal of the affected bone may be necessary. If taking bisphosphonates, make sure to inform your dentist, as certain surgical dental procedures can increase the severity of ONJ. Can Osteonecrosis of the Jaw be Avoided? Because osteonecrosis of the jaw is quite uncommon, definitive methods of preventing this side effect have not been developed. However, you can minimize your risk by informing your oncologist about any upcoming dental procedures, notifying your dentist that you will be taking bisphosphonates, and maintaining good oral hygiene. Thank you for exploring jaw problems and cancer with us. For further study, please explore the sources listed below. Sources: https://pubmed.ncbi.nlm.nih.gov/18422377/ https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Osteonecrosis https://www.aafp.org/afp/2012/0615/p1134.html https://www.mayoclinic.org/diseases-conditions/avascular-necrosis/symptoms-causes/syc-20369859 https://www.mskcc.org/cancer-care/patient-education/osteonecrosis-jaw-onj https://www.researchgate.net/figure/Clinical-staging-osteonecrosis-of-the-jaw_tbl2_6674303 SurvivingBreastCancer.org Resources, Support, & Events: Upcoming Events Our Weekly MeetUp