By Kim Dalzell, PhD, RD, Founder, Cancer Nutrition IQ Those I know who are living with metastatic breast cancer choose to feed themselves with things that support overall health and vitality. There is no talk of cure, which opens the door for living well intentionally every day. I believe this mindset makes food choices a little easier, knowing that you can consume something that will feed cancer stability and possibly stave off any side effects from ongoing treatment. A targeted nutrition plan can make your decisions a little more confident when deciding what to eat or which dietary supplements to take. One of the most serious side effects related to chemotherapy used to treat metastatic breast cancer is the weakening of the heart muscle, leading to heart damage that can impact your quality of life. And the cardiac side effects from chemo, like an enlarged heart or congestive heart failure, can appear during cancer treatment or years down the road. A recent study found that having a cardiovascular event, like a heart attack or stroke, may make breast cancer grow faster. (Nature Med, Jul 2020) Breast cancer survivors who developed specific cardiovascular diseases and events—namely heart attack, stroke, heart failure, coronary artery disease , or arrhythmia—had a 59% higher risk of breast cancer coming back and a 60% higher risk of dying from breast cancer than women who did not develop cardiovascular disease. Along with your doctor, who monitors for cardiotoxicity, there are some things you can do from a nutritional standpoint to decrease the negative impact of chemotherapy on your heart and support your goal of a stable diagnosis. Here are three classes of chemotherapy associated with damage to the heart muscle and the nutritional recommendations for each: Anthracyclines Anthracycline drugs like daunorubicin (Cerubidine), doxorubicin (Adriamycin, Doxil), epirubicin (Ellence), idarubicin (Idamycin), and valrubicin (Valstar) kill cancer cells by destroying their genetic material and preventing them from reproducing. This killing spree causes a buildup of unstable oxygen molecules, which leads to the development and progression of coronary artery disease. Researchers have discovered that if you can upregulate a gene called SESN2, the damaging cells clear out and you are more protected from heart damage. (J Mol Cell Cardiol, Aug 2019) Choosing foods that increase SESN2 activity may aid this process! Fruits and vegetables like strawberries, apples, mangoes, persimmons, kiwis, grapes, tomatoes, onions, and cucumbers contain a natural compound called fisetin, which upregulates SESN2. Fisetin may also decrease inflammation and stop the spreading of cancer cells. (Adv Exp Med Biol, 2016) One laboratory study found that fisetin dramatically inhibited the growth of primary breast tumors and reduced lung metastasis in triple-negative breast cancer cells. (Front Pharmacol, Jul 2018) Anti-Metabolites 5-fluorouracil (Adrucil) is one of the oldest chemotherapies for breast cancer and is used as palliative treatment for metastatic breast cancer patients. It is the second most common chemotherapeutic drug, after anthracyclines, associated with damage to the heart muscle. Cancer cells die when they incorporate anti-metabolites because their DNA and RNA become dysfunctional, preventing them from reproducing and making vital proteins. Unfortunately, this type of chemotherapy also causes collateral damage to the endothelium (the membrane that lines the inside of the heart and blood vessels). (Can J Cardio, Jul 2016) Choosing foods to support a healthy endothelium may help protect you against cardiotoxicity! Population studies and clinical trials reveal that omega-3 fatty acids can prevent cardiotoxicity and improve blood vessel responsiveness. Additional benefits of omega-3 fatty acids may include alleviating chemobrain and pain associated with chemotherapy (Nutrients, May 2019), and animal studies indicate a diet rich in omega-3 fatty acids protects against mouth or gut soreness and inflammation. (BMC Nutr, Mar 2016) High omega-3 foods include flaxseeds, chia seeds, fish, walnuts, tofu, shellfish, canola oil, navy beans, brussels sprouts, and avocados. It's almost impossible to get enough omega-3s through the diet. For synergistic cardioprotective benefits, choose an omega-3 supplement that contains a blend of balanced fatty acids combined with hawthorn berry, known to exert anti-cancer effects on human breast cancer cells. (Food Chem, Nov 2013) By the way, natural products containing folic acid may increase the effects of 5-FU, leading to more serious side effects like anemia, infections, and nerve damage, so check your dietary supplement labels carefully. Cyclophosphamide Alkylating agents, like cyclophosphamide (Cytoxan), kill cancer cells by slowing or stopping their growth. The incidence of acute heart failure is anywhere between 7% and 33% of patients receiving a total dose of more than 150 mg/kg of cyclophosphamide. To work in the body, cyclophosphamide requires the metabolic activation of the cytochrome CYP3A4 enzyme. If CYP3A4 expression is altered, drugs that are not metabolized may not work as designed. Or they may stay in the bloodstream longer, build up in the blood, and become toxic, increasing the risk for muscle damage and heart arrhythmia. Popular dietary supplements and foods that have a high risk for interaction with cyclophosphamide include grapefruit and grapefruit juice. Some less popular citrus fruits, such as Seville orange (bitter orange found in marmalade and savory dishes), pomelo, and star fruit, have similar properties to grapefruit and should be avoided as well. It is estimated that the inhibition of CYP3A4 can last for longer than 3 days after consuming grapefruit juice until new enzymes have been synthesized in the gut wall! (BMJ, Jan 2013) Some natural combinations have been tested in conjunction with cyclophosphamide administration and show some promise. For example, curcumin and black pepper (piperine) offered strong cardioprotection in animals. (Indian J Pharmacol, Jan-Feb 2017) Dietary glutamine given to animals decreases cardiac tissue damage and offers protection against the acute cardiotoxic effects of cyclophosphamide. (Nutrition, 2009). Nutrition recommendations include integrating turmeric and black pepper into meals and consuming glutamine-rich foods like chicken and fish, vegetables like beans, beets, cabbage, spinach, carrots, kale, and Brussels sprouts. When it comes to nutritional therapy, a general approach of healthy eating gets you started; however, when you choose a targeted approach based on the type of chemotherapy you are being treated with, as well as the subtype of breast cancer, you can pinpoint the foods to consume and learn which ones to avoid. Food is meant to be enjoyed, and with a targeted plan, you can relax knowing the foods and dietary supplements you choose will provide you with the best healing opportunities. --- Connect with Dr. Kim: Cancer Nutrition IQ FB community at CancerNutritionIQ YouTube Channel, DrKim Cancer Nutrition IQ

If you or someone you know is dealing with ongoing pain or is currently undergoing breast cancer treatment, acupuncture may provide relief. Acupuncture, a drug-free pain management option, helps to control and improve many side effects from chemotherapy, radiation, and surgery. Several studies have shown that acupuncture can help with pain, fatigue, insomnia, neuropathy, and nausea. One of the most significant benefits of acupuncture is that it lasts for months, unlike pain medications, which many patients must take frequently. What is Acupuncture? Acupuncture is a central part of traditional Chinese medicine (TCM), an ancient system of medicine. A fundamental belief in Chinese medicine is that vital energy “qi” (pronounced “chee”) flows through 20 pathways in the body. Therefore, if qi is blocked, the body can’t function at its peak. The goal of acupuncture is to open specific points on these pathways and release blocked qi. The practice of acupuncture uses sterile, hair-thin needles inserted into specific points on the skin, called "acupuncture points," and then gently moved. Researchers theorize that acupuncture stimulates the nervous system to release natural painkillers and immune system cells. They then travel to weakened areas of the body and relieve symptoms. While there is no evidence to show that acupuncture can help treat or cure cancer, multiple studies have confirmed that it provides excellent pain management options. In addition, growing evidence suggests that acupuncture surpassed other pain therapies , such as physical therapy, steroids, and pain medicine traditionally used to ease ongoing muscle and joint pain among cancer survivors. Acupuncture is considered a complementary and alternative medicine (CAM), the term for medical products and practices not included in standard medical care. Other forms of CAM include massage, tai chi, and drinking green tea. Types of Acupuncture A recent study reviewed the effectiveness of two types of acupuncture: Electroacupuncture and Auricular (ear) acupuncture. Electroacupuncture uses tiny, thin needles—about the width of a hair—and a very low-frequency electric current to stimulate points on the body. It is different from other forms of acupuncture that don’t use an electrical current. Electroacupuncture is very customizable to each patient, and the needles are removed after each session. Auricular (ear) acupuncture uses small studs that look like tiny earrings to stimulate up to ten points in a patient’s ear. The points are the same for each person, and the needles stay in the person’s ear for three to four days. The study found that ​both types of acupuncture significantly reduced people’s chronic pain compared to usual care with or without medication; however, ear acupuncture is not as effective as electroacupuncture. In addition, people were better able to tolerate electroacupuncture. Less than one percent of electroacupuncture participants dropped out of treatment because of side effects (most commonly bruising). However, eleven percent of those receiving ear acupuncture dropped out of treatment, primarily due to ear pain. Important Things to Consider Before Trying Acupuncture Check with your doctor to see if acupuncture might be right for you. Although millions of people are treated successfully with acupuncture every year, as with all therapies, acupuncture carries certain risks. Check Certification Acupuncture practitioners must have a certain number of hours of training and should be certified. The American Board of Medical Acupuncture keeps a list of board-certified physicians training in an approved program. In addition, the National Certification Commission of Acupuncture and Oriental Medicine website has a searchable practitioner directory of certified acupuncture practitioners who are not medical doctors. Risk of Lymphedema Patients who have had lymph nodes removed from under the arm should not have needles inserted into that arm. Using acupuncture on that arm carries a risk of lymphedema or swelling caused by excess fluid in the arm. Instead, consider using other treatments on that arm, such as aromatherapy. Risk of Infection It is standard practice to use disposable, single-use, sterile needles and to swab acupuncture areas with alcohol or a similar disinfectant before using needles. Infection is always a risk, but the risk is higher if the acupuncturist does not follow this process. In addition, people with low white blood cell counts are at an increased risk of infection during acupuncture because a low white blood cell count weakens their immune systems. Risk of Bleeding for Certain People Because of the risk of bleeding, people who have bleeding disorders or low white blood cell counts and those who take blood thinners shouldn’t have acupuncture. Risk of Reducing Chemotherapy Effectiveness Due to Herbal Supplements Sometimes acupuncture incorporates the use of herbal supplements. However, do not take herbal supplements while undergoing chemotherapy, as they can reduce the effectiveness of chemotherapy. Resources You Can Count On Dealing with breast cancer and the pain of treatment can be challenging. Your support enables Surviving Breast Cancer to provide a suite of programs and resources and online support groups to ensure that no one is alone.

Most people are aware that some form of movement is beneficial. Whether exercising your muscles or your brain, moving every day can improve your health. It doesn’t need to be strenuous, sweat-inducing, high-impact exercise. Implementing movements like walking, yoga, or cycling can positively impact your overall health. The Body, Mind, Spirit Connection You may be familiar with the body, mind, spirit connection—a whole-person approach. The interconnection suggests how our thoughts, physical selves, and emotions affect one another. The way we look after our physical bodies will determine our emotional well-being and vice versa. The link between mind, body, and spirit isn’t just anecdotal; it’s a scientific fact. Research reveals three separate neural pathway networks, leading to the head, the gut, and the heart . Dubbed the three brains, they are all capable of controlling how we feel and react. If our physical health is sound, but our mental or spiritual well-being is not, the effects will eventually impact our physical health. Similarly, poor physical health affects our satisfaction, contentment, and mental state. The delicate balancing act leads to optimal health. Nourishes Your Mind, Body, and Spirit Some consider movement “free medicine.” Even small doses practiced with consistency can extend longevity and prevent and treat disease. As far back as Hippocrates and Plato, physical activity was viewed as good for health. Over the years, evidence-based studies have confirmed that movement reduces mortality risks and protects us from chronic medical conditions like type 2 diabetes, obesity, dementia, and cancer . One study found that breast cancer survivors benefited from low-impact aquatic exercise, which improved common side effects of breast cancer treatments. Although more research is needed, the study also suggests water exercise may help with lymphedema . Research also shows that your thoughts, feelings, and expectations can positively impact your physical health. For example, if you're sick but have hope and a positive attitude and believe that you'll get better, your brain will likely produce chemicals that boost your body's healing power. While this doesn’t mean that simply being optimistic can cure your body, it can be helpful in some instances. How Movement Helps Protect Against Breast Cancer In addition to the overall health benefits of movement, engaging in exercise can help lower the risk of breast cancer . Although how movement lowers breast cancer risk is not fully understood, researchers believe that physical activity regulates hormones, including estrogen and insulin, which are known to fuel breast cancer growth. Movement Helps the Newly Diagnosed, Patients, & Those Living with Metastatic Disease Virtually any form of exercise, from aerobics to yoga, can relieve stress, so it can be a significant help when a breast cancer diagnosis amplifies your stress levels. Incorporating movement into your life can also affect how well you treat, manage, or cope with your illness. Even if you’re not the athletic type or you’re out of shape, even a small amount of exercise can be a factor for stress management. In addition to increasing your overall health and sense of well-being, exercise also has specific stress-reducing benefits. Increases Your Endorphins Physical activity is an excellent way to foster the production of your brain's feel-good neurotransmitters, called endorphins. Reduces Negative Effects of Stress Exercise can provide stress relief for your body by imitating the effects of stress, such as the flight or fight response, to help your body and its systems practice working together through those effects. It can also help protect your body from harmful effects of stress, including your cardiovascular, digestive, and immune systems. Improves Your Mood Regular exercise can build your self-confidence, improve your mood, and help you relax. Movement can also reduce the symptoms of mild depression and anxiety. In addition, exercise can also improve your sleep. The Benefits of Yoga You don’t have to be a yogi to reap the benefits of a yoga class! Yoga is one example of the positive impact of movement for breast cancer patients and survivors. One study showed that breast cancer patients who practiced yoga reported less fatigue and higher vitality levels three months after treatment had ended. Getting Physical Can Help Prevent Breast Cancer Recurrence There’s also evidence that physical activity might prevent breast cancer recurrence. One report found that women who engaged in regular physical activity before their cancer diagnosis and after treatment were less likely to have their cancer come back (recur) or die than those who were inactive. According to a review published in the Canadian Medical Association Journal, exercise significantly affects survival rates. In addition, the study found that exercise appeared to be far more likely than other lifestyle factors to reduce the risk for breast cancer recurrence and mortality. Another study by the National Cancer Institute concurs that regular exercise may improve survival rates. Getting Started Talk with your oncologist and care team before starting a fitness routine. Then, if you feel well enough to start exercising, and if your oncologist and care team have given their approval, you can work out during treatment. It's important to start slow; try walking, yoga, or stretching before working your way up to a more active routine. You should also listen to your body to determine how much movement is right for you and increase your exercise slowly, especially if you are still in treatment. Get Moving with Surviving Breast Cancer Regular physical activity can help maintain or improve your health during and after treatment. It can: Help you avoid or reduce some side effects of cancer treatment , including fatigue, weight gain, osteoporosis, and lymphedema Prevent or minimize the loss of muscle tone and general fitness during and after treatment Reduce anxiety, stress, and depression to help your mental well-being Surviving Breast Cancer offers free, weekly mind, body, and spirit exploration to help you heal. Join other members of our empowering community for yoga, Pilates, meditation, and more. We’re here for you every step of the way!

When you are diagnosed with breast cancer, you are confronted with many overwhelming choices, often without much time to consider all of your options. One choice is whether or not to have reconstructive breast surgery after a lumpectomy or mastectomy. Each woman’s choice is personal and unique, and should be honored as such. It’s part of your unique and personal story. If you choose not to undergo reconstruction, or have had reconstruction and later decided to have explant surgery and go flat , breast prosthetics can be a great accessory option for you. Of course, remaining flat is always certainly an option too! If you do decide that a breast prosthetic is a good alternative to implants or tissue reconstruction, the goal of breast prosthetics (or breast forms) is to create a natural body silhouette so that you feel balanced, comfortable and confident in your bra and clothing. Why Breast Forms? Wearing the right breast form can make a big difference in how you feel every day. Some women want to minimize the number of surgeries they have; others may not be candidates for reconstruction, based on health factors or treatments. The simplest reason you might choose a breast prosthesis is for your clothes to fit comfortably. They could be just a convenient accessory to wear only when you need them – like with a special-occasion outfit or top. High-quality silicone breast forms like the ones made by our partners at Amoena behave like a real breast, moving naturally when you walk and lie down. In fact, some women find that they feel better physically when they wear prosthetic breasts. Think about your posture and how you might hold your shoulders differently with and without the natural weight of your breasts. A properly-fitting breast form may be something to consider to help with back and neck pain. Breast form features vary; depending on your lifestyle and activities, you might choose: Silicone breast forms with an adhesive back that attaches directly to your chest; Lightweight breast form options A unique swim form for water activities Breast forms with soft gel-back layers to adapt to scars or tissue Volume-adjustable breast forms that can be adjusted (as you go through the reconstruction/expansion process, for example) Temperature-equalizing breast forms that can help prevent perspiration under the form Partial breast shapers that fill in for missing tissue, if you've had a lumpectomy Comfort should be your main consideration, and the broad choice includes special shapes, smart innovations like Amoena's AirChamber technology , and even custom-made breast forms . Finding a breast form that feels comfortable to you is definitely possible, whatever your needs. With the help of a certified fit specialist, you can try on different types to see which ones feel best. Many women say they forget they're wearing it. (Sponsored) How Does a Breast Form Fit? To securely hold a breast prosthesis, there are specially designed bras with hidden pockets in the cups. For many years, these mastectomy bras were medical-looking; you may even have written them off as "grandma bras." Today, our friends at Amoena have us, those diagnosed with breast cancer, in mind, and prosthetic bras are just as beautiful as any other brand. Yet, they have smart features that address particular needs, like: A slightly higher neckline and underarm A wider underbust band for support Soft, padded straps Even if you choose a self-adhesive breast form, we recommend wearing it with a bra for the best support. About six to eight weeks after surgery if your scars have healed, you can have a personal fitting before you purchase a mastectomy prosthesis. I don't need a prosthesis, but I'm a little uneven. What can I do? Breast surgeries can have unpredictable results, whether it's a lumpectomy or a mastectomy with reconstruction. And like natural breasts, reconstructed breasts can have imperfections; the most common of these is size. They aren’t always the same size as a remaining natural breast. Sometimes scar tissue and swelling cause breasts to become misshapen. Years after your initial surgery, you may notice that things have changed on one side or the other. For any of these reasons, or even for natural asymmetry, you might choose to wear a breast shaper, which is a kind of smaller version of a breast prosthesis, to help you feel like yourself again. Breast shapers fit right into your bra; here again, for best results, it's important to wear a bra that fits properly. Amoena makes Balance breast shapers that can be rotated to fit exactly where you need them. They offer shapes that are super thin and create a smooth surface if you have scarring or unevenness. They even have a shaper that can be adjusted with a small air pump, in case you have one bra that fits slightly differently from your others . A shaper is an accessory you can wear whenever you like! (Sponsored) Insurance should cover your breast forms or shapers As you know, health care costs in the U.S. can get complicated. But you should also know that if you have been diagnosed with breast cancer and have a prescription from your doctor, Medicare and private insurance should cover the cost of breast prosthetics, breast shapers, and even prosthetic nipples (yes, really). Where to Find More Information Amoena breast forms are designed for optimum comfort and performance. They’re meant to fit into your life and restore your body confidence. If you have any questions about Amoena prosthetics, you can find Amoena online and contact them directly on Facebook and Instagram, and their website - it has a chat feature if you’d like to reach out. Certified mastectomy fitters have experience with a wide variety of breast prosthetics for cancer patients, and can help you choose which breast form might work best for you. Many of them are breast cancer survivors themselves and wear the products. Allow plenty of time for a breast form fitting, so that you can try all of the options available to you. You can find a fitter near you using this Store Locator: www.amoena.us/stores

Music in its various manifestations has served humanity well throughout many thousands of years. It is believed to have originated during the middle of the Paleolithic Period, dating back 50,000 BP to 12,000 BP. Its evidence is even depicted by dancers in ancient original cave paintings. The rhythm of music is, and has long been, recognized far and wide as a powerful tool for uplifting one’s spirit. It’s quite capable of evoking an emotional response; it may relax or stimulate, and potentially help people heal. Indeed, nowadays it’s believed to improve medical outcomes and quality of life in a variety of ways. With that in mind, Laura and I recently had the distinct pleasure to speak with and record an interview with David Victor, a California-based Classic Rocker, on our podcast, Breast Cancer Conversations . David, a guitarist and lead singer for the band BOSTON, had an intriguing story to tell. For over an hour, he regaled us with his narrative, as well as sang several beautiful songs, including an original composition, all of which he accompanied himself with a lively, acoustic rhythm guitar. His story follows: As a performing member of the platinum-selling band BOSTON back in 2012, David noticed how fans were mesmerized and transported back to their youth. He was intrigued that even hardcore BOSTON fans didn’t seem to care who the on-stage bandmates were; “they only cared that we were reproducing this searing live music that resurfaced old, pleasant memories - which made them feel good”. While on one of the final tours, he was fortunate to have the opportunity to perform a live acoustic music show for some children at Miller Children’s Hospital in Long Beach, California. Even though these youngsters didn’t really know the BOSTON catalog, they nonetheless appreciated the vibe and spirit of the music, and that he was there singing to them. As he met and played for more and more of the kids, David realized that the spirit of music and the feeling it communicated channeled a universal healing power that went straight to their souls. He performed many songs for the children that day, then took special requests, performing for these young patients in their hospital rooms, accompanied by smiling parents. David came away from that visit with a powerful, uplifting, and profoundly meaningful emotional experience: “I very much enjoyed bringing live music to patients and their families in these extremely trying circumstances in an attempt to lift their spirits, ease their burden, and help them understand they were not alone”. When he left the hospital, he had an epiphany. “I felt as if I were on “Cloud 9”, and had a flash of inspiration that I needed to use music to raise the spirits and hopes of the most fragile among us: hospital patients, their families, and loved ones”. Thus, the idea of Harmony & Healing was born. The organizational goal is to get as many live musicians in front of as many hospital and hospice patients as possible, regardless of age, bringing them soothing and heartfelt live music that resonates in their souls, brings them solace, and gives them hope for tomorrow. Website: https://www.harmonyandhealing.org Founded in January 2019, Harmony & Healing is a hospital and healthcare facility music charity, and an IRS-recognized 501(c)(3) charitable organization, founded by San Ramon resident and former classic rock band BOSTON band member, David Victor.

By Nagu Sathappan My name is Nagu Sathappan. I was diagnosed with breast cancer on May 13, 2024. During a routine mammogram screening, a few centimeters of DCIS (ductal carcinoma in situ) , grade 2, were discovered. Following the diagnosis, I had to undergo six cycles of chemotherapy. The first three cycles involved a combination of drugs, while the remaining three were with a more aggressive drug called docetaxel. The side effects included heavy nausea and pain which were severe, and to make things even more challenging, I was living alone—my family is back in India. At the time of my diagnosis , I informed only a couple of people at my office. Later on, I found a few friends who stood by me throughout this journey. I had informed them quite late, but I am immensely grateful for their unwavering support . My job is based at Cambridge, but because of my treatment I am staying in Manchester. And of course 3 days a week, I have to be in the office, which I am unable to do. My workload is being adjusted based upon my hospital appointments. I’m in my early 40s and single . The girls who supported me are all much younger than me. Interestingly, I never worried much about losing my hair or my appearance. Instead, I focused on engaging in meaningful activities. I started exploring arts and crafts , which brought me great joy. I also immersed myself in music and dance—recording my own videos. I was never very active on social media, but my friends created an account for me, and I began sharing my blog posts and poetry there. These creative outlets (diamond art, painting, and knitting) kept me going. During this period, I also attended a job interview and was selected. I’m currently working for my new employer. The journey has had its fair share of ups and downs. I experienced emotional breakdowns, lost a few relationships, and went through deep emotional pain —but I have no regrets. I try to understand others’ perspectives, even when it hurts. I know I’ve paid a heavy price, but this journey has taught me a lot. After completing my six chemotherapy cycles, I underwent a lumpectomy. Unfortunately, the margins weren’t clear. I then had a second surgery—a re-excision—but again, the margins were not clear. My third surgery was a major one: a vertical therapeutic mammoplasty on both breasts. It was then that I received a major surprise—the pathology report revealed that 70% of my right breast was filled with high-grade DCIS. The cancer cells were almost invisible and also I gave only partial response to chemotherapy. Ultimately, I underwent a fourth surgery: a mastectomy with reconstruction. I opted for an ADM (acellular dermal matrix) implant. Now, I’m undergoing 14 more cycles of chemotherapy with Kadcyla, a drug designed to prevent the recurrence of cancer. These cycles will continue for a year. In addition, I’ve started hormone therapy and take tamoxifen tablets daily. It’s been a tough journey, and I’ve been fighting this for about a year now. But I believe I’ll make it through. I hope that by sharing my story, I can inspire and help others going through similar struggles. In photos with Nagu: Juhi Srivastava Read More: Ductal Carcinoma in Situ (“Stage Zero” Breast Cancer): What You Need To Know Supporting Loved Ones with Breast Cancer: How to Offer Meaningful Help Breast Cancer in Young Women: Common Questions Answered Breast Cancer and Mental Health: Recognizing and Addressing Depression and Anxiety On the Podcast: Breast Cancer Conversations Beyond One and Done: The Realities of Surgery and Reconstruction with Veronica Novy Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

Thanks to the dedication and diligence of researchers, there are some impressive developments in finding a cure for breast cancer . Scientists harness genetics, immunotherapy, and other innovative treatments to precisely diagnose and target the disease. As a result, the most recent breakthroughs are helping to shape the way breast cancer is treated. 3-D Mammography Also known as tomosynthesis or “tomo,” 3-D mammography captures X-ray images of breast tissue at multiple angles to create a digital 3-D picture of the breast. The dimensional images created by this new technology allow doctors to examine breast tissue layer-by-layer. Doctors can detect breast abnormalities and tumors earlier with these more precise images. According to one study , this technology can also reduce the number of false alarms that require women to return for additional, unnecessary testing. Tumor Profiling Previously, the two main factors in deciding treatment have been the tumor’s stage and whether it has a significant amount of hormone receptors, determining if specific therapies will be effective. Doctors are now implementing “tumor profiling,” looking for specific genes to help select the most appropriate treatment path. When used in early-stage, hormone-receptor-positive breast cancer patients, looking at the tumor's genetic profile can help predict whether the cancer is likely to recur or metastasize and determine whether to recommend chemotherapy. Tumor profiling, also known as molecular profiling, genomic testing, or biomarker testing, looks for changes (or mutations) to genes. Typically, tumor tissue is extracted during a biopsy or surgery, and then the DNA is removed from the tumor cells. The DNA is then tested or sequenced, allowing the doctors to understand how responsive (or not) a particular treatment may be. Immunotherapy The immune system plays an important role in fighting off disease. Many of our systems’ proteins (also known as checkpoints) ensure that our immune systems do not inadvertently destroy our healthy cells. When cancer lives in the body, the cancer cells exploit the immune checkpoints. Immunotherapy—using the body’s immune system to recognize and kill tumors—has shown great promise for several cancers in recent years. However, experts believed that breast cancer was immunologically silent, or undetectable to the body’s immune system. But some research suggests that immunotherapy could potentially be effective against two less-common aggressive subtypes, HER2-positive and triple-negative breast cancer. There are several immunotherapy options for those diagnosed with breast cancer, depending on their tumor type: Pertuzumab (Perjeta) and Trastuzumab (Herceptin) are monoclonal antibodies that are approved for people with HER2-positive breast cancer. There are also Antibody Drug Conjugates (ADCs) such as Trastuzumab (Kadcyla) and Trastuzumab Deruxtecan (Enhertu) that target the HER2 pathways for people with advanced-stage HER2-positive breast cancer. Similarly, Sacituzumab Govitecan (Trodelvy targets the TROP-2 pathway and is approved for those diagnosed with Triple Negative Breast Cancer (TNBC). MAPK4 Increasing scientific evidence supports the identification of MAPK4 as a potential target for triple-negative breast cancer (TNBC). Researchers at Baylor College of Medicine noticed significant levels of the enzyme MAPK4 present in cancer growth. Investigators believe their findings support further studies evaluating the potential of targeting MAPK4 in TNBC to offer improved treatments. However, the studies produced in their lab among animal models looked promising. Improved HER2+ Metastatic Breast Cancer Survival Rates Researchers have found that adding tucatinib to treatment with trastuzumab and capecitabine provides a lasting overall survival (OS) benefit for patients with previously treated, HER2-positive, metastatic breast cancer (MBC). Trastuzumab, a monoclonal antibody, blocks tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find and kill tumor cells or carry tumor-killing substances to them. Drugs used in chemotherapy, like capecitabine, work in different ways to stop the growth of tumor cells, either by killing the cells or preventing them from dividing. Giving trastuzumab together with capecitabine may kill more tumor cells. Tucatinib is a member of a class of drugs known as tyrosine kinase inhibitors (TKIs). These drugs bind to the part of the HER2 protein inside the cell and prevent it from sending signals that promote cell growth. Other HER2-targeted TKIs include neratinib (Nerlynx) and lapatinib (Tykerb) . In Vitro Diagnostic Testing Many doctors and healthcare physicians rely on various tools to diagnose disease and guide treatment decisions. One of the most common and widely used is in vitro diagnostics (IVDs), which are clinical tests that analyze blood or tissue samples taken from the body. According to the DFA, in vitro diagnostics may be used in precision medicine to identify those diagnosed with breast cancer who are likely to benefit from specific treatments or therapies, including next-generation sequencing tests, which scan a person’s DNA to detect genomic variations. Illumina, Inc. and Agendia N.V.recently announced a partnership to co-develop in vitro diagnostic tests for oncology testing. With next-generation sequencing , they aim to develop new tests to enhance the care and management of breast cancer patients, using the Illumina MiSeq™ Dx sequencing platform to expand the range of gene panels available for solid tumor analysis. Liquid Biopsy Testing Liquid biopsies are blood-based tests that look at circulating biomarkers or indicators in a laboratory test of features to determine what might be happening with cancer. In 2013, the U.S. Food and Drug Administration (FDA) approved the first liquid biopsy test, the CellSearch® CTC enumeration platform, to monitor patients with advanced metastatic breast, colon, and prostate cancers based on the cancers’ level of circulating tumor cells. Since then, additional liquid biopsy tests have received FDA approval. Examples of liquid biopsies include circulating tumor DNA and DNA fragments shed by primary or metastatic tumors into the blood circulation. Another example of a liquid biopsy would be circulating tumor cells, whole cells shed by tumors into the circulatory system. Other examples of liquid biopsies are more exploratory. Liquid biopsy tests provide a quick and non-invasive way to analyze tumors using biomarkers circulating in the blood. The process has been refined using next-generation sequencing to target many cancer-related genes in advanced cancer. As a result, these tests have increased their range of clinical applications in cancer treatment, including monitoring cancer growth, detecting genetic mutations, identifying signs of relapse, and predicting sensitivity to immunotherapy. Precision Medicine Precision medicine has transformed cancer therapy from a one-size-fits-all approach to customized treatment. For example, precision medicine for breast cancer is an approach to diagnosis, treatment, and prevention that considers the genes you're born with (your genetic makeup) and the genes or other markers present within the cancer cells. With this approach, your blood or tumor tissue is collected for analysis, often genetic. For example, with the knowledge that biological changes within DNA, RNA, and proteins—the underlying cause of cancer—vary widely across patient populations, precision medicine provides personalized solutions for each patient. Count On Us for the Tools and Support You Need Whether you’re newly diagnosed with breast cancer , are navigating survivorship, or are the loved one of someone experiencing breast cancer, you can count on Surviving Breast Cancer to keep you informed. We also provide educational information to help you better understand symptoms, testing, treatment options , surgery, etc., and podcasts that feature professionals, advocates, and caregivers who share valuable information. Our global online community not only offers opportunities to connect with others for safe, judgment-free, peer-to-peer support but also ensures that you’re never alone. We also offer healing workshops and mindful movement classes , and you can join any of our groups or get matched with a mentor .

Spirituality and Breast Cancer Thankfully, scientists have made many advances in breast cancer treatments. However, receiving a breast cancer diagnosis can still be devastating and terrifying. The immediate focus is on your medical treatment plan , but it usually doesn’t include any aspects addressing your mind, spirit, and soul. Integrating spirituality into your treatment plan can offer many benefits during your treatment. Defining Spirituality The word ​​spirituality is derived from the Latin spiritus, meaning breath. It’s the relationship you have with a force or power beyond yourself. That force could be God, or a life force, or an essence surrounding us all. Others might draw spiritual inspiration from philosophy or the arts. Spirituality differs from religion. It is the expression or experience of the sacred, the individual search for meaning, or a power greater than one’s existence. Religion is based on an organized system or group of practices and beliefs. Some people belong to a religious institution, while others can be spiritual but not religious. Religion and spirituality are similar in that they both have values and practices that help guide you through life. The main difference between spirituality and religion is that religion is a faith or belief system held by a community. Thus, religion is experienced as part of a group, whereas spirituality is more personal. Some people express their spirituality through religion. Cultural traditions, religious beliefs, and upbringing can impact spirituality. For example, some people may find comfort in childhood traditions while others may search for new ones. The Benefits of Spirituality How spirituality and health are related is not fully understood; however, research suggests that spirituality can help patients develop and maintain a positive attitude that helps them feel better and improves their well-being. Physical Well-Being Recent studies have shown that cancer patients who reported integrating spirituality and religion into their lives also reported better physical health and fewer physical symptoms of cancer. Mental Health Other studies reported that cancer patients with emotional aspects of religion and spirituality exhibited positive mental health . In other words, these patients had less anxiety, depression, or distress. Positive thinking can have a tremendous impact on everything from preventing illness to your healing capacity. How Spirituality Can Help You During Treatment Spirituality can be a significant resource for patients to help them cope with fear and anxiety during the various stages of the cancer journey. Those spiritual moments when you feel connected to a deeper meaning or reality, such as when you feel close to nature, speak with a loved one, or sense a greater power, can be extremely powerful and healing. A breast cancer diagnosis can leave you feeling many emotions. You may be scared, anxious, hopeless, lonely, and angry. It may force you to contemplate your mortality, which can be heavy at any age. It’s not unusual for your mind to be swimming with questions. You wonder what the outcome will be and why this is happening to you. Some people may find their beliefs and hopes for the future challenged. Others may feel anger toward God or a higher power and experience a loss of faith. Finally, those without a strong support system might feel alone. For some people, this is where the benefit of spirituality can make a difference. Research has shown that spirituality can offer many benefits to patients from diagnosis to survivorship . Spirituality can help you cope and decrease fear, anger, anxiety, and depression. It can also increase feelings of hope, optimism, and peace. Integrating spirituality into traditional and complementary treatment has also been shown to improve feelings of well-being and empowerment, which can benefit your treatment. Podcast #103. Yoga For Breast Cancer - It's More Than A Pose Integrating Spirituality Into Your Treatment Plan There are multiple ways to incorporate spiritual practices or rituals to help you cope with breast cancer. Spiritual exercises can be as simple as concentrating on gratitude or keeping a gratitude journal, listening to music , practicing mindfulness , or prayer . You can also find spirituality through guided imagery, yoga, pilates, or Tai Chi classes. Another option may be working with a Reiki energy healer. Tips for Strengthening Your Spirit There are many ways to focus on your spirituality, such as: Meditate or pray regularly. Meditating or praying can help you remain calm and hopeful during challenging times. Reflect quietly in nature: Take in the natural beauty around you, breathe and reflect on your inner peace. Seeing untouched nature can fill you with a sense of wonderment and harmony. Read spiritual writings. Sacred texts such as the Bhagavad Gita provide information about ancient wisdom traditions. Reading these materials may help you feel a sense of connection with more divine reality. Reach out to others for help. Speaking to someone about your feelings, fears, thoughts, and concerns can help you feel a sense of peace. You may consider speaking with a counselor, clergy or joining a support group. Visit spiritual places and works of art. Visiting spiritual sites, places of historical significance, and places with art and sculpture may help you appreciate beauty. Ask someone else to pray for you. Having someone who cares deeply about your well-being can help eliminate your feeling of loneliness. Repeat a passage from a vital spiritual or religious text. The act of repeating important text as if it were a mantra, using the language of your religion in your prayers, can have a calming effect. Count on Surviving Breast Cancer In addition to keeping you up-to-date on the most recent medical information, we offer multiple programs, including a few designed to help connect you with your spirituality. For example, Movement Mondays offer free, online classes including yoga, pilates, meditation, etc. Also, Healing Through The Arts is a free, online program to generate your creative side as a way to connect with your spirituality. You are always welcome to become part of our empowering community, including our weekly meetups . We’re always here for you!

By Hanah Kurosawa This is my first blog in my social outreach campaign focusing on racial disparities in breast cancer rates among Asian American women. I would like to start with a quick introduction. My name is Hanah Kurosawa and I am a senior at the University of Michigan studying biochemistry with a minor in the sociology of health and medicine. Outside of school, I am a volunteer tutor for The Education Project and an undergraduate research assistant at the University of Michigan School of Dentistry. I am passionate about medicine and am aspiring to become a future health practitioner. I am also very interested in the sociological aspect of health and well-being in the United States and globally. There are several disparities in the medical field in the United States today. Those disparities can be rooted in race, socioeconomic status, sexuality, and many other factors. Sociological factors play an instrumental role in determining a person’s access to healthcare, the quality of care they receive, and ultimately their well-being. One striking example of such disparity that I am focusing on in this blog is breast cancer rates among Asian-American women. What the Data Suggests About Breast Cancer in Asian-American Women As reported by Grace Hwang Lynch in her NBC News article , the steady increase over the past two decades in breast cancer rates among Asian-American women greatly contrast the stabilized rates in other racial groups. The article also mentions findings from research done at the Cancer Prevention Institute of California (CPIC) on breast cancer trends among women in the San Francisco Bay Area from seven different Asian-American groups from 1998 to 2013, that the groups that showed the most dramatic increases in breast cancer rates included South Asian (Indian and Pakistani), Vietnamese, and Southeast Asian (Cambodian, Laotians, Hmong, and Thai). Additionally, CPIC also reported that women of Filipino, Korean, and South Asian descent tend to be diagnosed with breast cancer at more advanced stages. Finally, the news article also highlights CPIC’s findings that Asian-American women may be prone to a more aggressive subtype of breast cancer, the HER2-Neu protein, than other racial groups. What Causes Asian-American Women to be Diagnosed Later? Factors that could be influential in these trends are lifestyle changes associated with immigration, the baseless belief prevalent among health practitioners that Asian women are less likely to get breast cancer, and the burden of daily physical needs that are experienced more among Asian-American and Pacific Islander women than the general population. In addition, both the NBC News article and Cancer Support Community blog written by Jenny Park mention that the stigma around the discussion about breast cancer remains very prevalent in the Asian-American community; women find difficulty in talking about it and consequently do not receive the support that they need. Park’s blog also mentions results from research done by the Asian-American Health Initiative that found cancer to be the leading cause of death only among the Asian-American population, which correlates with also having the lowest rate of breast cancer screenings and late diagnoses. As an Asian-American woman myself, I have seen and experienced the cultural differences in how health is perceived and discussed. Without addressing the misconceptions and barriers that arise from the differences in culture, the disparity in breast cancer rates among Asian-American women will only become exacerbated. Educating women who do not realize the cultural misconceptions or the resources accessible to them is a step in the right direction towards dismantling the health disparity.

By Alexis Puthussery Rural Americans make up about 15% of the population, and according to the US census, rural healthcare disparities continue to increase for this population every year. In terms of cancer, the CDC states that cancer deaths for metropolitan communities decrease by about 1.6% every year, while for rural communities, the decrease is only 1%. While in terms of percentage, this difference may not seem significant, the difference accumulates every year and continues to worsen the current situation for rural citizens. Rural and urban areas share three common types of cancer: breast, colorectal, and lung. Urban areas experience higher incident rates of breast cancer, while rural areas experience higher rates of colorectal and lung cancers. However, in all these cancers, rural areas experience higher overall mortality. For breast cancer in particular, the importance of regular mammograms and screenings are vital to detecting cancer early and facing better odds and survival rates. A study conducted in midwestern America in 2020 found that Americans in rural areas experience lower rates of breast cancer screening and higher rates of late-stage breast cancer diagnoses than their more urban counterparts. The disparity between rural and urban Americans is not only found in cancer in general, but specifically in breast cancer as well. The Rural Screening Gap Much of the disparity is known, so how do we start to tackle the problem and work towards improving it? An ideal first step for rural communities would be to focus on breast cancer screening disparities. A greater emphasis on rural healthcare funding, such as testing and primary care centers in these locations should be put on state government agendas. Additionally, studies have found that healthcare professionals are less likely to move to rural areas, so special incentives or benefits could be put in place for healthcare providers who decide to move to rural America. The lack of physicians in rural areas affects much more than the screening aspect of breast cancer. When diagnosed, having to travel hours for treatment is a significant impediment and contributes to the many barriers to healthcare within rural areas. Joy Anderson , a healthcare worker from Fossil, Oregon, stated that people in her town have to travel 70 miles to see the nearest physician. The effect this has on chemotherapy and/or radiation treatments, which have to be administered weekly, if not daily, is not hard to imagine. Programs like the California Oregon Medical Partnership to Address Disparities in Rural Education (COMPADRE) focus on placing doctors in rural areas and unrepresented areas should be supported, promoted, and funded. Another factor many rural patients experience is “breast cancer neglect.” Jennifer Lycette, M.D. has conducted research on this experience within rural areas and has found that these populations are more likely to delay, put off, or simply refuse breast cancer screenings. In one article, she describes her experience with a woman who had been neglecting a massive tumor for what Dr. Lycette believed for months or years. This woman also had bipolar disorder and was unable to receive mental health treatment. This contributed to her breast cancer neglect and eventually led to her death at 50 years old. Dr. Lycette’s work and findings show the multiple, confounding factors that contribute to rural breast cancer health disparities. Neglect of mental health and lack of mental health resources, lack of healthcare education and access, and a general distrust of physicians stemming from a lack of access saturate Dr. Lycette’s research, but also reveal possible avenues to improve the rural health disparities. How Can Breast Cancer Screening Awareness Improve in Rural Areas? Studies have found that mental health prevalence is the same in both urban and rural areas, but accessibility, affordability, availability, and acceptability all pose barriers for rural areas, causing many people to go untreated. With primary care doctors and oncologists, centralizing more mental health professionals in rural areas would greatly improve the treatment of cancer. Promotion of mental healthcare in rural communities would not only help patients cope better with breast cancer once they are diagnosed, but help their loved ones cope and function as better caregivers as well. At the root of many stories like Dr. Lycette’s is a distrust of the healthcare system. Groups who have been systematically mistreated in the past by American healthcare, such as rural Americans, low-income Americans, and black Americans have grown weary of the field as a whole and not without reason. This was made extremely apparent during the pandemic and vaccine rollout. Trust needs to be rebuilt between the healthcare system and these groups. This can be done with effective outreach programs and on-the-ground healthcare intervention where rural citizens receive the same level of attention and care as those in urban areas. Additionally, to get to the root of the problem, medical and healthcare students should be taught about these disparities during their schooling, so that they are more responsible as providers to these populations. Finally, the best way to help rural communities struggling with healthcare disparities is to just ask them what they need. Matthew Gavidia for an article in the American Journal of Managed Care pointed out that the best people who know what a town or city needs are the inhabitants of said city or town. Therefore, personalized programs should be implemented, where immediate, specific needs of communities are the top priority. A More Accessible Screening Future There is more that can be and must be done in terms of fighting for more government funding for rural medical centers and promoting mental health within their communities and more rural physicians. While important, these are things that will take months or even years to see substantial effects. For those who need immediate solutions, the answer for what to do when diagnosed with breast cancer is not so simple. One helpful resource is the CDC’s National Comprehensive Cancer Control Program (NCCCP). The NCCCP provides cancer plans for every state on their website at They provide prevention measures and aid in treatment, all of which can be found on their website. Another resource for those in rural areas is the Rural Cancer Control portion of the National Cancer Institute’s website found here . This provides rural patients with possible treatment centers in their area. Rural citizens face healthcare disparities on all fronts, and so when treating a disease as devastating as cancer, it is vital to improve access to healthcare, information, and education. Online resources are the best option for many rural citizens, but what will truly help is systematic change. Continuing to vote for and promote programs and laws at the state level that will benefit breast cancer patients is how everyone can contribute to closing the enormous disparity rural citizens face.

Dear Kristen, I’m planning to beat this disease, but I am aware of my mortality like never before. Do you have any ideas for things I could leave for my children and grandchildren that tell them about me and how much I love them? * * * Dear Reader, I relate to both your plans to live a long life and your desire to leave a legacy for the ones you love. Because I’m living with metastatic breast cancer, I’ve done a few things along these lines and I am happy to share them, plus give you (and others) some ideas I’ve read about. I’ll start with the easiest and work my way up to more complex projects. Letters Keep it simple and write a letter with your best pieces of advice, favorite quotes, top values, wishes for their future, and a whole lotta love. It could be designed for them to read anytime, or on their 18th birthday, graduation day, wedding day – your choice. Use your own handwriting! It’s so personal. No one will care whether it’s messy, they’ll just love seeing your personality come through on the page. Guided Memory Books You may have seen these at bookstores everywhere; here’s a link to one called “Tell Me Your Story, Mom,” on Amazon that has hundreds of great reviews. I’ve seen nice ones at Barnes & Noble and our local independent bookstore as well. These are nice because they guide your thoughts and give you inspiration. My son gave me a book a few years ago called “300 writing prompts” and I’m about halfway through it. It’s longer than most guided journals, but I’m giving it my best shot! “Mom Cards” Here’s something I made for my kids, who are 26 and 23 this year. I bought a blank card deck, also available from amazon, and wrote one piece of advice on each card. I made these over the course of a year or so, adding thoughts as they came to me or when I read something and thought it would make a great addition. I kept my ideas in a document on my computer and then made the cards one afternoon. Here’s a link to my document if you’d like to borrow any thoughts. Photo Albums / Scrapbooks At the more complex end of the spectrum are photo albums combined with handwritten memories. Last year, I finally made baby albums for my son and daughter; they had been on my to-do list for 20 years so it felt really good to get them done. You could also make “you albums,” which I did when they were children. I gathered photos that spoke to who they were as individuals, like being silly, creative, loving, and curious. You might make a “day in the life of” family album, showing the normal, simple, – or crazy – life you lead together. Stuffed Animals If you want to have something special made that will be loved for years to come, I really love these Memory Bears that can be made from a piece of clothing or fabric. Not only are they highly customizable, but they're a sweet way to repurpose an article of clothing, resulting in a beautiful and meaningful legacy item. * * * Whatever you make, it will be cherished, even if your children receive it when you fall off your bike at age 95 and decide it’s time to pass it along. xo Kristen Additional Resources: Breast Cancer Conversations Podcast episode 123: Creative Projects for Leaving a Legacy Metastatic Breast Cancer Meet-up With Thursday Night Thrivers

By Alexis Puthussery What is a caregiver? The American Cancer Society defines caregiver as “the person who most often helps the patient and is not paid to do so.” Like the patient, caregivers undergo stress and anxiety, although they may not always show it. It is thus important to pay attention to the mental health and well-being of caregivers as they truly are the unsung heroes. One must recognize that a cancer diagnosis takes a toll on the person diagnosed and all of those around them. Parents, siblings, friends, and other loved ones quickly fall into the caregiver role and are thrown into the intensity of a cancer diagnosis. Caregivers, more than anyone, assume some of this burden because of the love they have for the patient. Taking care of oneself as a caregiver should always be a priority, especially when you have decided to give so much of yourself to someone else. It is also important to emphasize that valuing a caregiver’s experience does not devalue or decenter the patient’s experience. This is an issue that may prevent many caregivers from seeking help when they need it. When one decides to become a caregiver (or sometimes by default become the caregiver) they willingly accept the mental and physical stress that comes with it. Studies have shown that caregivers experience significantly higher levels of anxiety and depression. This can lead to symptoms such as: Difficulty sleeping Higher irritability Becoming easily fatigued Other issues that may affect the caregiver’s daily life, and also the quality of care they can give to their loved one with cancer Additionally, studies have found that caregivers may suffer PTSD after a loved one has been diagnosed with cancer. Thus paying extra attention to oneself, as a caregiver, is important to maintaining mental and physical wellness. a strong support system is recommended for the caregiver as well, though it does not necessarily need to take on the traditional forms such as support groups or therapy. 5 Ideas to Maintain Mental Health & Well-Being as a Caregiver Carve out time for yourself each day, even if it is just 15 minutes, find time for YOU. While caregiving brings on new roles and responsibilities, do not cut yourself off from the activities you enjoy doing. If you are part of a sports league, church group, or a local society, keep participating as you will find that this brings a level of normality in a time when taking control of cancer seems impossible. Get exercise! Exercise is a great stress reliever. Try and find 30 minutes a day for a walk with a friend, pick up a tennis racket, or throw some weights around. Keeping physically active will help you fight off fatigue and help you sleep better! Develop a “code word.” It is natural that cancer is stress-reducing and even though you and the person diagnosed have the best intentions, it’s normal for emotions to run high. If you notice that communication is starting to break down, use your “code word” as a single that you need to take a time-out and break. This strategy will immediately defuse the situation and give you and your loved one an opportunity to reset. You are going to be busy, there is no doubt about that. But preparedness is key. Find a good friend or colleague and ask them to call you once or twice a week to check in on you. Have that person set a reminder in their phone so they don’t forget! When they call, this is a time to talk about YOU, not updates on how your loved one is doing or when the next doctor’s appointment is. This is your opportunity to take your mind off of cancer and just chat! When reflecting on their time as caregivers, many wished they had asked for help from their friends and families sooner rather than later “Help” can take on many forms and is unique to the individual. For example: Ask a neighbor if they wouldn’t mind coming over to help with daily chores like doing the dishes, cleaning the house, or doing the laundry. Ask friends to help with picking up or dropping off the kids from school and after-school activities. It seems like everyone these days brings food over or orders food online. If people are offering to help with meals, be sure you inform them of your food preferences and any allergies in advance! Taking care of oneself as the caregiver is not only important during the initial trauma of learning a loved one has been diagnosed, but also for the months and years to come. It is common for stress and anxiety to bubble up during times leading up to doctor visits, scans and medical appointments. Just as caregivers want to be there for the person with cancer, those close to the caregivers want to do the same for them. In order to face cancer, a strong community is necessary, and this extends to the community of caregivers as well. If you are caring for a loved one with cancer, what type of resources would be most helpful for you? Let us know so we can fill the gap in this important area of programming and services at SurvivingBreastCancer.org . Email info@survivingbreastcancer.org with your ideas!

A breast cancer diagnosis can send you into a tailspin. The official pronouncement can stir emotions whether you’re newly diagnosed , face a reoccurrence, or experiencing progression. A breast cancer diagnosis can leave some people feeling shocked, numb, and asking themselves, “How could this happen to me? I was doing everything ‘right.’” Others may feel frightened in a stressful time of uncertainty, while some kick it into high gear and fierce planning mode, trying to control what is in their power. Hopefully, knowing that your emotional reactions are natural can be reassuring. The reality is that breast cancer and its treatment can be unpleasant and frightening, so, understandably, you experience a range of emotions. In addition, you may feel uncertain about the future and worry about balancing work, finances, family, etc.— all of which can contribute to building stress and be traumatic. Each person reacts to breast cancer differently, and it is possible to feel many different emotions simultaneously. There’s no right or wrong way to respond to a life-changing diagnosis, just as there’s no single way to deal with the feelings that come about due to a diagnosis. Everyone is unique, and you have permission to deal with your emotions in the best way that works for you. Although there’s no easy solution, it may be reassuring to understand the emotional impact and seek support as you navigate this challenging time. Emotional Stages of a Breast Cancer Diagnosis The feelings generated by a breast cancer diagnosis are sometimes compared to the five stages of grief identified by psychiatrist Elisabeth Kübler-Ross in 1969—denial, anger, bargaining, sadness and depression, and acceptance. In many ways, it is much like mourning your pre-diagnosis life. However, while the framework included in this model is familiar to many people, it isn’t necessarily how everyone will process their diagnosis. Although the stages of grief are sometimes numbered sequentially, people don’t necessarily experience them in that order or for a specific time. You may feel all or some of these emotions or other emotions not referenced here. 1. Denial When faced with overwhelming news, people sometimes go into denial. The shock can make you feel numb or stunned, leading to an initial feeling of disbelief. Denial is a subconscious natural coping mechanism that protects us from becoming too overwhelmed. It allows us to process the news in more manageable pieces. 2. Anger Receiving a breast cancer diagnosis can trigger anger in some people. For example, you may feel angry because you feel out of control, feel life as you know it is changing, or if your family and friends don’t react to the news the way you expect. 3. Bargaining Although nothing could prepare you for getting a breast cancer diagnosis, many people respond by thinking, “what if.” If only you had found the tumor earlier or somehow prevented your cancer. Your mind focuses on those scenarios in an attempt to gain control. Unfortunately, bargaining can sometimes lead to blaming yourself for your cancer, but being diagnosed with breast cancer is not your fault. 4. Sadness and Depression It’s completely natural that learning you have breast cancer would cause you to feel sad or have symptoms of depression. Depression can manifest in several ways, including a lack of motivation and interest, sleeping issues, or a lack of appetite. 5. Acceptance Coming to terms with your new reality can be challenging but can lead to hope and feeling empowered. However, it doesn’t necessarily mean that you won’t continue to struggle with other feelings such as fear, anger, or sadness. Acceptance may help you make decisions about your future and experience inner strength. Navigating and Managing Your Emotions When diagnosed with breast cancer, you have to sort through the overwhelming volumes of information to make informed decisions about your treatment plan. Dealing with the roller coaster of emotions and the unknown can significantly increase your stress level and interfere with your ability to make informed decisions about your health. However, managing the emotional stages of your diagnosis is essential because it will put you in a better position to understand your treatment options and handle the treatment demands. It’s essential to alert your healthcare team about the emotions you’re experiencing so they can connect you with resources to help support you. Anger and depression, for example, can have severe consequences if left untreated. “Everyone has an opinion but what it is that I should do. However, at the end of the day, the choice was mine. They were my decisions and decisions I had to live with. For me, this gave me peace and control. As long as I could wake up every day and honestly look at myself in the mirror knowing that I made the best decision for ME, then I was content. This mindset also allowed me to alleviate a lot of the stress around me too!” –Laura Carfang Surviving Breast Cancer also offers multiple resources about financial support, including financial management guides, podcasts, and webinars to provide you with information and lessen your anxiety. In addition, our global online community offers opportunities to connect with others for safe, judgment-free, peer-to-peer support to ensure that you’re never alone. We also offer healing workshops and mindful movement classes , and you can join any of our groups or get matched with a mentor . Count On Us A breast cancer diagnosis can upend your life. It may sometimes feel like your head is spinning between dealing with your emotions, searching for information, finding the right doctor, and taking care of yourself. But, we are here for you from day one, with resources, a caring online community, and anything else to give you strength and hope. Whether you make a cash donation , host a fundraiser , or volunteer , your support enables us to make those resources available to as many people as possible.

Dear Kristen, My teenage daughter doesn’t want to hear anything about my cancer; it upsets her and she prefers to pretend I’m fine. She actually gets angry when it comes up or if I mention being tired, my hair falling out, etc. It’s strange not to talk about something that’s so big in my life, and I’m tired of pretending there’s nothing wrong just to appease her. Also, it would feel good to get even a little bit of sympathy or empathy from her. Any suggestions? Dear Reader, It sounds to me like both you and your daughter have emotional needs that might be met if you can have some loving but difficult conversations. The root of anger is fear, so, probably, underneath your daughter’s behavior lies her fear of losing you. And you probably have a desire to be seen and loved and supported through these difficult times. Your needs and hers are so natural. I wrote a book about how to navigate challenging topics with people you care about and will offer some suggestions on how you and your daughter might do this. This process can work really well if both people can “stick to the script,” which is designed to keep emotions in check while allowing you to say how you truly feel. The acronym for the six-step process is ISPEAQ (like “I speak”). I’ve attached a fill-in-the-blank template so you can plan out what you want to say beforehand. By thinking it through before you talk, you’ll improve your chances of a positive outcome. I is for Intentions and “I” language First things first; you want to know exactly what your intention is for the conversation. Make it positive, like having more open and empathetic communication with your daughter. When you get to the point of talking, stay away from using the word “you” as much as possible because it can put the other person on the defensive. S is for Suitable Setting Choose a calm time and place to talk, ideally somewhere you won’t be interrupted by cell phones, people, or other distractions. P is for Positive Preface The first thing you want to say is something positive that will resonate with the other person and show them that your intentions are good and loving; that you see the good in them. You might say to your daughter, for instance, “I admire the way you seem able to handle my illness without getting overwhelmed.” If that doesn’t feel 100% genuine, find something that does. She’ll know if you’re faking it. E is for Explicit Example Next, refer to a specific incident that upset you. Avoid the tendency to generalize, which can easily deteriorate into her saying,” that is not what happened,” and pitting you two against each other. A specific example might be, “When you got up and left the table when I was talking about the treatment I had today;” if she did that, she can’t argue about the facts. A is for Adversely Affected Next, say how the explicit example made you feel. So, “When you got up and left the table when I was talking about the treatment I had today, I felt sad and ignored and unheard.” (Note this is all done in “I” language. No one can argue that your feelings are not valid — they are.) Q is for what you reQuire going forward and whether the other person has Questions This is where you say what change you’d like to see and then invites the other person into the conversation. Ideally, they will also have worked through the ISPEAQ template and be prepared to calmly tell you what they saw happen, how it made them feel, and what they need going forward. ~ ~ ~ Yes, this might feel a bit scripted, but that can help us keep our difficult conversations on track instead of being derailed with emotional tangents and becoming heated in the moment. ISPEAQ is based on deep theory in non-violent communications and mediation techniques and has worked wonders with many people in families and in professional settings. It truly does give you a better chance to get close to the people you care about, even when a difficult subject matter arises. Kristen xo Additional Resources

By Kelley King Hello, my name is Kelley, and I am a 65-year-old MALE breast cancer survivor. Less than two years ago, I was diagnosed with stage 2 breast cancer. The discovery was completely unexpected . I had no symptoms and felt great. My diagnosis came through a groundbreaking DNA blood test called the Galleri test (offered to me through a wellness program with my life insurance company). Although not yet FDA-approved, the test flagged something my doctors would have otherwise missed. I truly believe it saved my life. My treatment journey included 18 weeks of chemotherapy, surgery , and 25 rounds of radiation at the Stephanie Spielman Comprehensive Breast Cancer Center. Like many in breast cancer treatment, I faced challenges along the way: stomach issues during chemo, low blood counts that required hospital stays, and significant weight loss (though most of it has returned). My biggest lingering issue is neuropathy in my feet. I’ve also struggled with medications, like tamoxifen. It felt like someone was taking over my brain and my body. I know that’s a risk, but I’m trying to balance quality of life with ongoing care . Being a man with breast cancer  has made this journey unique at times. More than once, a nurse in the lobby asked if I was waiting for my wife thinking she was the “Kelley.” I often had to explain that I was the patient . But in most ways, my experience is not so different from many others—the shock of diagnosis, the battles of treatment, and the determination to move forward. I don’t know exactly where this road will take me, but I’m deeply grateful to be here—to share, to learn, and to walk alongside all of you. Thank you for letting me be part of this community. Read More: Men: Know Your Breast Cancer Risk 10 Myths & Facts About Male Breast Cancer Male Breast Reconstruction: Fixed or Flat? Resources for Male Breast Cancer Patients Genderless Breast Cancer Research The Stigma Surrounding Male Breast Cancer On the Podcast: Breast Cancer Conversations God Had Other Plans For Me | With 3x Male Breast Cancer Survivor, Vance Stacks Share your story, poetry, or art: https://www.survivingbreastcancer.org/submit-breast-cancer-story SurvivingBreastCancer.org Resources & Support: Podcast Weekly Meetup s Free Events

Lymphedema , or the buildup of lymph fluid within your lymphatic system, is a potential side effect of cancer treatments. It often occurs in the arms, chest, or back, and those undergoing breast cancer treatments are often at a higher risk because of lymph node biopsy/dissection or breast, chest, or underarm radiation affecting the lymphatic system. (Listen Now) Lymphedema may present with cumbersome side effects, including swelling, pain, and heaviness in the affected area. Because of this, it is important to find a treatment plan that works to minimize your symptoms. Healthcare providers advise lymphatic drainage massages and compression sleeves, devices, or bandages as non-surgical treatments and can refer patients to physical therapists who are specifically trained in these techniques. Additionally, there are a few surgical treatments that may be worth considering if your lymphedema is significantly affecting your daily activities. There are 5 main surgical techniques that healthcare providers may use to reduce or eliminate lymphedema: 1. Liposuction Liposuction traditionally removes excess fat tissue from the body. However, in some patients, the excess lymph fluid can stimulate inflammation in the affected body part, leading to abnormal fat buildup, which then needs to be removed. Depending on the location of your lymphedema, liposuction can be an outpatient procedure, but usually requires about a week of recovery time. You will then be followed for an additional six months to ensure post-operative success, and are advised to wear compression garments during your recovery. This surgery is ideal for people who have not responded well to any other kind of treatment. For those suffering with late-stage, non-pitting lymphedema (lymphedema where, if you press on the area, no indent is left), liposuction can result in a near-complete reduction of swelling. However, if you have a type of lymphedema known as “pitting edema”, where there is still lymph fluid in the affected area (if you press on the area, an indent is left), this type of intervention is not recommended as it removes fat, not lymph fluid. Additionally, liposuction is not recommended for those actively undergoing cancer treatments or for those with metastatic cancers. 2. Lymphaticovenous Anastomosis/ Lymphovenous Bypass LVA or LVB uses microsurgical techniques to reroute your lymphatic system around the blocked area and connect your lymphatic system directly to your blood circulation. Your surgeon will identify the affected lymphatic channels using infrared dyes and an infrared camera. They will then identify the best vein to connect your lymphatic vessels to in order to restore proper flow to the area, and connect the two via an anastomosis , or vessel attachment surgery. LVA/LVB is a minimally invasive, outpatient procedure, and most people are discharged the same day they have their surgery. Typically, your surgeon will recommend that you do not use compression garments for about a month after the surgery, to allow the attached vessels to heal properly. Many patients experience a noticeable improvement in their symptoms, but this surgery does not cure the main lymphatic blockage; instead bypasses it. As a result, it may take up to a year for some patients to have results, while there may be no change in symptoms for a small number of people. If you want to learn more about this procedure, Mayo Clinic has produced an informational video that explains the details of the procedure with a visual explanation. 3. Vascularized Lymph Node Transfer Surgery/ Lymphovenous Transplant VLNT is a more invasive surgery, where your surgeon takes a group of lymph nodes from a part of your body not experiencing lymphedema, and transplants them to the area with lymphedema, rewiring the lymphatic system in that area to reestablish lymphatic flow. The extent of surgery and recovery time, as well as the outcomes/potential complications of the surgery, depend on where the source lymph nodes are harvested from. Your surgeon may choose to take lymph nodes from one of a few sites , including the groin, supraclavicular flap, the submental lymph node flap, the thoracic flap, and the jejunal mesenteric node. Healthcare providers need to be cautious about the area they take from, as removing lymph nodes from one area of the body can occasionally result in new lymphedema at that site. While there are pros and cons to each donor site, your surgeon will work with you to pick the best site for you. Since the procedure is more involved, VLNT recovery is typically done for a few days in the hospital, then a week or two at home. You’ll likely have to manage drainage tubes as well as be careful about moving or using the affected area until you’ve recovered. While VLNT is more of a treatment for lymphedema than LVA/LBA is, there are still some people who do not respond to treatment. However, most people typically see results between six weeks to two years post-procedure. 4. Laparoscopic Omental Lymph Node Transfer An omental transfer, sometimes known as VOLT, combines aspects of both the LVA/LBA and the VLNT to treat lymphedema. Surgeons take a sheet of fat in the abdomen known as the omentum and transplant it into the affected area, improving lymph circulation. The procedure can even be minimally invasive, with some hospitals, such as Mayo Clinic, opting to do the procedure assisted by a surgical robot (although this has not been formally approved by the FDA). Similarly to VLNT, VOLT recovery and outcomes vary from person to person. Some experience symptom reduction right away, while others, unfortunately, do not notice any improvement. The procedure is fairly new, but so far, it seems to work for the majority of patients studied. However, because it is a newer technique, more research needs to be done on determining who would benefit the most from it. 5. Charles Procedure The Charles procedure is the oldest surgical treatment for lymphedema, and it is also the one with the highest rate of complications. Because of this, and the fact that there are newer, better surgical interventions, it’s rarely performed. However, in some cases , the Charles procedure can help improve severe cases of lymphedema. The surgery is done by first cutting out the affected tissue, then using parts of the removed skin to act as a graft and seal the wound created. It is invasive and requires extensive recovery (about a month in the hospital) and monitoring to make sure the graft heals properly . The Charles procedure should only be considered if your lymphedema is severe enough that you are unable to use your limb or the affected area of your body normally. When done successfully, most patients are able to use their limb or affected body area for their everyday activities with no trouble. More Information While these are the main surgical interventions you would consider for lymphedema, we highly recommend talking to your healthcare provider about what the best decision is for you. At SurvivingBreastCancer.org, we want to give you the information you need to make an informed decision that is best for your body and your life. If you want to learn more about lymphedema or surgical interventions for lymphedema, check out these additional resources:

Dear Kristen, Having breast cancer is wearing me down in so many ways, not just physically. I used to be so full of life and energy, and now I feel weak and timid. What can you suggest for feeling stronger on the inside? One of my greatest beliefs is that each of us has inner strengths that help define who we are as individuals and that help us get through any situation with more confidence and clarity. When you’re feeling weak and timid, that is the perfect time to reconnect with your strengths and who you are when you are strong and confident. Perhaps you’ve done a strengths inventory at some time in the past. If you haven’t, or if you’d like to get a fresh perspective, I recommend taking the free online VIA Assessment of Character Strengths . It is the most widely used survey of its kind, having been taken by more than 15 million people over the past ten-plus years, and is scientifically validated. I also like it because it is not work-focused, as so many strengths tools are; instead, the VIA Assessment shows who you are across all areas of your life. (You can opt to purchase an extensive report on your strengths, but it is not necessary. For no charge, you will receive a summary of your strengths in ranked order.) What do you do once you know what your strengths are? You leverage them to do the things you’re struggling with. For instance, let’s take the strength of kindness. It is the most common strength among people worldwide, but I’ve found that it is most often directed at other people. For a change, try using kindness on yourself , treating yourself gently and with loving compassion. I recently retook the Assessment for the fun of it (for the fifth time in ten years), and my top strength is love. It’s always been near the top of my list, but since my diagnosis, the desire to deepen my relationships and focus on my family and dear friends has grown even stronger. I believe love and the people I care about are the most important aspects of life. Each of the 24 VIA strengths can be applied in this way. Read through the descriptions below and choose the ones that best describe you (or take the online assessment ). Those are your go-to, “signature” strengths and will be easy for you to use, feel essential to who you are as a person, and will energize you when you use them. Strengths of Wisdom Creativity: Thinking of novel and productive ways to think about and do things; includes artistic achievement but is not limited to it. Curiosity: Taking an interest in ongoing experience for its own sake; finding various subjects and topics fascinating; exploring and discovering. Judgment/ Critical Thinking: Thinking things through and examining them from all sides; not jumping to conclusions; being able to change your mind in light of evidence; weighing all evidence fairly. Love of Learning: Enjoying mastering new skills, topics, and bodies of knowledge, on your own or formally; adding systematically to what you know and what interests you. Perspective: Being able to provide wise counsel to others; having ways of looking at the world that make sense to you and others. Strengths of Courage Bravery: Not shrinking from threat, challenge, difficulty, or pain; speaking up for what’s right even if there’s opposition; acting on your convictions even if they’re unpopular; includes physical bravery but is not limited to it. Honesty/ Authenticity: Speaking the truth, but more broadly presenting yourself in a genuine way and acting in a sincere way; being unpretentious; taking responsibility for your feelings and actions. Perseverance: Finishing what you start; sticking with a course of action despite obstacles; taking pleasure in completing things. Zest: Approaching life with excitement and energy; not doing things halfway or half-heartedly; living life as an adventure; feeling alive and activated. Strengths of Humanity Kindness: Doing favors and good deeds for others; helping them; taking care of them. Love: Valuing close relations with others, particularly those in which sharing and caring are reciprocated. Social Intelligence: Being aware of the motives/feelings of others and yourself; knowing what to do to fit into different social situations; knowing what makes other people tick. Strengths of Justice Fairness: Treating all people the same according to notions of fairness and justice; not letting your feelings bias decisions about others; giving everyone a fair chance. Leadership: Encouraging a group you belong to to get things done while maintaining good relations within the group; organizing group activities and seeing that they happen. Teamwork: Working well as a member of a team or group; being loyal to the group; doing your share. Strengths of Temperance Forgiveness: Forgiving those who have done wrong; accepting others’ shortcomings; giving people a second chance; not being vengeful. Humility: Letting your accomplishments speak for themselves; not regarding yourself as more special than you are. Prudence: Being careful about your choices; not taking undue risks; not saying or doing things that might later be regretted. Self-regulation: Regulating what you feel and do; being disciplined; controlling your appetites and emotions. Strengths of Transcendence Appreciation of Beauty and Excellence: Noticing and appreciating beauty, excellence, and/or skilled performance in various domains of life, from nature to art to sports to science to everyday experience. Gratitude: Being aware of and thankful for the good things that happen; taking time to express thanks. Hope: Expecting the best in the future and working to achieve it; believing that a good future is something that can be brought about. Humor: Liking to laugh and tease; bringing smiles to other people; seeing the light side; making (not necessarily telling) jokes. Spirituality: Having coherent beliefs about the higher purpose and meaning of the universe; knowing where you fit within the larger scheme of things; having beliefs about the meaning of life that shape your conduct and provide comfort. Kristen xo

By Rod Ritchie Entering the world of breast cancer treatment can be a unique challenge for a guy. Be prepared to get around the scanning department in a pink gown! The emphasis on the color pink, used extensively in all breast cancer charity promotional materials, means that men are blindsided from coming up with a probable breast cancer diagnosis of a lump behind their nipple. 'Dr. Google' is the first port of call for most men I know after a breast cancer diagnosis. Of course, everyone says, "Don’t Google," but when there’s a dearth of information, what else can you do? This was particularly so eight years ago when I was diagnosed. In recent years, pink charities have improved awareness of breast cancer in men, but studies have shown the awareness rate in the community is still below 50%. Ideally, breast cancer charities would do more to educate people in raising awareness by stressing the simple fact that this is a genderless disease. Sometimes we are an inconvenient truth, and much of the marketing targets a population being asked to dig deep and donate for a women’s disease. I get this angle but so often I see young female breast cancer patients as the lead image when this cohort is a minority of those newly diagnosed. Women are generally diagnosed in their mid-50s, while men in their mid-60s. Because men don’t generally check themselves for breast lump, and because their general practitioners are not attuned to looking out for the disease in men, we can easily slip below the radar. Treatment for men is pretty much the same as that for women. And, until more research is carried out on male patients that might indicate a different path is required, this will likely remain the case. So, chemotherapy, surgery, radiation and then a five- or ten-year course of a hormone blocker, most commonly tamoxifen, is common treatment protocol. Prognosis For many newly diagnosed advanced breast cancer patients, the first thing they want to know once they are over the shock of the diagnosis is, what is my prognosis? Many use an online prognosis tool, using information about the diagnosis compared to data from large research studies to estimate prognosis. Mind you, this research does not always include men. Five and ten-year survival rates, often presented in the form of graphs, can give life expectancy estimates. Those who develop Stage IV breast cancer are particularly concerned about their prognosis, obviously. Setting end-points in someone’s life really is a guessing game. Bear in mind that so much depends on how a patient responds to the various treatments and, importantly, the new life-extending treatments that are in the pipeline. If you know a guy worried about a diagnosis or treatment, you might direct them to these resources: Signs of breast cancer in men. Statistics for men with breast cancer. Surgery is on the cards for all men with this disease. Sex and intimacy following treatment is an important consideration. Metastasis is the spread of cancer from where it began, to other places in the body. From the blank looks at medical receptionist counters, as in, where’s the patient, to looking for support groups on social media where like-minded men who have been there, done that with all aspects of the disease. But, really, I have met so many supportive women who are only too happy to not only help explain scientific data, and also offer emotional support when the going gets tough. --- Rod Ritchie is a Sydney-born writer, internet publisher, and breast cancer patient activist, living with breast and prostate cancers. Currently he’s NED for both. He’s president of the Board of Directors of the Male Breast Cancer Global Alliance, has a website at MaleBC.org and you can follow him on Twitter @malefitness His articles for Health Union can be found here: https://advancedbreastcancer.net/author/traveltext

Receiving a breast cancer diagnosis and dealing with the subsequent treatments and issues is challenging. The news can ignite many emotions, whether you’re newly diagnosed , facing a recurrence, or experiencing progression. Unfortunately, for some people, the cancer journey also includes heartache and partner abandonment from someone they thought they could count on, no matter what. It can be emotional or physical when a partner abandons a person with cancer. Emotional partner abandonment occurs when the non-cancerous person in a relationship withdraws their emotional support and affection. Physical partner abandonment happens when they leave the house for extended periods, stop paying bills, and cease to engage in other household-related activities. Women Are At Greater Risk for Partner Abandonment Sadly, partner abandonment after a cancer diagnosis isn’t unique, and it’s more likely to happen to women. Research from the University of Michigan found that 31% of marriages that involve physical illnesses end in divorce . In addition, the study found that more men than women develop serious health problems over time, but more men leave their sick wives. This means women are doubly vulnerable to marital dissolution connected to illnesses: they are more likely to become widowed and more likely to be abandoned if they get ill. Another study from the Fred Hutchinson Cancer Research Center found that significantly more husbands leave their wives compared to wives leaving husbands after a serious illness, such as a cancer or heart failure diagnosis. The overall rate of marital dissolution among cancer patients is about 12%. In addition, the divorce rate when a woman is the cancer patient is 20.8%, while the rate when a man has cancer is just 2.9%. Why People Abandon Loved Ones After a Cancer Diagnosis Sometimes people abandon their loved ones after a cancer diagnosis because they fear what will happen. They may be scared that their loved one will die or that cancer will cause them to suffer horribly. Others may simply be afraid of the unknown — what the future holds for them and their partner, and how it might change their lives forever. Some people also abandon their loved ones because they don't want to experience pain. Cancer can make people feel helpless and frustrated, especially if it prevents them from doing things they used to enjoy: going out with friends or family members, taking care of household chores, or even being intimate with someone they love. How To Tell If Your Partner Will Abandon You After a Cancer Diagnosis There’s no way to know if your partner will abandon you after you’ve been diagnosed with cancer — or at any part of the cancer journey. However, if you’re worried that your partner will leave you after a cancer diagnosis, you can do a few things to find out. It might seem like an obvious question, but ask them! Tell them that you are feeling anxious and scared about what having cancer means for your relationship, and ask them how they feel about it. While it may be understandable if they’re reluctant to talk about it or make plans for the future with you as a couple, it might be an indication that something is wrong. Another way to tell is if they start putting their own needs in front of yours — such as going out with friends more often than usual or spending money on themselves rather than saving up for important things like car repairs. You should also watch closely if your partner becomes withdrawn from the relationship: Does he always seem sad? Does he withdraw from affectionate gestures? These signs may mean he's starting to pull away emotionally, even though he hasn't said anything directly. It Might Not Be Abandonment If Your Partner Needs Space Before you give up on your partner, consider that they might be going through some of their feelings about what is happening. It can be difficult for anyone to see their loved one go through cancer. Your partner may feel overwhelmed and need some space to work through things in their own way. Your partner may also feel a lot of pressure to act differently than they usually would to help make things better for you. To do so, they may need time and space away from you to figure out how best to support your needs during treatment. Another reason a partner might pull away could be because changes ahead will impact the relationship dynamic between both parties (i.e., once treatment ends). This could leave them uncertain and afraid of what those changes might mean for their future with you now or later down the road (if at all). Abandonment Happens, But It Doesn't Mean You're Unlovable It’s normal to feel abandoned in the face of a cancer diagnosis. Unfortunately, the general public’s understanding of cancer remains woefully inadequate, leaving loved ones feeling powerless and afraid. Even those who have had personal experience with a loved one’s illness may be unprepared for how it can affect their relationship with their partner. Cancer is an emotionally intense journey that can stress even the happiest relationships; when coupled with abandonment issues and other intimacy challenges, it can be hard to hang on as things get more complex. Although being abandoned by your partner can leave you feeling alone, remember that you’re not alone! You are part of an enormous community of people who have faced similar challenges and survived them (or are still surviving them) together. For example, Surviving Breast Cancer’s global online community offers opportunities to connect with others for safe, judgment-free, peer-to-peer support to ensure you’re never alone. We’re Always Here For You! Surviving Breast Cancer is always available with multiple resources , including financial management guides, podcasts, and webinars, to provide you with information and lessen your anxiety. We also offer healing workshops and mindful movement classes , and you can join any of our groups or be matched with a mentor . Whether you make a cash donation , host a fundraiser , or volunteer , your support enables us to make those resources available to give strength and hope to as many people as possible.

Have you ever felt preemptively depressed or anxious about something that hasn’t yet happened? Specifically, regarding breast cancer, this may happen if you are awaiting news of a diagnosis, outcomes of a surgery or treatment, or any further development in your cancer. It can also bubble up as we discussed regarding putting down a pet , or if you know that a loved one’s prognosis is not good, and you want to make the most of the time you have left. If so, you’re not alone and are likely experiencing what can be called anticipatory grief . This phenomenon, while best studied in anticipated loss of life from any cause, can precede any major result or development from breast cancer that is assumed to be detrimental. Specifically, this often occurs within the contexts of receiving a breast cancer diagnosis, anticipating the loss of your breasts, or receiving the news of a metastatic prognosis. Understanding Anticipatory Grief In times of uncertainty regarding your or your loved one’s health, it is easy to assume the worst before it has been confirmed. For many, anticipatory grief is a coping strategy that may help soften the blow of an unfavorable outcome, and it can help those struggling to find closure when/if their outcome is realized. With a disease as nuanced and individualized as breast cancer, the way you may cope with it is equally as complex and personal. Common experiences include emotional stress, preoccupation with the uncertain outcome or diagnosis, loneliness or social withdrawal, irritability, anger, or physical changes such as increased or loss of appetite, or even pain/body aches. The key point to understand is that while it may seem counterintuitive to be sad about something that hasn't yet been confirmed or hasn't happened yet, especially to an outside party, it is completely normal to experience anticipatory grief. It is also more common than you might think; even those experiencing other kinds of losses, such as when your child is moving out for college or you’re moving cities for a new job, can experience grief over these impending changes. It’s something we need to bring to light and talk more about to normalize these feelings and emotions. Coping with Anticipatory Grief While it is hard to say definitively what may or may not help in coping with anticipatory grief, as it is an intrinsically personal experience, there are some strategies that may work for you. First and foremost, it is important to let yourself feel any grief as you experience it. Grief has four general purposes, including accepting the loss, processing your feelings towards it, adjusting to a “new normal”, and connecting you to those around you in a different way in light of the change. By allowing yourself to work through these issues beforehand, it shortens the time you need to process should you receive less than favorable news in the future. Other coping methods include regular exercise, activities like art , reading , or dance , journaling, and attending a support group or seeking help from a trained mental health professional. No matter how your breast cancer journey progresses, know that it is okay to grieve at any stage, as a cancer diagnosis is a major life change that you may need time to process fully. If you’ve experienced anticipatory grief and are willing to share your story, we’d love to hear about it! You can see additional breast cancer stories from our readers here . For those looking for additional support, download the SurvivingBreastCancer.org app , where we have community discussion boards and private groups so that you can connect with others in a similar situation and get peer-to-peer support. On the Podcast: Breast Cancer Conversations: Anticipatory Grief: How Do You Speak To Your Children About Cancer?

By Rod Ritchie I’ve written a lot about the stigma many men experience when they are given a breast cancer diagnosis. This truly is a big thing, and it very often kicks in, even before diagnosis, when a guy is wondering about a lump behind his nipple or even a nipple discharge. Perhaps a partner or a woman friend might offer advice like, better get that checked out, but many men are still getting over the shock that they could even get this disease and embarrassment when they find themselves entering a world of pink. I edit men’s breast cancer stories for the Male Breast Cancer Global Alliance and of the approximately 2,600 men diagnosed each year in the United States, only a dozen or so come forward to tell their story. Again, there’s not enough public awareness that breast cancer is genderless. Of course, it’s very obvious that women are better at not only talking to each other about their ailments, but also seeking medical attention when they are genuinely concerned. And, they have the benefit of public awareness, extensive research on the disease based on the results of trials on hundreds of thousands of women. The good news is that the FDA recently asked research institutions to consider including men when they submitted research proposals. Without the benefit of evidence-based research, men will continue to be treated using the research results of women. I have to say that I didn’t succumb to much stigma. I’m not sure if it’s because my mother was treated for metastatic breast cancer. I’ve often thought if she had been diagnosed just 10 years later, she would have benefitted from chemotherapy drugs that were just being introduced at the time. As it was, she had a radical mastectomy and very strong, but not well directed, radiation treatment. I was 10 at the time when I caught sight of mom getting out of the shower. Her chest was extensively scarred and this image is still clear in my mind today. She died two years later, aged 40. For too long now men have been blindsided by this cancer. I’ve made a point of being an active advocate for men with breast cancer through my writing, my patient counseling, my active social media presence, and sometimes through direct action. At a large breast cancer fun run in a capital city a few years ago, I asked for a turn at the microphone. The M.C., looking somewhat askance, passed it to me and I said, this disease is genderless, men, if you feel a lump, get it checked out, or if you have a family history of breast or prostate cancer, join a screening program. The microphone was pulled away from me after this. I’d broken the code of silence surrounding men and this disease. Well, I didn’t care. Unless we all make a noise, we’ll never change anything. Most important to all the patient advocates I know working on explaining the genderless nature of breast cancer, is to eliminate sexual stereotyping . This can be achieved by lobbying the big pink charities to include us in their education and awareness campaigns, advocating for more research that includes men of all races, and making a genuine effort to reduce the stigma attached to being a man with this disease. --- Rod Ritchie is a Sydney-born writer, internet publisher, and breast cancer patient activist, living with breast and prostate cancers. Currently he’s NED for both. He’s President, Board of Directors, Male Breast Cancer Global Alliance, has a website at MaleBC.org and you can follow him on Twitter @malefitness His articles for Health Union can be found here: https://advancedbreastcancer.net/author/traveltext

By Alexis Puthussery The presence of social media in modern life can’t be denied. Be it TikTok, Instagram, Facebook, or one of the many other available platforms out there, most people today have some form of social media. Whether its influence has been overall good or bad has been the subject of many debates. The reality is much more complicated than a single net positive or negative, with much of its influence depending on the individual user and their tastes and mindset. This is even truer in the context of breast cancer social media engagement. A Useful Tool Research has shown that social media is a useful tool for those diagnosed with breast cancer. A study published in 2019 in the Journal of Medical Internet Research wrote about the positive effects social media can have for patients. Developing connections with others is extremely important for people, no matter the state of their health, and it’s especially important for those who have been diagnosed with breast cancer. The study acknowledged that in-person interaction is the ideal way to maintain these connections, but this may not be possible for some. They write how some patients may not have many supportive people in their communities to turn to, so social media can give them the support they have been looking for. There are extensive online communities that offer advice, education, and morale for patients, many of which can be found on SurvivingBreastCancer.org Social Media and Quarantine The value of social media is highlighted well in the study from the Journal of Medical Internet Research, which was written in 2019, pre-pandemic. During COVID-19, however, the value of social media for breast cancer patients can’t be overstated. In quarantine, not only were breast cancer patients stuck in their homes and separated from many loved ones like everyone else in the world, but they were also one of the more susceptible populations to the virus. The study from the Journal of Medical Internet Research noted that cancer patients feel significant mental pressures on top of their physical ones. These pressures were amplified during the pandemic. This combination of being more susceptible to the virus and being separated from the community during quarantine made social media an important tool for breast cancer patients to keep their psyche healthy. Spread of Misinformation Though social media has certainly been beneficial for patients when seeking out communities, the spread of health misinformation on popular social media sites like TikTok and X has increased in the past few years . A study conducted in 2021 by Victor Suarez-Lledo and Javier Alvarez-Galvez found that noncommunicable diseases, such as cancer, were one of the six health topics about which misinformation was spread most often on social media. The prevalence of health misinformation increased during the pandemic regarding masking and vaccine protocols. Since then, the reliance on social media for medical information has only grown. In July 2022, Google revealed that about half of today’s youth (18-24 year olds) use TikTok or Instagram instead of Google Search. More and more people are starting to trust what they see on social media, even though studies, like the one by Suarez-Lledo and Alvarez-Galvez, have shown that misinformation is rampant on these sites. To avoid misinformation regarding breast cancer, after reading something on a social media site, double-check with a medical professional in your life or visit trusted cancer sites such as Survivingbreastcancer.org, American Cancer Society, or Cancer.gov. Ethics, Exploitation, and Permission Another potential pitfall of breast cancer on social media is the ethics of posting about someone with breast cancer. Many people post about a loved one who has cancer, often in good faith and to spread awareness. If someone plans on doing this, they must get the permission of the patient to prevent exploitation. Especially if the planned post intends to share details about the patient’s battle, no matter how significant, the patient must sign off on the post. Too often, breast cancer patients are exploited, and social media provides another avenue for this exploitation. It gets trickier if the patient has passed away. This is when the questions of what and whether or not someone should post about a patient’s illness become more case-by-case. Someone can still be exploited after they have passed away, and one should go to the greatest lengths possible to prevent this from happening. If the diagnosis is terminal, ask the patient what they are comfortable with you sharing and where. Permission is always necessary when posting about your loved ones. Do What Feels Good For You The effects of social media on the breast cancer community cannot be defined as completely good or bad. It is something that is dependent on the person and their involvement in a patient’s life and is completely up to them. During the pandemic, social media certainly was helpful for many, but the following rise in misinformation online highlights its pitfalls. Use social media in regard to your cancer journey as you see fit. If you feel that a specific community is lacking in your life regarding education or support for your breast cancer, there are plenty of groups that you will be able to find on social media. Survivingbreastcancer.org has many resources that can be found on the website. But if you feel like you have everything you need in your life in person, don’t feel pressured to go to social media just because it is everywhere.

A breast cancer diagnosis is overwhelming and can leave your head spinning. If you’re dealing with breast cancer, especially if you’ve recently been diagnosed, it's easy to get confused by all of the terms your healthcare team uses. However, it’s essential that you understand these terms so that you can play an informed, active role in your care. While most people are familiar with many basic terms, like mammograms and imaging, you’ll likely hear other references to treatments and tests that are not as recognizable. Keep reading to learn more about terms used involving the diagnosis and treatment of breast cancer and new groundbreaking data. Oncotype Scores vs. MammaPrint vs. BluePrint Several tests are available to determine a treatment plan and the likelihood of recurrence. They differ based on age and other factors, including cancer stage. Oncotype Score If you’ve been diagnosed with breast cancer, your doctor may recommend the Oncotype DX test. Depending on your cancer type, this test can tell doctors if the cancer is likely to return at some point. The Oncotype DX analyzes a cancer tumor sample to see the activity of specific genes and how likely it is to grow and spread. The test uses tissue taken during the initial biopsy or surgery. It measures 21 select breast cancer genes. (You might hear it called a "21-gene signature.") Your doctor might suggest the test if you have: Stage I or II invasive breast cancer Estrogen-receptor positive (called ER+) cancer, meaning the disease's cells grow in response to the hormone estrogen Cancer that isn’t in the lymph nodes The test uses a ‘numerical recurrence score’ (1 to 100) that divides tumors into three categories: low, intermediate, or high risk of recurrence. MammaPrint The MammaPrint test is a genomic test that analyzes the activity of specific genes in early-stage breast cancer. Genomic tests analyze a cancer tumor sample to see how active particular genes are, determining how likely it is to grow and spread. These tests help doctors make decisions about whether more treatments after surgery would be beneficial. While their names sound similar, genomic testing and genetic testing are very different. Genetic testing is done using blood, saliva, or other tissue samples and can tell if you have an abnormal change (also called a mutation) in a gene linked to a higher risk of breast cancer. The MammaPrint test can only be used to analyze early-stage breast cancers. For example, the test can be used on cancers that are: Stage I or stage II Invasive Smaller than 5 centimeters In three or fewer lymph nodes Hormone-receptor-positive (estrogen/ progesterone) and hormone-receptor-negative The MammaPrint test can be performed on a sample of preserved tissue that your doctor removed during the original biopsy or surgery. BluePrint BluePrint is a test used to predict tumor behavior in breast cancer. The test analyzes the activity of 80 genes to classify the tumors into three types: Luminal: This type of tumor is responsive to hormonal (Example: anti-estrogen) therapy HER2: This type of tumor multiplies rapidly, may recur, and can be treated with anti-HER2 therapies Basel: This type of tumor grows quickly and does not respond to hormonal or anti-HER2 therapies MammaPrint and BluePrint tests are run simultaneously on the same tumor tissue sample to provide results in ten days. It’s the only FDA-cleared test that is designed for people of all ages who: Are newly diagnosed with invasive early-stage breast cancer (Stage I or II) Have a tumor size up to 5 cm Are either lymph node-negative or have 1-3 positive lymph nodes Genomic Testing and Precision Medicine Genomic tests analyze a cancer tumor sample to determine certain genes’ activity. The genes analyzed are called biomarkers. For breast cancer, the genomic tests are used mainly to analyze early-stage, hormone-receptor-positive (estrogen +/- progesterone), HER2-negative breast cancer to predict the risk of recurrence — cancer coming back — usually within five to ten years following the initial diagnosis. Precision medicine — also called individualized or personalized medicine — is an approach to diagnosis, treatment, and prevention, taking into account a person’s genetic makeup. For example, the goal of precision medicine for breast cancer is to tailor treatment to your genetic makeup and the genetic changes in your cancer cells. Groundbreaking News on Cancer Research The world’s leading oncology researchers gathered at the 2022 American Society of Clinical Oncology (ASCO) meeting. There, they presented leading-edge research and tackled disparities in breast cancer, including the following five highlights: Improved Overall Survival Rates for Advanced Triple-Negative Breast Cancer A recent study showed that the addition of pembrolizumab to chemotherapy significantly improved the overall survival rates among patients with advanced triple-negative breast cancer tumors with a clinical and pathologic stage (CPS) score of 10 or more. Improved Survival in Women With Hormone-Positive, HER2-Negative Advanced Breast Cancer Another study has shown a significant benefit with adding ribociclib to letrozole as the first-line treatment in postmenopausal women with hormone receptor-positive, HER2-negative advanced breast cancer. Strides Are Being Made in the Treatment of Brain Metastases From Breast Cancer Promising study results show that new drugs for HER2-positive breast cancer can overcome some obstacles that have made brain metastases challenging to treat. Chemicals Used in Personal Care Products May Increase Breast Cancer Risk in Black Women Study findings show that chemical compounds called parabens, widely found in hair and personal care products, may increase breast cancer risk in Black women more than in White women. The Risk of Disease Progression Significantly Reduced for Hormone Receptor-Positive and HER2-Negative Advanced Breast Cancer Tests have shown that sacituzumab govitecan-hziy significantly reduced the risk of disease progression for patients with advanced breast cancer that is hormone receptor-positive and HER2-negative. Count On Us for Information, Resources, and Support Whether you’re newly diagnosed with breast cancer , are navigating survivorship, or are the loved one of someone experiencing breast cancer, you can count on Surviving Breast Cancer to keep you informed. We provide educational information to help you better understand symptoms, testing, treatment options , surgery, etc., and podcasts that feature professionals, advocates, and caregivers who share valuable information. Our global online community offers opportunities to connect with others for safe, judgment-free peer-to-peer support and ensures you’re never alone. We also offer healing workshops and mindfulness classes . Join any of our groups or get matched with a mentor. Contact us today to learn more about or benefit from our services.

Why are Surgical Margins Important in Breast Cancer Surgery? If surgery is part of your or a loved one's plan, then you’ll probably be hearing a term called “ surgical margins .” Understanding a surgical margin is one of the many ways your medical team can determine whether or not surgical intervention was successful or not, and whether or not further procedures will be necessary. As a result, the surgical margin can be a source of worry for many facing breast cancer. This article will hopefully be able to clear up a few points on what a margin is, what it can tell you, and what happens after. Understanding Your Pathology Report The National Comprehensive Cancer Network provides the most up-to-date information on breast cancer guidelines. A pathology report is a medical document that contains information about the tissue and cells that were removed during your biopsy or surgery. The report also includes information about the type of breast cancer you have and how aggressive it is. Pathology reports can be confusing, but it’s important to review them with your doctor so that you can better understand your diagnosis and treatment options. If you’ve been diagnosed with breast cancer, your pathology report can provide valuable information about your disease. Pathology reports can help your doctor determine the type of breast cancer you have and how aggressive it is. This information is important in developing a treatment plan that is tailored to your individual needs. Pathology reports can be confusing, but it’s important to review them with your doctor so that you can better understand your diagnosis and treatment options. If you have questions about your pathology report, don’t hesitate to ask your doctor for clarification. What Happens After My Tumor and Breast Tissue are Removed After your breast tissue is removed, it will be sent to a laboratory where a pathologist will examine it under a microscope. The pathologist will look for cancer cells and determine the type of breast cancer you have. The pathology report will also include information about the tumor’s grade, which is a measure of how aggressive the cancer is. The pathology report can provide valuable information about your disease and help your doctor develop a treatment plan that is tailored to your individual needs. If you have questions about your pathology report, don’t hesitate to ask your doctor for clarification. How to Measure a Surgical Margin? A surgical margin is an examination of the removed breast tissue following a surgery, to see where cancerous cells are in relation to the edge of the sample. Following a breast cancer removal surgery, pathologists will examine the distance between the cancer cells and the edge of the removed breast tissue, or the size of the border surrounding a removed tumor. Surgical margins are the tissue that surrounds a tumor that has been removed during surgery. The width of the margins varies depending on the type of cancer being treated. For example, breast cancer margins are typically 1-2 cm, while melanoma margins are usually 5-7 cm. The goal of surgery is to remove the entire tumor along with a margin of healthy tissue to reduce the high risk of recurrence. Margins are also important in determining the stage of cancer, which helps guide decisions. Margins are classified as either microscopically positive or negative. Microscopically positive margins mean that there are cancer cells at the edge of the removed tissue sample, while negative margins mean that there are no cancer cells at the edge of the sample. Knowing Your Surgical Margin Status Understanding your margin is also important in determining the stage of cancer, which helps guide treatments. When your breast tissue is sent to the pathologist, they will perform an analysis to determine if the surgery achieved clear margins. Margins are classified as either microscopically positive or negative. Microscopically positive surgical margins, or involved margins, mean that there are cancer cells at the edges of the tissue that was removed during surgery. This means that not all of the breast cancer cells were removed and that there is a higher risk of the cancer recurring. Negative surgical margins, or clear margins, mean that there are no breast cancer cells at the edges of the removed tissue, which signifies that all of the breast cancer cells were likely removed during surgery. Finally, close margins are when it is unclear if there are cancer cells at the edge of the tissue or not, or the cancer is very close to the edge of the tissue. What Happens If I Have a Positive Margin Result? The term “positive surgical margin” (PSM) is used when cancer cells are found at the edge of the removed tissue sample. This means that all of the cancer may not have been removed during surgery, and additional treatment, such as radiation therapy, may be needed. A PSM can also be a sign that the cancer may come back (recur). The chance of the cancer recurring is higher if the PSM is close to the edge of the removed tissue or if there is more than one area of PSM. If you or a loved one has been diagnosed with breast cancer and received this result, it may feel scary or like the surgery wasn’t successful. However, it’s important to keep in mind that a positive margin doesn’t necessarily mean that the breast cancer will come back or that the surgery wasn’t successful. In fact, many breast cancer patients with positive margins go on to have successful breast cancer treatment and remain cancer-free. What Does PSM Indicate About the Cancer? There are a few reasons why you may have a positive surgical margin even though the surgery was successful in removing the breast cancer tumor. One reason is that breast cancer cells can be very small, so it’s possible for some breast cancer cells to remain even after surgery. Additionally, the surgeon may have removed a larger margin of breast tissue than necessary to ensure all of the breast cancer cells were removed. It’s also important to keep in mind that breast cancer can spread beyond the breast. So, even if the surgeon removes the breast cancer tumor and a wide margin of breast tissue, there’s a possibility that breast cancer cells have already spread to other parts of the body. This is why breast cancer patients with this diagnosis often receive additional treatment, such as radiation therapy, to help kill any remaining breast cancer cells and reduce the risk of the breast cancer recurring. How Can You Lower Your Risk of Having Positive Margins? There are a few things you can do to lower your risk, including: Choose a breast cancer surgeon who is experienced in the type of surgery you are looking to have Have a preoperative breast MRI in addition to a mammogram Discuss your treatment options with your surgeon in advance of the surgery What Treatment Options are Available If You Have a Positive Margin? If you have breast cancer and did not have clear margins, your cancer treatment team will likely recommend additional treatment, such as radiation to help kill any remaining cancer cells and reduce the risk of the breast cancer recurring. Radiation is a common therapy for breast cancer patients. In fact, studies have shown that breast cancer patients who receive radiation treatment after surgery have a lower risk of the breast cancer recurring. If you or a loved one has breast cancer and positive margins, it’s important to talk to your healthcare team about all of your treatment options. Together, you can make a treatment plan that’s best for you. What Happens If I Have a Negative Surgical Margin Status? If you or a loved one has been diagnosed with breast cancer and receives this result, it’s good news! An NSM indicates that the surgery was successful in removing all of the cancer from the breast. Additionally, it means that there’s a lower risk of the cancer recurring. NSM is often used to describe hope. This article helped to clear up some questions you may have had about surgical margins. If you or a loved one has been diagnosed with breast cancer, it’s important to talk to your healthcare team about all of your treatment options. Together, you can make a treatment plan that’s best for you. If you or a loved one has been diagnosed with breast cancer and received negative margins, it means that there were no breast cancer cells at the edges of the removed tissue. This is generally good news, as it suggests that all of the breast cancer cells were likely removed during surgery. In most cases, no additional treatment will be necessary following surgery. Breast cancer patients with negative margins have a lower risk of the cancer recurring. However, it’s important to keep in mind that breast cancer can still come back even if you have negative margins. That’s why it’s important to follow up with your breast cancer treatment team and get regular breast cancer screenings, even if you’ve had breast surgery with negative surgical margins. What Happens If I Have a Close Surgical Margin Status? Close surgical margins, also called close margins or margin-negative breast cancer, refer to cancer tumors that are very close to the edge of the removed tissue but don’t have any breast cancer cells at the edges. Close margins are not considered positive because there are no breast cancer cells at the edge of the tissue. However, close margins may require additional treatment, such as radiation therapy, to help reduce the risk of the cancer recurring. Your team will likely recommend additional treatment. In most cases, this additional treatment will be radiation therapy. When Will I Know the Results? Margin results are usually given a week after surgery, and it also depends on what type of surgery you are getting. If you have negative margins, usually no follow-up surgery is recommended, although you may undergo further chemotherapy and/or radiation. However, for both positive and close margins, this means that further surgery may be required. The Different Types of Breast Cancer and How They Affect Surgical Margins While the reported nationwide rate of PSM for breast cancer is about 20% , according to a couple of reviews of margin outcomes, the actual statistics may be much smaller, closer to 5 or 6% due to the national rate not accounting for repeated procedures on aggressive cases. These statistics also vary between the types or stages of breast cancer, as well as the type of procedure a person chooses to undergo (total mastectomy vs. partial). Possible risk factors include HER2+ cancers, a lobular histology, and more conservative breast-conserving surgery types. However, despite these risk factors, the occurrence of positive margins for breast cancer in both men and women declined over one study period of 10 years. This means that surgeons are improving over time at removing most/all of the cancerous tissue for a given surgery, and the chances that you or a loved one will be faced with a positive margin are lower than they once were. According to guidelines published by the American Society of Breast Surgeons , the recommended course of action for those with negative margins is not to repeat a procedure; for those with close margins, to rely upon genetic markers and the location of close margins in deciding whether or not to repeat a procedure. Despite improving rates, the possibility of having positive margins at all can be a source of great stress and worry for many. Not knowing what surgical margins you’ll have following a potentially major, life-altering surgery can often lead to adverse consequences, such as insomnia, depression, anxiety, and anticipatory grief. Does Your Surgical Choice of Lumpectomy or Mastectomy Improve Your Chances of Clear Margins? Although there are some clear advantages to having a mastectomy over a lumpectomy, such as lower risk of cancer recurrence and no need for radiation therapy, the decision of which surgery to have is often a very personal one. Some people may feel that the disadvantages, such as a longer recovery time, more scarring, and a higher risk of complications, are not worth the slightly increased chance of clear margins. Ultimately, the decision should be made between you and your breast cancer treatment team, taking into account all of the available information on your individual case. It’s important to remember that even if you do have PSM, it doesn’t mean that your breast cancer treatment has failed. In most cases, further surgery or radiation therapy can be successful in achieving clear margins. And although the prospect of more surgery may be daunting, it’s important to remember that you are not alone in this journey. There are many resources available to help you through this difficult time, and with the support of your loved ones, you will get through it. Ways to Improve Your Chances of Getting Clear Margins in Breast Cancer Surgery There are a few ways that you can improve your chances of getting clear margins. First, you can choose to have a mastectomy instead of a breast-conserving surgery. While a mastectomy is more invasive, it also gives the surgeon a clear view of the breast tissue and allows them to remove more tissue. Second, you can choose to have a genetic test before surgery. This test can identify if you have certain genes that are linked to breast cancer. If you do have these genes, your surgeon may be able to remove more tissue to ensure clear margins. Finally, you can ask your surgeon about their experience with breast surgery. Choose a surgeon who has performed the procedure many times and has a good track record. While there is no guarantee that you will get clear margins, following these tips can improve your chances. How to Reduce Stress While Waiting On the Results of Your Surgery Some steps that you can take to mitigate these include reaching out to a support group or mental health professional, or partaking in creative works such as reading , writing , drawing, dance , and journaling. Finally, it is always a good idea to discuss your concerns with your medical team, as they will be able to best address your individual case. Grappling with surgical margins is something that many will have to face throughout their cancer journey, but it’s important to remember that they are not entirely indicative of how your story will go. At SurvivingBreastCancer.org, we want you to know that we are here with you, no matter how your journey may progress. How to Cope with a Diagnosis of a Positive Margin Status after Surgery? If you or a loved one receives a positive margin diagnosis, it’s important to remember that you are not alone. In fact, breast cancer patients with positive surgical margins often go on to have successful breast cancer treatment and remain cancer-free. If you’re struggling to cope with a diagnosis of positive margins, there are a few things you can do: Talk to your treatment team about your diagnosis and treatment options Join a breast cancer support group Talk to a counselor or therapist who specializes in helping people cope with breast cancer It’s important to remember that you are not alone. There are many resources available to help you cope with your diagnosis and treatment. What are the Long-Term Effects of Breast Surgery? The long-term effects of breast surgery will vary depending on the type of surgery you had. For example, if you had a lumpectomy, the long-term effects may be less severe than if you had a mastectomy. Additionally, whether or not you received radiation therapy after surgery can also affect the long-term effects. Some common long-term effects of surgery include: Pain at the site of the incision Lymphedema (swelling in the arm) Numbness in the breast or chest Infection Scarring If you’re experiencing any long-term effects from surgery, it’s important to talk to your doctor. They may be able to prescribe medications or suggest treatments that can help alleviate some of the side effects. Will a PET or CT Scan Be Required? A PET or CT scan may be required if your surgical margins are close or if there is a chance that cancer cells may have spread to other parts of your body. These scans can help your doctor determine whether or not you will need additional treatment. Breast cancer patients with positive surgical margins often go on to have successful breast cancer treatment and remain cancer-free. Talk to your treatment team about your diagnosis and treatment options- Join our SBC breast cancer support group (aka Thursday Night Thrivers ) What Questions Should I Ask My Breast Surgeon? If you are scheduled to have breast surgery, it’s important to ask your surgeon any questions you may have about the procedure. Some common questions patients ask their surgeons include: What type of surgery will I be having? What are the risks and complications associated with this type of surgery? How long will the surgery take? What can I expect the recovery process to be like? Will I need to stay in the hospital after the surgery? When can I expect to see results from the surgery? Asking questions can help ease some of the anxiety and stress you may be feeling about upcoming surgery. It’s also a good opportunity to get more information about what to expect during and after the procedure. What are the Different Types of Breast Cancer Surgery? The type of surgery you have will depend on a number of factors, including the stage of your cancer, the size of your tumor, and your overall health. The three most common types of breast surgery are: Lumpectomy: A lumpectomy is a minimally invasive surgery in which only the entire tumor and a small margin of healthy tissue surrounding it are removed. This type of surgery is typically used for early-stage breast cancers. Mastectomy: A mastectomy is a more extensive surgery in which the entire breast is removed. This type of surgery may be recommended for larger tumors or for patients who are at high risk of the cancer returning. Breast Reconstruction: Breast reconstruction is a surgery that is performed to rebuild the shape of the breast after a mastectomy. This type of surgery is typically done at the same time as a mastectomy or may be done in a separate procedure. Aesthetic Flat Closure What are some common side effects of breast cancer surgery? Some common side effects of breast surgery include: Pain at the site of the incision Swelling and bruising Fatigue Nausea and vomiting Difficulty urinating or having a bowel movement Lymphedema (swelling in the arm) Numbness in the breast or chest Infection Scarring How to Cope With a Breast Cancer Diagnosis? If you’ve been diagnosed with breast cancer, you may be feeling a range of emotions, including shock, fear, sadness, and anger. It’s important to remember that everyone copes with a cancer diagnosis differently. There is no right or wrong way to feel. Some people find it helpful to talk to a counselor or join a support group. Others find comfort in spending time with family and friends. There are also a number of resources available to help you cope with a breast cancer diagnosis, including the following: American Cancer Society: The American Cancer Society offers information and support for people affected by cancer. National Cancer Institute: The National Cancer Institute provides information about cancer treatment, research, and prevention. Breast Cancer Research Foundation: The Breast Cancer Research Foundation funds breast cancer research and provides information about breast cancer. Susan G. Komen: Susan G. Komen is a nonprofit organization that offers support and resources for people affected by breast cancer.

By Rod Ritchie Most cancers are genderless, with the notable exceptions of ovarian, cervical, testicular, and prostate cancers. Why is it, then, that breast cancer is so often thought to be exclusively female, when we all have some amount of breast tissue? With only one percent of new cases in males and other genders, there are often too few of this cohort to enroll in trials, and therefore, we don’t get new drugs tested on us at all. It’s as if we are statistically irrelevant. All this leads to treatment for all other genders based on women's treatment. While this treatment is often very successful, and thankful we should be for the research that created new medications, further research could eliminate a gap in treatment outcomes that was discovered in a recent study. Because awareness among the general population, including clinicians, that breast cancer is specific to women, studies are a start and prove that quality research can inform treatment for the better . A 2018 study of 1482 men by BCRF researcher Dr. Fatima Cardoso, Coordinator, European School of Oncology Breast Cancer Program, shows men are often under-treated with breast cancer . Also, they were much less likely to get breast-conserving surgery after an early-stage diagnosis. They were also less likely to receive endocrine therapy for ER-positive breast cancer, compared to women. Along with her colleagues, Dr. Cardoso has also reported the biological and molecular differences between male and female breast cancers. In recent good news, the FDA has issued a draft guidance document, Male Breast Cancer: Developing Drugs for Treatment. They are now recommending the inclusion of males in breast cancer clinical trials. The final guidance document will help guide companies undertaking clinical development of drugs to treat breast cancer in male patients. This will lead to real change. Advocating For All Stages of Breast Cancer As a Stage III patient advocate working alongside Stage IV advocates for eight years now, I regularly come across the common social media meme: 20-30% of people diagnosed with early-stage breast cancer will be re-diagnosed with MBC. I always think, well, that means a 70-80% chance of no regression. Not bad odds. But, as the years rolled by and I lost male and female friends to the disease, I could see that my odds may have been favorable, but without a cure, and having also been treated for aggressive prostate cancer, my prognosis was not so good. Patient advocates living with early-stage breast cancer are often advised to stay in their lane, rather than take up the cause for metastatic patients. At least that was true until recently, when influential advanced breast cancer patients and groups began to see the issue of advocacy sustainability as a problem moving forward. Sustainability is an awkward term, but here it is applied to describe the attrition of metastatic breast cancer (MBC) patient advocates, who pass because they’ve run out of lines of treatment. The breast cancer advocate community loses fine advocates all the time. As a second-generation breast cancer patient, one who lost my mother, aged 40, I’m particularly keen to support younger MBC women who have kids. But, I’ve come to know many metastatic patients from an active social media and forum presence, from attending training courses and seminars, and annual conferences like the San Antonio Breast Cancer Symposium. It was metastatic patients who were the patient advocacy movers and shakers. Conversely, while many early-stagers tended to be active whilst undergoing initial treatment, they were more often not so afterward. Pretty soon, my breast cancer pals were mostly MBC folks. And what an informed and active lot they were. We all crave hope; it is the corollary of fear, a natural emotion, and one common to patients of all stages. Whether we like it or not, we are all more or less in this together. As a man with breast cancer, I know this well. Early-stage patients like myself don’t just give practical and moral support; we learn about what might well be our future from MBC folks. But, regardless, we will have the experiences and memories, the advocacy methodology, and the inspiration based on personal relationships to guide us. --- Rod Ritchie is a Sydney-born writer, internet publisher, and breast cancer patient activist, living with breast and prostate cancers. Currently, he’s NED for both. He’s the President of the Male Breast Cancer Global Alliance, is on the board of directors, has a website at MaleBC.org , and you can follow him on Twitter @malefitness His articles for Health Union can be found here: https://advancedbreastcancer.net/author/traveltext