By William Laferriere one falls into the river and the breath catches not because the current is threatening (all at once), but because it wraps, it circles, it holds—water above, water below, there is only water a slow eclipse of light and sky there is a moment—spontaneous, involuntary—of clarity: submerged, the sound distorts, the pulse pounds, limbs fumble against invisible pressure, inertia settles in searching for the surface that feels impossibly far but danger isn’t the falling it is the decision not to fight, not to move, not to reach; the cold that spreads, a gentle invitation to that very stillness that cloaks itself as relief pain comes first, then numbness, then a kind of forgetting—letting the river erase the boundaries of body and will, letting the sediment settle in pockets of memory stillness grows in the silt, panic becomes resignation; the shore fades from possibility while above, the world continues its course you drown not in the initial moment, but in the moments after, in the staying, in the surrender, in the drift that becomes acceptance the surface awaits—a promise slightly muted, never denied, only neglected while the river keeps on rolling, indifferent, endless, never questioning  why you do not push upwards Share your poetry: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

Should breast cancer patients receive one of the new COVID-19 vaccines? Several of these COVID-19 Vaccines are now available on a sliding scale throughout the United States and elsewhere. Breast (and other) Cancer patients are asking, “Is it safe for me to get the vaccine”? This safety issue has proven to be quite confusing and adds to the stress level of those very patients. Other questions abound, including “Is it safe for me to get the vaccine while still in active treatment”? Background On The Vaccines At the present time, there are two vaccines being administered in the US. The Moderna and Pfizer vaccines recently received approval from the Federal Drug Administration (FDA) following extensive trials, with each involving many thousands of participants. The science behind these trials was highly scrutinized, and an independent body gave the approval necessary to allow for high-speed production, storage, and implementation. (Note: the cancer community was minimally represented in these trials). Both vaccines are believed to be 94+% effective. Apparently, the only vaccine with a greater efficacy is the measles vaccine, which comes in at the 98th percentile. It is well known that cancer and the corresponding treatments have the tendency to diminish a patient’s immune system. Does this make them more vulnerable to the COVID-19 virus or to the vaccine? And how about metastatic breast cancer patients? All great questions. "The Centers for Disease Control has a committee that determines how to equitably distribute all vaccines. Known as the Advisory Committee on Immunization Practices, or ACIP, it currently recommends COVID-19 vaccines be distributed in phases and tiers. Dr. Steve Pergam, director of infection prevention at Seattle Cancer Care Alliance, said the vaccine is going first to the groups most at risk: health care workers, people in long-term care facilities, people over 75, and front-line essential workers.” [1] Then come people with additional medical issues, such as cancer. SBC's Community Findings At a recent survivingbreastcancer.org - Thursday Night Thrivers Meet Up , we queried our community to see if they 1) planned on getting the vaccine, 2) already received the vaccine, 3) if they had the vaccination, which vaccine did they get, and 4) did they experience any side effects. We acknowledge that our survey was not scientific, but it did serve to help inform our community and provide an engaging conversation for sharing and telling. Several members, including an ICU nurse and an ER physician, had received one or the other vaccine, and only one experienced exhaustion side effects. Her fatigue and headaches lasted approximately 36 hours, but now she feels fine and, more importantly, didn’t miss work in the ICU (Thank you to all of the front-line workers!) So is the vaccine safe, and should cancer patients avail themselves of it? Scientists and doctors involved in the studies feel strongly that the vaccines are safe and that everyone should get vaccinated. At SurvivingBreastCancer.org we do advise you to research the issue and discuss with your medical team directly. They also have recommendations to receive the vaccination in-between treatment cycles, etc. We do plan to get vaccinated and will keep everyone updated on when and what the experience is like! References [1] https://www.fredhutch.org/en/news/center-news/2021/01/cancer-patients-covid19-vaccine-coronavirus.html

10-12% of Breast Cancer diagnoses are believed to be attributable to a genetic predisposition. This most assuredly leaves one to ask, “Then what is the root cause of the vast majority of breast cancer diagnoses?” Certainly environmental factors may play a significant role. But how do we know? What does the research say? Could makeup, shampoos, house cleaners, food preservatives and other chemical additives/ingredients be contributing to so many diagnoses and deaths? While we cannot say with 100% certainty that makeup causes cancer, what we can identify are the known carcinogens found within these common everyday products. Cosmetic Ingredient Regulations Under the law, cosmetic products and ingredients do not need FDA approval before going to market. The FDA has actually prohibits less than a dozen ingredients and color additives. You may find it surprising that the last law regulating cosmetics was passed in 1938! A lot has changed since then, but not the regulations. The beauty industry is a $60 billion –a-year business where the average woman uses12 products with 168 different ingredients every day (according to EWG.org) When I read this, I thought, that couldn't be true, I rarely put on makeup, how could I be using 12 products a day. Then I did the math: Body Soap Face wash Shampoo Conditioner Toothpaste Mouthwash Body lotion Face Moisturizer Hair Gel The occasional nail polish Chap stick Depending on what's going on that day, perhaps some concealer (#12), eyeliner (#13), and (mascara #14). Rush out the door with coffee and hand, and oh wait, cannot forget #15, Hand Sanitizer! The Importance of Skin Our skin is our largest organ. What we put on our face and scalp can penetrate into the deeper levels of our skin and be absorbed into our bloodstream. There is some truth in knowing that what we scrub, lather, spray and pencil onto our faces and hair can enter directly into our bodies. Let’s think about it. If we are using Cold Caps to limit the exposure of our hair follicles to toxic chemotherapy drugs, what chemicals are we messaging onto our scalp daily that are seeping into our pores? A quick point of clarification: pores and follicles are terms people used interchangeably and rightly so, your pores are actually tiny hair follicles! Think of your pores as a chimney stack, the gateway between your deeper layers of skin and the outside world. Your hair follicle is what comes to the surface, our bodies are covered with millions of these tiny follicles! Think of them as the smoke that comes out from the chimney! So what exactly are we putting on our skin? And what is "clean beauty"? In many countries, cosmetics ingredients must be assessed for safety before entering the marketplace. Those determined to be harmful are highly restricted. Unfortunately, this level of oversight does not exist in the U.S. (FDA) thus cosmetic companies are allowed to prey on the unwitting U.S consumer. I find this to be unethical and dangerous! For example, in Canada, they have regulated 600+ chemicals from their beauty products and the EU has banned 1500. Where does the U.S. stand? The US has banned under 40 products and one assumption could be the US’s favoritism towards companies and manufactures over the consumer. Tiffany from Follain mentions, “ The industry has been left to regulate itself and there hasn’t been a push or enough advocacy to more highly regulate this.” I am not saying you must immediately toss out all of your makeup products, shampoos and cleansers (Although William did just that to me, and I still haven't forgiven him!) but I would argue that we should make the transition to conscious beauty. If we want to be healthy and we are adding more fruits and vegetables to our diet, reducing and eliminating smoking and levels of alcohol and exercising regularly, then let’s also start to make the shift in terms of how we are taking care of our outer layers! Toxic Cosmetic Ingredients to Avoid Many toxic ingredients are permitted in the US as cosmetic ingredients. Look out for the following ingredients when searching for cosmetics and self-care products: Parabens & Long Chain Parabens like propyl paraben and butyl paraben Phthalates Ethylene oxide ( Formaldehyde) Diazolidinyl Urea DMDM Hydantoin Imidazolidinyl urea Quaternium-15 Tosylamide/Formaldehyde Resin Sodium hydroxymethylglycinate 2-bromo-2-nitropropane-1,3-diol (bronopol) Polyoxymethylene Urea 5-Bromo-5-Nitro-1,3 Dioxane Methenamine Glyoxal Benzylhemiformal Aluminum compounds Fragrance Phenoxyethanol PEG Compounds Sodium Lauryl Sulfate & Sodium Laureth Sulfate (SLS & SLES) Check out our Podcast where we speak with three beauty conscious women about how we can start making the switch to with simple and actionable choices! You may also be interested in other articles we wrote about on this topic! Going Green with your Clean Routine 5 Toxic Ingredients to Void

Precision medicine, according to the National Research Council, focuses “on identifying which approaches will be effective for which patients based on genetic, environmental, and lifestyle factors.” Once doctors have this important information regarding your tumor and genetics, they can make informed recommendations related to your diagnosis and treatment plan. A breast cancer diagnosis unites us, and it provides a common thread as we share stories about treatments, surgeries, and coping mechanisms. Within breast cancer circles, however, we quickly jump to questions about one’s HER2 status, hormone receptor status, or whether or not we opted for genetic testing. We have the ability to rattle off pharmaceutical and generic name drugs, which aromatase inhibitor we are on, and the bond we innately forge when we meet someone else who is also Triple Negative, or BRCA Positive. (Watch the Webinar) We have these conversations with our breast cancer besties, and we start to identify our “breast cancer twin”. That is to say, someone else diagnosed around the same age, with the same stage and type of breast cancer. However, if we have found our breast cancer twin, then why do we have different side effects? Why would my cancer twin have a complete response to neo-adjuvant chemotherapy (receiving chemotherapy prior to surgery), whereas I did not? Why did my cancer come back (recurrence) 4 years later, and hers did not? How Precision Medicine Provides Answers Precision medicine enables us to answer some of these tough questions and to identify specific treatment options based on our tumor characteristics. For example, if you have tested positive for the HER2 gene, oncologists recognize that this particular gene causes the cancer to grow and spread faster than if you tested negative for HER2. If you do have HER2+ breast cancer, the good news is that there are targeted therapies, such as Herceptin, that work to slow or even stop the growth of the cancer cells by blocking any signals trying to get to the HER2 protein. Because of precision medicine, researchers have been able to develop targeted therapies to benefit those diagnosed with HER2+ breast cancer. Precision medicine can improve disease detection and preempt disease progression. It also places emphasis on prevention rather than just serving as a reaction to a particular disease. Concisely, precision medicine is an attractive option as it can help us to better understand cancer, Alzheimer’s, diabetes, and many other illnesses that plague us. DNA is the Key to Advancement Technological advances have enabled researchers and scientists to decode DNA at lightning speed. If we can decode our genes, understand what secrets they hold, and harness that information to target, treat, and prevent disease, we are literally holding the golden ticket. In 2015, under then-President Barack Obama, the National Institute of Health (NIH) launched a national, patient-powered research initiative seeking one million or more Americans to volunteer as participants in research. In order to understand the human genome and the onset of disease, scientists and researchers will need a substantial and very diverse sample size. This is a heroic opportunity for people to get involved in the advancement of medicine. However, it is easier said than done. There is currently a lack of trust in Science and Medicine. Smirnoff, Willets, and their team (2018) identified a framework for understanding specific areas of research trust/mistrust amongst disparate study populations. In their published paper, A paradigm for understanding trust and mistrust in Medical Research: The Community VOICES Study , the scholars laid out four pillars that offer a conceptual framework in order to strengthen truths and increase broader participation in clinical research. The areas are: General Trustworthiness (Older age, not disabled) Perceptions of Discrimination (African American, Latino, Spanish Language Preference) Perceptions of Deception (prior research experience, African American) Perceptions of Exploitation (less education) Despite federal mandates to ensure the inclusion of women and minorities in federally funded research, there continues to be additional barriers to participation, including “logistical problems, low levels of health literacy, and sociocultural factors” (Scharff, Mathews, Jackson, Hoffsuemmer, Martin & Edwards, 2010). Issues with Past Studies If we take a look at the Tuskegee Study , why wouldn’t one be skeptical? The Tuskegee Study was a 40-year experiment run by Public Health Service Offices who followed 600 rural black men in Alabama with syphilis over the course of their lives, refusing to tell them of their diagnosis, refusing to treat them, and denying them treatment. The U.S. has a long-rooted history ingrained in our system and structures, but we need to overcome this. We can do better. As a result of the horrific experiment of the Tuskegee Study, policies and legislation were formed to protect human subjects. For example, researchers need to obtain voluntary informed consent and have their research reviewed and approved by institutional review boards to ensure that ethical standards are met. To begin, we need to recognize that precision medicine does have its perils. While we’ve been focusing on the advantages, such as unlocking the information hidden within our DNA, we as a society need to do better to ensure we are including all of the players and inviting them to the table. There are ethical considerations that must be explored before we hand over our genetic information for research. For example, what are the legal ramifications of sharing your DNA? Who owns the data? Can an employer or life insurance company discriminate against you based on your genetic information? How can we get it right? We have an opportunity to rebuild trust, to improve clinical trial participation, and to support research; this initiative is bigger than any individual, it is the sum of one million data points to ensure that our sons, daughters, and their children have access to the best medicine and preventative care in years to come. References: Smirnoff, M., Wilets, I., Ragin, D. F., Adams, R., Holohan, J., Rhodes, R., Winkel, G., Ricci, E. M., Clesca, C., & Richardson, L. D. (2018). A paradigm for understanding trust and mistrust in medical research: The Community VOICES study. AJOB empirical bioethics , 9 (1), 39–47. https://doi.org/10.1080/23294515.2018.1432718 Scharff, D. P., Mathews, K. J., Jackson, P., Hoffsuemmer, J., Martin, E., & Edwards, D. (2010). More than Tuskegee: understanding mistrust about research participation. Journal of health care for the poor and underserved , 21 (3), 879–897. https://doi.org/10.1353/hpu.0.0323

Clinical trials are research studies involving people that help inform medical practice, answer specific questions regarding biomedical remediation, and test the efficacy of specific treatments and drugs. The US breast cancer drug market alone is projected to become a $20 billion industry by 2026, with 350 drugs currently in the pipeline, according to the latest report from Research and Markets[1]. With so many new drugs being studied, there is great expectation to be able to extend a patient’s life and potentially find a cure for breast cancer. With so many breast cancer drugs in the queue, would you be willing to participate in an upcoming clinical trial? Before we address that very personal question, let’s take a step back to understand what a clinical trial actually is. What is a Clinical Trial As mentioned above, clinical trials are research studies that involve people and help to inform medical practice. Clinical trials are divided into four phases, which build upon each other and each answer a specific research question in order to identify ways to prevent, screen, or treat a disease. Some clinical trials are also comparative and evaluate the benefits and efficacy of current treatments compared to new potential therapies. Phase I studies usually test new drugs for the first time in a group of 10 or fewer to evaluate a safe dosage range, how to administer the drug (i.e., oral, intravenous, etc.), and identify side effects. Phase II studies continue to evaluate the safety and expand a larger group of human subjects to monitor side effects. During this phase, the drug is rarely compared to treatments that are considered to be the standard of care. The goal of this phase is to monitor the participants to see if the drug works. If so, it will progress to phase III. Phase III studies are conducted on larger populations, typically involving 100 or more people and in different regions and countries. They are often the necessary phase needed before the drug is approved. Phase IV studies take place after country approval and there is a need for further testing in a wide population over a longer timeframe. Participating in a Clinical Trial While the goal of clinical trials is to reflect a diverse population, data show that Black/African Americans make up 5% of trial participants, with Hispanic/Latinos representing less than 1%[2]. This lack of representation in clinical trials results in drugs being approved and widely administered, which may not be as efficacious among different populations. These clinical trials are carefully designed, reviewed, and completed, and need to be approved before they can start. It is important to know that participating in a clinical trial is voluntary and 100% at one’s own will. What are the Benefits of Participating in a Clinical Trial Though they are experimental by nature, clinical trials can offer several benefits to participants, including: The opportunity to play an active role in your own healthcare Access to an expert team that can give you a deeper understanding of your condition Access to new research or investigational medications before they are widely available Additional care/tests specific to the trial The knowledge that you’re helping others Your quality of health and life may improve Learn More This is just scratching the surface of clinical trials. Join us for a livestream webinar where we speak with the experts and those diagnosed with breast cancer to learn more and hear about their experiences participating in trials. References [1] https://www.globenewswire.com/news-release/2021/01/21/2162347/0/en/US-Breast-Cancer-Drug-Market-Report-2021-2026-Drug-Price-Dosage-Clinical-Trials-Insights-20-Billion-Opportunity.html [2] https://acrpnet.org/2020/08/10/representation-in-clinical-trials-a-review-on-reaching-underrepresented-populations-in-research/

Breasts are made up of Fibrous Tissue, Glandular Tissue, and Fatty Tissue . During a mammography screening, a radiologist will be able to determine if your tissue is mostly made up of: Fat (about 10% in women) Scattered dense tissue throughout the breast (about 40% in women) Evenly dense tissue throughout the breast (about 40% in women) Extremely dense tissue, which makes up the remaining 10%. A first important note: Fully 40% of women age 40 and over have dense breasts, and cancer is 4-6 times more likely in women with extremely dense breasts than in women with fatty breasts. A second important note: It is a misconception to assume you have dense tissue because your breasts are firm. However, you cannot gauge breast density by look and feel. Breast density can only be seen/detected via mammograms. Why Breast Density Matters Knowing your breast density matters because the fibrous tissue in your breast appears white on a mammogram screening. Similarly, breast cancer appears white on a mammogram! While mammograms may find some cancers not seen on other screening tests, in cases involving dense breast tissue, mammograms will miss more than 50% of the cancers present. Thus, the short and sweet version: If you are looking for a white spot on a white sheet of paper, chances are you will never find the spot, no matter how good your vision is! In 2019, Congress passed a National Breast Density Notification Law. (Prior to that, 38 states and the District of Columbia separately legislated some form of notification). This new law established national minimum standards to include fibroglandular breast density information on mammography reports. If you are informed that you have dense breast tissue, you should discuss with your provider to ascertain whether additional screening is recommended. Recently, in a webinar we hosted on breast density with Leslie Ferris Yerger from My Density Matters , we discussed the need to encourage these types of conversations between patients and their physicians. It may be recommended that you have an ultrasound, an MRI, or even consider additional screening modalities such as Molecular Breast Imaging or a 3D mammogram. At survivingbreastcancer.org , we are always in favor of self-empowerment and self-advocacy. In case you missed our webinar, you can view it here .

Physician (and Nurse) Burnout has been officially recognized for years and poses a significant existential threat to the safety of medical personnel and the treatment success of patients across the spectrum. Death by suicide in the medical profession has now reached approximately 400 annually just in the United States[1]. According to the Medscape Physician Lifestyle Report, nearly “half of all physicians experience burnout, with emergency care, critical care, and family medicine experiencing the highest rates”.[2] Burnout During COVID-19 The onset of COVID-19 has certainly exacerbated this phenomenon. However, burnout was quite real, with 79% of physicians reporting burnout prior to the pandemic.[3] There are many contributing factors, such as excessive paperwork and computer time associated with the practice, but there are many other drivers and influencing facets. The latter includes perfectionism re: personality traits, excessive expectations, and fears, including failure, loss of control, and exposure. These last issues are associated with internal forces, but there are many external pressures as well. In no particular order would be the long hours, demands of seeing more patients in a shorter amount of time, network frustrations, too many bureaucratic tasks, difficult/unrealistic patients, and work-life balance. There can be severe consequences associated with physician burnout: physical decline, relationship issues, addiction, anxiety, depression, and the above-referenced suicide. In addition, patient quality of care may be adversely affected, including medical errors, prescription issuance, and overall patient satisfaction. The danger signs of physician burnout include negativity, exhaustion, illness, and the development of poor habits. Physician Burnout Intervention There are a number of ways for medical personnel to combat burnout, and they are similar to caregiver relief. For example, taking care of yourself being foremost, consider the final safety advice an airline stewardess gives regarding the use and implementation of the O2 masks if necessary: “Be sure to place yours on first, then place one on your child, loved one or neighbor that needs assistance.” Proper nutrition and exercise also play a significant role in stemming the tide of burnout. Lastly, make time for yourself (here I recall a close friend calling me out in my role of cancer caregiver, to make sure that I was finding the time to walk, rest, & exercise by myself. She always maintained that I was more valuable as a caregiver when I could find the time to unwind. According to the Agency for Healthcare Research and Quality (AHRQ), Dr. Mark Linzer developed a mini survey to allow physicians to check in on their stress and burnout levels. From his research, Dr. Linzer identified three interventions that could help to alleviate physician burnout: Scheduling monthly provider meetings focused on work-life issues or clinical topics after surveying staff members on which topics to address. Enhancing team functioning through diabetes and depression screening quality improvement projects to engage office staff, enhance teamwork, and reduce the pressure on physicians to be responsible for all aspects of care. Having medical assistants enter patient data into electronic health records, track forms, and send faxes to give doctors more face-to-face time with patients.[4] The final advice we recommend for defeating burnout is to laugh. Find yourself a comedy on Netflix, take your shoes off, sit back, and smile. Laughing may just be the greatest antidote to burnout. So for your next appointment, when your doctors are asking if you have fallen recently, or if there are any changes to your medication list, be sure to take a moment to ask your doctor how they are doing, when was the last time they laughed so hard their belly hurt, and what they are grateful for today. We are partners and in this together. References [1] Andrew, L.A., (2018), Physician Suicide, Medscape , https://emedicine.medscape.com/article/806779-overview [2] Martin, K. L., (2020). Physician Lifestyle & Happiness Report 2020: The Generational Divide, Medscape https://www.medscape.com/slideshow/2020-lifestyle-happiness-6012424#1 [3] Kane, L., (2021). Death by 1000 Cuts': Medscape National Physician Burnout & Suicide Report 2021, Medscape. https://www.medscape.com/slideshow/2021-lifestyle-burnout-6013456#4 [4] Physician Burnout, (2017). https://www.ahrq.gov/prevention/clinician/ahrq-works/burnout/index.html

Dating. It can be fun. It can be confusing and frustrating. It can be stressful. Navigating the dating world with breast cancer takes it to another level. Dealing with breast cancer is daunting enough without the added stress of dating. To endure chemotherapy and radiation, losing their hair, eyebrows, eyelashes, or, for some women, a double mastectomy, and then trying to maneuver the dating world is not for the weak. Just the thought of dating when you’re going through breast cancer or after can be scary. It can leave you feeling insecure and uninterested. Understandably, lots of questions and concerns might occupy your mind. For example, when is the right time to mention it to a date? Would people see me as weak? Will I ever feel confident again? How you handle dating with breast cancer depends on each individual. We’re all different, so it makes sense that our responses may be different. Here are a few things to consider about dating with breast cancer: Dealing with Your Emotions Being diagnosed with breast cancer can and does bring about a tsunami of emotions. If you want to start dating but feel paralyzed, it may be that the thought of dating may reawaken or increase emotional responses you had at diagnosis or treatment. You may experience anxiety or depression, which can cause you to focus on or magnify negative thoughts about your prospects for dating now or in the future. Your reluctance could also be due to low energy, fatigue, or fear of rejection. It might be especially difficult to jump into the dating world if you isolated yourself during treatment. But there are a few things you can try to combat these feelings: Take small steps, and stay focused on today. The fear of rejection may be complicated due to your breast cancer, but it’s a common emotion for anyone dating. Look for opportunities to meet people in low-pressure social settings, such as at a friend’s party or a community event. Join a group focused on activities that you enjoy, where you may find people with similar interests. Improve your energy, lessen fatigue, and treat anxiety/depression by taking regular exercise. Talk with an oncology social worker, psychologist, or counselor for help with your emotions. Putting Yourself Out There Let close friends and acquaintances know that you want to start dating and ask if they know anyone they think would be a good prospect. Pursue activities and volunteer opportunities where you might find people with similar interests. Consider using an online dating site. Sites such as CancerMatch connect people with health conditions, making your entry into the dating world a bit easier. Talking About Breast Cancer with Dates A big worry for many women is how a date will react to hearing about their experience with breast cancer and seeing any physical changes caused by treatment. Timing is everything. Each situation will differ, depending on who you’re dating and how you feel. Some women think it’s best to rip the proverbial band-aid off right away; others prefer to get comfortable with a person before spilling the beans. It’s up to you. There’s no rush to tell everything about your life right away, including your diagnosis! Sharing very personal information when you’re new to each other might make you both uncomfortable. There’s no “right time,” but many women wait until they’ve had a few dates to see how they feel about the other person. However, if you’ve chronicled your experience online, for example, on Facebook or Twitter, realize that your date may have looked you up and read about it. In that case, you probably don’t want them to feel as though you’re withholding information. Trust your judgment about when it feels right to you. Try to have the conversation before you’re about to become sexually intimate. Choose a neutral place and a relaxed time to talk, where you both feel at ease. Say as much or as little as you want. There’s no “right answer,” just the right answer for you. Some women create one sentence to explain their diagnosis. Practice what you want to say in front of a mirror or with a friend. Recognize that your date may have questions about your experience or your treatment. Body Image & Confidence Breast cancer therapies and procedures can affect your body and your feelings about it. Surgery , reconstruction, lymphedema , hair loss , skin changes, weight gain, and infertility can alter your self-image and enthusiasm for dating. Here are some tips that may help you recapture positive feelings about your body: Take care of yourself with comforts such as skin lotions, a new hairstyle, or head covering, or makeup. Talk with your healthcare provider about ways to help with physical effects and learn what physical changes are temporary and which are permanent. Get to know how your body looks and feels now When your thoughts become critical of your body, remind yourself of your strength and your resilience. Indulge in positive thinking . Reconnect with your body through exercise . Although breast cancer will most likely always be a part of you, it should not define you. You are much more than a cancer patient, and anyone you choose to be intimate with should accept you for you. The reality is that scars, stretch marks, birthmarks, and other unique features help define us and make each of us imperfectly perfect. By being open, you’re conveying your confidence not just to your potential partner, but also to yourself. You got this!

By JoAnna Brown of Near. Near offers end-of-life navigation and grief support for patients, families, and caregivers. End of life is something nobody wants to talk about, because let’s be honest, no one wants to experience it. Whether you’re the patient or the caregiver, the end-of-life transition can be chaotic and complicated, filled with big and constantly changing emotions. In addition to the fear, uncertainty, exhaustion, and grief, there’s also a mountain of logistics to work through, from advance care planning to after-death preparation. All the medical, legal, and financial tasks can feel intimidating and overwhelming. The mental and emotional toll is highest, just as personal bandwidth is low. This is where seeking the services of an end-of-life navigator can make all the difference. These experienced, compassionate guides help replace overwhelm with clarity and confusion with comfort. Navigators come alongside patients, families, and caregivers as they figure out all the planning, logistics, and next steps of the dying process. Whether you choose to work with a Navigator or a trusted friend or family member, here are some things to think about as you create and carry out your end-of-life plans. Cast a Vision There are important conversations that need to take place at the end of life. These discussions give the person dying an opportunity to honestly and directly communicate their vision and desires for their final days and beyond. As hard and painful as they may be, vision conversations can help you and your loved ones approach death with love and meaning instead of fear and anxiety. Make a Clear Advance Care Plan Advance care planning involves making decisions about the care you want to receive in the event of a medical crisis. Each individual should make these decisions based on their own personal values, preferences, and candid discussions with loved ones. Make a Clear After-Death Care Plan When it comes to planning out what will happen after death, it’s important to once again ensure that the individual’s wishes align with their goals and values, and that they are communicated clearly to all parties involved. This gives loved ones the gift of a clear plan in the midst of their grief, and simplifies the overwhelming logistical and legal tasks that come along with the end of life. Leave a Lasting Legacy What do you want to leave behind for future generations? If you can, put some time and intention into creating an expression of love, remembrance, or inspiration for the people you love for years to come. Some examples include milestone notes, letters to children or loved ones, life interviews, audio or video recordings, photo projects, slideshows, cookbooks, letters to the future, or a work of art. Legacies convey what we want remaining and future generations to know and understand about our life experiences. Don’t Neglect the Details In addition to grief, most family members and caretakers are left to figure out passwords, hunt down insurance policies, and search for important paperwork when their loved one passes. Once again, you can give your loved ones an amazing gift by creating a Life Details Folder, compiling important information in one place, removing all the guesswork, and reducing overwhelm and stress. Reach Out For Grief Support Before and After Loss Facing loss at each stage gives patients and caregivers a chance to heal and find meaning. Grief and loss play a role in our experience long before someone we love dies, and by addressing loss along the way (loss of identity due to illness, a job, relationship roles, health, mobility, assumptions about the future, etc.), we can heal, experience deeper relationships, and ultimately have a more meaningful life. About Near Near provides personalized, one-on-one end-of-life navigation for patients and caregivers. After a free meeting with a member of their Care Team, you can select a customized plan to make your end-of-life experience less stressful and more meaningful so you can live your life well, even as it’s ending. Near’s Care Plans include one-on-one support that includes everything from advance directives, health care POA/proxy, vigil planning, and weekly check-in meetings with your Navigator. They help you with all the details, offering extra support and guidance, so you can focus on what matters most. To learn more about End of Life Navigation services, visit StayNear.co & be sure to follow them at @staynearco on FB, IG, and Twitter

We’ve Come So Far, But Still Have Far To Go! By Dr. Paula Gordon The breast density movement in the US started in 2004 with Dr. Nancy Capello. As of early 2021, 37 states and the District of Columbia have legislation requiring women to receive some information about breast density. And soon, ALL women in the USA will be informed. Kathy Kaufield of Saint John found her breast cancer by chance. While on a business trip in 2015, she didn’t have the shower puff she regularly used in the shower at home. When her soapy hand grazed the underside of her left breast, she felt a lump. She thought it couldn’t be cancer. After all, she just had a negative mammogram five months earlier. Kathy didn’t know she had dense breasts, and she didn’t know the implications of dense breasts. She wasn’t aware that she shouldn’t trust her mammogram as much as she had. Unfortunately, like many women, she didn’t know she should have been more vigilant with her monthly breast self-exams. Following surgery, 16 rounds of chemotherapy, and six weeks of radiation, Kathy became an advocate for breast density notification. She joined other patient advocates, including Dense Breasts Canada, and since its beginnings in 2016, women in Kathy’s province of New Brunswick and 5 other provinces in Canada are now notified of their breast density in their screening mammogram results letter. What is Breast Density? Every woman’s breasts are composed of fat and breast tissue, but the proportions vary. There are four categories of breast density. Categories C and D are considered “dense.” Dense breasts are normal. Over 40 per cent of women aged 40+ have dense breasts. Approximately 40 per cent of women have heterogeneously dense breasts (Category C) while 10 per cent have extremely dense breasts (Category D). Breast density is determined only on a mammogram. It cannot be determined through physical examination. Most commonly, breast density is determined by a radiologist when they look at the mammogram. Software that can determine density is being incorporated into mammography equipment, but it is not yet widely used in Canada. Why Does Breast Density Matter? Dense breasts reduce the accuracy of a mammogram. A missed diagnosis like Kathy’s is more likely with dense breasts because dense breast tissue and cancer both appear white on mammograms, so cancer can be masked. Mammograms are 92-100 per cent effective in fatty breasts but only 50 per cent effective in the highest density. Dense breasts are an independent risk factor for breast cancer. The denser the breasts, the higher the risk. Cancer occurs four to six times more often in women with the highest level of density than in women with the lowest level. Breast density is a more prevalent risk factor than family history. Dense breasts result in higher rates of interval cancers. As seen in Kathy’s case, women with dense breasts may find a lump after a negative mammogram. These are called “Interval cancers” and are 18 times more common in women with dense breasts. Interval cancers are larger at diagnosis and more often node-positive and more aggressive subtypes. They are more likely to need more aggressive treatment and are more likely to require mastectomy, axillary dissection, and chemotherapy. They have a poorer prognosis compared to screen-detected cancers. What Should Physicians Discuss with Women Who Have Dense Breasts Any other risk factors the patient may have, breast density should be placed in context with other risk factors and risk reduction strategies The importance of having regular mammograms and the consideration of annual mammograms for Categories C and D The importance of regular self-exams Modification (improving) of lifestyle behaviors: maintaining a healthy weight, increasing exercise, decreasing alcohol intake, and avoiding/decreasing hormone use. Evidence of Benefits of Supplemental Screening for Women with Dense Breasts Mammography is the only screening test proven to reduce deaths due to breast cancer because it is the only modality studied in an RCT. The key to mortality reduction by screening is finding cancers smaller, and before they have spread to the lymph nodes, and reducing the incidence of advanced cancers. It has been known since 1995 that ultrasound can find cancers in dense breasts that were missed on mammograms. Subsequent research from multiple institutions confirms that ultrasound can find 3-4 cancers per 1,000 women screened. An RCT of supplementary ultrasound screening is underway in Japan and is showing greater cancer detection and reduced interval cancers. The Canadian Association of Radiologists’ position paper states, “supplemental screening breast ultrasound may be considered for patients with dense breast tissue (C & D density categories),” and annual mammography is suggested for all women with extremely dense breast tissue (Category D). False alarms occur with screening ultrasound, just as with mammograms and pap smears. These, understandably cause anxiety. Most women are willing to accept the transient stress associated with a recall or even a needle biopsy in exchange for avoiding an advanced cancer diagnosis. Physicians have a key role to play by considering breast density in context of other risk factors, assessing a woman’s overall risk, identifying higher-than-average risk patients who need increased surveillance (i.e. Ultrasound and MRI), discussing supplemental screening benefits and harms, and encouraging women to do regular breast self-examination and reduce their modifiable risk factors. An excellent reference of medically sourced information is www.densebreast-info.org . So what’s next: There are another 4 provinces and 3 territories yet to give breast density information directly to women. Supplemental screening should be covered by public health insurance, just like mammography. All women in Canada should be able to access screening mammography starting at age 40. Currently, only 3 provinces’ mammography screening programs allow women to self-refer starting at 40. We Have Our Work Cut Out For Us! Dr. Paula Gordon is a clinical professor in the Department of Radiology at the University of British Columbia. She is a volunteer advisor to both Dense Breasts Canada, a Canadian patient advocacy group, and Dense Breast Info, an American educational website. In recognition of her research and teaching, she has been awarded the Order of British Columbia. Jennie Dale is a breast cancer survivor, and co-founder of Dense Breasts Canada.

There have been, and continue to be, numerous studies that attempt to link the consumption of sugar to breast and other cancer(s). These myriad studies have investigated whether sugar ingestion contributes to breast cancer or further stimulates its growth. So, the question of whether or not sugar contributes to or feeds breast cancer cells remains unresolved at this time. Watch Now Sugar's Role in the Body Physiologically speaking, our cells need energy to develop and survive. Similarly, so do cancer cells, which typically grow fast and therefore require even more energy to do so. But, where does all this energy come from? Our bodies’ energy comes from several sources, including glucose, which is found in sugary foods in our diet, but especially from foods containing carbohydrates that are converted into glucose. Glucose is a simple sugar or monosaccharide, is a component found in many carbohydrates, and remains our body’s favorite energy source. Note: Scientifically speaking, sugars are categorized as monosaccharides or disaccharides. Disaccharides are made up of two linked monosaccharides (simple sugars), which are then broken back down into the latter during digestion. Types of Sugar and Where They Come From Is glucose good or bad for you? What about fructose, sucrose, dextrose, etc.? Fructose is known as the fruit sugar, and like glucose, is a simple sugar. Fructose is naturally found in fruit and most root vegetables. However, fructose is commonly added to processed foods in the form of high-fructose corn syrup, which is derived from sugar cane, sugar beets, and corn. Sucrose (more commonly known as table sugar) is a disaccharide consisting of glucose and fructose. It’s a naturally occurring carbohydrate found in many fruits, vegetables, and grains, but it’s also added to many processed foods, such as candy, ice cream, breakfast cereals, canned foods, soda, etc. Sucrose found in processed foods is commonly derived from sugar cane or sugar beets. Glucose, fructose, and sucrose are found naturally in many foods but are also added to processed foods. However, they are digested and absorbed differently (i.e., our bodies digest and absorb monosaccharides and disaccharides differently). As mentioned, monosaccharides are already in their simplest form; therefore, they don’t need to be broken down before our bodies can use them. They’re absorbed directly into our bloodstream, primarily through the small intestine. On the other hand, disaccharides like sucrose must be broken down into simple sugars before they can be absorbed. Does Sugar Increase Breast Cancer Risk? According to a recent study by The University of Texas MD Anderson Cancer Center, Rolaynne Kimmons posits, “High amounts of dietary sugar in the typical Western diet may increase the risk of breast cancer and metastasis to the lungs.” Another study looked at the “intersection of obesity, cardiovascular disease, and breast cancer,” while Megan Rosessler from the Mayo Clinic suggests that "sugar seems to be a major source of anxiety and fear for people with cancer. There is a myth circulating that sugar feeds cancer and that avoiding sugar will prevent the growth of cancer. To set things straight, sugar does not cause cancer on its own. Giving sugar to cancer cells does not make them grow faster, and depriving cancer cells of sugar does not make them grow more slowly. However, sugar may be indirectly involved in the development of cancer.” These and other studies make it seem possible that if you had no sugar in your diet, it could help stop cancer from developing or growing. But all our other cells also need glucose to survive, and there’s no way of letting just the healthy cells get the amount of glucose they need while starving the cancer cells. What You Can Do to Decrease Your Risk Perhaps the most important prescription for cancer patients is to limit the amount of sugar in their diet, read ingredient labels, enjoy simple, unprocessed foods, and follow the advice of your nutritionist/oncology team to focus on getting the nutrients they need to stay strong during and after treatment. In short, eat the healthy sugars found in fruits and veggies while shying away from the cookies, cakes, and processed cereals. While the possible link between sugar and cancer is often discussed, the research so far has not shown evidence of a direct link, but that research continues.

By Cara Scinto Calling a breast cancer diagnosis overwhelming is an understatement. From the moment you hear the words, "you have cancer," the mind goes into overdrive. From the whirlwind appointments, the need to make critical decisions, and jumping into surgery and various therapies, it's no wonder our minds become distracted. But aside from the discombobulation a cancer diagnosis throws at us, is it possible that our treatments are impairing our cogitative function? What is Chemo Brain? What exactly is “Chemo brain?” We’ve all heard the term. Perhaps we’ve also, on occasion, experienced the fog associated with cancer treatment. According to the Mayo Clinic, “Chemo brain is a common term used by cancer survivors to describe thinking and memory problems that can occur during and after cancer treatment”. It is also referred to as chemo fog, (cancer-related) cognitive impairment, or cognitive dysfunction. Examples include decreases in short-term memory, difficulty finding words, concentrating, and multitasking. The causes of concentration and memory problems aren't well-understood. According to Fremonta Meyer, MD , a clinical psychiatrist in Dana-Farber's Department of Psychosocial Oncology and Palliative Care , suggests that "Cyclophosphamide, Adriamycin , 5-FU, and Taxol seem to be noteworthy culprits of chemo brain, but there are others that can cause the condition. Dose dense chemotherapy may be associated with more chemo-brain symptoms, but chemotherapy can cause symptoms regardless of whether that specific drug crosses the blood-brain barrier." Chemo Brain Symptoms No matter the cause, chemo brain can be a frustrating and debilitating side effect of cancer and its treatment. There are teams of researchers working to understand the memory changes that cancer patients endure during and post-treatment. The Mayo Clinic associates the following symptoms with Chemo brain: Being unusually disorganized Confusion Difficulty concentrating Difficulty finding the right word Difficulty learning new skills Difficulty multitasking Feeling of mental fogginess Short attention span Short-term memory problems Taking longer than usual to complete routine tasks Trouble with verbal memory, such as remembering a conversation Trouble with visual memory, such as recalling an image or a list of words How to Combat Chemo Brain Symptoms With this in mind we turned to survivingbreastcancer.org friend Cara Scinto. Cara is a Certified Dementia Practitioner, Personal Trainer, with an MS in Nutrition and an agile, sensible website: TheBalancedBod.com . Cara writes: “As if having cancer isn’t hard enough, the side effects of treatment can seem even worse to deal with. Chemo brain — a type of dementia — can interfere with memory and judgement; not something helpful to a patient facing doctors' appointments, taking medications, and all of the other things life throws your way. The good news is that it does not have to last forever. There are techniques you can use to cope with this frustrating side effect of chemotherapy: Make lists. If you are tech savvy, use a note on your phone. You have the option to make it shareable with a family member or your physician. Keep your mind active. Word puzzles, test yourself while you watch jeopardy, memorize a short children’s book, or attend an online class that interests you. Meditate daily. You can use an app like insight timer or reach out to me for a curated YouTube playlist - just for you. Having a mindfulness practice can help minimize distractions and drop into your calming breath when you need it most. Tell a loved one what you’re going through. Tell your family, so that they’ll understand if you forget things you normally wouldn’t forget. They may be able to help and encourage you. Speak with an oncology social worker. If living with symptoms of Chemo brain makes you anxious or sad, seek help. Being a part of a support group and making use of resources such as survivingbreastcancer.org can be a comforting reminder that you are not alone.” Do you experience chemo-brain? What tips and strategies do you recommend? Send us an email and let us know! (info@survivingbreastcancer.org)

By Brady Scheiner Informed consent in medical practice, not to be confused with informed consent in sexual activity, is the process by which patients are educated about the possible risks of and alternatives to a healthcare intervention before consenting to receive that intervention. In the United States, this is done to satisfy the legal (and moral) obligations of the physician to ensure a patient understands the consequences of a procedure or intervention. Although informed consent is generally required to be received from the patient themselves, there are scenarios in which this would not be the case. More specifically, informed consent will not be required from the patient if the patient is unable to give it; a patient would be unable to give informed consent if they are a minor (in which case their legal guardians would), if they are severely mentally handicapped (in which case their healthcare power of attorney would), or if they are unconscious. In the case that they are unconscious and will die without prompt treatment, the need for informed consent is waived entirely, unless otherwise stated in their medical file. Debates Surrounding Informed Consent of Care There is a great deal of controversy surrounding informed consent. For example, if a doctor were to be performing an unrelated surgery on a patient who he then found to have cancerous tissue, should he be allowed, by law, to do what he feels is necessary to remove it immediately? If you think he should, then would your answer change knowing that this may even include womb or testicle removal, preventing the patient from reproducing without ever giving them options in the matter? Some of you may believe that physicians know best, so it should be done right away, no matter what, but others of you may believe that physicians should always provide wholly encapsulating information on every single medical proposal, no matter how big or small. Now, let’s say the doctor did remove the tissue; If determining this case purely based on the doctrine of informed consent, then the doctor acted negligently because he did not inform the patient about the risks of or alternatives to the cancer’s surgical removal, but it’s not always this clear. Differing Interpretations of Consent of Care There is even more discourse surrounding the “standard of care” that should be followed when informed consent is given. The standard is always intended for the benefit of the patient; however, states generally have two varying approaches to this. The first is the “patient standard”, which holds that the legal standard for determining informed consent cases is what a “reasonable patient…would expect to be told prior to making a decision about treatment” (Studdert 104). In contrast, the “professional standard” holds that the legal standard is “testimony by medical experts about which risks and alternatives physicians customarily convey” in analogous situations (Studdert 105). The conflict between these two approaches is reflected in the state laws surrounding which standard must be followed. In 25 states and the District of Columbia, the patient standard is codified in law, whereas the professional standard is practiced in 23 states (Studdert 105). The leftover two states follow a hybrid of the two approaches (Studdert 105). To find out the specific standard for informed consent laws in your state, check out the figure below from “Geographic Variation in Informed Consent Law: Two Standards for Disclosure of Treatment Risks” and look for your state! Citations “Informed Consent.” AMA Principles of Medical Ethics, American Medical Association, www.ama-assn.org/delivering-care/ethics/informed-consent . Shah, Parth. “Informed Consent.” StatPearls [Internet]., U.S. National Library of Medicine, 22 Aug. 2020, www.ncbi.nlm.nih.gov/books/NBK430827/#:~:text=The%20patient%2 0must%20be%20competent,what%20happens%20to%20their%20bo dy . Studdert, David M., et al. “Geographic Variation in Informed Consent Law: Two Standards for Disclosure of Treatment Risks.” Journal of Empirical Legal Studies, vol. 4, no. 1, 2007, pp. 103–124., doi:10.1111/j.1740-1461.2007.00083.x .

By Brady Scheiner Do-not-resuscitate orders, also known as DNR orders, are typically intended to legally indicate that someone does not want to receive cardiopulmonary resuscitation (CPR) in the case of cardiac arrest. Sometimes, they are used to prevent other life-saving interventions, but this is not as common. In order to properly give a DNR order, the physician must obtain the informed consent of the patient (or their guardian). For more information on the process of informed consent , click here ! The Types of DNR Orders There are two general types of DNR orders: DNR Comfort Care (DNR-CC) orders and DNR Comfort Care-Arrest (DNR-CCA) orders, with DNR-CCA orders being the most common type. This order permits the use of life-saving interventions, such as chemotherapy, curative surgery, or medication, up until one’s breathing or heart stops; after this point, only interventions relating to one’s comfort are permitted (Ethics Committee). Basically, CPR will not be provided, but physicians are still expected to provide the patient with comfort care to the best of their abilities. In contrast, DNR-CC orders require that only comfort care be provided even before the patient’s breathing or heart stops (Ethics Committee). This type of order is typically used in the case of a short life expectancy or terminal illness where curative treatment does not prove to be beneficial. Another option at some hospitals is often referred to as DNR-Specified, which is a custom order crafted by a patient in consultation with their physician (Ethics Committee). This allows for a more individualized DNR order, but it is unavailable at many hospitals and non-transferable between institutions. When DNR orders are discussed broadly, they are likely referring to DNR-CCA orders, as they are the least restrictive and most frequent. Frequent Issues with DNR Orders Like a lot of legislation in the medical field, DNR orders are not without complication. In recent years, researchers have found that the presence of a DNR order in a patient’s charts can unintentionally decrease the use of non-CPR medical interventions (McCaughey). Ultimately, this lower level of care can prove fatal; in fact, it was found that, following a hip surgery, patients with DNR orders had over double the mortality rate of patients without one (McCaughey). Another frequent issue with DNR orders is that physicians may not adequately discuss the complications with DNR orders, which would constitute a lack of informed consent . Additionally, a DNR order may be overridden against a patient’s wishes; a survey of physicians showed that 69% would be very likely to disregard a DNR order and perform CPR anyway if their treatment caused a cardiac arrest (Tan). This is thought to be due to lawsuit concerns, guilt, or a lack of consideration of this possibility (Tan). On the other end of this issue, DNR orders are sometimes placed against a patient’s will, which is known as a unilateral DNR (Courtwright et al.). Generally, this decision is made by an ethics committee or physician when they deem further treatment to be futile (Courtwright et al.). This is especially concerning because in some cases, the patients were found to have potentially treatable conditions (Courtwright et al.). There is a lot of ongoing debate and contention surrounding this issue, even among doctors, as roughly half are opposed to this practice (Putman). To find out the specifics of DNR orders in your state, search “DNR order laws” followed by your state! For example, a search for “DNR order laws in (insert state here)” should bring up all the information you need! Citations Courtwright, A., et al. “Unilateral Do-Not-Attempt Resuscitation Orders at the Massachusetts General Hospital.” Medical Futility Blog, 11 May 2014, medicalfutility.blogspot.com/2014/05/unilateral-do-not-attempt-resusci tation.html?utm_source=twitterfeed&utm_medium=twitter . Ethics Committee. “DNR Orders and Comfort Care.” Ethics Resources and Services, Cleveland Clinic, my.clevelandclinic.org/ccf/media/Files/Bioethics/DNR%20Handout%204_28.pdf?la=en#:~:text=DNR%20Comfort%20Care%2DArrest%3A%20DNR,person's%20heart%20or%20breathing%20stops . McCaughey, Betsy. “Do Not Sign A DNR Before You Read This.” Investor's Business Daily, 28 Mar. 2018, www.investors.com/politics/columnists/do-not-resuscitate-dnr-orders- dangerous-for-patients/ . Putman, Micheal S. “Ethics of Unilateral DNR Orders: Physicians Are Evenly Divided.” Relias Media - Continuing Medical Education Publishing, 1 Feb. 2018, www.reliasmedia.com/articles/142102-ethics-of-unilateral-dnr-orders-physicians-are-evenly-divided . Tan, S. Y. “Consent and DNR Orders.” The Hospitalist, 14 Feb. 2018, www.the-hospitalist.org/hospitalist/article/158675/business-medicine/ consent-and-dnr-orders .

You may be familiar with the phrase; you are what you eat. What may surprise you is that its origins date back to the 1800s, when a French lawyer, politician, and famous gastronome, was said to have first uttered a similar French version of the popular saying. Since then, the concept has been the basis for best-selling books and entire nutrition plans. We’ve known for a long time that diet contributes to our health . It’s a simple concept: good nutrition helps children grow and develop and contributes to health over a lifespan. An unhealthy diet is associated with harmful effects, including obesity, heart disease, stroke, Type 2 diabetes, and cancer. Studies have also found a correlation between a diet high in refined sugars and impaired brain function —and evidence that it can worsen symptoms of mood disorders, such as depression. The Connection Between Breast Cancer and Nutrition It’s likely that you’ve heard conflicting reports about the effect of certain foods on breast cancer. One year, you read that soy contributes to breast cancer, and a year later, you read that soy reduces breast cancer. Understandably, a person could easily become confused and frustrated. What is going on? Why can’t they get it right? Science is constantly evolving. Advances in technology enable researchers to gain new information and learn new things. A great example of this is the progress of genetic testing for breast cancer that became available only twenty-five years ago. That new knowledge may lead scientists to draw new conclusions that contradict earlier information. It doesn’t mean that the science is flawed, only that new evidence has been discovered. Watch Now Alcohol and Breast Cancer Multiple studies have shown a link between alcohol consumption and breast cancer. Two landmark papers published in The New England Journal of Medicine in 1987 determined that, even at moderate levels, alcohol consumption was associated with the risk of breast cancer. Since then, numerous global studies have been conducted with the same findings. Several studies examined alcohol consumption with other known breast cancer risk factors, such as diet, genetic conditions, body mass index, physical activity levels, and smoking. Soy and Breast Cancer There’s been a lot of debate over the past 25 years on whether soy increases breast cancer risk. On the contrary, recent research findings indicate that soy and soy-based foods, including tempeh, tofu, and miso, lower breast cancer risk . A study commissioned by the National Cancer Institute and the World Cancer Research Fund determined that the culprit is cow’s milk. Drinking cow’s milk increases a woman’s risk of breast cancer by as much as 80 percent compared with drinking soy milk. The Mayo Clinic chalks up the confusion to isoflavones (plant estrogens) found in soy. High levels of estrogen have been linked to an increased risk of breast cancer; however, the levels of isoflavones in food sources of soy aren’t high enough to increase breast cancer risk. Soy or isoflavone supplements, however, generally contain higher isoflavone levels. Some studies have suggested a link between soy or isoflavone supplements and an increased risk of breast cancer in women who have a family or personal history of breast cancer or thyroid problems. It’s helpful to understand the differences between natural, unprocessed soy and soy supplements and additives. Sugar and Breast Cancer Sugar has been implicated as a cause of breast cancer, depicted as providing a feeding frenzy enabling cancer cells to grow out of control quickly. Like all cells, cancer cells require energy to grow and multiply, and use glucose as their primary fuel source. Glucose is the simplest form of sugar and comes from any food that contains carbohydrates. That list includes healthy foods, such as vegetables, fruits, dairy, whole grains, refined carbohydrates, and foods with added sugars, such as white bread, pasta, sweetened beverages, and sweets. The idea that sugar expedites cancer cells’ growth has led some people to completely cut out all carbohydrates from their diet based on the belief that cancer cells need glucose; eliminating it will stop cancer growth. Sugar has not been found to make cancer cells grow faster , nor has cutting sugar out of your diet been connected with slowing down cancer cells’ growth. It’s not that simple. Glucose is a critical component needed for healthy cells to function, and there is no way for our bodies to let healthy cells have the glucose they need but stop it from feeding the cancer cells. Removing carbohydrate intake from the foods we eat doesn’t work because our bodies will make glucose from other sources, such as protein and fat. There is an indirect link between sugar and cancer. We know that eating a lot of sugary foods such as cakes, cookies, and sweetened beverages can contribute to weight gain and excess body fat. Research has shown that being overweight or obese increases the risk of 11 types of cancers, including postmenopausal breast cancer. Another study in the American Journal of Clinical Nutrition found that in a cohort of more than 100,000 people whose dietary intake was assessed every six months, sugar was associated with cancer, especially with breast cancer. Sugars from fruit, however, were not associated with cancer risk. Some scientists are investigating the possibility of measuring sugar to detect breast cancer . We continue to learn the impact of nutrition on our health and how understanding our dietary choices can benefit our ability to prevent breast cancer. Following a healthy diet can also help you feel your best. Explore our guidelines for a healthy diet , and become part of our empowering community, including our Breast Cancer Survivor & Friends Meet and Greets . We’re always here for you! Watch Now

It's no secret that money is a major cause of stress for far too many people. A breast cancer diagnosis can certainly be a major cause of stress. The two combined create a devastatingly stressful situation. While it's never a bad time to educate yourself about personal and family finances, the fresh start that a new season and month bring is a great time to do so. What is Financial Literacy? Where is the best place to start? Financial literacy is defined as the ability to understand and effectively use various financial skills, including personal financial management and budgeting. But who anticipates large medical bills? Breast cancer treatment typically involves screening, surgery, chemotherapy, radiation, and oncological team and hospital expenses that can approach hundreds of thousands of dollars. Insurance and Medicare do cover many of these bills, but not all in most cases. For instance, Breast cancer patients with lymphedema — a common side effect after the removal of lymph nodes as part of cancer treatment — experience an average exceeding $2,000 in out-of-pocket costs per year, compared to just over $1,000 for those without lymphedema ( Forbes, 2020 ) . Are you familiar with your insurance’s deductibles and out-of-pocket payments? Plans are all different, and most of us do not necessarily know the financial details until we are hit with a crisis and need to tap into medical insurance. Some plans offer low deductibles and copays, while others do not. In fact, some deductibles run as high as $5000 annually. Even if and when you reach your deductible, it is never guaranteed that insurance companies will pick up 100% of the balance thereafter, thus adding additional financial burden. Incorrect Medical Bills In addition to the incredibly high costs associated with cancer treatment, oftentimes, bills are incorrect, and many patients do not take the time to review their bills line by line. The nonprofit Patient Advocate Foundation estimates that about “half of all medical bills contain incorrect charges, wrongly denied claims or surprise bills”. They may charge you for the wrong service or charge you twice for the same service, or say you had an ibuprofen when you didn’t. That’s why it’s important to take notes during and after your appointments, make a note of the dates and the names of the doctors you’ve seen, so you can easily remember the services, shots, scans, and infusions you received and be able to thoroughly review your bill when it arrives. Lastly, many medical providers don’t include an itemized list of charges when they first bill you, especially for a hospital visit. Instead, they lump all the charges together in what's called a “summary” bill, with a “total due” at the bottom. Some initial statements don’t factor in payments from Medicare or your insurance company, which could give you the impression that you owe more than you do. The Impact of Financial Stress on Cancer Patients Dr. Greenup, a surgeon at Duke Cancer Institute, and her colleagues investigated the costs of cancer treatment and its impact on the patients. “One-third of the participants reported that the costs of their breast cancer care turned out to be higher than they expected. Although most said that paying for their cancer treatment did not interfere with their other medical care, a quarter of the women with the lowest incomes reported avoiding doctors and medical tests.” ( NIH, 2019 ) Financial Stress is, therefore, most understandable. As April is Financial Literacy Month, we've highlighted some resources below to help you learn about ways to lessen the financial burdens and stress of a cancer diagnosis. Health Insurance Literacy and Financial Hardship in Cancer Survivors A recent study indicated that health insurance literacy may be an important intervention for addressing financial problems associated with cancer. Rising costs of cancer care can result in financial hardship for cancer survivors—even among those with health insurance. Read More. Ways To 'Celebrate' Financial Literacy Month (That Don't Cost Anything) While it might seem like a strange topic to “celebrate,” the more education you have about finances, the more equipped you’ll be to make smart decisions. According to the Financial Industry Regulatory Authority, financial literacy is declining among Americans. Read More. The Association of Community Cancer Centers & Financial Advocacy The goal of the Financial Advocacy Network is to empower providers to proactively integrate financial health into the oncology care continuum and help patients gain access to high-quality care for a better quality of life. Read More. Steps for Managing Finances & Health Insurance After A Cancer Diagnosis Studies show that cancer survivors with financial burden had significantly higher rates of depression. Fortunately, there are ways to minimize the financial burden of a cancer diagnosis. Read More.

Almost 90,000 “young people,” defined as anyone aged 15-39, are diagnosed with cancer each year in the United States, according to the American Cancer Society , accounting for about 5 percent of all cancer diagnoses. And among the 25- to 39-year-olds considered “young people,” breast cancer and thyroid cancer are the most common. ( NCI’s Surveillance, Epidemiology, and End Results Program Cancer Stat Facts So why are there so many AYA cancer diagnoses, yet so little focus on this group as compared to childhood or adult cancers? Young people find themselves in an “in-between” group—there is no specific medical home or doctors specializing in treating the AYA population, a recent study by the National Cancer Institute found, and they are often in transition periods in their lives without consistent relationships with medical providers. Furthermore, “AYAs have lower enrollment in clinical trials compared with people treated for cancer in childhood or older adulthood,” said Emily Tonorezos, M.D., M.P.H., director of NCI’s Office of Cancer Survivorship . Typically, in the U.S., breast cancer screenings do not begin until the age of 40. In other countries, it can be as high as 50 or even 55. With no effective breast cancer screening tool yet for women under 40, according to YoungSurvival.org , most young adults find a lump or change in their breast themselves. Routine breast self-exams help you become familiar with how your breasts look and feel, so you can be cognizant of any changes that may occur. A cancer diagnosis at any age is isolating and scary, but as the most underserved community by age, it can be especially so for those in the AYA population who receive a diagnosis. Many are told time and time again that they are wrong and too young for what they are feeling in their body to be cancer. Always remember that the best advocate for yourself and your health is you. Demand the testing, scans, and answers to what you feel is going on in your body. As Adolescents and Young Adults (AYA) Cancer Awareness Week 2021 draws to a close, we've highlighted some resources below to help you learn about breast cancer in the AYA community. Breast Cancer Statistics in Young Adults Although breast cancer in young adults is rare, more than 250,000 people living in the United States today were diagnosed under age 40. In young adults, breast cancer tends to be diagnosed in its later stages and tends to be more aggressive. Read More. Breast Cancer In Young Women Though more common in older adults than younger women, more than 13,000 women ages 40 or under will be diagnosed this year. What are the unique challenges young women with breast cancer face? Read More. Too Young to Screen: Breast Cancer in Younger Women If you’re under age 40, which is when it’s recommended that women begin having screening mammograms, you may think you are too young to get breast cancer—but that’s not true. While breast cancer in younger women is rare, it is the most common cancer among women ages 15 to 39. Read More. Young, High-Risk Women Benefit From Breast Self-Exam Diagnosis Studies found that a breast self-exam (BSE) can be an important way to find cancer in young women, especially young women with a higher-than-average risk of developing breast cancer. The results offer another point of view in the ongoing discussion about the role of BSE in breast cancer screening. Read More.

2020 was a year that forced doctors, patients, and their caregivers to rethink how they work together–virtual appointments over Zoom, conversing through electronic portals, viewing diagnoses through the lens of a global pandemic. One bright spot, however, was that patients and caregivers had to get creative and look into alternative forms of therapy and relief. The numerous benefits of acupuncture, acupressure, and other forms of alternative treatment have been widely shared and discussed, but the stay-at-home orders as a result of the pandemic shone a new light on just how great those benefits are, and how easily some of them, like acupressure, can be administered at home. Acupressure is an ancient healing art that’s based on the traditional Chinese medicine practice of acupuncture, but instead of using needles, pressure is put on specific places on the body, called acupoints. Pressure on acupoints helps to relieve muscle tension, promote blood circulation, and can even relieve many common side effects of chemotherapy. Pressure Point P-6, also known as Neiguan and located on your inner arm near your wrist, for example, can help relieve nausea and vomiting related to chemotherapy, according to Memorial Sloan Cancer Center . Acupressure is a great option not only for relief from chemotherapy symptoms, but it can also be used to help alleviate lingering symptoms of treatment that many breast cancer survivors experience. The results of a randomized study published in JAMA Oncology found that six weeks of self-administered acupressure reduced fatigue in breast cancer survivors by as much as 34% as compared to those with no intervention. Suzanna M. Zick, ND, MPH, of the departments of family medicine and nutritional sciences at the University of Michigan in Ann Arbor, one of the authors of the study, notes, “Fatigue is an underappreciated symptom across a lot of chronic diseases, especially cancer. It has a significant impact on quality of life.” Acupressure requires little to no cost and is easy and safe to learn and self-administer. Read on to learn more about the benefits of this ancient healing art and ways you can incorporate it into your own daily practice. Acupressure for Cancer-Related Fatigue Difficult-to-treat, cancer-related fatigue is a common, distressing clinical issue. It impedes daily activities, severely affecting patients’ quality of life. Read More. Acupressure Relieves Breast Cancer Treatment Symptoms, Study Finds A new study finds acupressure could be a low-cost, at-home solution to a suite of persistent side effects that linger after breast cancer treatment ends. Read More. Acupressure Helps with Depression, Sleep After Breast Cancer Treatment A recent study found that acupressure could help alleviate multiple symptoms women often experience after breast cancer treatment. Read More. Young, High-Risk Women Benefit From Breast Self-Exam Diagnosis Learn how to perform acupressure for the treatment of nausea and vomiting from Jonathan Siman, an acupuncturist at the Memorial Sloan Kettering Integrative Medicine Service. Watch Now.

Thursday, April 22nd, 2021, marked the 51st anniversary of Earth Day . What started in 1970 with over 20 million Americans calling for action to protect our planet has grown into the worldwide celebration we know today, with over 1 billion people in more than 190 countries celebrating our planet and highlighting the work that needs to be done to protect it. The invention of the automobile and the increase in industry resulted in Americans consuming vast amounts of leaded gas, smoke, sludge, and polluted air–no thought was given to how a polluted environment threatens human health. The release of Rachel Carson’s Silent Spring in 1962 raised public awareness and concern for the environment, pollution, and its link to public health. How does this relate to breast cancer? We all know the sobering fact that about 12%, or 1 in 8, women in the United States will develop breast cancer during their lifetime, and although scientists have identified many of the risk factors that increase a woman’s chance of developing breast cancer, there is still very little knowledge about what causes normal cells to become cancerous. Most experts agree that breast cancer is caused by a combination of genetic, hormonal, and environmental factors . In fact, evidence cited in a 2017 study from The National Center for Biotechnology Information reinforces the conclusion that exposure to a wide variety of toxins–many of which are found in things we eat, drink, touch, or breathe–can lead to an increased risk for the development of breast cancer. So where are we now? A deeper appreciation of how the environment affects breast health and the importance of research in this area, combined with a society that is increasingly more concerned with overall health and well-being, has thankfully led to more studies, such as The Sister Study , and people taking a more active stance in what they expose themselves to in their environments. Read on to learn more about advances in research, studies, and steps you can take to protect not only our environment, but yourself and your loved ones. Breast Cancer and the Environment The National Institute of Environmental Health Sciences plays a leadership role in funding and conducting studies on the ways in which environmental exposures increase breast cancer risk. Identifying and reducing contact with environmental factors linked to breast cancer presents a tremendous opportunity to prevent this disease. Read More. Every Day Earth Tips We love our planet, right? So, protecting it seems like a no-brainer. Breast Cancer Prevention Partners has put together some easy ways to help you go green and keep the planet clean. Since we have no planet B, let’s make a difference and care for the one we have. Read More. Why Study Environmental Chemicals and Breast Cancer? In order to truly lift the burden of breast cancer, the important contribution of environmental chemicals to the development of the disease must be an integral part of cancer prevention strategies. Read More. State of the Evidence 2017: An Update on the Connection Between Breast Cancer and the Environment This review examines the continually expanding and increasingly compelling data linking radiation and various chemicals in our environment to the current high incidence of breast cancer. Read More.

Writing can serve as a therapeutic and creative outlet. More specifically, journaling offers opportunities for expression and reflection and can help those going through a cancer diagnosis process the emotions and loss that come with the territory. Writing isn’t necessarily just for the patient, either. It is a powerful tool that can be useful for families, caregivers, and children. There is no right or wrong way to start this mindful practice. Set aside 10 minutes during your day; it could be the first thing when you wake up (before you pick up your phone and start scrolling through news and emails), or it can be during your lunch break or in the evenings as part of your nighttime routine. Writing can take on many forms, such as journaling about your day, keeping a gratitude journal, or even making lists of all of the accomplishments from the day (think – opposite of a “to-do” list!). Research from the University of Rochester Medical Center suggests that writing and journaling can have numerous benefits and help: Manage anxiety Reduce stress Cope with depression It can also improve mood by: Helping you prioritize problems, fears, and concerns Tracking any symptoms day-to-day so that you can recognize triggers and learn ways to better control them Providing an opportunity for positive self-talk and identifying negative thoughts and behaviors So how do you get started? It’s simple. Set a timer and let your mind relax as you write your stream of consciousness. Don’t worry about penmanship, grammar, or punctuation. Writing helps us make sense of our lived experiences. It can help us process what we are going through as well as provide an outlet for decompressing. Whether it is journaling or writing expressive poetry, it is a beautiful and therapeutic art form that we encourage you to try! If you are stuck on what to write about, try any of these writing prompts: Three things I value about myself are….(perfect for fostering abundance and self-worth) I feel like myself when…(one of my very faves and a great way to get to know your inner self) I would love to get some support with…(if you're trying to do it all on your own, but it's just not happening) Emotional and physical health benefits of expressive writing Over the past 20 years, a growing body of literature has demonstrated the beneficial effects that writing about traumatic or stressful events has on physical and emotional health. The immediate impact of expressive writing is usually a short-term increase in distress, negative mood and physical symptoms, and a decrease in positive mood compared with controls. Expressive writing participants also rate their writing as significantly more personal, meaningful and emotional. However, at longer-term follow-up, many studies have continued to find evidence of health benefits in terms of objectively assessed outcomes, self-reported physical health outcomes and self-reported emotional health outcomes. Read More . The Power of Writing: 3 Types of Therapeutic Writing Some of us think that writing is only for writers. But writing is for all of us. As Julia Cameron notes in her book The Right to Write: An Invitation and Initiation into the Writing Life, “I believe we all come into life as writers.” Writing can be beneficial for all of us, because it can be therapeutic. One of the most powerful parts of therapy is cultivating the ability to observe our thoughts and feelings, said Elizabeth Sullivan, a licensed marriage and family therapist in San Francisco. And that’s what writing helps us do. “Most of us do not think in complete sentences but in self-interrupted, looping, impressionistic cacophony,” she said. Writing helps us track our spinning thoughts and feelings, which can lead to key insights (e.g., I don’t want to go to that party; I think I’m falling for this person; I’m no longer passionate about my job; I realize how I can solve that problem; I’m really scared about that situation.) Writing is “speaking to another consciousness — ‘the reader’ or another part of the self. We come to know who we really are in the present moment,” she said. Read More. Evidence of the Healing Power of Expressive Writing Seeking counseling from a therapist is one of the most common recommendations for people who are struggling to cope with a recent emotional upheaval or with past traumas. Yet writing therapy, or expressive writing, has proven to be a powerful, free, and easily accessible remedy for both the mind and the body. Read More. The puzzling way that writing heals the body In 1986 the psychology professor James Pennebaker discovered something extraordinary, something which would inspire a generation of researchers to conduct several hundred studies. He asked students to spend 15 minutes writing about the biggest trauma of their lives or, if they hadn’t experienced a trauma, their most difficult time. Read More.

Humans are social beings. Early humans depended on the community for survival . Living in clans enabled them to share food, care for infants, and build social networks to meet the daily challenges of their environments. We’re not so different today. We forge social connections and embrace communities to learn new things, share our experiences, and give or receive support. Hardwired to Connect Extensive neuroscience research shows that humans are hardwired to connect with others. We find solace when we belong. Scientific evidence even demonstrates that mirror neurons in our brains are stimulated when we interact, making pathways in our brain light up to mirror the emotions and behaviors the other person is conveying when talking with someone. The Importance of Human Connection Maslow’s “hierarchy of needs” theory, published in 1943, argued that a person couldn’t reach fulfillment without love and belonging and that it followed closely behind basic needs, such as food and shelter. At the time, there was little scientific evidence to support his theory. However, emerging research gives his theory credibility and takes it a step further, suggesting that the human need to connect socially is a basic human need , as crucial to survival as food, shelter, and water. Even without scientific proof that humans need to be connected, the way we live our lives clarifies that humans desire a sense of community. We thrive in groups; whether belonging to a social group, a religious group, Boy Scouts, Girl Scouts, or a fitness group, we find solace by belonging. I n every culture, women have fostered and nurtured communities. From sewing circles to book clubs, sororities to professional associations, running clubs to quilting clubs, women have historically understood the power of community. While some people are quick to point out the downside of modern technology, the other side of the coin is that it can alleviate isolation for those who are unable, for various reasons, to connect in person. The pandemic made that fact clear. Social platforms such as Facebook provide people with a way to connect with like-minded people based on interests, and you can find a MeetUp online for just about any interest. The Link Between Community and Health It doesn’t just feel good to be part of a group; being connected has proven tangible health benefits. Just how powerful is a person’s social connection to health? One landmark study showed that lack of social connection is a greater detriment to health than obesity, smoking, and high blood pressure. Research has also shown compelling evidence that strong social connections can: Increase longevity by as much as 50 percent Strengthen your immune system Help you recover from the disease faster Experience lower levels of anxiety and depression Boost your self-esteem The Breast Cancer Community Receiving a diagnosis of any serious disease, such as breast cancer, can send a person’s life into a tailspin. Accessing information is essential, but equally as important is connecting with others experiencing similar things. It’s not just helpful for survivors, but their families and caretakers, too. Online breast cancer support communities provide you with an opportunity to meet other women in various stages, including some who had it many years ago and are living happy, healthy lives. Knowing long-term survivors can help you realize that breast cancer doesn’t automatically mean you’re doomed. You can also build a sense of comradeship with those at your stage who understand your fears and concerns because they’re going through a similar experience. You are never alone when you become part of our global community. Instead, you’re surrounded by others who have been touched by breast cancer. Our Thursday Night Thrivers MeetUp goes beyond a steady dose of breast cancer stories. Sure, people are generous with their personal stories and helpful hints, but it’s also a chance to form long-lasting friendships. They will support you, laugh with you, empower you, and always be by your side. Not in the mood to discuss cancer? No problem, check out our Breast Cancer Book Club™ . Connect with our community for resources and support, and know that you are not alone!

Many breast cancer patients suffer from post-traumatic stress disorder (PTSD), an anxiety disorder typically brought on by a traumatic event. Notably, PTSD can happen after any life-threatening situation, and a breast cancer diagnosis or cancer recurrence certainly qualifies. PTSD can affect one’s ability to cope with life’s daily tasks and make it difficult to function. Several years ago, while hosting an exhibit table at a pre-COVID-19 era Nurse Navigator conference in Las Vegas, we were asked to explain the function of our organization, survingbreastcancer.org (SBC). Our response was that “our programming for the breast cancer community was predicated on the ongoing needs and concerns of the breast cancer patient”. The Nurse Navigator attendees would invariably respond with further territorial probing, to which we would reply: “At SBC, we realize that the oncology teams were the primary caregivers, but that once a patient enters into the realm of post-active treatment, PTSD may begin to set in. After surveying literally thousands of survivors, we found that 'fear of recurrence' was an overarching theme.” How PTSD Emerges in Breast Cancer Patients Most newly diagnosed breast cancer patients feel like their emotions are all over the place, e.g., scared, stressed, worried, and angered. This is certainly understandable due to the physiological, psychological, and surgical impacts of the Dx. But what separates “normal” stress from PTSD symptoms? PTSD symptoms last longer than a month and may severely affect one’s daily life. Symptoms include: Memory loss (“ Chemo Brain ”) Concentration issues Nightmares or about the whole cancer experience Continuously focusing on the cancer experience Over the top irritability Emotional numbness Loss of appetite Self-destructive behavior (drug or alcohol abuse) Being startled or frightened easily PTSD symptoms may appear within 3 months of a traumatic event, last longer than a few weeks, and may severely affect daily life. But in some cases, symptoms don't appear for years after the traumatic event. How is Cancer PTSD Treated? Treatment options can include medications, such as antidepressants, and therapy to help you learn ways to cope with situations that may trigger a traumatic response. Above all, treatment and therapy help the patient understand that a disorder like this one develops because of extraordinary stress, not because of weakness. The following may help if you’re coping with PTSD brought on by breast cancer: Stick to your treatment plan Get plenty of rest/sleep Exercise regularly Eat a healthy diet Minimize caffeine and nicotine Don’t use alcohol or drugs Surround yourself with supportive people Consider joining a support group like SBC's Thursday Night Thrivers In addition, some complementary, holistic techniques have been shown to ease anxiety, stress, and fear, such as aromatherapy (my favorite is lavender), journaling, meditation, and art as healing. It also should be noted that the parents and or loved ones of patients who go through cancer treatment can also suffer from PTSD, with similar triggers and symptoms. The key is to get treatment early. Symptoms and mental distress are often long-lasting and can affect your relationships, your job, and your overall health. At SBC, we urge all to seek help before these symptoms have a chance to further disturb your life. To make sure you get the help you need, talk to your doctor right away if you’re having PTSD symptoms.

Evidence-Based Recommendations For A Healthy Diet Parents spend countless hours pleading, cajoling, and even bribing their children to eat their vegetables, and for a good reason. Science makes strong connections between a healthy diet (and veggies are packed with the good stuff) and good health and chronic disease prevention . A nutritional diet even plays a role in our mental and emotional well-being . Research also tells us that individuals who follow five essential habits—eating a healthy diet, exercising regularly, keeping a healthy body weight, not drinking too much alcohol, and not smoking— live more than a decade longer than those who don’t. Maintaining these practices may help us live longer and potentially protect us from diseases , such as type 2 diabetes, cardiovascular disease, and some cancers. Unfortunately, there isn’t a magical diet that guarantees protection against breast cancer or any foods that can cure cancer. However, some foods can make your body as healthy as possible, boost your immune system, minimize your risk, and even some that may control the side effects of treatments. That being said, no one’s perfect. Sticking to a healthy diet is sometimes easier said than done, so this isn’t meant to add guilt or judgment if you stray from a healthy diet. Hopefully, this information will provide tips to make diet choices to feel better. Recommended Diet Choices Good nutrition— ensuring that your body gets the nutrients it needs—is important for everyone. However, it may be even more essential when you’re facing a breast cancer diagnosis. A well-balanced diet before, during, and after cancer treatment can help you feel better, preserve your strength, and speed your recovery. Choose Protein-Rich Foods Protein supports the body repair cells and tissue, supports your immune system, and supports recovery from illness. Good sources of lean protein include: Lean meats such as chicken, fish, or turkey Eggs Low-fat dairy products such as milk, yogurt, and cheese or dairy substitutes Nuts and nut butters Beans Soy foods Include Whole-Grain Foods Whole-grain foods are a good source of carbohydrates and fiber, which contribute to energy levels. A diet high in fiber and antioxidants is the best way to reduce your risk of breast cancer . One study even showed that a low-fat diet reduces the risk of death from breast cancer by 21 percent . Good sources of whole grain foods include: Oatmeal Whole wheat breads Brown rice Whole grain pastas Sources of Fiber There are two types of fiber: soluble and insoluble. They’re both parts of a healthy diet that can help lower your cancer risk. Soluble fiber attracts water and turns to gel during digestion, slowing the digestive process. A partial list of foods high in soluble fiber include: Oats Barley Nuts and seeds Peas Avocado Oranges Brussels sprouts Insoluble fiber helps food pass more quickly through the stomach and intestines. Examples of foods high in Insoluble fiber include: Apples Whole grains Wheat bran Eat a Variety of Foods that Provide Antioxidants Good news for chocolate lovers! While fruits and vegetables are the stars of the antioxidant food list, dark chocolate is also a good source of antioxidants! Antioxidants contain nutrients that boost your immune system and protect against free radicals, the molecules that damage tissue and lead to cancer growth. They can also block the cancer-causing effects of carcinogens and lower blood sugar and estrogen levels, slowing or halting tumor growth. For the most significant benefit, choose various colorful fruits and vegetables and strive to eat a minimum of five servings of whole fruits and vegetables daily—cook fresh fruits and vegetables for those in treatment with a weakened immune system, including: Blueberries Strawberries Artichokes Goji Berries Raspberries Kale Red Cabbage Beans Beets Spinach Choose Sources of Healthy Fat Avoid fried, greasy, and fatty foods. Instead, choose baked, broiled, or grilled foods. Healthy fats include: Olive oil Avocados Nuts Seeds Preventive Dietary Measures On the flip side, some foods are best avoided for those living with breast cancer. One study found that nutrition impacts 35 percent of all breast cancer cases . Consider the following dietary findings: Meat and Dairy: Another study specifically linked meat and dairy to an elevated risk of breast cancer . It found that women who ate as little as one-quarter of a cup of full-fat milk or dairy a day had an increased risk of breast cancer. Sugar: The link between sugar and breast cancer is inconclusive. While there is no definitive direct connection, there may be an indirect one, so it’s probably advisable to limit your sugar intake . Many foods may seem healthy but contain hidden sugar. For example, dried fruit contains much more sugar than fresh fruit. Alcoholic drinks and some diet foods may also have high amounts of sugar. It’s best to check the labels when considering your sugar intake. Alcohol: Alcohol consumption has been known to increase estrogen levels in women, and just three drinks a week is enough to increase your risk of breast cancer by 15 percent . We understand that everyone’s cancer experience is unique. Side effects due to treatments may affect your ability to follow these recommendations. If you’re struggling with any side effects, such as loss of appetite, nausea, diarrhea, vomiting, or any other nutritional concerns, your needs may be different. A registered dietitian can suggest nutrition guidelines that will be appropriate for you and your situation. We’ll keep you up-to-date as science uncovers information about the impact of nutrition on breast cancer. In the meantime, explore our guidelines for a healthy diet , and become part of our empowering community, including our Breast Cancer Survivor & Friends Meet and Greets . We’re always here for you! SurvivingBreastCancer.org Resources, Support, & Events: Nutrition And Exercise For Breast Cancer Upcoming Events Our Weekly MeetUp

By Naomi Aaronson MA OTR/L and Ann Marie Turo OTR/L 2 Experts In Breast Cancer Rehabilitation Share Their Insight Into The Benefit Of This Safe, Effective Form Of Exercise Why Pilates For Breast Cancer? Pilates is a gentle form of exercise that engages the mind, body, and spirit. The various Pilates exercises help develop muscular flexibility and strength while increasing me­tabolism and promoting lymphatic, respiratory, and circulatory func­tion. They improve balance and co­ordination and also help you relax and “get centered.” Pilates is able to meet you where you are, and it can be done throughout your life and wherever you are, even while seat­ed. For these reasons, it is an excel­lent approach to healing for breast cancer survivors. The Pilates method was first developed by Joseph Pilates to strengthen muscles, increase flex­ibility, and improve overall health. It is a mixture of yoga, martial arts, and gymnastics. He first taught his method as “Contrology,” a mash-up of Eastern and Western philoso­phies and techniques, to a small group of devoted teachers and stu­dents in the United States after emigrating from Germany follow­ing World War I. Years later, in the 1950s, Pilates used his techniques to rehabilitate dancers at his studio in New York City without receiving much recognition for his method. One of Pilates’s first protégés was Eve Gentry, whom he rehabilitated after a radical mastectomy. Eve was able to regain full use of her arm and torso, which is remark­able because all of her lymph nodes and chest muscles, as well as breast tissue, had been removed. Doctors could not believe the success that she had obtained with the Pilates method. He was a man ahead of his time. Research is now being con­ducted that documents the benefits of the Pilates method for breast cancer recovery. What are the Benefits of Pilates? Beth Mast, an occupational thera­pist and Pilates practitioner, used Pilates to recover from breast can­cer and is now using the method on her journey through living with metastatic cancer. She says that Pi­lates has always been available to her, even on really bad days. It was the only exercise she could tolerate after going through chemotherapy and becoming increasingly ane­mic, unable to stand even to brush her teeth. Here are the specific benefits Beth has found with her Pilates practice: You can do Pilates in many different positions: supine (on the back), prone (on the stomach), side-lying, standing, and seated. The exercises and equipment can be modified for any level. You will be able to use the affected arm(s) more easily and naturally because Pilates is a whole-body exercise system that includes the arms and legs in the movements. The principles help you live in the moment by keeping you focused on moving properly, with control and without momentum. Deep rib cage breathing and the multidimensional breathing patterns help ease tension, encourage lymphatic drainage, and stretch tight areas affected by scars. Pilates provides a gentle introduction or reintroduction to exercise. Pilates increases muscle strength, especially in the back of the shoulders and the middle back, where you need it after breast cancer surgery. Pilates increases your ability to perform activities of daily living as you build core strength, allowing you to more easily roll over and move from different positions. Pilates improves muscle proprioception (the reception of stimuli) and kinesthesia (awareness of the position and movement of the parts of the body by means of sensory organs) in the muscles and joints; these sensations are often lost after surgery, when nerves and muscles may have been inadvertently cut. Pilates strengthens the transverse abdominis, a muscle that is very important for back stability and strength after a TRAM (transverse rectus abdominis myocutaneous) flap or DIEP (deep inferior epigastric perforator) flap breast reconstruction procedure. Pilates can help with bladder control problems, such as stress incontinence, a common complication of menopause. Many treatments for breast cancer can induce menopause in women who are not yet meno­pausal. Pilates helps by strength­ening the pelvic floor muscles, which are responsible for bladder control. Pilates takes the focus off the damaged areas of your body and what you cannot do and rein­forces what you can do. You will appreciate all the movement your body is capable of, no matter how small or limited at first, and its capacity to heal. American Cancer Society Recommends Regular Physical Activity for Breast Cancer Survivors The ACS Guidelines on Nutrition and Physical Activity for Cancer Prevention recommend that breast cancer survivors avoid inactivity and return as soon as possible to normal activities after surgery and during radiation and adjuvant treatment (chemotherapy, hormone therapy, and/or targeted therapy). The guidelines recommend regular physical activity and strength training at least twice a week, aiming for 150 minutes of exercise per week. Physical activity offers additional benefits for breast cancer survivors: Boosts positive mood Improves physical condition and movement Improves body image Increases sexuality Decreases depression Decreases fatigue Maintains bone health We know that exercise is good for us. We just need to start somewhere and feel safe. Pilates is a gentle, safe place to begin. What Does the Research Say? The first study on the benefits of Pilates for breast cancer survivors was completed by physical therapists in 2008. It was a pilot study with only four participants, so the conclusions we can draw are limited. The researchers found that Pilates increased the flexibility of the affected arm after a 12-week program during which participants exercised three times a week. Another study, done in 2010, examined the effects of Pilates exercises on functional capacity, flexibility, fatigue, depression, and quality of life in female breast cancer patients. Pilates was performed three times a week for eight weeks. After participation in the exercises, improvements were noted in the subjects’ levels of fatigue, flexibility, quality of life, and performance on a six-minute walking test. This study proved that Pilates was safe and effective for breast cancer survivors. The most recent study, published in 2012, found that after 12 weeks of Pilates, 13 participants improved their shoulder and neck flexibility. Improvements were noted in mood, body image, and quality of life. Although volume increased on the affected arm (a sign of lymphedema), one must note that this program did not modify the exercises for the class and that the sessions increased in frequency over the 12-week period. This article was posted with permission and was originally published at awomanshealth.com. SurvivingBreastCancer.org Resources, Support, & Events: Fitness Tips For Breast Cancer Thrivers Nutrition And Exercise For Breast Cancer Upcoming Events Our Weekly MeetUp

As we continue to celebrate LGBTQIA+ Pride Month, this week, we are featuring several articles and stories about transgender people who are diagnosed with breast cancer. While breast cancer is much more prevalent in those assigned female at birth, it can be found in all genders, including both transgender men and women. Below, we bring you stories of transgender people who are breast cancer survivors. These thrivers share their experiences and struggles with the life-changing news of a breast cancer diagnosis, in navigating the stigmas and misconceptions within the medical field, and in their relationships with supportive, understanding physicians and oncologists. These incredible humans are helping to advocate and educate others in their community so that future thrivers may have more supportive experiences. We also share research on the risks of cancer among transgender individuals and the LGBTQIA+ community at large. As always, let us know your thoughts and how you’d like to contribute to the discussion. Living as a Man, Fighting Breast Cancer: How Trans People Face Care Gaps Eli Oberman was 27 when he was diagnosed with breast cancer. Eight years earlier, he started taking testosterone for its masculinizing effects, but never opted for "top surgery" (breast reduction). Facing a double mastectomy to treat his aggressive cancer, he felt conflicted about receiving the surgery. “I felt guilty, able to get free surgery I didn’t want because I had cancer, and so many others want it and can’t get it,” he said. In this article from the New York Times, he goes on to discuss the challenges, stigma, and discrimination he and other transgender friends have faced in the healthcare system. Eli's physician, Dr. Asa Radix, at the Callen-Lorde Community Health Center in New York, is empathetic and understanding of the barriers that transgender patients face and why they may try to avoid the healthcare system altogether. Still, Oberman noted that he did not join breast cancer support groups for fear of not being accepted. Hopefully, by discussing these challenges more openly, we can create a more accepting community for other thrivers like Eli. Read More . Study Shows Increased Risk of Breast Cancer in Transgender Women Whether to undergo gender-affirming hormone replacement therapy (HRT) is a very personal decision for transgender individuals. There are a number of factors to discuss with one's physician before starting treatment, including a slightly higher risk of breast cancer. A 2019 Dutch study found that transgender women (people assigned male at birth, identifying as female) using hormone treatment have a higher rate of breast cancer than cisgender males (assigned male at birth, identifying as male). This finding is similar to previous studies that have found increased risk of breast cancer in postmenopausal women using HRT. However, the risk for transgender women is still lower than that of the general female population. Furthermore, since the risk of breast cancer in cisgender men is very low to begin with, even with this increased risk, the absolute risk to transgender women still remains low. Like cisgender women (assigned female at birth), transgender individuals should remain aware of the signs and symptoms of breast cancer and talk to their doctor if they have any concerns. Read More . Cancer Incidence and Survivorship in Transgender Patients A 2020 report estimates that 62,530 of the nearly 17 million cancer survivors in the United States are transgender. The researchers used 2014–2018 data from the Behavioral Risk Factor Surveillance System for the 37 states and one territory (Guam) in the United States, based on gender identity questions on their surveys. The study found that transgender men were twice as likely as cisgender men to have gotten a cancer diagnosis. However, gender nonconforming individuals and transgender women did not have a rate of cancer prevalence that was significantly different from that of cisgender men and cisgender women. While the actual rates of cancer diagnosis among transgender women are similar to those of the general population, the researchers found that transgender and non-binary people were less likely to have health insurance and were more likely to be low-income and have unmet medical needs because of the cost of care. These findings are important to health outcomes for those diagnosed. “We hope these findings are a wake-up call for health-care providers that transgender cancer survivors have complex medical needs,” said study lead author Ulrike Boehmer , PhD, Associate Professor of Community Health Sciences at Boston University School of Public Health (BUSPH). Read More. Trans Woman Urges to Be 'Proactive' After Rare Breast Cancer Diagnosis After finding a lump in her breast that would not go away, Beverly Lipscomb learned she had triple-negative breast cancer, a rare and aggressive form of cancer. As part of her cancer treatment, Beverly's doctors recommended that she stop taking her gender-affirming hormones. Having taken these hormones since she was a teen, Beverly was worried about how discontinuing their use would change her body. "Luckily for Lipscomb, the staff worked with her to make sure she felt comfortable with all the decisions, including stopping her hormones. Dr. Joshua Safer, Executive Director of the Mount Sinai Center for Transgender Medicine and Surgery, said it’s essential that transgender patients receive respectful treatment. Many transgender patients put off seeing a doctor because of worries about being misgendered or not being taken seriously. Dr. Safer said that it is important to create a medical environment that is friendlier to transgender people because the earlier that breast cancer is detected, the better the chance of saving the patient's life. Thankfully for Lipscomb, her fears were not confirmed: “Here I am, I’m Black. I’m trans and I’m going to this hospital to be taken care of, I said, ‘How are they going to receive me?’” she said. “But nothing. No kind of racism. No anti-trans anything. I was really worried. I had already built up a wall of defense.” Now, she has finished radiation and is encouraging other trans women to seek care as needed. Read Mor e.