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By Kiara Ford A promising breakthrough has recently emerged in the ongoing clinical trials for the datopotamab deruxtecan drug . AstraZeneca and Daiichi Sankyo have been conducting research as part of their TROPION-Breast01 trial, seeking to determine the effects of datopotamab deruxtecan against single-agent chemotherapy for patients with inoperable or metastatic HR-positive, HER2-low or negative breast cancer who are not candidates for endocrine therapy or have already previously progressed on other interventions. This research is taking place through randomized, multicenter, open-label trials with over 700 patients across Asia, Europe, North America, South America, and Africa. What is Datopotamab Deruxtecan? Datopotamab Deruxtecan is an antibody-drug conjugate , a class of drug designed for targeted therapies and most often used in cancer treatment. There are currently at least 12 clinical trials ongoing worldwide to study the effects of the drug on multiple tumors, with a particular interest in its effects on hormone receptor-positive, HER2-low or negative breast cancer. Breast cancer is classified as “ hormone receptor-positive ” after a biopsy to collect cancer cells. These cells are then tested to determine whether they contain proteins that can act as receptors for the hormones estrogen and progesterone. Cancer cells with receptors will require these same hormones to grow. Being hormone receptor-positive means that the cancer cells contain receptors for either estrogen, progesterone, or both. Hormone receptor-positive cancer typically grows slower than hormone receptor-negative cancer. HER2-low or negative breast cancer is a categorization based on the level of human epidermal growth factor receptor 2 (HER2) proteins in breast cells. At the right level, HER2 proteins can help control the rate of breast cell growth and maintenance. In cancer patients, however, a high level of HER2 may indicate that the breast cancer is growing and spreading rapidly. Specific drugs and therapies which target HER2 proteins, but patients who are HER2-low or negative typically will not respond well to such treatments. Does Datopotamab Deruxtecan Improve Cancer Survival Rates? The most recent development from the Datopotamab Deruxtecan Phase III trials demonstrated that patients whose cancer was hormone receptor-positive and HER2 low or negative had “statistically significant and clinically meaningful improvement” toward the end goal of progression-free survival while taking the drug, compared to chemotherapy. Progression-free survival is the amount of time during or after treatment in which a patient continues to live with the disease without disease progression. The datopotamab deruxtecan trials seek to understand the drug’s impact on both progression-free survival and overall survival (the duration of life after initial diagnosis). This most recent study also suggests that datopotamab deruxtecan can have a positive impact on overall survival, but the data are still new and require further study before any definitive statements are made. These results are just the beginning of Phase III of the drug trials, and a greater understanding of datopotamab deruxtecan’s efficacy will become clearer as more data is gathered. Still, in the meantime, it is encouraging to see the drug yielding positive results for patients with hormone receptor-positive HER2-negative breast cancer. Learn More: Video: Clinical Trials 101 Clinical Trials Resource Guide Understanding Your Pathology Report: A Comprehensive Step-By-Step Guide Different Types of Breast Cancer On the Podcast: Breast Cancer Conversations Is the Medicine Working? Exploring Treatment Efficacy in Breast Cancer A bout the Author: Kiara Ford is a recent graduate of Emerson College, where she majored in communication studies and minored in health and society. She is currently a community health worker trainee with the non-profit organization Asian Women for Health. She is passionate about patient advocacy and health equity, and hopes to raise awareness and increase understanding of patients’ rights through her work. From the Same Author: Metastatic Breast Cancer: Understanding the Significance of Stage IV Breast Cancer and Healthcare Access Within the Hispanic Community Inflammatory Breast Cancer: Breaking Down the Basics

By Danny Barbare Content warning: death My uncle took her to the emergency room that night. She suffered from breast cancer several years. My immediate family stood around her. Her face was yellow. In her hospital room we tried to comfort her, afraid of the doctor giving her morphine, but she needed something. Later that night I was given a call she had passed away. She was good, did everything right, ate right, did her best. She died at a young age. That’s all I can remember, but a sweet, loveable sister we all loved. Share your poetry: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

When we think about breast cancer, our minds naturally go  to things like early detection, treatment plans, and survivorship. However, we sometimes overlook another crucial piece of the puzzle: heart health . It might surprise you, but research has found that some breast cancer treatments can increase the risk of heart problems. That’s why it’s so important to look after your heart, too — not just during treatment, but also afterward. Continue reading to stay informed, proactive, and empowered every step of the way. Why Heart Health Matters for Breast Cancer Patients Heart disease is the leading cause of death in women in the United States , and breast cancer is the most commonly diagnosed cancer in women. Unfortunately, those who survive breast cancer may face an increased risk of developing cardiovascular disease due to specific cancer treatments. According to the National Cancer Institute, some breast cancer treatments can cause short- or long-term damage to the heart.  These include: Anthracyclines (chemotherapy drugs) such as doxorubicin can weaken the heart muscle HER2-targeted therapies,  such as trastuzumab (Herceptin), can interfere with heart function Radiation therapy directed at the left side of the chest can expose the heart to radiation and increase the risk of heart disease later in life How Big Is the Risk? A study by the Mayo Clinic, published by the National Cancer Institute, found that women treated for breast cancer had a significantly higher risk of developing heart failure compared to those who did not have cancer . The risk varies depending on the type and duration of treatment. What You Can Do to Protect Your Heart If you or someone you care about is undergoing treatment for breast cancer, it’s essential to know that cancer therapies, while lifesaving, can sometimes affect the heart. The good news is that there are proactive steps you can take to support heart health during and after treatment. Here’s how you can take charge: 1. Talk to Your Care Team Start by having an open and honest conversation with your oncologist  about the potential effects your cancer treatment could have on your heart. Certain chemotherapy drugs, targeted therapies, and radiation — mainly if directed near the chest — can increase the risk of heart complications. Ask whether your treatment plan includes any therapies known to affect the heart and whether seeing a cardio-oncologist — a specialist who focuses on managing heart health in people with cancer — might be beneficial. Involving this expert early on can help you prevent or manage heart issues more effectively. 2. Monitor Your Heart Health Regular monitoring can help detect any early signs of heart strain or damage before they become serious. Your health care team may recommend heart tests such as: Echocardiograms  to measure how well your heart is pumping Electrocardiograms (EKGs)  to check your heart’s electrical activity Blood tests  to monitor heart-specific enzymes You can complete these tasks at various points — before treatment begins, during therapy, and follow-up visits after you complete treatment. Staying on top of these appointments is crucial for identifying any issues early. 3. Practice Heart-Healthy Habits Taking care of your heart can also mean making everyday choices that support your overall well-being. Here are some heart-smart habits that can make a difference: Eat a nutritious, balanced diet  of fruits, vegetables, whole grains, and lean proteins. Try to limit processed foods, excess salt, and added sugars. Move your body regularly . Even gentle forms of exercise, such as walking, stretching, or yoga, can improve circulation, boost your mood, and help maintain a healthy heart. Join SurvivingBreastCancer.org  for yoga, Pilates, and other movement programs. You can check out our full event calendar at https://www.survivingbreastcancer.org/events . Avoid tobacco use  and limit alcohol intake. Both can add stress to your heart and reduce your body’s ability to heal. Manage stress . Cancer treatment can be emotionally taxing, so it’s important to care for your mental and emotional health, too. Mindfulness exercises, deep breathing, journaling, speaking with a counselor, or joining a support group  can all be beneficial. Join SurvivingBreastCancer.org for   Thursday Night Thrivers , our weekly virtual support group with special meetups for metastatic breast cancer, early-stage breast cancer, inflammatory breast cancer, and a Spanish-language group! 4. Know the Symptoms of Heart Trouble As you focus on cancer treatment, make sure to watch for signs that your heart may be under strain. Notify your doctor right away if you experience: Shortness of breath, especially if exacerbated by minimal physical activity Persistent fatigue  that feels unusual for you Chest pain or discomfort Swelling in the ankles, feet, or legs A rapid or irregular heartbeat These symptoms can sometimes be subtle or overlap with side effects from cancer treatment, which is why it’s so important to speak up if something doesn’t feel right. Remember:  You don’t have to choose between treating cancer and protecting your heart — both are possible. With the correct information, support, and care, you can work closely with your medical team to manage your heart health while focusing on your overall recovery. Count On Us for Information, Resources, and Support  Understanding the connection between breast cancer and heart health  is essential for survivorship and long-term wellness. Healthcare professionals are increasingly recognizing the need for integrated care  that supports both cancer recovery and cardiovascular health. With the right knowledge and support, you can thrive during and after your breast cancer treatment and protect your heart for the journey ahead. Remember, you’re not alone. Rely on your health care team, loved ones, and support networks to help you through this time. 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: Treatment Tips & Questions to Ask Your Medical Oncology Team Exercise and Breast Cancer Managing Fatigue During Breast Cancer Treatment: Tips for Conserving Energy Nutrition After a Cancer Diagnosis On the Podcast: Breast Cancer Conversations Breast Cancer in Younger Women: Navigating Survivorship, Surgery Choices, and Lymphedema with Dr. Kohli 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 Debbie Lesser Listen to Debbie on the SBC podcast, Breast Cancer Conversations: 23andMe Found my BRCA Mutation with Debbie Lesser Have you ever heard of The Butterfly Effect ? It’s the idea that something as small as the flutter of a butterfly’s wing can ultimately cause a typhoon halfway around the world. That theory pretty much sums up how I ended up here, as a BRCA1 mutation-positive previvor  with cherry blossoms tattooed across my chest. Let me back up. In 2013, I was a full-time medical sign language interpreter. I spent my days (and nights... and weekends) interpreting for doctors and hospitals across the country via video - picture Zoom, but with more emergencies and less “can you hear me now?” I’ve always been a curious person. A bit of a medical nerd, if you will. So, when I was accepted into a highly competitive medical interpreter training program (only 15 of us were chosen nationwide), I jumped at the opportunity. One of the speakers in that program was a genetic counselor. Her presentation was fascinating. Afterward, I thanked her, and she casually mentioned I could take an at-home DNA test to learn about my ancestry and health risks. So, obviously, I ordered one for myself, my husband... and our dogs. (Don’t judge… they needed to know where they came from, too.) And you better believe I spat in that little tube the second I got home. And Then… The Results A few weeks later, the results were in. I was fully expecting to be Scottish (thanks to reading the entire Outlander  series). But, plot twist: I was actually Polish, Russian, and Ukrainian. Which, honestly, made way more sense given my carb preferences. Turns out, I’m almost 100% Ashkenazi Jewish. Cool. Fun (and not-so-fun) fact: being of Ashkenazi Jewish descent puts you in a high-risk category for BRCA mutations. If that’s your background, get tested! Seriously… it’s a tiny tube of spit and a whole lot of peace of mind.  And then I saw it - BRCA1 gene mutation. I wasn’t alarmed. I thought: these at-home DNA tests are cheap, probably full of false positives, and besides, no one in my family had breast or ovarian cancer. So, I casually mentioned it at my next mammogram appointment. My doctor agreed it was probably  bogus but offered to refer me to a genetic counselor just in case. I said yes, not because I was worried, but because I’d never seen genetic mapping done before. I thought, “Hey, this will be fun and educational.” (I know, I’m a riot at parties.) At the appointment, I told the counselor, “I’m sure this is nothing, I just wanted to see how you do your thing.” She asked if I was Jewish (check) and if there was any cancer in the family. The only thing I could think of was my paternal grandfather, who died of pancreatic cancer in his late 70s. But again, nothing too alarming, right? Except... wrong. The genetic counselor recommended that I undergo additional testing to confirm the direct-to-consumer results, which indicated I did indeed have the BRCA1 mutation.   Now, here’s the thing: everyone  has BRCA1 and BRCA2 genes . They’re like your body’s personal cancer security team, meant to suppress tumor growth. But when there’s a mutation… it’s like firing the security team and leaving the door wide open. Suddenly, I wasn’t playing with house odds anymore; I was holding a losing hand. There was more than 60% chance I’d get breast cancer and about 39-58% chance of ovarian cancer . Not exactly the kind of gamble anyone wants to take, and definitely not the kind of lottery you want to win. I was 45. No family history. No warning. Just a wildly inconvenient mutation silently passed down through my father’s side; a family line I barely knew. My dad had no siblings, was distant from extended family, and both his parents had already passed. The counselor suspected the “silent” gene mutation came from him. The Family Web My mother is one of five siblings, four of them women. Still, no history of breast or ovarian cancer there. I, however, have five sisters (my dad has two girls from each of his three marriages… yes, it’s like a mini-series). I also have two daughters. I told everyone. My older sister, who has developmental disabilities, tested negative …huge relief. I’m the second oldest. The next two sisters tested positive. The last two have never spoken to me about it (families are complicated, right?). When my daughters turned 18, they wanted to get tested . They’re both BRCA1 mutation-positive. That moment hit me hard – not just as a woman, but as a mom. The Choices We Make After confirming my DNA results through a second (far more expensive) clinical test – not covered by my insurance, of course – I began the slow, messy journey of risk management. First up: full hysterectomy. Ovarian cancer is nearly impossible to detect early and has a 51.6% 5-year relative survival rate . I was done having kids, so this was a no-brainer. The surgery went smoothly. I was up and walking quickly. And thanks to a low-dose estrogen patch, menopause didn’t completely knock me flat. But deciding whether to have a mastectomy? That was harder. At first, I said no. I went with “watchful waiting” – alternating mammograms and MRIs every six months. I figured I’d cross the mastectomy bridge if  I got cancer. Then one day, at a routine mammogram, my breast specialist (the same one who agreed that the original test was “probably a false positive”) noticed my estrogen patch and said, “You need to take that thing off or get a mastectomy.” Then she hit me with this zinger: “Do you want your mastectomy with a side of chemo or not?” Surgery, Setbacks, and Strength So, on June 1, 2016, at 48 years old, I underwent a nipple-sparing prophylactic bilateral mastectomy  with direct-to-implant reconstruction using textured teardrop implants (yes, that’s a mouthful). Recovery was… let’s just say “challenging.” I couldn’t lie flat for two weeks because gravity hurt. I lived in a recliner. About three weeks after surgery, my right nipple developed necrosis and required an emergency surgery. (I now refer to it as my “wonky nipple.”) Three rounds of fat grafting followed. Then, in 2019, my annual routine MRI showed my left implant had ruptured. Around the same time, those very implants were banned worldwide for causing a rare lymphoma. So, hey, silver lining? That rupture may have saved my life. In July 2019, I had implant exchange surgery and, you guessed it, more fat grafting. But you know what? It’s been smooth sailing ever since. No cancer. Just scars, gratitude, and a new perspective. The Cherry Blossoms To reclaim something beautiful from all this - the surgeries, the fear, the lost sensation, the hard choices - I got a tattoo that wraps from my right breast up to my shoulder. Cherry blossoms. They symbolize the fragility and brilliance of life… how it blooms gloriously and ends too soon. They’re a reminder to live in the present. To bloom fully, even if briefly. To be grateful. Life is short and stunning, so pay attention. Previvor, Not Survivor… But Still Impacted Previvor  means “a survivor of a predisposition to cancer.” In my case, it goes beyond carrying the gene mutation. It’s facing your odds and choosing to fight preemptively . And yes, some people have actually said to me, “At least you got a boob job out of it!” Okay. Deep breath. Let me put it this way: A boob job is like remodeling your kitchen. A prophylactic mastectomy ? That’s like evacuating ahead of a Category 5 hurricane because you live on the coast (Hi, I’m from Florida). You demolish the house before  the storm hits, rebuild it from the foundation up, and live every day knowing you made the right call. It doesn’t look the same. It doesn’t feel the same. But I’m grateful for the choice and for my life. No, I didn’t “suffer” the way many cancer survivors have. I didn’t lose my hair or vomit my way through chemo. I didn’t have to stare down a terrifying diagnosis or wait for a doctor to tell me the odds. But I did make gut-wrenching, body-altering, emotionally exhausting, counterintuitive decisions – choosing to remove healthy body parts in order to avoid that suffering. That takes a whole different kind of strength – the kind that whispers, just because you’re not sick yet doesn’t mean you sit and wait to be . And through it all, my daughters got front row seats. They didn’t just watch their mom navigate risk; they watched her flip the script. They’ve seen strength that doesn’t wear a cape but walks into a surgical consult with a spreadsheet. They’ve learned that being proactive isn’t overreacting. It’s smart. It’s fierce. It’s survival with a strategy. They’ve learned to be vigilant, stay informed, and trust themselves to make decisions that are right for them. People have asked, “Why would you go through all of that when you might never even get cancer?” And my answer? Ask a breast cancer survivor if they’d have jumped at the chance to prevent it all… the chemo, the surgeries, the fear. I don’t need a crystal ball to know what most of them would say. The Final Flutter All of this, every test, every decision, every scar, traces back to a single conversation I almost didn’t have at a training I almost didn’t attend. And that traces back to a woman named Dr. Mary-Claire King, who almost didn’t get on a flight to present her BRCA research to the NIH in 1981. She got on the plane. She got the grant. The rest is world-changing science. I wrote to her once and thanked her. Because her butterfly wings flapped hard enough to reach me decades later. We are all  part of someone’s Butterfly Effect. You reading this might be part of someone else’s. And if sharing my story helps even one person take action, to get tested, talk to their doctor, or just pay closer attention, then maybe my wings are flapping too. Read More: Understanding Genetic Testing for BRCA1 and BRCA2 Mutations Genetic Testing and Previvorship: Preventative Measures to Reduce Cancer Risk My Previvor Story From Fear to Freedom: Embracing a Risk Reduction Mastectomy The Power of Knowledge (My BRCA Story) On the Podcast: Breast Cancer Conversations 23andMe Found my BRCA Mutation with Debbie Lesser 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 Kristen Carter Dear Kristen, I have gained six or seven pounds since I finished chemo and began taking Letrozole. Nothing fits, I don’t feel like I look like a woman anymore, and my oncologist and PCP say there’s nothing they can do. Please help; I’m desperate and hate the way I look. B.E. Dear B.E. I’m so sorry to hear you’ve been struggling with this issue, which is one so many of us in our community face. I am not a metabolism expert, but fortunately our president, Laura Carfang, has done some research on this AND has sought the advice of people who are. That content will begin to appear in this newsletter beginning in April or May. One thing Laura discovered in the Journal of Clinical Endocrinology & Metabolism is that women on Letrozole and other aromatase inhibitors had a greater percentage of body fat and insulin resistance compared to those with no history of breast cancer. They are also more likely to develop high cholesterol, hypertension, and hyperlipidemia. In short, you are in very good company, even though you’d rather not be. Laura is also on Letrozole and wrote a blog not too long about her personal struggles with weight gain as well. When you next speak to your doctors about this, ask for targeted advice for your situation, and insist they take you seriously. What you are going through is tough and they may have recommendations to refer you to a nutritionist. Members in our breast cancer community also rave about the Live Strong program, which also provides participants with a gym membership. As for the non-metabolic aspect of your question, as a life coach and someone who has experienced my own permanent physical changes due to cancer treatment, I would love to wave a magic wand over you and help you appreciate your body regardless of the numbers on the scale. When I was first diagnosed and given a few weeks to live (I was already in liver failure), I realized just how precious this bag of skin and bones is to me. I was almost always critical of it until then, finding flaws by comparing myself to others and my own ideal image of myself. All off a sudden, *poof*, it was my favorite place to be in the whole universe, and I wanted to keep it forever (or at least a few more decades). I know my story is pretty dramatic, but all of us who have been diagnosed with breast cancer and lived through therapy could look down at our amazing bodies and say, “Geez, you’ve dealt with so much. Thank you for coping and getting me this far.” Not only would kinder self-talk feel better, it could also help you achieve your health goals. According to research by the U.S. National Institutes of Health, being dissatisfied with your body leads to poorer health behaviors like binge eating, lower levels of physical activity, and less fruit and vegetable intake. It’s like we’re punishing the poor thing for not being the way we want it to be. On the other hand, people with positive feelings about their bodies were more likely to engage in healthier behaviors. Simple steps anyone can incorporate include: Starting the morning off with a big glass of water to wake up your insides. I love the visual imagery of water washing over my body! Incorporate movement into your day. Perhaps a stroll after dinner to wind down, or a few quick 10-minute walks throughout the day. I recently started Taxol, which has sapped my energy so much that even a stroll down the block and back feels like a long walk, but it makes me feel so much better. Capture your feelings in a journal – the good, the bad, and the ugly. Laura noticed that when she starts journaling about the weight gain and frustration, she often ends her journal entry with “new day same goal” and recommits to making healthy choices one day at a time. We’re in it for the long game! Try choosing one day a week where you eat vegetarian or vegan, and play around with new recipes. And of course , check out the number of Movement Monday classes SBC offers, you’ll be with an amazing community of women who enjoy yoga, meditation, Zumba and more! No matter your weight, shape, or size, you matter. You are lovable, loved passionately by the universe, and deserve to be kind to yourself. I’ll let the poet Mary Oliver take it from here: Wild Geese You do not have to be good. You do not have to walk on your knees for a hundred miles through the desert repenting. You only have to let the soft animal of your body love what it loves. Tell me about despair, yours, and I will tell you mine. Meanwhile the world goes on. Meanwhile the sun and the clear pebbles of the rain are moving across the landscapes, over the prairies and the deep trees, the mountains and the rivers. Meanwhile the wild geese, high in the clean blue air, are heading home again. Whoever you are, no matter how lonely, the world offers itself to your imagination, calls to you like the wild geese, harsh and exciting – over and over announcing your place in the family of things. xo Kristen

By Kristen Carter Dear Kristen, Do you have any suggestions for dealing with moodiness? Between the stress of having breast cancer and the side effects of treatment, I get irritable so easily. I’ve even snapped at my daughter, who’s the most important person in my life! I’d love some ideas for staying calm. First of all, give yourself some compassion for your irritable feelings; it’s no wonder you have them when the major stressors of cancer, surgery, radiation, and/or chemo are invading your life. Additionally, if you are pre-menopausal, chemotherapy and hormonal therapies can throw you into forced menopause causing a dramatic shift in your hormones. Acknowledging your emotions and being gentle with yourself for having them is sometimes enough to let a little light shine into your dark mood. If you are looking for more recommendations beyond giving yourself grace, try one or more of the following strategies: Ask Yourself, “Why?” It might feel like it’s the slow cashier who’s causing your blood to boil, but in truth it might be the fact that you’re tired or nauseous or worried about tomorrow’s scan. Try Smiling When you smile, your brain releases tiny molecules called neuropeptides to help fight off stress. And a 2019 meta-analysis of 138 research studies showed that smiling makes people happier. Laughter can also be a great mood-changer; try TikTok, YouTube, favorite comedians, laughing yoga – anything to help crack open your negative mood. Give Yourself a Time-Out It works with young children and it can work for you, too – ask whoever you’re with to please excuse you, then go somewhere quiet and calming for a few minutes. Get Some Perspective This is one of my personal favorites: Imagine watching the scene you’re in from a different spot in the room, like above it all, floating next to the ceiling. This perspective gives me just enough space to see how temporary the situation really is and to calm down. Another trick: imagine standing behind the other person and seeing things from their point of view. Belly Breathe When we’re stressed, we tend to breathe in and out of our chest, which signals to the brain that we are under threat. Taking big, deep breaths in and out of your belly, on the other hand, tells your brain that you are safe and helps calm down your whole nervous system. Surviving Breast Cancer offers several free programs to help get you breathing, including Zumba with Angela Rose, Restorative Yoga with Kate, and Group Meditation with Gloria. Be Grateful It is difficult, if not impossible, to feel gratitude and stress at the same time. So make a quick mental list of things you’re grateful for right at that moment, even if it’s as simple as “life is precious and every day is a miracle.” If you try these and still blow your top, the best thing to do is apologize. You’ll probably wish you had behaved differently, so say so. Acknowledge what you said or did and the impact it had on the other person, say you’re sorry, and promise that you won’t let it happen again. If you end up on the receiving end of someone else’s bad mood, forward this column with a note that says something like, “I love you and I know you’re going through a hard time, but I’m feeling stressed out by what you’re saying/doing. Here are some lovely ideas that might help.” Advice From Others in the SBC Community I really loved your question and wanted to garner perspective from what other people in our SBC community do and keep in their tool box when their emotions are wild. I turned to Laura, the Executive Director of SBC to ask her what her tactics are. Here’s what she shared: “As a Scorpio, I love hard and I fight hard. Throw a cancer diagnosis on top of that and deplete my estrogen to zilch, you have complete chaos! Here are my go-tos: Exercise. I am someone who has no time and I cannot always prioritize exercising 30 minutes a day, but I always try to get the heart pumping for a minimum of 10 minutes. If I break my day up into a few bursts of jumping jacks in between zoom calls, a brisk 110 minute walk with the pup at lunch, and then maybe some light weights at the stove while I am waiting for the water to boil for dinner, bam – somehow I reached my 30 minutes of exercise that day. Remember, it’s ok to break things up and exercise has been a great tool for me to release steam. Similar to what you mentioned above about receiving other people’s bad energy, a friend told me about this visualization technique that I love to do to kick off my nighttime routine (this can also be done before walking into the house after a long day at work, before picking up your kids at school, etc). I take several deep breaths to ground myself and I literally wipe off the bad energy that clung itself to my body. Literally, I will go through the motions of wiping off my arms, my shoulders, and my legs. Bad vibes don’t always cling either. I take my hand in the form of scissors and literally cut away the strings of cobwebs around me, literally detaching myself from the negativity. Finally, I visualize the “crazy” float off of me and drift far far away. Lastly, I want to break the stigma that seeing a psychiatrist is a bad and shameful thing that we need to keep secret. No, seeing a psychiatrist is to be rewarded! It means you are carving out time for you! It means you are engaging in self care. It means you are getting help and support! Having constant mood swings was impacting my day to day life. I was so sensitive at work, I would have to rush to the bathroom sometimes to burst into tears. Seeing a colleague's email pop up in my inbox gave me so much anxiety I couldn’t even open the message. My debilitating anger was unmanageable (after all, I was the vegan who got cancer!). After seeing a psychiatrist, I am on medication to help create balance. I am proud of this because it enables me to remain on my treatment regimen and for me, that was my priority.” Wishing you peace, Kristen

By Kristen Carter Dear Kristen, I’ve always been a positive person and I’m trying to stay positive since my recent cancer diagnosis, but it’s hard work. I believe our emotions and thoughts help create our reality, and that my positive thoughts will help me with healing. How do I stay upbeat instead of giving in to fear and anxiety and other negativity? Dear Reader, You’re right that our attitudes play a large part in our healing, and I thought I’d give you some good hard data to back this up. In one study, Johns Hopkins researcher Lisa Yanek and her colleagues explored the effects of positive and negative thinking on patients with a family history of heart disease. Her findings concluded that people with a family history of heart disease who also had a positive outlook were one-third less likely to have a heart attack or other cardiovascular event within five to 25 years than those with a more negative outlook. Yanek’s findings are relevant to those of us with breast cancer because positive thinking offered protection from the inflammatory damage of stress (inflammation is a factor in cancer as well), and the more positive people also made better health and life decisions. On the flip side, the researchers found that negative emotions can weaken immune responses. Much research on the link between our emotions and our health has also been done by scientists in the field of positive psychology as well. In a number of different studies, people who reported having the highest levels of happiness also had: Improved heart health (Steptoe & Wardle, 2005) The ability to combat stress more effectively (Zautra, Johnson & Davis, 2005) Reduced risk for stroke (Ostir, Markides, Peek & Goodwin, 2001) A stronger immune system, leading to greater health all around and the ability to fight off illness and disease more effectively (Stone et al, 1987, Cohen et al, 2003, Marsland et al, 2006). An overall healthier lifestyle including eating a healthier diet (Dubois et al, 2012), engaging in more physical activity (Sapranaviciute-Zabazlajeva et al, 2017), and overcoming poor sleeping habits (Steptoe et al, 2008). A better ability to mitigate pain (Zautra, Johnson & Davis, 2005) Increased longevity: Researchers believe that because of the impact happiness has on all of the above health benefits, it can ultimately help you live a longer life (Carstensen et al, 2011, Lawrence, Rogers & Wadsworth, 2015, Chida & Steptoe, 2008). So, there are plenty of reasons to lean into your positive emotions and to cultivate as much positive energy as you can. But all this doesn’t mean we should try to be only positive all the time. Doing so would be to ignore reality when you’re living with something as serious as breast cancer. All your thoughts and feelings are valid, and trying to suppress the negative ones is like trying to hold an inflated beach ball underwater: exhausting and futile. It’s gonna pop up sooner or later. The trick is to not dwell on those negative thoughts, ruminating on them and letting them take over our whole lives. To process negative emotions, try this technique: Take one negative emotion at a time and imagine it as a tiny human or creature standing in the palm of your left hand. What does she/it look like? A monster? A dictator? A scolding parent? A wild version of yourself? What does she have to say? Let her say everything that’s on her mind until she grows quieter and more still. Thank her for sharing all that valuable information with you, and sympathize with her emotions by saying something like, “I totally get what you’re telling me and I empathize with what you’re going through. It isn’t easy.” Ask her what she needs most. Can you grant this wish? If yes, promise to do so. If not, tell her you will do your best to find the solution. Ask if there is anything more this small person wants to say to you, and repeat the last few steps until she feels fully seen, safe, and supported by you. Invite her to return to her place within your body/ mind/ system and promise her you will check in on her regularly to ensure she is still feeling okay. Check in with her daily for a few days, see if she needs to talk to you, and repeat this process if things come up. A couple of years ago I created an evening journaling process that helped build my positive emotions and also allowed me to touch base with my negative emotions. On one page of my journal, I wrote three things I was grateful for and what I did to make those things happen (this builds a sense of empowerment and agency), and then wrote down one thing that was really bothering me that day. It allowed me to get that thought out of my head and onto paper, and sometimes that was all I needed to move on. Other times, I used the seven steps above as journaling prompts and wrote until I felt I understood the problem well and had taken some of the intensity out of it. Finally, the best way to boost overall happiness is to experience more moments of happiness; happiness is fleeting, so plan ways to experience small doses of it as often as you can. xo Kristen

By, William Laferriere, Survivingbreastcancer.org board member Hello darkness my old friend.... I’ve come to talk with you again, Because a vision softly creeping, Left it’s seeds while I was sleeping. Fools, said I you do not know, how Silence like a cancer grows… Paul Simon, Art Garfunkel, The Sounds of Silence While hosting an exhibit booth recently with survivingbreastcancer.org founder Laura Carfang at the CelebASIANS Breast Cancer Awareness benefit in Boston, MA, I met a survivor who approached with the plaintive cry that “I am so lonely”. I walked around the exhibit table, hugged her and said that she had come to the right place, exemplified by our raison d'etre @ survivingbreastcancer.org , where we attempt to empower breast cancer survivors from day one. I suggested that she join our Fb group and introduce herself and enjoin our community of Survivors. Loneliness is a complex and unusually unpleasant response to isolation, and ergo, a lack of companionship. A great Beatles song, Eleanor Rigby opined: All the lonely people, Where do they all come from? All the lonely people, Where do they all belong? The affects of loneliness are felt by many of our vaunted breast cancer community. Early on at the September, 2018 Living Beyond Breast Cancer Conference in Philadelphia, PA an elderly woman approached our exhibit table and talked at length about her diagnosis and long term treatment and survivability, but then said she mostly came over for hugs and an embrace from Laura and myself. We gladly obliged and she asked us what we we @ survivingbreastcancer.org were all about. I gave her the impromptu response that “We look to inject positivity into the fabric of a heinous diagnosis”. At a white water raft trip last summer in the Poconos, along with the Staten Island Cancer Tamer gang we shared a communal experience of rafting, zip lining and Soul Re-engineering’s Claudia and Jim’s incredible Shamanic, Akashic Lakota chanting/readings/cleansing on the waterfront. At the end of the day we performed a group hug. One of the survivors, currently a second time stage 4 BC diagnosis at the age of 74, held onto me for a prolonged hug and told me that we had just made her so incredibly happy. We’ve also met survivors whose spouses couldn’t handle the impact-fulness of a BC diagnosis and treatment; many verbalized that their family and friends couldn’t handle either. One woman contacted me through our website and informed me that her spouse had an affair while she was in the hospital having her surgery. He proceeded to leave her for the other woman shortly thereafter. I suggested that by just reaching out she was halfway back from the despair of loneliness and invited her to join us as well. Laura and I have discussed these, and other similar stories of loneliness, and despair, and how valuable community, embracing, and hugging were and how these consistently contributed to enhancing the health and wellness of a survivor. Studies (credit below) have found that part of the reason for this loneliness is because the person with breast cancer is experiencing situations and emotions that few others can understand. Experiencing loneliness, especially chronic loneliness, may aggravate the cancer. In fact these studies “have determined that rats who were isolated experienced increased incidences of breast cancer. The tumors were significantly larger than in the rats who were not isolated. The researchers suggested that people who experience high degrees of loneliness may also experience greater degrees of breast cancer as well.” Therefore, lonely women could be at greater risk of breast cancer returning or exacerbating. Scientists have shown the stress and anxiety caused by ‘social isolation’ can speed up the growth of potentially deadly tumors. Other studies have shown that social support and friendship can boost a woman’s chances of recovering from breast cancer, and that the lonely and depressed are more vulnerable to a host of serious diseases. Warner (credit below) identifies the relationship between loneliness and decreased immune functioning as well as increased inflammation, all of which may negatively impact attempts at treating breast cancer. Even after a person goes into remission, loneliness continues to linger. Mary Rosedale (credit below), in her research talks about survivor loneliness of breast cancer survivors. “Their experience of loneliness included several themes such as emerging consciousness, in which women talked about the ongoing feelings of loneliness despite others being around and transcending time, where family and friends often moved on from the breast cancer experience whereas the women were still dealing with it. Often this would happen after the first year, when people assumed that the women have moved on.” Misunderstanding “was another theme that focused around how even those closest to them misunderstood how breast cancer changed their lives. One other important theme was withholding truth, which discussed how these women would censor what they say, and not communicate what they are really thinking or feeling. Withholding truth was a form of protection from having to hear feedback from others; feedback that is often hurtful, such as confirming a fear or having others feel sorry for them.” So, what can be done for those who are currently experiencing or have experienced breast cancer and loneliness? The process of connecting to others who are experiencing similar conditions is a common thread among support/self-help groups. The powerful component of these groups is the ability to be authentic, to reveal one’s fears, desires, hopes, and concerns to others who “get it” because they have similar experiences. In those groups, it’s okay to say, “I am scared about a relapse,” because there are others in the room who are scared as well. The point at which a person can become authentic, vulnerable, and truly connect with others is the point at which loneliness begins to disappear. Support groups are an excellent way of doing that, but certainly paying attention to feelings of loneliness and making deliberate attempts to be authentic, vulnerable, and to connect to important loved ones is also a great strategy. In closing a look at loneliness through the eyes of a poet: I shiver melancholia, entombed with my winter blues in the dark dreamless hollow of my frowning igloo. Draped in decor of dispirited drear I wear a wistful woebegone fog, an overcoat of overcast moods sown of sneering sunless, scentless days. I weep wall to wall in the long light-less nights alone with my lonely longings~ my psyche withers a little more each dull day, I shrivel. I shiver sadness, my colorless tears cry out loud for color; yearning for watermelon sunsets, pink sands and swirls of marigold kisses, for rainbows to color my lackluster laughter and fireworks to celebrate in my mirthless eyes, for Sol’s warm hands to tenderly undress and caress me and lay bare my soul straitjacketed by winter blues... Susan Ashley January 4, 2018 Please see the below links for blog contributions. • The Harmful Connection Between Breast Cancer and Loneliness ... www.psychologytoday.com/blog/web-loneliness/... The researchers suggested that people who experience high degrees of loneliness may also experience greater degrees of breast cancer as well. You can get a summary article here on the study . • Cancer And Loneliness: The Vicious Cycle | The Breast Cancer ... blog.thebreastcancersite.greatergood.com/cancer... And cancer sends a person to a unique place—suddenly everyday matters seem unimportant when forced to consider your own mortality. Cancer tends to focus a person on what’s truly important, and that may mean that relationships that worked before cancer no longer work during or after cancer . • The Loneliness of Cancer | HuffPost www.huffingtonpost.com/lisa-masters/the... The Loneliness of Cancer . ... Even though I write about breast cancer now being treated as a "chronic disease" again, today's reality says that this cancer will kill me. I push those thoughts to ... • Loneliness and breast cancer - 'Breast cancer treatment left ... www.goodhousekeeping.com/uk/news/a579443/breast... Loneliness and breast cancer - Battling breast cancer in rural Cumbria left me isolated and lonely. A teacher and mum of two is calling for more emotional support for those affected by breast cancer . • Loneliness may sabotage breast cancer survival ... - CBS News www.cbsnews.com/news/loneliness-may-sabotage... Loneliness may impede long-term breast cancer survival, a new study suggests. In the years after treatment, women who don’t have strong social ties are more likely to have their cancer return or ... • Loneliness May Sabotage Breast Cancer Survival - WebMD www.webmd.com/breast-cancer/news/20161212/... MONDAY, Dec. 12, 2016 (HealthDay News) -- Loneliness may impede long-term breast cancer survival, a new study suggests. In the years after treatment, women who don't have strong social ties are ...

SurvivingBreastCancer.org (SBC) is excited to unveil new accessibility features on our website ! As mentioned in our 2024 Impact Report , SBC is committed to making our website and mobile app as accessible as possible. Through our accessibility efforts, SBC aims “to break down barriers so that every person diagnosed with breast cancer can easily access the resources, support, and community they need, no matter their circumstances.” What exactly do we mean by making our website accessible, and why is this important? Let’s take a closer look. What is website accessibility? When a website is described as “accessible,” this means the site can be used by people with various disabilities, which can include visual, auditory, and motor impairments. Accessible websites use specific designs and features to facilitate access for these site users. As explained by the U.S. Department of Justice Civil Rights Division , “People who are blind may use screen readers, which are devices that speak the text that appears on a screen. People who are deaf or hard of hearing may use captioning. And people whose disabilities affect their ability to grasp and use a mouse may use voice recognition software to control their computers and other devices with verbal commands.” Why is web accessibility important? When a website isn’t designed and planned with accessibility in mind, it’s very likely that site visitors with various disabilities will be unable to use some or all of the site’s content and features. The Civil Rights Division  goes on to describe just how detrimental this can be for potential site users: “Inaccessible web content means that people with disabilities are denied equal access to information. An inaccessible website can exclude people just as much as steps at an entrance to a physical location.” Through our accessibility efforts, SBC aims to make all of our resources more accessible for everyone – from those diagnosed with breast cancer and their loved ones to individuals wanting to know more about breast cancer risk factors, signs and symptoms, and treatment options. What’s new on SBC’s website? The SBC website now includes an accessibility toolbar from Recite Me. This toolbar allows our website users to customize their website experience based on their accessibility needs. By clicking the “Accessibility Tools” button at the top of our website, users can choose from a variety of accessibility options. These include text-to-speech, text size customization, automated translation, magnifier, and more. Give it a try and find the settings that work best for you! We aim to make our website accessible to everyone. If you have any questions or feedback regarding our website accessibility, please reach out to us at info@survivingbreastcancer.org .

Issue: 276 Tick, tock... did you remember to change your clocks ahead one hour yesterday? Let’s enjoy these later sunsets as we make our way towards a glorious springtime!   This weekend, SBC attended the Infinite Strength MBC Conference in New Haven, CT. A huge congratulations and shout-out to Infinite Strength's founder and president, Roberta Lombardi, and her fabulous team, for hosting an educational, powerful, and intimate conference where we were able to connect with experts in the field and forge strong bonds with patient advocates. Among the many key takeaways, I learned the importance of exercise. The question now is, how much exercise does one need to do to receive the benefits and at what point is more not necessarily better? Research is being conducted to explore what the #RightDose of exercise. Dr. Teplinsky gave an exceptional talk normalizing the discussion around sex and intimacy when living with metastatic breast cancer. From providing recommendations on creams and suppositories like Intrarosa and Revaree, she encouraged us to speak with our oncologists and gynecologist about vaginal and pelvic floor health. Oftentimes these questions come up at the end of our already short and usually rushed appointments with our doctors so Dr. Teplinsky recommended making a separate appointment to specifically address these concerns with your team. From laughing about the crazy stuff people say to those diagnosed with breast cancer, to discussions around "you don't look sick", we laughed, cried, hugged, and came together as a community in support of each other's experiences.   As the founder of SurvivingBreastCancer.org (SBC), and diagnosed with early-stage breast cancer, I am so grateful to be welcomed into the sacred space of the MBC community! We continue to provide relevant programming to address the pressing topics of those living with MBC. You can check out our MBC Webinar Series and catch our next Webinar this Wednesday hosted by Abigail Johnston and Amy Parliman where we talk about everything you need to know about scans. And a reminder that this Thursday is Write Your Story Day! Perhaps you'd like to attend tonight’s writing workshop with Thomas  to write it out. Whether or not you submit your writing for our blog, writing down thoughts can be a really helpful way to process your breast cancer experience. I encourage you to give it a shot! You might be surprised at what you create :) Happy writing! xo, Laura Editorial: Effective Listening At SBC we received a heartfelt, brilliant note from community member and MBC Leadership Team member Kathleen Friel, regarding how to properly listen to and respond when speaking with someone with a speech impairment. See her email below. Kathleen’s memo got me to thinking about how I can personally improve and develop effective listening habits, and after some quick research I came up with the following: Effective listening is a crucial skill that goes beyond simply hearing words; it involves fully comprehending and interpreting the message being conveyed. One key aspect of effective listening is providing the speaker with your undivided attention. This means putting aside distractions, such as phones or other electronic devices, and maintaining eye contact to signal that you are fully engaged. Furthermore, active listening involves non-verbal cues, like nodding or mirroring the speaker’s body language, to convey understanding and encouragement. In addition to non-verbal cues, paraphrasing and summarizing the speaker's message demonstrate that you are not only hearing but also processing the information. This reflective aspect of listening ensures that both parties are on the same page, fostering clarity and preventing misunderstandings. It’s essential to refrain from interrupting and allow the speaker to express themselves fully before responding. This patience and respect contribute to a more open and communicative environment, where individuals feel heard and valued. Ultimately, effective listening is a skill that strengthens relationships, promotes understanding, and facilitates successful communication. From The SBC Blog No Scars to Your Beautiful By Jayita Chatterjee [This one is for me, for my pink cancer friends that went through lumpectomy, mastectomy and/or reconstruction , and really anyone else that needs to hear this.] If you feel horrible, looking like a Frankenstein, with giant stitches all across your body… I am here to tell you it is OK to feel how you feel! It is NOT vain. If your partner or others say that you look beautiful, but you don’t like how you look right now, it’s OK. If you don’t want to look at your body right now, it’s OK. You went through a lot. You went through multiple surgeries, chemo, maybe radiation, immunotherapy. And yes, you are alive. But we are allowed to mourn our old self… not just the body, but the person we were the day before we were told we had cancer.  Yes, it’s physical changes, but that’s on TOP of so many other life-altering moments. One day you’re just living your life, and the next you’re talking to oncologists, geneticists, and surgeons. The world will tell you that you’re supposed to be grateful for being alive, and how you look does not matter. But it DOES. From the SBC Poetry Lab Moremi By Goldiin Kelvins In life, I met a girl so strong, brave, and true, Within four walls, she battled, a constant cue. Surviving, not living, she faced a relentless strife, Moremi, a young soul navigating through life. Born in Nigeria's west, in Africa's embrace, Her memory lingers, my heart's sacred space. I try to divert my thoughts, but I can't deny, Her innocent gaze, a plea in each dark eye. Her mind puzzled, imagining the world outside, Yet, hope waned, like a fading tide. She fought against sickness, a brave young soul, Yet, it fought harder, taking its toll. A 12-year-old warrior, courage in her stare, Yet, sickness, a ruthless terror in the air. Determined to live, dreams she'd conceive, But sickness threatened, luring dreams to grieve. Docs and teams fought, her heartbeat's descent, Body systems failing, a despairing lament. Yet, she'd jolt back, gasping for air, Mother's dripping tears, a father's silent prayer. Wishing for release, from the hands that tried, From loved ones' grasp, in pain, she'd hide. Drowning in the pit where life began, Her tears echoed, a heart-wrenching plan. Today, we lay her down in the earth's embrace, Cancer claims victory, a bitter taste. To those fighting, courage to you I send, May your stories not meet this tragic end. Lost a girl, lost a niece, grief in the wind, Adieu, Moremi, where memories begin. Today on the Podcast 11 Years of Survivorship - A Breast Cancer Survivor's Story with Dawn Aegle Dawn shares her journey from diagnosis to traveling the world doing cat sitting after caring for her mother. Their conversation touches on major milestones, personal experiences, and the impact of travel on Dawn's life post-treatment. Tune in for an inspiring story of resilience and adventure. (Click to Listen) Upcoming Events

I am halfway through radiation treatment (15/30)! So far so good. I wasn’t really sure what to expect. Like everything, I was doing way too much research and preparing for the worst. Radiation is a local treatment impacting just the area of cells being radiated (unlike chemotherapy). In my case, we are using radiation as part of my preventative care and to be extra sure that the cancer will not recur. By going through radiation, we are “killing” any residual, or leftover, rogue cancer cells that were not removed from surgery, or did not “die” from chemo. Overall, I have to say, I am responding to radiation pretty well. The skin looks good and after 15 rounds, I’m not too red (yet). I like to thank my Italian genes for allowing me to tan well! Outside of skin irritation, other side effects include fatigue. While I am managing this well, I do get tired and nap when I have to. If anything, just listen to your body as it knows best! When going through radiation, it is important to speak with your doctor about the pros and cons. Like any treatment, a benefit analysis needs to be taking into consideration. In my case, because we are radiating on my left breast and lymph node area (which I did not realize goes up to your color bone!) a few key risk factors needed to be hashed out. For example, the impact radiation would have on my heart and lungs were a big concern for me! I am a very active person and plan on remaining active for a long time! Having heart and lung problems are not things I am looking forward to! Nor is the potential development of lymphedema, or other cancer in the long term. While there are a few risks to manage, I cannot lose sight of my initial goal which is to be cancer free and ensure breast cancer does not return! As such, radiation and onward. Moisturizers I recommend:

Taxol Treatments for Triple Negative Breast Cancer (TNBC) My name is Bridget Bates. I’m 38 years old and I was recently diagnosed this year, January 3rd, 2020 with Triple Negative Breast Cancer (TNBC) Stage 3 in my left breast. Because Triple Negative Breast Cancer (TNBC) is such an aggressive type of breast cancer my doctors went forward right away with all tests and scans necessary. Let’s break it down! Mammogram: Breast Ultrasound: Breast Biopsy:Left Breast MRI: Breast Bone Scan CT Scan: Chest, Abdomen, Pelvic Biopsy: Armpit left lymph node PET Scan: Sternum MRI/Biopsy: Right Breast Brain MRI After all is said and done, but still waiting on my brain scan results, but I can say the cancer only has spread to one lymph node under my left armpit. I started chemotherapy January 27, 2020 with appointments every Monday featuring a combination of Taxol (Paclitaxel) and Carboplatin. The first round of treatment was stressful. I went in that Monday with high anxiety. Taxol Allergic Reaction My Doctors did warn me that the majority of women are allergic to their first dose of Taxol. Understandably, I was so anxious. I did become allergic within the first 30 minutes of my treatment. My hands started turning bright red. I rang the nurse immediately. Thankfully they were quick to stop treatment and flush me out and add more Benadryl to stop the reaction. My anxiety hit the roof at this time and I was going into full panic attack mode. One of the nurses asked if I wanted some lavender oil to calm my nerves. Knowing about how essential oils work wonders, I responded “Yes, Please”! After all this excitement, we decided to start up again. I was still nervous, but knew I couldn’t just give up on the first try. I can say I completed my first round somewhat successfully. Taxol Side Effects Now going on my sixth infusion, it appears to get easier over time. Of course anxiety is still there, but my lavender is never too far. I have to say I've been pretty lucky regarding my side effects from taxol. Mild nausea once or twice. I definitely can’t eat any dairy, or I will end up with nightly bathroom runs. Lol. But I feel deciding early on that I would combine holistic with my chemotherapy has definitely helped me get through my rough days. Headaches Hairloss I’m not one to pill pop, so I find natural ways to cope with the side effects from taxol. But I know if it ever gets too hard “I will give in and take a pill". Only if necessary! With the headaches, this has been more of the pill popping scenario. I've experienced more headaches than ever which I attribute to the steroids given during treatment. Taxol Hair Loss One of the hardest side effects from taxol for me has been the hair loss. I discovered my hair falling out after the third infusion. I couldn’t control it, chunk after chunk. I decided to shave the back and leave some hair on top. I will eventually shave it all, but I wear hats a lot and beanies at home. It’s wonderful to know there’s so many options on the market to help with this issue. There are so many different organizations and hospitals that give away free wigs and head accessories. If you just ask, people will help! As for now I take it day by day. I enjoy the moments I feel my best and make those days were I take a walk, get fresh air and just enjoy being around family and friends who lift me. I still have a long journey ahead: six months of chemotherapy followed by a bilateral mastectomy, followed by six weeks of radiation, but I will never give up. This girl is staying positive and strong every step of the way. Cancer isn’t me, I am me.

I cannot believe it is 2018, another year of survivorship is upon us, with new resolutions, new goals, inspiring ambitions, and when the holiday cheer winds down and the excitement wears off, I realize I’m still just taking it one day at a time, and that’s OK. I fall into the category like most people around this time of year; I set new health and fitness goals, still trying to lose the “chemo” weight I put on last year, planning new financial goals, striving to be kinder each day, and to laugh more. But as the weeks go on, the overzealous plans to make this the best year ever starts to fade away like a dream. I was doing the 2017 inventory of everything I’ve been through in 2017: 12 months of chemo therapy (multiple drugs) 1 surgery 6 weeks of radiation And just a few weeks ago, I finished my last round of the oral chemo drug, Xeloda . Now that I am finished with one drug, it is time to look ahead and start taking others! As I head into 2018 I am looking at 10 years of hormonal therapies and shots , infusions to counter bone decay and osteoporosis, and additional meds to assist with joint pain, fatigue, mental health, the list goes on. The only way I can describe this is that I am 36 years old on the outside but 80 on the inside, but I’m grateful! I am alive and thriving! Can you relate? Among the breast cancer community, I hear a lot of people saying this is the “new normal” and we need to learn to live with lymphedema (or being at risk for it for the rest of our lives!), joint pain, the fear of recurrence, quarterly diagnostic testing, mammograms, CT Scans, MRI’s etc. Unfortunately, we were the ones indoctrinated (not by choice) into a lifelong club, but don’t get me wrong, the pink sisterhood is a bond like no other and for that I am grateful. While the initiation process into this “club’ is grueling, the perspective gained makes the fight worth it! Cancer has actually made me a better person! Instead of focusing on what I cannot do and settling for the “new normal”, I am approaching 2018 as my year of REDISCOVERY . Rediscovering the things that matter most Rediscovering the activities I enjoy doing Rediscovering the foods I enjoy tasting (now that my taste buds have returned) Rediscovering how I can take a devastating experience and make a difference. Follow me on my rediscovery in 2018! There is so much more to learn about breast cancer and while I have gone through the traditional steps of chemo, surgery, and radiation, no one has given me the road map for what happens next. While several amazing women with inner strength have gone down the path of survivorship for 5 years, 10 years, and decades, understanding how being diagnosed with breast cancer manifests in terms of longterm treatment continues as rollercoaster ride; I am so glad you are on this journey with me! What have your experiences been like? I’d love to hear from you! Share Your Story .

Lobular breast cancer, also known as invasive lobular carcinoma (ILC) , is a type of breast cancer that originates in the milk-producing lobules of the breast. Distinguished from the more common invasive ductal carcinoma (IDC), which begins in the milk ducts, ILC typically presents with a unique pattern of spread and growth. ILC is the second most common form of breast cancer and accounts for about 10% to 15% of all breast cancers . Most commonly diagnosed in older women, although it can occur at any age, ILC is often challenging to detect due to its diffuse nature. The treatment and prognosis for lobular breast cancer generally align with other types of breast cancer, involving a combination of surgery, radiation, chemotherapy, and hormone therapy, depending on the individual case.  Continue reading to learn how lobular breast cancer is different from other forms of breast cancer , its connections with genetic mutations, and how ILC is diagnosed and treated. How is Lobular Breast Cancer Different From Other Subtypes of Breast Cancer? Invasive lobular carcinoma (ILC) is a type of breast cancer that is recognized as biologically distinct from the more common invasive ductal carcinoma (IDC).  ILC is distinct from other forms of breast cancer in several ways: Cellular characteristics:  ILC is characterized by the loss of the cell adhesion molecule E-cadherin, leading to discohesive cells that proliferate into single-file strands. This unique growth pattern contributes to the difficulty in detecting ILC using standard imaging techniques​. Hormone receptor status:  ILC tumors are often estrogen receptor- (ER) positive, affecting treatment choices and responsiveness​. Metastatic patterns:  Unlike ductal carcinomas that form distinct lumps, ILC grows in sheets throughout the breast tissue ,  making tumors more challenging to detect. It ’s also more likely to be multifocal (occurring in multiple sites) and bilateral (occurring in both breasts). What Genetic and Molecular Factors are Associated With Lobular Breast Cancer? ILC often exhibits specific genetic mutations and molecular features distinct from IDC. For example, mutations in the CDH1 gene are commonly associated with ILC, which can affect how cells adhere to each other. Several genetic and molecular factors have also been linked to ILC, including TP53, PIK3CA, FOXA1, ZNF703, FGFR1, and BCAR4. These factors contribute to the unique molecular characteristics of ILC and may have implications for its development and progression. Here’s an overview of these factors: TP53 mutations:  TP53 is a tumor suppressor gene that plays a crucial role in preventing the growth of cancer cells. Mutations in TP53 have been associated with ILC. TP53 mutations can lead to the loss of its tumor-suppressing function, allowing cancer cells to proliferate more rapidly and evade cell cycle checkpoints. PIK3CA mutations:  PIK3CA is a gene involved in the PI3K/AKT/mTOR signaling pathway, which regulates cell growth and survival. Mutations in PIK3CA are common in various cancer types, including ILC. These mutations can activate the pathway, promoting cell growth and survival. FOXA1 expression:  FOXA1 is a transcription factor that plays a role in hormone receptor signaling. ILC often exhibits high levels of FOXA1 expression. This can influence the behavior of hormone receptor-positive ILC and its response to hormone therapy. ZNF703 amplification:  Amplification of the ZNF703 gene has been observed in some cases of ILC. ZNF703 is involved in gene regulation and may contribute to the growth and progression of ILC. FGFR1 amplification:  Amplification of the FGFR1 gene has also been associated with ILC. FGFR1 is a receptor tyrosine kinase that can promote cell proliferation when amplified. BCAR4 expression:  BCAR4 is a long non-coding RNA (lncRNA) that has been linked to the progression of ILC. It may play a role in the invasive behavior of ILC cells. These genetic and molecular factors can interact and influence the biology of ILC, making it distinct from other breast cancer types, such as invasive ductal carcinoma (IDC). Understanding these molecular characteristics is important for tailoring treatment strategies for individuals diagnosed with ILC. In practice, the presence of specific mutations or molecular alterations in ILC tumors may guide treatment decisions. For example, hormone receptor-positive ILC may respond well to hormone therapy, while targeted therapies that inhibit pathways like PI3K/AKT/mTOR may be considered for cases with PIK3CA mutations. Additionally, ongoing research continues to explore these molecular factors and their potential as therapeutic targets for ILC. How Is Lobular Breast Cancer Detected? Detecting ILC poses significant challenges given its unique characteristics, including the following challenges: Mammography limitations:  Since ILC does not usually form distinct masses, it may not appear on mammograms, or it may appear as asymmetrical tissue thickening rather than a distinctive mass. For this reason, ILC can be more challenging to diagnose early. Know what to look and feel for, especially changes in breast shape or texture and mild, diffuse pain. Pay attention to subtle changes and always report them promptly to your doctor. Breast ultrasound:   Ultrasound imaging may be used in conjunction with mammography to evaluate areas of concern in the breast. It can help distinguish between solid masses and cysts and provide additional information about the characteristics of a lesion. MRI as a superior modality:  Magnetic resonance imaging (MRI) is an exceptionally sensitive technique for detecting ILC, showcasing an impressive sensitivity range of 94% to 99%. The high level of accuracy is due to MRI’s advanced imaging capabilities, which are adept at discerning the distinct and often subtle tumor characteristics unique to ILC.  Unlike other imaging modalities, MRI excels in providing detailed images of the breast tissue , enabling it to detect ILC’s atypical growth patterns and diffuse spread, which traditional methods like mammography might miss. MRI’s superior imaging proficiency in identifying the intricate and distinct features of ILC enhances the accuracy of diagnoses, ensuring earlier and more effective treatment interventions. What Treatment Is Available For Lobular Breast Cancer? When caught early, ILC generally has a similar prognosis to invasive ductal carcinoma . Surgery is often the first line of treatment, followed by radiation, chemotherapy, hormone therapy, or targeted drugs as needed. The following procedures and therapies are medical options during ILC treatment: Surgery:  Often the first line of treatment, which may include lumpectomy or mastectomy, coupled with an evaluation of lymph node involvement​. Lumpectomy:  This involves the removal of the cancerous tumor along with a margin of surrounding healthy tissue. It is an option for early-stage lobular breast cancer. Mastectomy: In some cases, a mastectomy, which is the removal of the entire breast, may be recommended. This decision depends on factors such as the size of the tumor, its location, and individual preference. Sentinel lymph node biopsy or axillary lymph node dissection:  During surgery, a sentinel lymph node biopsy or axillary lymph node dissection may be performed to determine if the cancer has spread to nearby lymph nodes. Radiation therapy:  Typically used post-surgery to target any residual cancer cells in the breast and surrounding areas​. Chemotherapy:  Used to kill cancer cells throughout the body, either before surgery to shrink the tumor or after surgery to eliminate remaining cancer cells​. Targeted therapy:  Involves treatments that specifically target the characteristics of cancer cells, with a reduced likelihood of harming healthy cells​. Antihormone therapy:  Especially effective in ILC due to its high ER positivity, this therapy reduces estrogen levels in the body, thereby inhibiting the growth of breast cancer cells​. Endocrine therapy:  Favored due to ILC’s low chemosensitivity and reduced pathological response rates to chemotherapy​. Count On Us for Information, Resources, and Support  Understanding lobular breast cancer is crucial for effective diagnosis and treatment. Support for ongoing research and awareness initiatives is vital.  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 , 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 is designed to provide general information and not replace professional medical advice. Always discuss your options with your healthcare provider. Lobular breast cancer stories from the SBC community: My Lobular Breast Cancer Story: Not a “Journey” Energy Healing from Lobular Breast Cancer From Diagnosed To Advocate On the Podcast: Breast Cancer Conversations Inflammatory and Lobular Breast Cancer: Patient Advocates Share SABCS Insights SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

Breast cancer is one of the most common cancers worldwide, affecting millions of individuals annually. Understanding breast cancer stages  is crucial for patients and their loved ones to make informed decisions about treatment and prognosis. This article delves into what breast cancer is, explains the stages of breast cancer , and provides details about symptoms, treatments, and survival rates at each stage. What Is Breast Cancer? Breast cancer  occurs when abnormal cells in the breast grow uncontrollably. These cells often form tumors, which can be benign (non-cancerous) or malignant (cancerous). Malignant tumors have the potential to spread to other parts of the body through the lymphatic system or bloodstream. While breast cancer is most common in women, individuals of any gender can develop the disease. Early detection is vital for improving outcomes, which underscores the importance of understanding breast cancer staging . How Breast Cancer Is Staged The breast cancer staging  system helps doctors assess the size of the tumor, whether it has spread to lymph nodes, and if it has metastasized to distant organs. This information is critical for determining treatment options and predicting outcomes. The stages range from 0 to IV, with subcategories that further detail the cancer’s characteristics. The stages are based on the TNM system: T (Tumor):  Size and extent of the primary tumor. N (Node):  Whether cancer has spread to lymph nodes. M (Metastasis):  Whether cancer has spread to other parts of the body. Detailed Overview of the Stages of Breast Cancer Stage 0: Ductal Carcinoma In Situ  (DCIS) What It Is:  Stage 0 breast cancer is non-invasive . The cancer cells are confined to the ducts of the breast and have not spread to the surrounding tissue. Symptoms:  Typically asymptomatic and often detected through mammograms. Treatment:  Surgery (lumpectomy or mastectomy) followed by radiation therapy. Hormone therapy may also be recommended for hormone receptor-positive DCIS. Survival Rate:  Nearly 100% when treated early. Learn more about the continuum of breast cancer care  and how early intervention improves outcomes. Stage I: Early-Stage Invasive Breast Cancer What It Is:  Cancer has begun to invade nearby breast tissue but remains small (up to 2 cm) with minimal or no lymph node involvement. Symptoms:  May include a lump in the breast, nipple discharge, or skin changes. Treatment:  Surgery (lumpectomy or mastectomy) with possible sentinel lymph node biopsy. Radiation and hormone therapy are common, and chemotherapy may be considered. Survival Rate:  The 5-year survival rate for stage I is approximately 99% . Stage II: Larger Tumors or Limited Spread to Lymph Nodes What It Is:  Tumors range from 2 to 5 cm or involve 1 to 3 lymph nodes. Symptoms:  Noticeable lumps, breast swelling, or skin dimpling. Treatment:  Surgery is often combined with chemotherapy, radiation therapy, and hormone therapy for hormone receptor-positive cancers. Survival Rate:  The 5-year survival rate for stage II remains high at about 86%-99% . Explore ways to   reduce the risk of recurrence  after treatment. Stage III: Locally Advanced Breast Cancer What It Is:  Cancer has spread to 4 or more lymph nodes or invaded the chest wall or skin. Tumors may be larger than 5 cm. Symptoms:  Significant breast changes, such as redness, swelling, or skin ulceration. Treatment:  Treatment usually begins with chemotherapy to shrink the tumor, followed by surgery and radiation therapy. Targeted therapies may also be used for HER2-positive cancers . Survival Rate:  The 5-year survival rate for stage III is approximately 86% . For those with aggressive subtypes like triple-negative breast cancer , emerging therapies offer hope. Learn more here . Stage IV: Metastatic Breast Cancer What It Is:  Cancer has spread to distant organs such as the bones, liver, lungs, or brain. Symptoms:  Symptoms vary based on the location of metastasis and may include bone pain, fatigue, and difficulty breathing. Treatment:  While stage IV breast cancer is not curable, treatment focuses on prolonging life and managing symptoms. Options include systemic therapies like chemotherapy, targeted therapy, hormone therapy, and immunotherapy. Survival Rate:  The 5-year survival rate  for stage IV is about 31% , but individual outcomes vary widely. Key Takeaways on Survival Rates and Recurrence Early detection improves prognosis significantly, with stage 0 and stage I having survival rates close to 100%. Breast cancer recurrence rates increase by stage, highlighting the importance of vigilant follow-up care. Advancements in treatment, such as immunotherapy  and targeted therapies, continue to improve outcomes across all stages. Visit SurvivingBreastCancer.org  for resources, support, and updated information on managing breast cancer at every stage. Symptoms to Watch For Knowing the signs of breast cancer is essential for early detection. Common symptoms include: A lump or thickening in the breast or underarm Changes in breast size, shape, or appearance Nipple discharge, particularly if it is bloody Breast pain or tenderness Skin changes, such as redness, scaling, or dimpling Treatment Advancements and Emerging Trends Treatment strategies for breast cancer have evolved significantly, incorporating cutting-edge technologies and personalized medicine. For aggressive cancers, such as metastatic triple-negative breast cancer,   emerging therapies  offer new hope. Additionally, support networks play a vital role in helping you navigate the physical and emotional challenges of treatment. Explore resources such as SurvivingBreastCancer.org ’s weekly support groups . Understanding breast cancer stages  empowers you to take control of your health and advocate for the best possible care. From early detection to advanced treatment, knowledge is a powerful tool in the fight against breast cancer. By staying informed about the stages of breast cancer , recognizing symptoms, and seeking appropriate care, you can improve your outcomes and quality of life. For more information about risk reduction, treatments, and survivorship, visit SurvivingBreastCancer.org . Count On Us for Information, Resources, and Support  If you or a loved one is experiencing breast cancer at any stage, understanding the nature of the diagnosis is crucial for navigating treatment options and establishing a support plan. Speaking with healthcare professionals, connecting with cancer support groups , and educating yourself can provide comfort and empowerment. 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 us 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 SBC, 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: Ductal Carcinoma in Situ (“Stage Zero” Breast Cancer): What You Need To Know Invasive vs. Non-Invasive Breast Cancer: Key Differences and What They Mean The Promise of the Triple Negative Breast Cancer Vaccine Metastatic Triple-Negative Breast Cancer: Emerging Therapies Deliver Hope Metastatic Breast Cancer: Understanding the Significance of Stage IV Advances in Immunotherapy: A New Frontier in Breast Cancer Treatment On the Podcast: Breast Cancer Conversations The Role of Advanced Imaging in Breast Cancer Diagnosis and Treatment Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

Understanding connections between breast cancer and seemingly unrelated symptoms like back pain is crucial for early detection and effective intervention for those diagnosed with breast cancer. Dr. Yolanda Tammaro , a board-certified general surgeon with distinguished fellowship training in breast surgery, offers insight into the potential link between breast cancer symptoms  and back pain.  Continue reading to learn about the possible links between breast cancer and back pain, how back pain is diagnosed and treated, and tips for managing back pain with breast cancer. Exploring the Connection Between Breast Cancer and Back Pain While back pain is not typically an early sign of breast cancer, it can be a concerning symptom in the later stages of the disease due to bone metastasis, tumor location, or treatment-related side effects. As breast cancer progresses to an advanced or metastatic stage (stage 4) , it can spread to other parts of the body, including the bones. When breast cancer spreads to the bones, it can weaken the bones and cause pain or even fractures  in the ribs, spine, and hips. According to Dr. Tammaro, this bone metastasis of breast cancer can ultimately lead to back pain. In some cases, a breast cancer tumor can directly press on the spinal cord or surrounding tissues in the back, causing direct back pain. Additionally, certain medications and therapies used to treat breast cancer, such as hormonal therapies like Faslodex and Femara, and chemotherapy drugs like Novantrone, can potentially cause back pain as a side effect. Back Pain Symptoms Accompanying Breast Cancer Those with a breast cancer diagnosis  experiencing any new or worsening pain should be evaluated by a doctor promptly. If you notice any of the following symptoms that persist for more than a few days, you should seek medical attention: Persistent or severe back pain Back pain accompanied by other breast cancer symptoms, such as a breast lump, nipple discharge, or changes in breast appearance Back pain along with fatigue, nausea, constipation, irritability, thirst, or confusion Headaches, dizziness, or seizures Shortness of breath Jaundice or abdominal swelling Diagnosing and Treating Back Pain with Breast Cancer If you are experiencing back pain, especially in conjunction with other concerning symptoms or a prior breast cancer diagnosis, Dr. Tammaro recommends that you undergo several diagnostic tests. A physical examination can help identify the nature and location of the back pain. Imaging tests like X-rays, CT scans, MRI, or bone scans can reveal if there are any abnormalities, fractures, or lesions in the spine or other bones that could indicate metastatic spread from breast cancer.  Blood tests can also provide clues, as elevated levels of certain biomarkers like alkaline phosphatase or calcium may signal bone metastasis. If the imaging tests show a suspicious area, a biopsy of the spine or other affected bone may be performed to definitively differentiate between a benign cause and cancerous lesions from metastatic disease. Clinical History and Breast Cancer-Induced Back Pain In cases where an individual has a known breast cancer diagnosis, their clinical history is also a key factor. Dr. Tammaro shares that physicians will consider the breast cancer type, stage, previous treatments, and any new or changing symptoms holistically. Sudden onset of severe back pain in someone with metastatic breast cancer would raise high suspicion for disease progression, compared to someone with no cancer history presenting with typical musculoskeletal back pain. “Breast cancer patients experiencing back pain from metastatic disease face a complex array of physical and emotional challenges,” says Dr. Tammaro. “In my practice, I firmly believe that a multidisciplinary treatment approach provides the most comprehensive and effective way to alleviate their suffering.” By integrating conventional therapies like targeted chemotherapy, radiation, and bone-modifying agents with complementary modalities such as massage, acupuncture, and mindfulness practices , Dr. Tammaro shares, you can holistically address not just the cancer itself, but also the debilitating pain symptoms.  Tips For Managing Back Pain with Breast Cancer Dr. Tammaro recommends taking a multidisciplinary approach to managing back pain. Some tips for managing back pain associated with breast cancer include: Staying active with gentle exercise  and stretching, as tolerated, to reduce stiffness and improve mobility Applying hot or cold packs to the painful areas to provide temporary relief Maintaining a healthy diet  with adequate calcium and vitamin D to support bone health Considering complementary therapies like massage, acupuncture, or yoga  to help relax the muscles and promote healing Practicing relaxation techniques such as deep breathing, meditation , or guided imagery Following instructions carefully when using medications for pain relief, whether over-the-counter or prescription, to avoid interactions with cancer treatments Consulting a physical therapist  for specific exercises and postural advice to ease back strain Using supportive devices like braces or orthotics to stabilize the spine Seeking emotional support from counselors, therapists, or cancer support groups  to cope with chronic pain Communicating openly with your cancer care team about the severity and nature of your back pain to adjust treatment plans as needed Combining medical interventions with self-care strategies and alternative therapies can help manage breast cancer-related back pain. Note: This article is designed to provide general information and not replace professional medical advice. Always discuss your options with your healthcare provider. Learn more about Dr. Tammaro: https://www.premiersurgicalnetwork.com/dr-yolanda-tammaro/ Learn More: Tips for Pain Management with Cancer Breast Cancer Symptoms Newly Diagnosed Metastatic Breast Cancer: Understanding the Significance of Stage IV Exercise and Breast Cancer The Importance of Physical Therapy During and After Cancer Treatment SurvivingBreastCancer.org  Resources & Support: Join us for yoga, Pilates, and other mindfulness and movement programs! Weekly Support Groups On the Podcast: Breast Cancer Conversations The Benefits of Pilates for Breast Cancer Recovery

In the realm of cancer treatment, discussions about fertility preservation are often overshadowed by the immediate focus on life-saving interventions. Yet, informing patients about their reproductive options is a vital part of comprehensive cancer care. The integration of fertility preservation discussions into the care continuum is essential not only for patients' emotional well-being but also for their long-term quality of life. When patients are well-informed, they are better equipped to make decisions that align with their personal desires and circumstances, ultimately improving fertility outcomes. Listen Now on Breast Cancer Conversations Podcast: 257. What is Oncofertility? How To Navigate Genetics, Fertility and Cancer Care (click below) The Importance of Fertility Discussions During Breast Cancer Treatment Involving patients in decisions about their fertility risks and preservation options is a critical component of patient-centered care. Healthcare providers must take the initiative to ask the right questions and engage patients early in their treatment planning. Guidelines from the American Society of Clinical Oncology (ASCO) and the American Society of Reproductive Medicine (ASRM) have long advocated for informing patients at risk of infertility about their options. However, despite these recommendations being in place since 2012, a significant study conducted in 2020 revealed that only 44% of oncologists were providing this crucial information to their patients. This gap highlights a systemic issue in cancer care, where time constraints, treatment urgency, and competing priorities can lead to fertility discussions being overlooked. Yet, these conversations are essential—they offer patients a sense of control during an otherwise overwhelming time and open the door for future family-building opportunities. A Multidisciplinary Approach to Oncofertility Care Addressing the issue of fertility preservation requires a multidisciplinary team approach. Oncologists, while primarily focused on treating the cancer itself, may not have the time or specialized knowledge to cover fertility risks in depth. Involving other healthcare professionals—such as social workers, nurse practitioners, fertility specialists, patient navigators, and genetic counselors—can ensure patients receive thorough and timely information. Research shows that multidisciplinary involvement improves patient understanding. However, gaps remain, and one study found that while 60% of breast cancer patients were informed about fertility preservation, only 25% of those who met with a genetic counselor received relevant fertility information. This underscores a missed opportunity. Genetic counselors are uniquely positioned to discuss hereditary risks, reproductive planning, and fertility preservation options with patients facing complex medical decisions. Addressing Disparities in Fertility Preservation Communication Fertility preservation information is not always offered equally. Studies reveal that single women without children are more likely to receive fertility preservation counseling compared to married women or women over the age of 36. This bias can have serious implications for patients' reproductive futures. It is essential for healthcare providers to recognize that every patient—regardless of marital status, age, or perceived likelihood of childbearing—deserves access to information about fertility preservation. A standardized, equitable approach ensures that no patient is denied the opportunity to make informed decisions about their reproductive future. The Role of Tailored Resources and Genetic Counseling Patients consistently express appreciation for clear, accessible, and tailored educational resources about fertility preservation. Online materials, decision aids, and personalized counseling sessions can significantly enhance patients’ understanding and confidence. Genetic counselors, trained in delivering personalized support, can play a pivotal role. Beyond addressing inherited cancer risks, they can provide crucial guidance about fertility preservation strategies, such as egg or embryo freezing, ovarian tissue preservation, and considerations related to genetic testing of embryos. By equipping patients with individualized resources and support, healthcare teams empower them to make informed choices that align with their values and life goals. Empowering Patients Through Fertility Preservation Awareness As cancer care continues to advance, fertility preservation must remain a central focus of comprehensive, patient-centered treatment. Empowering patients with knowledge and options not only improves fertility outcomes but also supports emotional resilience, reduces future regret, and enhances overall quality of life. Fertility preservation is not merely a peripheral issue; it is a fundamental aspect of compassionate and holistic healthcare. Ensuring that patients have the information they need to shape their own futures is not just a matter of medical ethics—it is a commitment to honoring the dignity, dreams, and autonomy of every individual facing a cancer diagnosis. If you or someone you love is navigating a cancer diagnosis, ask your care team about fertility preservation options. Early conversations can make all the difference.

By Liana Reznik Everyone’s journey to a nipple tattoo is different. While some feel comfortable without having the areola and nipple present, others feel more complete with a replacement of the area. It is a personal decision that should be taken seriously. Nowadays, many women opt for breast reconstruction surgery when they are fully healed. However, surgery of any kind can still add additional pain, stress, and medical bills. There is a much less invasive alternative, known as a 3-D areola tattoo. Liana Reznik is the owner and the executive creator behind Fancy Shmancy PMU in Highland Park, IL. The studio specializes in paramedical areola 3-D tattoo, breast scar treatment, nipple & areola correction, radiation mark care, and many other permanent makeup services, with financial aid and insurance coverage offered to all clients. What is a 3-D Nipple Tattoo? While a tattoo cannot produce the projection required to be truly “3-D”, a high-quality, detailed tattoo can appear to have dimension much like a real nipple/areola. The 3-D nipple or areola tattoo is a work of art that looks like an authentic nipple. Shading, shadows, and other artistic skills make the tattoos look just like real nipples and help patients feel confident in their breasts once again. The inks used for nipple tattooing are mixed to create the most realistic appearance possible for each patient's skin. The tattoo artist strives to create a shade that resembles the patient’s original nipple and complements her natural skin tone. This is one of the reasons it is important to have a tattoo artist perform the procedure — there is an art to making each nipple unique for every patient. The Difference between 3D Tattoos and 4D Nipple Reconstruction 3D nipple tattoos refer to tattoos created in the traditional sense with tattoo ink using the colors of nipple pigment. They are designed using realistic markings to give the illusion of a realistic nipple. 4D nipple reconstruction is one step up from 3D tattoos, utilizing a surgical procedure to create hyperrealistic tattoos. They add a “fourth” dimension in the form of depth to the nipple so that it not only looks like a real nipple but feels like one. While working on helping women through my PMU art, I realize the importance of hope. Hope is something we give to each other, especially to those who may be less fortunate. As an areola tattoo artist, I am happy to support and to be of genuine use to other females to make them feel "whole" again. Nipple Tattooing vs Nipple Pigmentation Areola re-pigmentation and 3D nipple tattoos are a specialty area of medical tattooing; truly an art form of its own. Nipple tattoos can help improve the appearance of both women and men who have undergone breast surgery. 3D nipple tattooing techniques “create” a natural-looking breast after reconstruction surgery. It is a special technique of semi-permanent makeup that creates a realistic image of an areola and a nipple for breast cancer survivors. 3D nipple and areola tattoos are often used instead of nipple reconstruction surgery. As a tattoo artist, I will design and perform this semi-permanent technique to recreate a nipple. Is Scar Camouflage with Permanent Makeup Possible? Scar micropigmentation is an effective way to cover up or at least minimize the visibility of scars of different origins. By injecting pigments into the tissue, the scar or discolored patch of skin is matched to the skin surrounding it. This treatment is also possibly the best way to cover up scalp scars and has become an integral part of breast reconstruction. The result is a custom, permanent makeup solution that looks natural and gives women additional confidence in their bodies going forward. Questions to Ask Your Nipple Tattoo Artist How soon can I get my Areola Tattoo? It is safe to receive this treatment once you get a "green light" from your doctor and wait at least 6 months after the date of your final surgery for necessary healing (scar camouflage 12-18 months). How long will the procedure take? Typically, there is a one-hour consultation where the tattoo artist will often perform a patch test, discuss all of the options, and answer any questions or concerns you may have. The procedure itself takes up to three hours (depending on whether you do 1 or 2 nipples). Is the procedure painful? You may experience slight swelling and redness following the procedure and the skin may feel tight. This should improve within the first week, depending on how sensitive your skin is. Will there be any downtime following the procedure? You should be able to resume normal activities immediately following the procedure. However, avoid swimming and using a sauna or jacuzzi for two weeks after the procedure, as chlorine can act as a bleach and change the appearance of the tattoo. If using the gym within the first two weeks following your tattoo, please cover the treated area with a small amount of after cream that was provided by your artist beforehand to limit friction. Please ensure the area is cleaned afterwards. What should I do if I have a problem? Infection is very rare. If you experience any of the following symptoms, please contact your permanent makeup artist: Swelling and/or heat that doesn’t resolve in the first two days. Redness spreading from the tattoo that gets worse over a few days A fever (temperature higher than 37.5C °C / 99.5 °F) Will I have a follow-up appointment? You will typically have a follow-up appointment six to eight weeks after the initial treatment. Following an assessment, the permanent make-up artist will discuss whether further pigment is necessary. It is common to need two treatments, as the color will fade over time, and another procedure may be required to maintain the desired color. Why should I go to an Areola and Nipple Tattoo Specialist (vs a regular tattoo artist)? It can be difficult to ensure the ideal color match, shape, and size for your nipple. Nipple Tattoo Specialists have studied the skillful art of recreating a real, lifelike areola and 3D nipple down to the finest details. Now, women can have breasts that appear normal and the most realistic-looking nipples possible.

Within Breast Cancer Awareness Month throughout October, there are several specific awareness days. October 7th, for example, is "Going Flat" Day. This day recognizes the choice to go flat as opposed to having reconstructive breast surgery following a mastectomy. Additionally, some women who originally had breast reconstruction after their mastectomy may choose to have their implants removed later on. This is known as an “explant” surgery. There are numerous reasons someone may choose to go flat immediately or have their implants removed at some point. Continue reading for stories from patients who have chosen this route, the importance of using the correct language to describe your desired outcome (i.e, aesthetic flat closure ), pros and cons of going flat or removing current implants, and whether this could be a good option for you. From SurvivingBreastCancer.org Podcast Episode 48 Radical Mastectomy and Going Flat - Interview with Alicia Duncan In this episode, the surviving breast cancer team discusses Alicia’s struggle with her stage III breast cancer diagnosis and the loss of her breasts. The team highlights how a fast cancer diagnosis can take a toll on one’s mental health, along with the PTSD that may come in the aftermath of being cured of cancer. Lastly, Alicia explains her tattoos, and both Alicia and Angela discuss the strength needed to be a caregiver. Listen Now. Informed Decision Making About Going Flat In 2019, Devorah had a double mastectomy after a local recurrence. She always knew she did not want breast reconstruction, and feels fortunate that her breast surgeon – who told her about the flat movement – honored her choice. Devorah is also on the Board of Not Putting on a Shirt, a 501(c)(3) organization whose mission is to promote optimal surgical outcomes for women who choose to go flat after mastectomy and full disclosure of all post-mastectomy options. Read More. Meghan's Call To Trust You Instincts After her double mastectomy, Meghan initially opted for reconstruction. But after issues with her expanders and later the implants shifting, she also had unpleasant side effects. Known as breast implant illness (BII), she experienced fatigue, dizziness, vision problems, sleep problems and more. While little is currently known about BII, she chose to remove her implants. Read more for her story and how she shares the importance of speaking up if you're noticing any of these symptoms. Read More. Content Across The Web Going Flat: Choosing No Reconstruction ( BreastCancer.org ) Some women prefer to go flat because the recovery time after a mastectomy is typically shorter than with reconstruction. “If you have immediate reconstruction (reconstruction at the same time as surgery), the recovery time is longer than it is with no reconstruction. Depending on the type of procedure you have, there may be some muscle weakness and/or mobility issues as well, although some of the newer flap procedures minimize this risk by preserving the muscle structure at the tissue donor site. Generally, immediate reconstruction does lead to the most cosmetically pleasing results. If you choose delayed reconstruction — reconstruction 6 or 12 months or more after mastectomy — your recovery from mastectomy should be a bit easier. If you choose implant reconstruction, your doctor may need to use a device called a tissue expander, which is used to create a pocket under the skin where the implant will eventually go. If you have a tissue flap reconstruction, the skin that was removed at mastectomy will be replaced with the skin that comes with the flap (if reconstruction is performed at the time of mastectomy, this skin replacement may not be necessary).” Some patients who opt for no reconstructive surgery still want the look of their natural breasts and wear prosthetic breasts. If you’ve been using a prosthesis and are considering going without, but are uncomfortable about the idea of it, try not wearing the prosthesis while at home. Then try working your way up to going without it for short errands and see how you feel. You may realize most people don’t even notice! “If you like the idea of going flat but are worried about looking lopsided in form-fitting clothing, choose styles that draw attention away from your chest area. BreastFree has some great clothing tips: Fabrics with busy, irregular patterns that aren’t too small, such as florals and paisleys, keep the eye moving Dark colors, especially black, camouflage the lack of shadow underneath the flat part of your chest Crisp shirts with breast pockets mask your contours Jackets and sweaters layered over form-fitting t-shirts draw attention away from your chest and hide any unevenness Scarves and shawls can be used to cover part of your chest Instead of plunging necklines, choose styles that show off your other assets, such as high necklines that bare your back or shorter/slit skirts that highlight your legs.” Read More. 5 Aesthetic Options after Removing Breast Implants ( Plastic Surgery Center of Nashville ) Some common reasons that women may choose to have their breast implants removed include: An MRI has revealed a problem with your implant(s): All women with silicone breast implants should periodically undergo MRI testing to make sure their implants haven’t ruptured. Though silicone isn’t toxic, ruptured implants can cause pain, irritation, and infection if left untreated. Your Lifestyle or Preferences Have Changed: If you feel like your breast implants are too large or too heavy, they can be replaced with smaller implants or removed entirely. Health Concerns That Make Explant Surgery Necessary: Breast implant removal is medically necessary for women who have received a diagnosis of breast cancer, as they can interfere with treatment. Some women choose to have their breast implants removed because they’re experiencing non-specific symptoms, like fatigue and unexplained fevers, and they think their symptoms are related to having breast implants. This condition is known as breast implant illness, and while it’s poorly understood at present, researchers think it may be caused by an autoimmune reaction. A few options after removing implants: Implant Exchange: The original implants are removed, and new implants of your choice are placed into the existing “pocket.” The recovery time is similar to that of the original reconstruction surgery. Breast Lift with Implants: “Like large natural breasts, surgically augmented breasts often sag over time. If you’ve had breast implants for many years, normal aging and the effects of gravity may have created loose, stretched skin around your implants. To make sure your new implants sit in the correct position, surgeons may combine your implant exchange with a breast lift. They’ll remove excess skin from your breasts, insert new implants, and adjust the position of your nipples, as needed.” Implant Removal: You may choose to remove your implants altogether. Note: while this article shares that a few months after implant removal, the breasts will fill out to their natural shape, this only applies to women who have had augmentation of their existing breasts, not a mastectomy and reconstruction. Read More. From Full Reconstruction To Flat: My Decision to Explant Eight Years Later ( Anaono ) Because of a family history of breast cancer, personal history of thyroid cancer, and being BRCA1+, Samantha decided to undergo a prophylactic double mastectomy. She did not want to worry about another cancer diagnosis and wanted to know she would be there for her new daughter. “Reconstruction with silicone implants was the only option I remembered being presented with any great support or detail. ... I recall someone encouraging the implants, so as to “look normal” for my daughter and to “go as big as possible” (the infamous “reconstruction is a boob job” view). I ended up with arguably perfect, gorgeous and quite large reconstructed breasts, but was never comfortable in my body.” Eight years later she had explant surgery. “I had not been feeling well for years and hoped the explant would help, which it did. Equally importantly, I did not feel whole, sexy or connected to my implanted chest. It always felt foreign to me. The most important aspect of my decision to remove my implants was not a gallant act of bravery, nor a rejection of boobs, foobs or anything in between. It was an act of self-love and self-honoring ... Even when we are overwhelmed, scared and often rushed, it is incredibly important to ask the questions, be informed, do our homework, take our time (when possible) to digest and react, own our own bodies and make our decisions based on our own voice and not the (often negative) internal and external ones that chime in.” Read More. International FLAT Day ( Not Putting On A Shirt ) Not Putting On A Shirt is one of the organizations that spearheaded Going Flat Day a few years ago. Going Flat Day is all about advocating for flat closure as a valid choice post-mastectomy and to encourage doctors to present it as an option to their patients. By increasing awareness about the option to go flat, they hope to improve the aesthetic outcomes for women who go flat and empower them to make informed decisions about their surgery. Not Putting On A Shirt celebrates women who have chosen to go flat and helps them embrace their beauty and sensuality without their breasts. They share photos of women proudly showing off their surgery scars , and offer resources for patients and providers about this option. Read More.

Breast cancer treatment, while essential for combating the disease, often brings along various side effects that can significantly impact a patient's quality of life. Effective management of these side effects is crucial for the well-being and comfort of individuals undergoing treatment. Common Side Effects of Breast Cancer Treatment Breast cancer treatments can be extremely taxing on patients' bodies, often carrying disruptive side effects. The presence and severity of treatment side effects can vary based on the type of treatment administered and the patient's unique biology. The following are some of the most common side effects from breast cancer treatment: Fatigue :  Persistent tiredness or lack of energy that can affect daily activities Hair Loss :  Often a side effect of chemotherapy, causing temporary or permanent hair loss Nausea and Vomiting :  Chemotherapy or other medications can cause digestive issues Pain :  Aches or discomfort, especially after surgery or radiation Lymphedema :  Swelling in the arms or chest due to lymphatic system damage Cognitive Changes :  Referred to as "chemo brain," causing memory problems or mental fog Emotional Distress :  Anxiety, depression, or mood changes due to the stress of diagnosis and treatment Tips for Managing Side Effects Many breast cancer treatment side effects are inevitable realities of fighting the disease. Fortunately, you can help yourself by prioritizing side-effect management efforts to remain steadfast during your treatment cycle. The physical and psychological impact intensity of many symptoms can be mitigated through several methods, including: Fatigue Management :  Prioritize rest, practice gentle exercises like walking or yoga, and maintain a balanced diet. Hair Loss Support :  Consider wearing scarves, hats, or wigs. Opting for natural baldness can also be an empowering statement of strength for some. Nausea Relief :  Follow prescribed anti-nausea medications, eat smaller meals, and avoid strong odors and spicy foods. Pain Management :  Communicate with healthcare providers regarding your pain levels to plan appropriate pain relief strategies. Lymphedema Prevention : Wear compression garments to reduce swelling, practice gentle exercises, and avoid heavy lifting. Coping with Cognitive Changes :  Utilize memory aids, carefully organize tasks, and allow allotted time for mental breaks. Seeking Emotional Support :  Join support groups , speak with a therapist, or consider complementary therapies like mindfulness or meditation. Supportive Care Services Breast cancer side-effect management doesn't have to be a solo endeavour. Reputable care providers offer services to help you embrace effective coping strategies during your treatment. Some avenues to seek out for side-effect management include: Palliative Care :  Specialized medical care focusing on improving the quality of life for patients and their families Rehabilitation Services :  Physical therapy or occupational therapy to address functional limitations Nutritional Support :  Consulting a dietitian to maintain proper nutrition and manage side effects Psychosocial Support :  Counseling, support groups, or therapy to address emotional distress and promote mental well-being Complementary Therapies :  Integrative therapies like acupuncture, massage, or relaxation techniques to alleviate side effects Embracing Support and Self-Care Managing side effects during breast cancer treatment is a significant aspect of the journey. By adopting various strategies, seeking support, and accessing available resources, individuals can enhance their quality of life and navigate through treatment with greater comfort and resilience.

By Jill An Inspiring Story And Her Thanks To Cancer Jill's Story 2 years ago. On 1/13/2016, I heard those three little words that changed everything. “You have cancer.” (It was something like that...I was so nervous that I don’t remember the exact words). Looking back at the past 2 years, I realize how much life has changed and how much I have changed. Mostly good changes but some not so good changes too. Thanks to cancer , I’ve become a little more adventurous and have learned to spend more time with, and be more appreciative of, my family and friends. Thanks to cancer , I got my butt off the couch and started leading a healthier lifestyle. Thanks to cancer , I’ve met some pretty great people, both in person and on social media. My oncologist, my infusion nurses, my running girls and an amazing group of other survivors. I truly believe that people come into you life at the right time and for the right reason and I am so thankful for all of these new relationships. Thanks to cancer , I have learned to be thankful for every moment that adds to my story. Some days are difficult and I have a hard time thinking about anything but cancer, worried that I’m going to be so busy enjoying life that I miss some subtle sign of recurrence. Other days, I don’t think about cancer much at all. There are other days when I’m not even sure I had cancer, like it was all a dream or something. I am thankful for family and friends that are sticking with me. I know I’m more complicated than I used to be, and I know that I can be a moody pain, but you are trying to understand me as I struggle to understand myself. So here’s to another year of: Health, happiness, and embracing the hot mess that I am. Learn about supporting the Sunshine Bag Project The Sunshine Bag started out as a way to celebrate my 40th birthday by donating hats to my cancer center. Since tomorrow is never guaranteed, this has become an annual celebration. Thanks to the generosity of friends, family, and strangers, I started receiving yellow items and have been able to donate 90 Sunshine Bags to 2 cancer centers, and send a few to personal requests of people who know someone battling cancer! Thank you for sharing your story, Jill. SBC loves you. SurvivingBreastCancer.org Resources & Support: Breast Cancer Fitness Guide Breast Cancer Nutrition Guide Online Support Groups

Meet Rosa, Diagnosed At 48 With Stage 1B, ER+ HER2- Breast Cancer Hi, My name is Rosa. I was diagnosed at 48 with Stage 1B, ER+ HER2- Breast Cancer. This is my story. In April, 2018 I was diagnosed with cancer in my left breast. They found five tumors there. I had a lumpectomy and one lymph node dissection, but did not have clear margins. ​I caught an abscess (a swollen area within body tissue, containing an accumulation of pus and fluid) in the wound, which resulted in 2 months of antibiotics. I had lots of packing and it was an incredibly painful experience. In June, I had the left breast. After surgery and clear margins, I was negative for cancer. Everything was removed...Stage 1B. Onco score 30. I did 4 rounds of chemotherapy (the TC regiment), from July to September. I lost my hair... I lost my mind... I cried every day. I am on to the Aromataise inhibitor (AI) Letrozole. What a nightmare!!! I have excessive joint pain and underwent 16 rounds of radiation rads. My cancer was close to the chest wall and skeletal muscle. On my right side there was no trace of cancer... so I didn’t have it removed... But now I have fibroadenoma, which is the most common type of benign breast tumors. Most don't increase your risk of breast cancer, although women of any age can develop fibroadenomas. They usually occur in younger, premenopausal women. ​I will be removing the right breast next month, followed by reconstruction. Thought for sure I was not going to make it. I survived. I am doing OK... & I thank God every day. Thank you for sharing your story, Rosa. SBC loves you! SurvivingBreastCancer.org Resources & Support: Breast Cancer Poems Online Support Groups Writing For Healing

I never thought I would get breast cancer. In fact, the idea never crossed my mind until I felt a lump. I hear this story time and time again where women are "too young" to have breast cancer. However, according to an article published in October, 2019 from Yale Medical , 11% of women under the age of 45 develop breast cancer. In fact, breast cancer is the number one cancer among women between ages 19 and 39. Interestingly, the National Breast Cancer Foundation posits that 15% of breast cancers are triple negative breast (ER/PR and HER2 Negative) and typically occur in younger women. While we can google and read about triple negative breast cancer, we thought we'd take time today to speak with two women who have been diagnosed with TNBC in the 20's and 30's and have them share their first hand experience. SBC: Sara and Caitlin, thank you so much for taking the time and sharing your experience with triple negative breast cancer. As two women diagnosed at a young age, I would like to share with our readers a bit more about your diagnosis, your treatments, advice you have to others who are recently diagnosed and how you are doing now! Let’s dive in. Tell me a bit about your diagnosis, type, stage, age when diagnosed? Sara: I was 27 years old; 2 months shy of 28. I was initially diagnosed at stage 2a (no lymph node involvement); triple negative. This was the lump I initially found and got checked out. An MRI revealed a tiny spot in my other breast, which was biopsied. This was stage 0 due to size, but was not completely triple negative- a very low amount of one of the hormones (I can't remember which!) Treated as triple negative and the tumor board revisited my case after treatment and concluded I did not need hormone therapy for the little bit that was present. I also tested positive for the BRCA1 genetic mutation. Caitlin: I was diagnosed at age 30; 1 month before I turned 31. I Diagnosed with triple negative, stage 2b, grade 3. SBC: Did you have Chemotherapy and if so, which drugs were you on? : Sara: Yes, 16 rounds of chemo. I first did 12 rounds of Taxol, with carboplatin every 3rd treatment. I requested a few weeks off after finishing Taxol and starting the next round of chemotherapy and my oncologist was fine with this. Then, I started Adriamycin and Cytoxan (A+C) also known as "the red devil" which I completed four rounds, once every 2 weeks. Caitlin: Yes, I was on chemotherapy as well. Similarly, I had 4 rounds Adriamycin and Cytoxan followed by 4 rounds Taxol SBC: Did you have Radiation? If so, how many weeks? Sara: No. Caitlin: Yes, 5 weeks plus 1 extra boost week (30 rounds total). SBC: Radiation can be a bit confusing. We speak with Dr. Jimenez to get more information about radiation and what a boost week is. See short video below: Were you on any experimental trials? How did they go? Sara: Yes. I was on an immunotherapy clinical trial. Lasted an entire year. It went okay, I didn’t have any reactions while still in chemo but a few months after I started getting a whole-body rash. Caitlin: No, I wasn’t on any clinical trials. SBC What was your experience with Adriamycin and Cytoxan plus Taxol? Sara: I used cold caps through treatment and it actually went pretty well. I probably lost about 30-40% of my hair. While I didn't completely lose my hair, it still was an emotional rollercoaster. The hair washing routine was tough and I absolutely dreaded it thinking 'will this be the day I start to really get bald spots, etc'. So not the same hair journey as many cancer patients, but still a traumatic one. I hate washing my hair to this day. Caitlin: I did cold cap also, in fact, you can hear all about my experience on the podcast Breast Cancer Conversations we did together a few months ago. What advice do you have for someone going through treatment? For example, body changes, how to cope, health and nutrition/eating habits, etc. Sara: I ate pretty healthy before my diagnosis so I didn't make a whole lot of changes. Cold capping has you hydrating extra so I drank a lot of water. Made smoothies almost daily with greens. Still ate a crap ton of sugar - I needed junk food to cope. I also started taking Biotin. I had started weightlifting seriously a few months before my diagnosis and I tried to stay with it as much as possible. Some weeks I only made it to the gym once or twice but I did my best to keep up my strength and fitness. Caitlin: Listening to body about rest is my number 1 advice. Not the time to “push yourself”. I was able to fight fatigue because I as listening to my body and resting when needed. I designated down time for myself every day so that even if I felt “good” I rested to not push myself too hard. Honestly, I wasn’t the best with the health and nutrition piece. But I wasn’t the worst either. I tried to be moderate but also found a lot of comfort in comfort food. I luckily never lost flavor or had issues eating so being able to enjoy comfort food was something I often turned to. How did you fight fatigue and chemo brain? Sara: I don’t think I really fought the fatigue; just learned to accept it. I'd stay at my parents the day or 2 after chemo so I didn't have to do too much for myself those days. My mom would come by for a 'mom visit' to my apartment most weekends to help me with household stuff. I live alone so it was tough to keep up with things and take care of myself. Chemo brain is something I still deal with now; I forget things and find it hard to focus. I haven't really found anything to be helpful with this. How did you Manage with work, home, life balance while in treatment? Sara: I was lucky enough to have the capability of working remotely through treatment; that really made my life easier- in terms of demand on my time and financially. My apartment was a mess most of the time but in a clean way, if that makes sense. I'd go out with my friends when I felt up to it and I also went out on dates here and there. Caitlin: I was able to work throughout treatment, which isn’t for everyone, but it worked well for me. I enjoyed keeping some normalcy in my life. Socially I had people come visit me at home since my energy wasn’t always up for going out. What are the top 10 things you wish you knew before starting treatment/surgery (it’s ok if you don’t have 10!) Sara: 1.Wish I knew I could defer my student loans while in treatment!!!! Literally the top thing I wish I had known. 2. There are some organizations I've only found out about since being done with everything- like Ellie Fund and Joe Andruzzi fund. 3. I wish skincare and sexual health was better addressed. There are resources available for sexual health where I currently am a patient but it's kind of glazed over. 4. I am well aware that mental health plays a big part here but again, I wish this was an integrated component of cancer treatment. I guess the last 2 points were more things I'd like to see, not what I wish I knew. Honestly, I can't really think of much else! I felt pretty well informed in terms of what the plan was and we (my family and I) asked a lot of questions. A LOT OF QUESTIONS. Most of my appointments had 3 or 4 of my family members present. Very grateful for that. Caitlin: : I don’t really have a top 10 list of things that I wish I knew. I had great support. However, here is the advice I would give to someone just starting treatment: 1. Dr. Susan Love’s breast book is a great resource 2. Don’t google your diagnosis 3. It will take months, if not years post treatment, to have the energy to even start making changes towards coming back. How are you doing now? Sara: I still do most things I did before. Work, gym, go out, travel, all that stuff. But I do have a renewed sense of gratitude I think. Even on the most mundane, unexciting days. I think I definitely have PTSD from this experience, and I think this affects my daily life in a variety of ways. I think about cancer every day and have had a couple pretty real scares since finishing treatment, complete with biopsies and all. Having the genetic mutation..... I pretty much feel like there's a target on my back. I doubt this will be my one and only encounter with cancer. I'm still single and I don't really see that changing with everything that's happened; what's likely to happen again. Think my perspective on a lifelong partner has changed since I didn't have a partner through the worst time in my life. Caitlin: Since I found my lump through an at home self-exam and have made it my ongoing mission to bring awareness and education to other young women out there. I am so lucky to have found so much love, support and inspiration throughout the entire cancer community, but especially the triple negative gals!

By Ilene Kaminsky Something is missing. Where’s the deep emotional fallout that makes us wobble as we try our best to balance on that one wheel without handlebars to steer ourselves post diagnosis? There’s pain: Embarrassment Physical changes Sexual changes Loss of identity Once we accept that we are doing the work, we can silence our internal critic that believes that feeling pain means we’re “doing something wrong.” Instead, we begin to understand that feeling our pain is important and productive. When we understand the true nature of our work, we can summon compassion for ourselves as we move through our uncomfortable feelings on the path to healing, peace, and wholeness. The Healing Circle Framework has changed my life. I’ve applied it to my most acutely painful emotions as well as milder ones. I’ve applied it to one on one conversation and used parts of the framework in broader discussions, like support groups. Here’s a great example of applying part of the framework. I’m in a Monday night MBC support group that I attend about 90% of the time. There are weeks I’ve not got the stamina or the energy I need to keep up with all that happens in what usually runs about 1 hour and 45 minutes. The call, on zoom, felt frantic to me at times. “You’re not trying hard enough.” Then there are those darkest moments of sorrow, the moments when grief shakes even our sturdiest foundations. When we lose a loved one. When illness consumes us. When we experience a tragedy so emotionally excruciating that it redefines our very understanding of pain. In these moments, when we can’t find a single silver lining for miles, we can summon the courage to sit with our sorrow. We can find solace in the truth that there is simply nothing else to do. Experiencing our grief—if only for moments at a time—is work. This is the work of living on this Earth, of being human, and of surviving the universal rites of passage that mark our lives as we age. Somehow, the vast majority of people around me have weathered similarly painful times. The mere fact of their existence, when I’m certain I will shatter into nothingness, is strength enough to soldier on. Before I learned the benefit of sitting with my feelings, doing work of this nature didn’t appeal to me. Why wallow in sorrow when you could just do something about it? I wondered. When I felt uncomfortable, I would find a way to occupy my time and distract my heart. I’d burrow my nose in a screen until I was only dimly aware of the world around me; call one friend after another, repeating the same painful story, swimming concentric circles around my pain without ever diving in; grab a pen and scribble a to-do list to feel the rush of purposefulness at the expense of true catharsis. In retrospect, it’s easy to see that my “coping strategies” were no such thing. When we distract ourselves from our pain with a flurry of motion, we fool ourselves into thinking we’re being productive. We fall victim to the addictive high of the quick fix. Which begs the question: Given the undeniable difficulty of this brand of work, why do it at all? What is the reward for expending such mental and physical effort? Different folks will offer different answers. As for me, I’ve always believed that our purpose on this earth is to live our richest, most beautiful lives. Anything less seems like a terrible waste of the gift of conscious experience. I believe that in order to live such lives, we must live our essential truth . Living our essential truth means making the conscious effort to feel the spectrum of our pain, magnificent and minor. It means giving ourselves permission to feel emotions as they are, and rid our lives of the pressures to conform, perform, and self-delude. When we act in accordance with our deepest feelings, our lives become simpler. Instead of constantly choosing how to act or what to say—spurring waterfalls of anxiety and self-doubt –there is always one choice: the choice that is true for us. The choice that we feel in our hearts. The next time you are hurting, uncomfortable, or lonely, feel your pain . Feel as much of it as you can bear. Your pain is a necessary step on your journey towards healing. And remember: You are doing your best. You are healing at exactly the right pace. You are doing work. Your work has meaning. It can serve a purpose. It can serve you. I wanted to offer sanctuary to those who felt that they had an inner journey but down a very lonely road. So many of us do our best to heal alone with metastatic breast cancer or with any cancer. But our circle is very special. Not all circles hold together as well as ours. We began with a goal of three months or six “sessions.” I knew at first and for a while I’d be a host without a guardian but one would show up naturally out of the group and so one has. Yet as strong as the rim of our circle, it can collapse at any time if there’s no one with the je ne sai quois to shepherd the highly emotional sharing that takes place in such a confidential but safe container to dump our feelings into without fear. We all want to fix and help but this is not a forum as such. A support group and a healing circle depart ways here especially. SurvivingBreastCancer.org Resources & Support: Breast Cancer Poetry Our Podcast Online Support Groups Free, Weekly Events

By Carol Collins Early in October 2021, I was in the shower and felt a lump on my right breast . I thought it was odd but I was on my cycle so decided to wait it out and see if it went away. A couple of weeks went by and after making my husband feel the lump to make sure I wasn't imagining things, I decided to make an OBGYN appointment. I was 44 at the time but had not had a mammogram yet. In my mind I had no reason to worry. I have no history of breast cancer in my family so I was safe, right? I had my OB appointment on October 19th. My Dr. ordered a diagnostic mammogram after confirming there was a lump. However, she kept telling me it felt like a cyst. I walked out thinking I was still safe. My mammogram was on November 4th and the nurse was a breast cancer survivor. She was so positive and kept telling me to not overthink it. She completed my mammogram and walked down the hall to have results read. She came back in the room and said, "You need an ultrasound." The mammogram was inconclusive. I moved into another room and the ultrasound was completed. Again the nurse left the room to have results read. The next time the door opened the Dr. and both nurses walked in. At that moment it hit me... I might actually not be safe! I was told I needed a biopsy but that it still just looked like a cyst but the images were not clear enough to say either way. Even the doctor that did my biopsy kept trying to tell me it looked like a cyst. Honestly, all of the days between November 4th and December 1st were a blur. On December 2nd, I received a text message that test results were available in my MyChart app. I was sitting on my couch at home and my husband was in the shower. I opened the app and the results. The first word I saw was carcinoma. I read and reread the report. Invasive Ductal Carcinoma HER 2+ ER/PR- with so many other words I had to google. I was alone on my couch when I found out I had breast cancer! No one warned me not to open the app. I walked into the bathroom and told my husband that I had cancer while he was in the shower. That's how in shock I was. I couldn't even think well enough to wait until he was out of the shower. The Dr called me about 15 mins later and confirmed what I already knew - Mrs. Collins, you have breast cancer . I had only told my mom and husband that I had found a lump. I have 3 children (2 daughters and a son) that I now had to tell. How do you tell your child you have cancer? My children are all in their 20's so it's not easy to get them all in the same place at the same time. I didn't want to ruin the holiday season by waiting until our Christmas get together. I decided to call each of them that night. Those calls were the hardest things I have ever done in my life. I also decided in that moment that I never wanted another woman to make those calls. I knew nothing about breast cancer. I am a woman and knew nothing! How is that possible? Fast forward past an MRI to properly measure the tumor, an MRI guided biopsy for a 2nd area of concern, being told there were actually 7 "satellite" areas in my right breast, being told there was a significant number of "cysts" in my left breast, 6 rounds of TCHP , a double mastectomy on 6/17, and reconstruction surgery on 9/29. Not to mention all of the tests in between. Here I am today thriving! My hair is growing back thick, curly, and gray. I can eat and drink again and can't wait to start exercising to help with overall stamina. I have started a Facebook group in my local area for all cancer thrivers, survivors, fighters, and supporters. I found an in-person support group and am looking forward to continuing to build the membership. The current meeting leader is a breast cancer survivor, but she is older and wanting me to take over the group in 2023. I am co-hosting a local Breast Cancer Awareness Walk on October 29th. We have been out in the community garnering support from local businesses as well as inviting everyone to join us for a night of fun. I was recently nominated to attend a gala event hosted by another amazing cancer organization in Mississippi. I want to continue to build connections and push for more focus on early detection. My overall goal is to make sure anyone I know is aware of breast cancer and they know how to properly do self-checks and/or get mammograms. Like Gloria says, if we can make a difference in one person's life it is worth it. I have met so many amazing people through this journey and I am thankful that I am here to use my story to help others. Cancer has such a bad reputation. It doesn't have to be the end. It can lead to a path you never imagined full of hope and courage. I will always tell my story. Thank you for allowing me to share. Thank you for sharing your story, Carol. SBC loves you! SurvivingBreastCancer.org Resources & Support: Our Podcast Online Support Groups Free, Weekly Events